Real-world efficacy of single-agent belantamab mafodotin in relapsed systemic AL amyloidosis.

Systemic light chain (AL) amyloidosis is a relapsing plasma cell disorder. Therapy is limited, particularly for triple-class refractory disease. We report the use of belantamab mafodotin, a BCMA-directed drug-antibody conjugate, for relapsed AL amyloidosis, including patients traditionally excluded from clinical trials. Thirty-one patients were reviewed, with a median of three prior lines of therapy. The median follow-up was 12 months (95% CI 4-19), and a median of five doses were delivered. The best haematological overall response rate was 71%, and the complete/very good partial response was 58%. Sixty-eight percent had keratopathy and improved in all. Belantamab mafodotin has high efficacy and good tolerability in patients with relapsed AL amyloidosis.

Visual Supports for Children With Autism in Physical Activity.

Visual supports have been advocated as one strategy to teach children with autism in physical education. However, empirical studies documented inconsistencies in their effectiveness, with some demonstrating positive effects while others reported limited support for their use. Without a clear synthesis of information, physical educators may have difficulties in identifying and meaningfully utilizing visual supports. A systematic literature review on visual supports was conducted with synthesized current literature for physical educators to make informed decisions regarding their use for children with autism in physical education. A total of 27 articles were reviewed, which included empirical- and narrative-based manuscripts. Results suggest that picture task cards, visual activity schedules, and video prompting can be potential strategies that physical educators can use to teach motor skills to children on the spectrum. However, video modeling may need to be further investigated to fully understand how to use it in the context of physical education.

Prediction of Anthocyanin Color Stability against Iron Co-Pigmentation by Surface-Enhanced Raman Spectroscopy.

The color change resulting from anthocyanin and iron co-pigmentation has been a significant challenge for the food industry in the development of many iron-fortified foods. This present study aims to establish a quantitative model to predict the degree of color stability in the presence of dissolved iron using surface-enhanced Raman spectroscopic (SERS) spectra. The SERS spectra of anthocyanin extracts from seven different plant sources were measured and analyzed by principal component analysis (PCA). Discrimination among different sources of anthocyanin was observed in the PCA plot. Different stability indexes, obtained by measuring both the color intensity stability and color hue stability of each sample, were established based on UV-vis analysis of anthocyanin at pH 3 and 6 with and without ferric sulfate. Partial least square (PLS) regression models were applied to establish the correlation between SERS spectra and stability indexes. The best PLS model was built based on the stability index calculated from the bathochromic shift (UV-vis spectral range: 380-750 nm) in pH3 buffer and the SERS spectra, achieving a root mean square error of prediction (RMSEP) of 2.16 nm and a correlation coefficient value (R2) of 0.98. In conclusion, the present study developed a feasible approach to predict the stability of anthocyanin colorants against iron co-pigmentation. The developed method and models can be used for fast screenings of raw ingredients in iron-fortified food products.

CHOP versus GEM-P in previously untreated patients with peripheral T-cell lymphoma (CHEMO-T): a phase 2, multicentre, randomised, open-label trial.

BACKGROUND: Outcomes with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like chemotherapy in peripheral T-cell lymphoma are poor. We investigated whether the regimen of gemcitabine, cisplatin, and methylprednisolone (GEM-P) was superior to CHOP as front-line therapy in previously untreated patients. METHODS: We did a phase 2, parallel-group, multicentre, open-label randomised trial in 47 hospitals: 46 in the UK and one in Australia. Participants were patients aged 18 years and older with bulky (tumour mass diameter >10 cm) stage I to stage IV disease (WHO performance status 0-3), previously untreated peripheral T-cell lymphoma not otherwise specified, angioimmunoblastic T-cell lymphoma, anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, enteropathy-associated T-cell lymphoma, or hepatosplenic γδ T-cell lymphoma. We randomly assigned patients (1:1) stratified by subtype of peripheral T-cell lymphoma and international prognostic index to either CHOP (intravenous cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 [maximum 2 mg] on day 1, and oral prednisolone 100 mg on days 1-5) every 21 days for six cycles; or GEM-P (intravenous gemcitabine 1000 mg/m2 on days 1, 8, and 15, cisplatin 100 mg/m2 on day 15, and oral or intravenous methylprednisolone 1000 mg on days 1-5) every 28 days for four cycles. The primary endpoint was the proportion of patients with a CT-based complete response or unconfirmed complete response on completion of study chemotherapy, to detect a 20% superiority of GEM-P compared with CHOP, assessed in all patients who received at least one cycle of treatment and had an end-of-treatment CT scan or reported clinical progression as the reason for stopping trial treatment. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov (NCT01719835) and the European Clinical Trials Database (EudraCT 2011-004146-18). FINDINGS: Between June 18, 2012, and Nov 16, 2016, we randomly assigned 87 patients to treatment, 43 to CHOP and 44 to GEM-P. A planned unmasked review of efficacy data by the independent data monitoring committee in November, 2016, showed that the number of patients with a confirmed or unconfirmed complete response with GEM-P was non-significantly inferior compared with CHOP and the trial was closed early. At a median follow-up of 27·4 months (IQR 16·6-38·4), 23 patients (62%) of 37 assessable patients assigned to CHOP had achieved a complete response or unconfirmed complete response compared with 17 (46%) of 37 assigned to GEM-P (odds ratio 0·52, 95% CI 0·21-1·31; p=0·164). The most common adverse events of grade 3 or worse in both groups were neutropenia (17 [40%] with CHOP and nine [20%] with GEM-P), thrombocytopenia (4 [10%] with CHOP and 13 [30%] with GEM-P, and febrile neutropenia (12 [29%] with CHOP and 3 [7%] with GEM-P). Two patients (5%) died during the study, both in the GEM-P group, from lung infections. INTERPRETATION: The number of patients with a complete response or unconfirmed complete response did not differ between the groups, indicating that GEM-P was not superior for this outcome. CHOP should therefore remain the reference regimen for previously untreated peripheral T-cell lymphoma. FUNDING: Bloodwise and the UK National Institute of Health Research.

What is the significance of haemosiderin in the lungs of deceased infants?

In infants, pulmonary haemosiderin has been put forward as a marker of previous asphyxic abuse and possible grounds for suspicion of homicide. Review of the available literature does not provide a strong enough evidence base to support this claim. Further research is needed before instigation of criminal proceedings can be justified on this pathological finding.