Eosinophilia as Monitoring Parameter for Chronic Graft-versus-Host Disease and Vitamin D Metabolism as Monitoring Parameter for Increased Infection Rates in Very Long-Term Survivors of Allogeneic Stem Cell Transplantation—A Prospective Clinical Study
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis study investigates the health status, quality of life, cardiovascular risk factors, chronic graft-versus-host disease (GvHD), and vitamin D metabolism in long-term survivors of adult allogeneic stem cell transplantation (alloSCT). However, a more detailed analysis and discussion would be beneficial. The reviewer suggests it would be resubmitted after a minor revision.
Some specific comments are addressed below.
1. The sample size of 33 patients is relatively small, which may limit the generalizability of the findings. The paper should discuss the implications of this small sample size on the robustness of the results.
2. While the statistical methods used are appropriate, the results suggest that some associations are not significant. The paper should provide a more detailed discussion of the potential reasons for these non-significant findings, including any limitations in the study design or data collection.
3. The study found a link between vitamin D deficiency and increased infection rates. This warrants a more detailed discussion on the potential mechanisms through which vitamin D influences infection rates and quality of life.
Comments on the Quality of English Language
Good
Author Response
Dear Editor, Dear Reviewers,
Thank you for your valuable time and your thoughtful comments to improve our manuscript and even our research. We highly appreciate this.
Please, find our comments to your concerns below and we have marked all changes in the manuscript in red color.
Thanks again and very Kind Regards,
Laila Schneidewind, on behalf of all authors
This study investigates the health status, quality of life, cardiovascular risk factors, chronic graft-versus-host disease (GvHD), and vitamin D metabolism in long-term survivors of adult allogeneic stem cell transplantation (alloSCT). However, a more detailed analysis and discussion would be beneficial. The reviewer suggests it would be resubmitted after a minor revision. Some specific comments are addressed below.
- The sample size of 33 patients is relatively small, which may limit the generalizability of the findings. The paper should discuss the implications of this small sample size on the robustness of the results.
Thank you, this is certainly true, but we must state that this is a prospective study, but indeed we have added it to our limitations section, because small sample size means selection bias.
- While the statistical methods used are appropriate, the results suggest that some associations are not significant. The paper should provide a more detailed discussion of the potential reasons for these non-significant findings, including any limitations in the study design or data collection.
True, we have also added this information to our limitations section.
- The study found a link between vitamin D deficiency and increased infection rates. This warrants a more detailed discussion on the potential mechanisms through which vitamin D influences infection rates and quality of life.
This is a very good point and we have added this also to our discussion section.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe manuscript deals with the cardiovascular risk assessment of patients after alloSCT.
Although the design of the investigation could be acceptable, no new insights were gained from the study, also because of the limited number of patients followed-up.
The Authors should deeply revise the text, in order to highlight the significance of their results for the scientific community.
Hoping to be of help, few issues are listed below.
- The final sentences of the Discussion section are identical to those in the Conclusion section.
- Check for English language throughout the manuscript, avoiding typos and grammar mistakes. Some sentences seem to be truncated, others are repeated.
- Ensure to define each acronym at first occurrence (i.e. HRQoL in the abstract section).
- Adjust Tables format to that reported in the Authors Guidelines.
Comments on the Quality of English Language- Check for English language throughout the manuscript, avoiding typos and grammar mistakes.
Author Response
Dear Editor, Dear Reviewers,
Thank you for your valuable time and your thoughtful comments to improve our manuscript and even our research. We highly appreciate this.
Please, find our comments to your concerns below and we have marked all changes in the manuscript in red color.
Thanks again and very Kind Regards,
Laila Schneidewind, on behalf of all authors
The manuscript deals with the cardiovascular risk assessment of patients after alloSCT.
Although the design of the investigation could be acceptable, no new insights were gained from the study, also because of the limited number of patients followed-up.
The Authors should deeply revise the text, in order to highlight the significance of their results for the scientific community.
Hoping to be of help, few issues are listed below.
- The final sentences of the Discussion section are identical to those in the Conclusion section.
Thank you, this is certainly a good point and we have improved this
- Check for English language throughout the manuscript, avoiding typos and grammar mistakes. Some sentences seem to be truncated, others are repeated.
True, we tried to improve this
- Ensure to define each acronym at first occurrence (i.e. HRQoL in the abstract section).
Yes, but for us, due to word counts abstract and text stand alone.
- Adjust Tables format to that reported in the Authors Guidelines.
Sorry, for that issue since the table are big. It would not be possible to read all information, so we decided on a bigger readable format. Maybe the journal could decide to put it online another way.
Reviewer 3 Report
Comments and Suggestions for AuthorsThis manuscript, entitled “Cardiovascular risk, chronic graft-versus-host disease, and vitamin D metabolism in very long-term survivors of allogeneic stem cell transplantation – a prospective clinical study” by Neumann et al., is a well-designed, well-analyzed, and well-written study. However, some concerns need to be addressed before acceptance for publication.
· The rationale for investigating cardiovascular risk, GVHD, and vitamin D metabolism in alloSCT survivors is unclear, as numerous studies have already identified their correlations (PMID: 24166350, PMID: 12720215, PMID: 31229642). The novelty of this manuscript should be well-described in the introduction.
· A significant concern is that the study population comprises patients with different hematological malignancies, which can differentially influence immune parameters. The manuscript should address how the influence of tumor cells as a confounder in the correlation analysis between immunological factors, vitamin D, and GVHD is excluded.
· The timing of the detection of clinical parameters (cardiovascular risk factors, immunological factors, GHS, and vitamin D metabolism) relative to alloSCT should be clearly stated in the manuscript. Specify how many years after alloSCT these parameters were measured.
Author Response
Dear Editor, Dear Reviewers,
Thank you for your valuable time and your thoughtful comments to improve our manuscript and even our research. We highly appreciate this.
Please, find our comments to your concerns below and we have marked all changes in the manuscript in red color.
Thanks again and very Kind Regards,
Laila Schneidewind, on behalf of all authors
This manuscript, entitled “Cardiovascular risk, chronic graft-versus-host disease, and vitamin D metabolism in very long-term survivors of allogeneic stem cell transplantation – a prospective clinical study” by Neumann et al., is a well-designed, well-analyzed, and well-written study. However, some concerns need to be addressed before acceptance for publication.
- The rationale for investigating cardiovascular risk, GVHD, and vitamin D metabolism in alloSCT survivors is unclear, as numerous studies have already identified their correlations (PMID: 24166350 , PMID: 12720215 , PMID: 31229642 ). The novelty of this manuscript should be well-described in the introduction.
This very good point of yours, thank you. We investigated a population of very long-term survivors of allogeneic stem cell transplantation and this actually is the novelty of our study since most studies only focus on two years of long-term survival. Furthermore, and due to the fact that transplantation practice improves more and more this data also become more and more important. We tried to make this fact more clear in the discussion section.
- A significant concern is that the study population comprises patients with different hematological malignancies, which can differentially influence immune parameters. The manuscript should address how the influence of tumor cells as a confounder in the correlation analysis between immunological factors, vitamin D, and GVHD is excluded.
This is true, but a well known problem of all studies in stem cell transplantation, but we have added this information to our limitations section.
- The timing of the detection of clinical parameters (cardiovascular risk factors, immunological factors, GHS, and vitamin D metabolism) relative to alloSCT should be clearly stated in the manuscript. Specify how many years after alloSCT these parameters were measured.
True, we tried to make this more clear in our methods section.
