Glasdegib in combination with low-dose Cytarabine for the outpatient treatment of relapsed or refractory acute myeloid leukemia in unfit patients.

We retrospectively collected clinical data on 31 relapsed or refractory acute myeloid leukemia (R/R AML) patients who were treated with outpatient glasdegib and low-dose Cytarabine (LDAraC) at our institution. The median age was 67 years (45-86). The median Eastern Cooperative Oncology Group performance status was 2 (1-3). The patients had previously received a median number of 2 (1-4) treatment lines, 61% (19/31) had been treated with intensive chemotherapy, 29% (9/31) had relapsed after allogeneic stem cell transplantation, and 45% (14/31) had had venetoclax exposure. Adverse cytogenetics were identified in 45% (14/31) of the cases. The CR + CRp rate was 21% (6/29) among evaluable patients. The median overall survival was 3.9 months for all patients. Different median overall survival times were observed in responders, patients achieving stable disease and those diagnosed with progressive disease: not reached vs 3.9 months vs 0.8 months, respectively (p < 0.001). The most common adverse events were pneumonia (29%, 9/31), sepsis (23%, 7/31), and febrile neutropenia (16%, 5/31). Glasdegib + LDAraC is a fairly safe, non-intensive, outpatient regimen inducing complete remission and resulting in prolonged survival in some R/R AML patients.

Mitigating arrhythmia risk in Hydroxychloroquine and Azithromycin treated COVID-19 patients using arrhythmia risk management plan.

AIMS: To assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using arrhythmia risk management plan. METHODS AND RESULTS: We retrospectively examined arrhythmia safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined arrhythmia risk management plan. The data was analyzed using R statistical package version 4.0.0. A two-tailed p-value<0.05 was considered significant. 81 patients were included from March 23rd to May 10th 2020. The median age was 59 years, 58.0% were female. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia. Fourteen patients (17.3%) experienced QTc ≥ 480 ms and 16 patients (19.8%) had an increase of QTc ≥ 60 ms. Seven patients (8.6%) had QTc prolongation of ≥ 500 ms. The treatment was discontinued in 4 patients (4.9%). None of the patients developed ventricular tachycardia. The risk factors significantly associated with QTc ≥ 500 ms were hypokalemia (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients (3.7%) died, the cause of death was bacterial superinfection with septic shock in two patients, and disseminated intravascular coagulation with multiple organ failure in one patient. None of these deaths were associated with cardiac arrhythmias. CONCLUSION: We recorded a low incidence of QTc prolongation ≥ 500 ms and no ventricular tachycardia events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia risk management plan.

Association between the Khorana score and pulmonary embolism risk in patients with advanced stage lung cancer.

INTRODUCTION: The Khorana score may help physicians to identify patients at high risk of Pulmonary embolism (PE) and decide who is eligible for thromboprophylaxis, however, its role in lung cancer patients remains unclear. OBJECTIVES: The aim of this study was to evaluate association between the Khorana score and risk of PE development among advanced stage lung cancer inpatients treated with chemotherapy. MATERIALS AND METHODS: A retrospective cohort study included 2008-2017 year data of 217 lung cancer inpatients with IIIB and IV clinical stages receiving chemotherapy. The Khorana score was evaluated and patients were divided in two groups: a group of patients with 1 point and a group of patients with 2 or more points of the Khorana score. RESULTS: The study population included 46 (21.2%) female and 171 (78.8%) male patients whose median age was 62. During median observation period of 308.5 days 26 (11.9%) patients developed PE. Study included 137 patients with 1 point and 80 patients with 2 or more points of the Khorana score. The frequency of PE was 17 (12.4%) among patients with 1 point and 9 (11.3%) among patients with 2 points of the Khorana score. The relative risk of PE for patients with 2 or more points was 0.895 (95% CI = 0.379-2.114), P = 0.800. CONCLUSION: The Khorana score was not associated with PE development risk among advanced stage lung cancer inpatients treated with chemotherapy.

