Alam, Arif

Abstract Background: Until 2022, the United Arab Emirates (UAE) lacked in-country allogenic hematopoietic stem cell transplant (allo-HSCT) services, forcing patients abroad for curative treatment while local hematologists managed pre- and post-transplant care. This fragmented model created unique challenges in graft-versus-host disease (GVHD) monitoring and survival tracking. We present the first analysis of outcomes in this underserved population. Aims: To evaluate overall survival (OS) and GVHD rates in adults receiving allo-HSCT abroad with UAE-based follow-up, establishing benchmarks for emerging local transplant programs. Methods: Retrospective multicenter study of adults undergoing allo-HSCT outside the UAE (2009–2023) with follow-up at three tertiary centers (SSMC, SKMC, Tawam). Of 454 screened patients, we excluded pediatric cases (n=245), autologous HSCT (n=76; excluded due to distinct indications/outcomes), and rare allo-HSCT indications (n=33), focusing on the most common diagnoses: acute myeloid leukemia (AML, n=54), B/T-acute lymphoblastic leukemia (B/T-ALL, n=38), and sickle cell disease (SCD, n=8). Kaplan-Meier (KM) analysis estimated 1/3/5-year OS. Observed median survival was calculated for deceased patients. GVHD grading followed NIH consensus criteria. Log-rank tests compared subgroups (donor type). Results: Survival: AML 1/3/5-year OS: 96%/79.3%/55.5% (95% CI 48–63). KM-estimated median not reached; observed median in deceased patients: 20 months. Matched unrelated donor (MUD) recipients had inferior survival vs. matched related donor (MRD)/mismatched related donor (MMRD) (p=0.03). B-ALL: 1/3/5-year OS: 92%/76.4%/69.2% (95% CI 61–77). T-ALL (n=7): 1/3-year OS: 80%/50% (limited by small sample) SCD (n=8): 100% survival at all timepoints; no GVHD observed. GVHD: Any-grade GVHD: 68.5% (AML), 73.3% (B-ALL), 71.4% (T-ALL)—exceeding CIBMTR benchmarks (50–60%). Acute GVHD 35.2% (AML), 43.3% (B-ALL), 28.6% (T-ALL). Chronic GVHD 46.3% (AML), 40% (B-ALL), 57.1% (T-ALL). Conclusion: Despite high GVHD rates, survival outcomes support selective overseas referral for AML/B-ALL patients, particularly younger recipients. SCD results highlight the safety of HSCT in non-malignant disease. These findings underscore the need for local HSCT capacity to mitigate care fragmentation and establish a critical benchmark for UAE programs. Prospective studies should evaluate socioeconomic drivers of referral patterns and GVHD disparities.

The authors requested to update the acknowledgement, funding, and authors contribution section in their article titled “UAE Consensus on Patient Profiles for Pre-exposure Prophylaxis with Monoclonal Antibodies against COVID-19 in Hematological Malignancies and Immunocompromised States” published in “New Emirates Medical Journal,” 2024; 5: e02506882347591 [1]. We apologize for any inconvenience caused and appreciate the opportunity to rectify this matter. The original article can be found online at https://www. eurekaselect.com/article/147185 Original: AUTHORS’ CONTRIBUTIONS It is hereby acknowledged that all authors have accepted responsibility for the manuscript's content and consented to its submission. They have meticulously reviewed all results and unanimously approved the final version of the manuscript. FUNDING None. ACKNOWLEDGEMENTS Declared none. Corrected: AUTHORS’ CONTRIBUTIONS S.H., J.A., A.R.A., M.A., A.Al.M., B.G., A.L., H.Y.O., P.K.: All contributed to the delphie and discus-sion meetings; S.H., A.Al.M., A.R.A. and M.A.: Contributed to writing the main manuscript; S.H., B.G., A.L., H.Y.O., P.K.: Contributed to revising the main manuscript. FUNDING The consensus logistics and medical publication was funded by AstraZeneca FZ LLC, Dubai, United Arab Emirates. ACKNOWLEDGEMENTS The authors extend their sincere gratitude to Meeting Minds Medical Communications Agency for their unwavering support in medical content development, including invaluable editorial and formatting assis-tance, which significantly contributed to the successful completion of the manuscript. Additionally, we express our appreciation to the Emirates Society of Hematology (ESH) for their endorsement of this work, further enhancing its credibility and relevance within the field. A courtesy copy of the final manuscript was provided to AstraZeneca as a gesture of acknowledgment for their interest in this research endeavor.

Introduction: Despite significant advancements in COVID-19 treatment and prevention, immunocompromised individuals, particularly those with hematological malignancies, remain at high risk for severe infection and suboptimal vaccine response. Pre-exposure prophylaxis strategies for these vulnerable populations have been limited. Monoclonal antibodies, proteins designed to target specific antigens, offer a promising preventive solution for individuals unable to mount a sufficient immune response to vaccination. However, there is a critical unmet need to establish clear patient selection criteria for pre-exposure prophylaxis with monoclonal antibodies in these groups. This consensus statement explores recent research to address this gap, outlining profiles of patients most likely to benefit from monoclonal antibody-based prophylaxis. Methodology: The consensus statement was developed through a rigorous process, utilizing a pre-Delphi search method and a modified Delphi technique to gather expert opinions. This approach ensured a comprehensive and informed consensus among experts in the field. Initially, nine distinct patient categories requiring pre-exposure prophylaxis with monoclonal antibodies were identified. Through iterative rounds of expert feedback, discussion, and refinement, these nine categories were expanded and subdivided into twelve more specific groups of hematological malignancies and immunocompromised disorders. This refinement aimed to better capture the diverse patient profiles requiring prophylaxis, providing a more detailed framework for the targeted administration of monoclonal antibodies. Results: The study resulted in the panel members agreeing on nine categories for the use of monoclonal antibodies in COVID-19 prevention for high-risk patients. Achieving consensus among experts is crucial as it reflects the collective validation of evidence-based recommendations that can be reliably applied in clinical practice. A 100% agreement was reached for HIV and AIDS, underscoring the unanimous recognition of the vulnerability of this group to severe COVID-19 outcomes. Similarly, 96% agreement was reached for patients on immunomodulatory drugs (IMiDs), and 90.5% for those with hematological diseases, highlighting strong expert support for prophylaxis in these categories. Immunodeficiencies and renal conditions garnered 86% agreement, indicating broad, although slightly more varied, expert consensus on these groups. Lastly, 80% of the panel supported patients with solid organ cancer, liver conditions, rare neurological disorders, and severe life-limiting neuro-disabilities, reflecting recognition of their elevated risk despite more diverse opinions for these categories. Conclusion: This consensus statement offers healthcare professionals in the UAE a clear, evidence-based framework for the use of monoclonal antibodies in preventing COVID-19 among patients with hematological malignancies and immunocompromised conditions. By outlining specific patient categories, the statement provides a practical guide that enables clinicians to make informed decisions about pre-exposure prophylaxis, ensuring that high-risk individuals receive timely and appropriate protection. The consensus not only enhances the ability of healthcare providers to identify and prioritize at-risk populations, but also optimizes patient outcomes by streamlining preventive measures in clinical practice. In addition, these findings lay the groundwork for future research and the development of standardized protocols, ultimately improving the management of vulnerable populations in the ongoing fight against COVID-19.