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Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.
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Eutanásia , Suicídio Assistido , Assistência Terminal , Humanos , Estudos Transversais , Portugal , Assistência Terminal/psicologiaRESUMO
This study focuses on the impact of common spiritual beliefs regarding metaphysical questions in agreeability with the practice of hastened death. A sample of 497 Portuguese medical students was collected. Differences between genders and religions, predictors for agreeability with hastened death and the association between spiritual beliefs and opinion towards hastened death cases were assessed. Respondents were mostly favourable to the practice of hastened death. Formal religious affiliation and higher levels of religiosity significantly associated with lesser agreeability with hastened death. Statistically significant association was found between every hastened death scenario and multiple of the spiritual beliefs used. A number of spiritual beliefs were predictors of agreeability. We discuss the implications of religion and spirituality in agreeability with hastened death. Further research is required to better understand the true weight of spirituality in one's opinion towards this ethical dilemma.
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Estudantes de Medicina , Feminino , Humanos , Masculino , Religião , Espiritualidade , Inquéritos e QuestionáriosRESUMO
The opportunity for patients to request support to die is legalised in several countries and is associated with the development of a social and political debate that has taken place in recent years. We believe that psychologists can contribute to this debate. Here, we conducted a literature and legislation review with the aim of understanding arguments regarding the roles of the psychologist in hastening death. A systematic review of the peer-review literature in this field was carried out. The legislation of each country with hasten death practices was analysed to understand if psychologists are included in the protocols of hasten death practices. Despite a lack of literature, we found competence assessment, communication, psychological counselling, research and training and public policy to be the possible roles of psychologists in requests to hasten death. Based on the review, an agenda for future research is developed. We highlight the importance of psychology, raising its profile in the study of the various forms of death hastening requests.
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Psicologia/normas , Suicídio Assistido/psicologia , Feminino , Humanos , Masculino , Suicídio Assistido/legislação & jurisprudênciaRESUMO
This article analyzes suicidal behavior and how its inherent processes of death ideation can overlap with those seeking euthanasia. We present a literature review of three main events in suicide (suicidal ideation, suicide attempt, and suicide) in different populations and evaluate implications for health-care practice and risk assessment taking into account the context of euthanasia. We ponder upon the motives behind suicide and its link with wish to die requests to hasten death. We discuss the possibility of the reversal of a wish to die as well as a potential process of differentiating between individuals who would maintain their wish and benefit from termination of life and others who would later change their minds.
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Atitude Frente a Morte , Eutanásia , Humanos , Ideação Suicida , Tentativa de Suicídio , Suicídio ConsumadoRESUMO
BACKGROUND: During COVID-19 pandemic, healthcare workers (HCWs) have had high workload and have been exposed to multiple psychosocial stressors. The aim of this study was to evaluate HCWs in terms of the relative contributions of socio-demographic and mental health variables on three burnout dimensions: personal, work-related, and client-related burnout. METHODS: A cross-sectional study was performed using an online questionnaire spread via social networks. A snowball technique supported by health care institutions and professional organizations was applied. RESULTS: A total of 2008 subjects completed the survey. Gender, parental status, marriage status, and salary reduction were found to be significant factors for personal burnout. Health problems and direct contact with infected people were significantly associated with more susceptibility to high personal and work-related burnout. Frontline working positions were associated with all three dimensions. Higher levels of stress and depression in HCWs were significantly associated with increased levels of all burnout dimensions. Higher levels of satisfaction with life and resilience were significantly associated with lower levels of all burnout dimensions. CONCLUSIONS: All three burnout dimensions were associated with a specific set of covariates. Consideration of these three dimensions is important when designing future burnout prevention programs for HCWs.