Time from Symptom Onset to Diagnosis and Treatment among Haematological Malignancies: Influencing Factors and Associated Negative Outcomes.

Background and objectives: Diagnostic delay causes unfavorable outcomes among cancer patients. It has been widely analyzed in solid tumors. However, data regarding hematological malignancies diagnostic delay are scarce. We aimed to evaluate diagnostic intervals, their influencing factors, and the negative effect on clinical outcomes among multiple myeloma and lymphoma patients. Materials and methods: One hundred patients diagnosed with multiple myeloma (n = 53) or lymphoma (n = 47) (ICD codes-C90, C81-C84) were asked to participate during their scheduled hematology consultations. Interval durations and the majority of influencing factors were assessed based on a face-to-face questionnaire. Data of disease characteristics were collected from medical records. Results: The median interval from symptom onset to registration for medical consultation was 30 (0-730) days, from registration to consultation 2 (0-30) days, from first consultation to diagnosis 73 (6-1779) days, and from diagnosis to treatment 5 (0-97) days. Overall time to diagnosis median was 151 (23-1800) days. Factors significantly prolonging diagnostic intervals in multivariate linear regression were living in big cities (p = 0.008), anxiety and depression (p = 0.002), self-medication (p = 0.019), and more specialists seen before diagnosis (p = 0.022). Longer diagnostic intervals resulted in higher incidences of multiple myeloma complications (p = 0.024) and more advanced Durie-Salmon stage (p = 0.049), but not ISS stage and Ann-Arbor staging systems for lymphomas. Conclusion: Median overall diagnostic delay was nearly 5 months, indicating that there is room for improvement. The most important factors causing delays were living in big cities, anxiety and depression, self-medication, and more specialists seen before diagnosis. Diagnostic delay may have a negative influence on clinical outcomes for multiple myeloma patients.

Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularisation.

BACKGROUND: Exercise electrocardiography is a long-standing method for the evaluation of coronary artery disease (CAD), and it remains the initial test for most patients who can exercise adequately with a baseline interpretable electrocardiogram. However, there is little information about the relationship between Duke treadmill test score (DTS) and severity of coronary artery lesion, as well as estimating the need for revascularisation. AIM: The aim of the study was to ascertain whether the DTS could be an efficient parameter in choosing coronary revascularisation in different DTS groups. METHODS: Two hundred and fifty-eight (n = 258) patients had positive exercise testing for CAD and underwent coronary angiography. The patients were divided into three groups according to the DTS: low-risk (with a score of ≥ +5), moderate-risk (with scores ranging from -10 to +4), and high-risk (with a score of ≤ -11). Coronary angiography was done by the Judkins technique. A coronary lesion was considered significant when stenosis of the coronary artery was ≥ 70% and stenosis of the trunk was ≥ 50%. The SYNTAX score was determined. RESULTS: The study group included 258 patients with mean age 62.66 ± 9.6 years, and most of them were men (72.8%). Patients with high- and intermediate-risk DTS had the same SYNTAX score (16.35 ± 7.3, 15.09 ± 10.08 and 11.80 ± 9.88, respectively; p = 0.064) compared to low-risk DTS. A negative correlation between DTS and significant coronary artery stenosis (r = -0.181; p = 0.005), SYNTAX score (r = -0.173; p = 0.007), and cardiac revascularisations (r = -0.213; p = 0.001) were found. In multiple linear regressions to predict coronary revascularisation the SYNTAX score (B = 0.018; p = 0.0001), DTS (B = -0.014, p = 0.008) and previous myocardial infarction (B = -0.143; p = 0.047) were significant predictors. CONCLUSIONS: The DTS alone is a useful tool in suspecting a significant coronary artery stenosis, but it is not accurate enough for revascularisation. Thus, by adding clinical information, its value may be maximised.