Selinexor, daratumumab, bortezomib and dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma: results of the phase II, non-randomized, multicenter GEM-SELIBORDARA study.

The treatment landscape for multiple myeloma has significantly evolved in the last decade. Notwithstanding, a large proportion of patients continue to relapse and novel combinations continue to be needed. In this phase 2 study, selinexor, a first-in-class inhibitor of exportin-1 was evaluated in combination with standard daratumumab-bortezomib-dexamethasone (DVd), for the treatment of relapsed and refractory multiple myeloma (RRMM). The aim of the trial was to assess the efficacy and safety of the combination of selinexor with DVd (S-DVd). A total of 57 patients were enrolled in the two parts of the study. Part 1 enrolled a heavily pretreated population with at least 3 prior lines of therapy and part 2 enrolled an early relapse population with at least 1 prior therapy. The primary endpoint was complete response (CR) rate in part 2 and overall response rate (ORR) in part 1. In the latter, 24 patients were treated with a median of 3 prior lines. Overall response rate (ORR) was 50% with 2 CR. Median progressionfree survival (PFS) was 7 months. In part 2, 33 patients were enrolled, with a median of 1 prior lines. ORR was 82% and CR or better was 33%. Median PFS was 24 months. In lenalidomide refractory patients, a median PFS of 22.1 months was observed. Thrombocytopenia was the most common hematological adverse event (69%; grade 3-4: 34%) and nausea, the most frequent nonhematological AE (38%; grade 3-4: 6%). 62% of the patients required dose modifications. In summary, although the primary endpoint of the study was not met, the combination of S-DVd showed encouraging clinical efficacy with a generally manageable safety profile representing a potential option for the treatment of RRMM patients.

Validation of clinical symptom IRT scores for diagnosis and severity assessment of common mental disorders.

PURPOSE: We studied the validity and responsiveness of an item response theory (IRT) scoring method for assessing major depressive episode (MDE) and generalized anxiety disorder (GAD) severity based on direct assessment of DSM-IV-TR symptoms. METHODS: Prospective cohort study (baseline, 1-month, 3-months assessments) of patients seeking help for incident or aggravated mood or anxiety symptoms from primary, outpatient and inpatient mental health centers (N = 244; 67.81 % active cases - 100 % under psychiatric treatment). The drop-out rate at 3 months was 24.89 %. Patients were assessed at each follow-up for presence/absence of DSM-IV symptoms of MDE (nine symptoms) and GAD (eight symptoms). IRT scores for depression (INS-D) and anxiety (INS-G), based on response patterns, were obtained by means of a 2-parameter model. Diagnostic accuracy was assessed with receiver operating characteristic analysis, using a blinded MINI interview as gold standard. Scores' construct validity was compared with external clinician-administered (Hamilton Depression Rating Scale, HRSD; Hamilton Anxiety Rating Scale, HAM-A) and self-reported severity measures (PHQ-9; Beck Anxiety Inventory-Subjective Aspects, BAI-Sub). Responsiveness was analyzed based on the evolution of HRSD and HAM-A scores. RESULTS: Both severity scores showed excellent reliability (INS-D: 0.92; INS-G: 0.93) and yielded high diagnostic accuracy (INS-D: AUC = 0.96; INS-G: AUC = 0.91) with respect to MINI diagnoses. INS-D and INS-G had higher correlations with clinician-administered measures of the same disorder (INS-D-HRSD: 0.73; INS-G-HAM-A: 0.53) than with self-reported measures (INS-D-PHQ-9: 0.69; INS-G-BAI-Sub: 0.49). Patients who recovered during follow-up showed important decreases in severity (Cohen's d INS-D:-1.38; INS-G: -1.75). About 90 % variance of INS-D and INS-G score changes over time was associated with changes in clinical status. CONCLUSIONS: INS-D and INS-G are short reliable, valid, and responsive measures that can be used for diagnostic and severity assessment of mood and anxiety disorders in outpatient care.

Visual performance in preterm infants with brain injuries compared with low-risk preterm infants.

BACKGROUND: Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. AIM: To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. STUDY DESIGN AND SUBJECTS: Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. OUTCOME MEASURES: The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. RESULTS: The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. CONCLUSION: Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life.

¿Existe una relación específica entre la ansiedad por separación en la infancia y la aparición posterior de los trastornos de pánico y agorafobia? / Is there a specific relationship between childhood separation anxiety and the later development of panic and agoraphobia disorders?

Diversos autores han afirmado que el nivel elevado de ansiedad por separación en la infancia es un factor específico de riesgo para el trastorno de pánico (con o sin agorafobia). En la revisión realizada por Silove, Manicavasagar, Curtis y Blaszczynski (1996) estos autores concluyeron que ambos fenómenos están asociados, pero que los datos eran inconsistentes sobre si esta asociación era específica o existía también respecto a otros trastornos. Además, avanzaron la hipótesis de que el trastorno por ansiedad de separación en la infancia puede progresar a un trastorno equivalente en la adultez y predisponer al desarrollo del pánico. Debido a que desde entonces han surgido numerosos estudios sobre el tema, algunos de ellos prospectivos, llevamos a cabo una revisión crítica de los mismos. El análisis de los 28 estudios confirma la asociación entre ansiedad por separación y trastorno de pánico, pero plantea grandes dudas sobre la especificidad de esta relación. Por otra parte, el trastorno de ansiedad por separación se da en la adultez, pero su relación con el trastorno de pánico tampoco parece específica (AU)

One persistent hypothesis in the literature is that heightened levels of early separation anxiety are a specific risk factor for developing panic disorder (with or without agoraphobia). In the review carried out by Silove, Manicavasagar, Curtis, & Blaszczynski (1996) these authors concluded that both phenomena were associated, but whether this association reflected a specific relationship or existed also in relation to other disorders was an issue that remained inconclusive. Moreover, they advanced the hypothesis of the possible persistence of early separation anxiety disorder into adulthood, rendering the sufferer vulnerable to panic. Since then, a number of studies have investigated this question, some of them prospectively, so the present article aims to review them critically. The analysis of 28 studies confirms the association between separation anxiety and panic disorder, but it raises great doubts about the specificity of such relationship. Furthermore, separation anxiety disorder also exists in adulthood, but its relationship with panic disorder does not seem to be specific either