CREST-UK: Real-world effectiveness, safety and outpatient delivery of CPX-351 for first-line treatment of newly diagnosed therapy-related AML and AML with myelodysplasia-related changes in the UK.

Favourable outcomes with CPX-351 versus conventional 7 + 3 were demonstrated in the pivotal phase III trial in adults aged 60-75 years with newly diagnosed, highrisk/secondary acute myeloid leukaemia (AML). As a complement to the clinical trial and to address important data gaps, the CPX-351 Real-World Effectiveness and SafeTy (CREST-UK; NCT05169307) study evaluated the use of CPX-351 in routine clinical practice in the UK, in 147 patients with newly diagnosed therapy-related AML or AML with myelodysplasia-related changes. Best response of complete remission or complete remission with incomplete platelet or neutrophil recovery was achieved by 53% of evaluable patients. Kaplan-Meier median overall survival (OS) was 12.8 months (95% confidence interval 9.2-15.3). Fifty (34%) patients proceeded to haematopoietic cell transplantation (HCT); median OS landmarked from the HCT date was not reached. There were no new safety concerns with CPX-351 identified in CREST-UK. Patients treated with CPX-351 in the outpatient setting spent an average of 24.4, 16.7, 28.2, and 27.7 fewer days on the ward compared with inpatients during first induction, second induction, first consolidation, and second consolidation, respectively. The results from CREST-UK provide valuable insights into the effectiveness, safety, and outpatient delivery of CPX-351 in routine clinical practice in the UK.

Prior experience with wheel running produces cross-tolerance to the rewarding effect of morphine.

The rewarding effect of wheel running is hypothesized to be mediated by endogenous opioids. Thus, prior experience with wheel running might be expected to affect the reward value of an opiate drug like morphine. In three similar experiments to test this idea, 10 rats (wheel-morphine group) were confined in running wheels for 2 h on each of eight consecutive days during the first phase; the 10 in the cage-morphine group were confined in small metal cages. Then, in the second phase, a distinctive place was paired with morphine (1 mg/kg) on three occasions to produce conditioned place preference (CPP). In all experiments, CPP occurred in the cage-morphine group, but not in the wheel-morphine group, implying that prior wheel running resulted in cross-tolerance to the rewarding effect of morphine. This finding supports the idea that the rewarding effect of wheel running is mediated by endogenous opioids.