Elisabetta Metafuni

The treatment of choice for patients with myelofibrosis (MF), relapsing after an allogeneic stem cell transplantation (HSCT), is the infusion of donor lymphocytes (DLI) in escalating doses [1]. This procedure is particularly effective when patients are treated at the time of molecular relapse (MRel) [2]. For patients not responding to DLI, the current European Group for Blood and Marrow Transplantation (EBMT) guidelines, suggest a second allogeneic HSCT [3].

Hemorrhagic cystitis (HC) is a frequent complication after hematopoietic cell transplant (HCT), with an incidence ranging from 2 to 66% depending on the type of transplant and the age of the patient [1,2]. In the last two decades, the use of post-transplant cyclophosphamide (PT-Cy) as graft-versus-host-disease (GVHD) prophylaxis has been associated with an increased incidence of HC [3,4].

COVID-19 has been associated with increased morbidity and mortality in immunocompromised patients due to inadequate control of the virus, resulting in higher risk of progression to severe disease, clinical and virological relapses and long time to viral elimination [1, 2]. Prolonged shedding of SARS-CoV-2 can also lead to delays in treatment of the underlying disease and viral evolution with the development of resistance [3,4,5].