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Esgotamento Profissional/epidemiologia , COVID-19/terapia , Pessoal de Saúde/psicologia , Pandemias , Adulto , COVID-19/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Inquéritos e QuestionáriosRESUMO
In the era of personalised therapies, liquid biopsy is considered an important diagnostic tool in the clinical management of cancer patients. Tissue specimen represents the gold standard for molecular evaluation of specific gene targets alterations that lead cancer patients to benefit of a "tailed therapy" based on molecular features of the tumour. This innovative source of nucleic acids was introduced in clinical setting only for non-small-cell lung cancer (NSCLC) patients to test epidermal grow factor receptor (EGFR) mutations when tissue is not available for a number of reasons (difficult access to the lesion, the presence of other disabling pathologies, especially in elderly patients, rejection by the patient, etcetera) or to monitor acquired resistance mutation after a first line of treatment. The present study aimed at assessing the diagnostic potential of liquid biopsy in balanced tertiary screening modelling. The cases relating to 5 years of activity regarding to molecular diagnostics performed on liquid biopsy specimens in the Predictive diagnostic laboratory of the University hospital "Federico II" of Naples (Campania Region, Southern Italy) were reviewed. Laboratory data were collected through the software SPSS. Non-parametric analysis was performed in order to test the differences between "wild type" patients or not. A multivariate logistic model was performed in order to assess the effect of mutation, age, and gender on the tumour progression. The results of the revision concern 515 total cases (almost of all plasma or peripheral blood), which allowed to evaluate the liquid biopsies for women and men. The average age of the patients is 66.3 years, and the 25° percentile is 59 years. The cases are: 221 basal and 294 by progression. The cases with mutation, as expected, have an odds ratio of 4,15, compared to the basal, to have a tumour progression (95%IC 2,7-6,3), regardless of gender and age. The detected mutations were 131 from different types of pulmonary carcinomas. Working on case data, specifying the characteristics of the patients with mutations will drive a further estimate in tertiary prevention screening designs.
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Neoplasias Pulmonares/prevenção & controle , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/prevenção & controle , Feminino , Humanos , Itália/epidemiologia , Biópsia Líquida , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevenção TerciáriaRESUMO
BACKGROUND: Few studies in Portugal have attempted to assess the impact of psychological interventions in primary health care regarding the problems shared by clients, and which variables predicted the success of this intervention. The current study, therefore, aimed to identify predictors of success related to psychological intervention in a single primary health care center in the north of Portugal. METHOD: This was a retrospective study from secondary data, using the data from 1024 clients who attended the psychological consultation at a primary health care center over a period of 8 years. The success of the psychological consultation was defined according to the discharge made by the psychologist. The multiple logistic regression analysis was employed. RESULTS: The attendance of a greater number of consultations and the biweekly frequency of consultations significantly predicted the success of psychological intervention. Additionally, the success was associated with having a diagnosis or specific problem identified. CONCLUSIONS: These findings provide contributions to enrich the literature in this field, in particular, in Portuguese primary health care. We highlight the importance of investing in psychological services in primary health care centers.
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Transtornos Mentais/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Portugal , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Legionellosis' treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms. OBJECTIVES: In this study we investigate the antibiotic susceptibility of environmental Legionella pneumophila (Lpn) strains isolated from hospital water systems in Campania, a region located in Southwest Italy. METHODS: 5321 hospital water samples were investigated for the presence of Lpn. Among positive samples, antibiotic susceptibility was tested for a random subset of 125 Lpn strains (25 Lpn isolates from each of the following serogroups: 1, 3, 5, 6, 8). Susceptibility testing was performed, using the E-test on buffered charcoal yeast extract agar supplemented with α-ketoglutarate, for 10 antimicrobial drugs: azithromycin, cefotaxime, clarithromycin, doxycycline, erythromycin, rifampicin, tigecycline, ciprofloxacin, levofloxacin and moxifloxacin. Non parametric tests were used to determine and assess the significant differences in susceptibility to the different antimicrobics between the serogroups. RESULTS: Among the isolated strains, none showed resistance to the antibiotics tested. Rifampicin was the most active antibiotic against overall Legionella strains, followed by levofloxacin. Between the macrolides the clarithromycin was overall the most active drug, instead the azithromycin was the less active. Analyzing the different serogroups a significant difference was found between serogroup 1 and non-1 serogroup isolates for doxycycline and tigecycline. CONCLUSIONS: Antibiotic susceptibility of environmental isolates of Legionella spp. might be useful for the early detection of resistance to antibiotics that directly impacts on mortality and length of hospital stay.
