ABSTRACT
Core-binding factor acute myeloid leukemia (CBF-AML) is characterized by the presence of inv(16)/t(16;16) or t(8;21) and is classified as a favorable risk by the 2022 European LeukemiaNet (ELN) guidelines. The CD33-targeting antibody-drug conjugate, gemtuzumab ozogamicin (GO), is commonly added to intensive chemotherapy (IC) in CBF-AML. We sought to compare outcomes in patients treated with IC with or without GO in CBF-AML. We included 200 patients with CBF-AML treated with IC across seven academic centers. Induction treatment regimens were categorized as IC alone, IC with GO, or IC with KIT inhibitor (dasatinib or midostaurin). Median follow-up for the whole cohort was 2.5 years. Three-year overall survival (OS) was 70% and 3-year event-free survival (EFS) was 51%. Patients treated with IC with GO experienced a 3-year EFS of 50% compared to those treated with IC alone who experienced a 3-year EFS of 47%, with no statistically significant difference (p = 0.62). Similarly, those treated with IC with GO did not experience an improved OS compared to those treated with IC alone (p = 0.67). Patients treated with IC with KIT inhibitor experienced a significantly improved 3-year EFS of 85% compared to those with IC with or without GO (p = 0.04). We find in our study that there is no survival benefit in patients treated with IC with the addition of GO; improved EFS was seen in patients with CBF-AML treated with IC plus KIT inhibitors, consistent with outcomes noted in prospective studies utilizing this approach.
ABSTRACT
Background: First classified in 2016, high-grade B-cell lymphoma (HGBCL) is a lymphoid neoplasm that is typically seen as an aggressive lymphoproliferative disorder (LPD). In most patients with HGBCL, various oncogene rearrangements present with advanced clinical features, such as central nervous system involvement. Patients with underlying autoimmune and rheumatologic conditions, such as rheumatoid arthritis, are at higher risk for developing LPDs, including highly aggressive subtypes of non-Hodgkin lymphomas such as HGBCL. Case Presentation: We present a case of stage IV double-hit HGBCL with the presence of MYC and BCL6 gene rearrangements in an older veteran with rheumatoid arthritis treated with methotrexate. An excellent sustained response was observed for the patient's disease within 4 weeks of methotrexate discontinuation. To our knowledge, this is the first reported response to methotrexate discontinuation for a patient with HGBCL. Conclusions: Reducing immunosuppression should be considered in all patients with LPDs associated with autoimmune conditions or immunosuppressive medications, regardless of additional multiagent systemic therapy administration.
ABSTRACT
COVID-19 infection has worse outcomes in immunocompromised individuals. This includes those with diabetes mellitus, cancer, chronic autoimmune diseases requiring immunomodulatory therapy, and solid-organ transplant recipients on chronic immunosuppression. Using the National Inpatient Sample Database, this study retrospectively compared 14,915 renal transplant recipients who were hospitalized with either COVID-19 or Influenza virus infection in the US at any point between 1st January 2020 and 31st December 2020. We found that compared to renal transplant recipients with influenza infection, recipients with COVID-19 infection were more likely to require mechanical ventilation and vasopressor support and develop acute kidney injury requiring hemodialysis. COVID-19 patients also had significantly longer length of hospital stay. Renal transplant recipients with COVID-19 had significantly higher in-hospital mortality compared to recipients with influenza infection (14.09% vs 2.61%, adjusted odds ratio [aOR] 9.73 [95% CI (5.74-16.52)], P < .001). Our study clearly demonstrates the severe outcomes of high mortality and morbidity in renal transplant recipients with COVID-19. Further research should be undertaken to focus on the key areas noted to reduce morbidity and mortality in this population.