Journal of Blood & Lymph

As advancements in cancer treatment such as Hematopoietic Stem Cell Transplant (HSCT) continue to improve the survival rates of pediatric, Adolescent and Young Adult (AYA) cancers, a growing number of survivors are living to their reproductive years. Many of these patients will experience the adverse impact that oncology care can have on reproductive potential such as infertility, gonadal insufficiency, genital graftversus- host disease, uterine injury, psychosexual dysfunction and increased risks of breast and cervical cancer. Termed Late Effects (LE), these concerns may greatly impact patients’ quality-of-life post-treatment and are therefore an essential component of developing comprehensive cancer treatment plans. There is expert consensus on how to screen for, prevent and treat many of the aforementioned LEs, however the recommended practices are rarely executed. As with other topics in oncofertility, educating providers and establishing standardized workflows which encourage interdisciplinary collaborations will go a long way towards widespread improvements in the quality of reproductive care offered to patients who receive HSCT. Here, we offer suggestions on how to promote the implementation of new and established standards of reproductive healthcare for young patients who receive HSCT and related treatments.

Although Post-Exposure Prophylaxis (PEP) is a powerful tool to abort HIV infection within 72 hours of exposure, blocking the establishment of chronic infection, follow-up metrics of this intervention are scarce. As antiretroviral use delays diagnosis biomarkers, so the moment to perform serological evaluations must consider this to avoid missing diagnosis. We assessed the adherence to follow up visits after PEP dispensation in a service in the Sao Paulo metropolitan area and reviewed the literature, both showing limited adherence to current protocols, leading to difficulties of diagnose early HIV infection. The current proposed date for the first return after PEP is both associated with low adherence and if infection has occurred, too early to detect antibodies in some patients. Guidelines should allow or promote a longer time for follow up visits after PEP discontinuation along with continued contact as with message reminders maximizing the benefit for both patient and community.

Nowadays, the development of cancer immunotherapy has brought breakthrough results in treatment. However, understanding of the limitations of this therapy remains unclear. While the significant role of dietary energy intake in regulating cancer progression and host immunity is widely acknowledged, the impact of dietary Calorie Restriction (CR) on anti-tumor immune responses remains uncertain. Investigating this, we utilized an immunogenic B16 melanoma cell expressing ovalbumin (B16-OVA) to assess the effect of the CR diet on tumor growth and host immune responses. Furthermore, we evaluated whether the CR diet influenced the effectiveness of cancer immunotherapy, specifically anti-PD-1 monoclonal antibody (anti-PD-1 Ab) treatment. Our findings indicate that the CR diet notably decelerated B16-OVA tumor growth without altering CD4⁺ and CD8⁺ T cell infiltration into the tumor. Despite in vivo depletion of CD8⁺ T cells facilitating tumor growth in the control diet group, no significant change occurred in the CR diet group, with or without CD8⁺ T cell-depletion. Moreover, under CR conditions, anti-PD-1 Ab treatment lost its efficacy to suppress tumor growth, accompanied by the activation and metabolic shift of CD8⁺ T cells. In conclusion, our study suggests that restricted energy intake in cancer patients may impair CD8⁺ T cell immune surveillance and diminish the efficacy of immunotherapy.