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Anti-Infecciosos , Legionella pneumophila , Legionella , Antibacterianos/farmacologia , Monitoramento Ambiental , Itália , Legionella pneumophila/efeitos dos fármacos , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: recently, healthcare network models have been proposed to improve general awareness of rare diseases for patients and specific knowledge about diagnosis, treatment, and management for healthcare services. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare haematological disease that still has no framing in an official network. OBJECTIVES: to describe the use of network models in diagnosis, treatment, and management of PNH patients both in Italy and abroad and its impact on patients and healthcare service. DISEGN: literature search was performed using the keywords "Hemoglobinuria", "Network", "PHN", and "Screening" in both MedLine and EMBASE. Search was restricted to the articles published in the last 5 years and written in English, French or Italian language. RESULTS: from the total 251 articles of the initial search, only 21 were finally included in our review. None of the included study explicitly described a network model. In general, we were able to identify two different kind of networks implicitly described in the studies: laboratory networks for diagnostic harmonization or screening of the population at risk of PNH (10/21 studies) and PNH registry as network of clinical information to be use for better understanding of the natural history of the disease and to assess therapeutic effectiveness (11/21 studies). CONCLUSIONS: few network approaches in PNH diagnosis, treatment, and management are described in literature. Despite the scarce application of the networks, our review highlights the positive impact that networks have in both patients and healthcare services.
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Hemoglobinúria Paroxística/diagnóstico , Hemoglobinúria Paroxística/epidemiologia , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Adulto , Humanos , Serviços de Informação , Itália/epidemiologiaRESUMO
Background: Stigmatising attitudes among healthcare professionals can hinder access to healthcare, making it important to address this issue. This study aimed to investigate the prevalence of stigma related to mental illness among Portuguese healthcare professionals and to compare the results among mental health professionals, General Practitioners (GPs) and other health professionals. Methods: An online cross-sectional observational study was conducted in Portugal using Google Forms® to collect data. The data collection process lasted five months, from September 2023 to January 2024. Participants were recruited from various professional associations and Health Centre Groups, through a purposive sampling. The study used the Portuguese version of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) to measure stigma which assesses three dimensions: attitudes towards disclosure and help-seeking, attitudes towards people with mental illness, and attitudes towards social distance. Results: A total of 292 healthcare professionals participated in the study. In Portugal, healthcare professionals displayed low to moderate levels of stigma towards mental illness (M = 22.17, SD = 5.41). Mental health professionals demonstrated significantly lower levels of stigma (M=20.37, SD=5.37) compared to other healthcare professionals (M=24.15, SD=4.71), including GPs (M=23.97, SD=5.03). Additionally, having a close friend or relative with mental illness seemed to be related with lower levels of stigma for the dimension attitudes towards social distance (M=6.93, SD=2.50), compared to not having one (M=7.60, SD=2.56). On the other hand, a personal history of mental illness indicated higher levels of stigma for the dimension disclosure and help-seeking (M=8.95, SD=3.07), compared to having no history of mental illness (M=8.16, SD=2.67). Conclusion: This study indicates that Portuguese healthcare professionals have stigmatising attitudes towards mental illness, although at low to moderate levels. Training and frequent interaction with people with mental illness seem to be associated with lower levels of stigma. Personal experience of mental illness seems to follow the opposite path regarding disclosure and seeking help. Thus, further research is necessary to evaluate the effectiveness of anti-stigma measures and deepen the study of the concept of self-stigma in healthcare professionals.
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Background: Stigma toward mental illness significantly contributes to a lower quality of healthcare that can be provided. There are few studies on this topic in Portugal, so validating a scale that can evaluate and study the stigma is paramount. The aim of this study was to validate the Opening Minds Stigma Scale for Portuguese healthcare professionals. Methods: A total of 503 participants were included in this study, and the majority was female (81.1%). The sample consisted mainly of psychologists (39.4%) and physicians (30.8%). Reliability and validity analyses were conducted and included exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Results: Our results suggest that a 12-item model was the most appropriate (RMSEA = 0.026, SRMR = 0.057, CFI = 0.979, TLI = 0.973, GFI = 0.955) compared to our 15-item model and the original model. Items 8, 9 and 10 were removed. The 12-item scale's internal consistency was adequate (α = 0.71; ω = 0.72). Conclusion: The 12-item model of the scale showed good reliability and validity and is appropriate for use with Portuguese healthcare professionals.
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Acute promyelocytic leukemia is a rare form of acute myeloid leukemia in which immature promyelocytes abnormally proliferate in the bone marrow. In most cases, the disease is characterised by the translocation t(15;17) (q24;q21), which causes the formation of PML::RARA, an oncogenic fusion protein responsible for blocking myeloid differentiation and survival advantage. Here, we present a case of acute promyelocytic leukemia with two unusual features: basophilic differentiation and a three-way translocation involving chromosomes 12, 15 and 17. In the few cases reported, basophilic differentiation was associated with a poor prognosis. In contrast, our patient responded promptly to the standard treatment with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) and obtained complete remission. To our knowledge, this is the first report of basophilic acute promyelocytic leukemia with the three-way translocation t(12;17;15) (p13; q24;q21).
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INTRODUCTION: A growing number of countries have legalized the process of hastening death. At a time when laws decriminalizing hastened death have been passed in the Portuguese Parliament, the development of research related with decision making regarding this issue is of crucial importance. This study seeks to evaluate, in a sample of Portuguese doctors, whether the presentation of clinical vignettes changes the agreement with the practice of hastened death compared with general scenarios. MATERIAL AND METHODS: A questionnaire was distributed among academic physicians from medical schools across Portugal to assess their level of agreement or disagreement with the practice of hastened death. The questionnaire included eight standard cases and eight clinical vignettes framed under conditions defined by law for the practice of hastened death. Differences were analyzed using the t-Student test for paired samples. RESULTS: There were statistically significant differences in five scenarios (t = 3.46; p < 0.05; t = 2.47; p < 0.05; t = 4.28; p < 0.05; t = 3.38; p < 0.05; t = 3.66; p < 0.05) with greater agreement concerning the clinical vignettes. The highest acceptance was found in the requests made by adults with terminal and incurable illnesses. CONCLUSION: Agreement increased when the clinical vignette was presented in comparison with the respective standard for most of the cases of hastened death presented.
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Médicos , Adulto , Humanos , Portugal , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in addition to CO, other factors that may lead the HCP not to want to participate in a certain procedure. Therefore, we can say that CO is a form of refusal of treatment based on conscience. Hastened death has become an increasingly reality around the world, being a procedure in which not all HCPs are willing to participate. There are several factors that can condition the HCPs' refusal to treat in this scenario. METHODS: With the aim of identifying these factors, we performed a systematic review, following the PRISMA guidelines. On 1 October 2022, we searched for relevant articles on Pubmed, Web of Science and Scopus databases. RESULTS: From an initial search of 693 articles, 12 were included in the final analysis. Several motivations that condition refusal to treat were identified, including legal, technical, social, and CO. Three main motivations for CO were also identified, namely religious, moral/secular, and emotional/psychological motivations. CONCLUSIONS: We must adopt an understanding approach respecting the position of each HCP, avoiding judgmental and discriminatory positions, although we must ensure also that patients have access to care. The identification of these motivations may permit solutions that, while protecting the HCPS' position, may also mitigate potential problems concerning patients' access to this type of procedure.
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We repeated a Portuguese study, 5 months after a first evaluation, to observe any change in the average levels of trust of professional groups during the COVID-19 pandemic. From our sample of the Portuguese population, 1455 completed the questionnaire from June through September 2020, and 1156 during 2 months, February and March 2021. We found a trend toward higher trust of medical doctors, nurses, and researchers. Analysis of changes between the two pandemic periods (first and second lockdown) showed a statistically significant increase in trust in nurses (t = - 2.01; p = 0.04) and researchers (t = - 2.40; p = 0.02), and the opposite trend for journalists and politicians. This study shows a trend in increasing trust of the Portuguese people toward science-based activities during the COVID-19 pandemic.
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COVID-19 , Humanos , COVID-19/epidemiologia , Portugal/epidemiologia , Confiança , Pandemias , Controle de Doenças TransmissíveisRESUMO
Background: Lecturers face a large wide of occupational stressors. If the prolonged stress and the symptomatology associated with the working conditions to which lecturers were exposed were already a concern before the pandemic, the pandemic may have exacerbated this psychosocial vulnerability. Burnout is a psychological syndrome that develops in response to chronic work stress. This study aims to describe burnout amongst lecturers working in Portugal and to analyse potential determinants of burnout during the COVID-19 pandemic. Methods: A cross-sectional study was performed using an online questionnaire distributed via social networks. The survey collected sociodemographic and sleep patterns data in addition to applying the Copenhagen Burnout Inventory (personal, work- and student-related burnout), the Resilience Scale, the Depression Anxiety and Stress Scales, and the Satisfaction with Life Scale. Results: The sample included 331 lecturers from 35 different colleges and faculties. Three significant models explained personal (R2 = 54%), work- (R2 = 47%) and student- (R2 = 19%) related burnout. Lower levels of resilience and higher levels of depression and stress were significantly associated with personal and work-related burnout. Changes in sleep patterns were additionally associated with both personal and work-related burnout. Conclusion: Higher education institutions must recognize the impact of the work environment and organizational culture on faculty mental health and take proactive measures to improve this environment. These institutions can implement support strategies such as educational technology training, professional development programmes, emotional support resources, and workload flexibility. Implementing measures to enhance lecturers' resilience and overall life satisfaction could potentially help mitigate burnout and improve the well-being of educators, ultimately contributing to the overall quality of education.
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Voluntary euthanasia and physician assisted suicide has been legally performed in several countries. However, little is known about how decision-making occurs. We undertook this study to describe trends in officially reported cases of voluntary euthanasia or physician assisted suicide and to explore the decision-making procedures and understand relevant criteria. Thematic analysis of the official reports from several countries was performed. Differences in the number of reported deaths from hasten death practices between countries was found, with higher numbers in countries who performed voluntary euthanasia. Patients profiles follow the trends in the literature (the majority is aged between 70 and 89 years old, men die more often than women in most countries, most prevalent underlying disease is cancer, most people died at home). Despite there being little detail in the reports, decision is explored in the majority of countries and states (exploration of acceptable alternatives and verification of the voluntariness of the request). The importance of collecting data on this topic around the world and establishing a firm evidence-base to support professionals' practice is highlighted.
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Eutanásia , Neoplasias , Suicídio Assistido , Idoso , Idoso de 80 Anos ou mais , Eutanásia Ativa Voluntária , Feminino , Humanos , Masculino , Países BaixosRESUMO
BACKGROUND: The COVID-19 pandemic is emerging in a world where science is highly developed. Nevertheless, science is not the only resource that people resort to when they have difficulties. In this pandemic context, some professions became more relevant, including front-line professionals, such as medical doctors and nurses, and those who may have an indirect role. The aim of this study is to understand whether there is a strengthening of people's confidence, in politicians, journalists, science-based activities, and in more mystical dimensions. METHODS: A cross-sectional study was carried out to understand the levels of confidence of the Portuguese population in several professional groups, measured in two pandemic moments. Participants were recruited to participate in the study through online platforms. The sample was randomly collected from the Portuguese population. The sample was composed of 1455 Portuguese people with a mean age of 44 years, and 1080 were female. RESULTS: We found high levels of confidence in medical doctors and nurses, as well as in other health professions, science, and education. We detected the opposite trend for politicians and journalists. Measured in two pandemic moments, we found confidence levels in these professionals were lower in September than in July with statistical significance differences [(politicians (t = 3.15, p = 0.00); journalists (t = 2.49, p = 0.01)]. CONCLUSION: It is important to improve a joint action between politicians, journalists, health and science professionals to communicate measures to increase confidence from people. There is a need for the engagement of the population in the adoption of protective measures and contribute to easier control in pandemic situations.
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The potent oral inhibitor of BCL2, venetoclax (VEN), used to treat adults with chronic lymphocytic leukaemia, has been approved in US for the treatment of naïve patients with acute myeloid leukemia (AML) unfit for intensive chemotherapy and recently in Europe, too. However, the drug has been used for years in combination with hypomethylating agents (HMAs) in patients not eligible to other treatment option, according to the so-called off-label use. We collected real-world data about patients treated with VEN + HMAs in the context of a pharmacovigilance project focused on the evaluation of the safety and effectiveness of drugs used for unapproved indication in Italian hospitals. From March to December 2020, 24 patients started treatment with VEN combined with HMAs. 21 patients have been assessed for response. Eleven (52%) patients reached complete remission (CR), and three patients (14%) CR with partial hematological recovery (CRh), with a median duration of response of 4.5 months (range 0.5-12.5). 19 patients experienced at least 1 adverse drug reaction (ADR), mostly serious, including 3 deaths (9% of ADRs; 12.5% of patients) in febrile neutropenia. Hematological toxicities and infections (cytopenia, neutropenia, febrile neutropenia, sepsis), were the most reported ADRs (84.4%). In general, neutropenic fever occurred more frequently in patients treated with decitabine (7 out of 9, 78%) compared to azacitidine (5 out of 15, 33%; p = 0.03), whereas response assessment did not differ based on used HMA (p = 0.1). These results confirm the benefit-risk profile of VEN in a real-world setting of patients with no adequate therapeutic options.
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BACKGROUND: The anti-CD38 monoclonal antibody daratumumab is approved as a single agent for the treatment of patients with relapsed/refractory multiple myeloma (RRMM) who received at least three prior lines of therapy, including proteasome inhibitor and immunomodulatory agent. A retrospective multicentric study was designed to evaluate feasibility, tolerability, and efficacy of daratumumab in monotherapy in RRMM. METHODS: This study included 44 consecutive RRMM patients that underwent daratumumab monotherapy after a median number of four prior therapies (range 2-9). Patients were treated in seven Sicilian centers, as part of Sicilian Myeloma Network and three Calabrian centers outside of controlled clinical trials from August 2016 through July 2020. RESULTS: The regimen was well tolerated with few grade 3-4 haematological and rare non-haematological adverse events, such as pneumonia. Definitive discontinuation was due to disease progression in 25 (57%) patients. Since three patients did not complete at least one full cycle, a total of 41 patients was evaluated for response. Overall response rate was 37%, and the disease control rate (stable disease or better) was high (73%). The best achieved responses within 6 months were very good partial remission or better (27%), partial remission (10%), minimal response (14%) and stable disease (22%). After a median follow up of 7.8 months, median progression free survival (PFS) was 7.2 months and overall survival (OS) 7.8 months. Univariate analysis showed that patients with PR or better after 6 months of therapy had longer median PFS and OS (respectively 29.5 vs 3.6 months, p=0.0001 and 30.6 vs 3.9 months p=0.0001), confirmed by multivariate analysis. Furthermore, standard cytogenetic risk and biochemical relapse type had prolonged median PFS, but not OS (respectively unreached vs 2.6, p=0.03 and 23.9 vs 6.2, p=0.05) in both univariate and multivariate analysis. Additionally, univariate analysis showed that patients treated with carfilzomib-lenalidomide-dexamethasone prior to daratumumab had significantly shorter PFS compared to pomalidomide-dexamethasone (3.4 months vs 9.3 months, p=0.03), that multivariate analysis failed to confirm. CONCLUSIONS: Our findings indicate that daratumumab as single agent is safe and well-tolerated regimen in real-life, associated to prolonged PFS and OS in responding patients. No new safety signals were identified.