Clinical Edge Journal Scan

Key clinical point: Both overall survival and progression-free survival rates were significantly higher in patients with unresectable HCC who were treated with TACE-MWA compared to those treated with TACE alone.

Major finding:  After propensity score matching, the 1-, 2-, and 3-year overall survival rates for patients treated with TACE-MWA were 93.6%, 80.5%, and 61.6%, respectively, compared to 72.4%, 48.9%, and 41.9%, respectively, in patients treated with TACE alone group, respectively.

Study details: The data come from a propensity score matching study of 91 adults with unresectable HCC who underwent transarterial chemoembolization (TACE) plus percutaneous microwave ablation (MWA) and 140 who underwent TACE alone at four medical centers.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Li H-Z et al. J Hepatocell Carcinoma. 2021 Nov 1. doi: 10.2147/JHC.S338456.

Key clinical point: Both overall survival and progression-free survival rates were significantly higher in patients with unresectable HCC who were treated with TACE-MWA compared to those treated with TACE alone.

Major finding:  After propensity score matching, the 1-, 2-, and 3-year overall survival rates for patients treated with TACE-MWA were 93.6%, 80.5%, and 61.6%, respectively, compared to 72.4%, 48.9%, and 41.9%, respectively, in patients treated with TACE alone group, respectively.

Study details: The data come from a propensity score matching study of 91 adults with unresectable HCC who underwent transarterial chemoembolization (TACE) plus percutaneous microwave ablation (MWA) and 140 who underwent TACE alone at four medical centers.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Li H-Z et al. J Hepatocell Carcinoma. 2021 Nov 1. doi: 10.2147/JHC.S338456.

Key clinical point: Both overall survival and progression-free survival rates were significantly higher in patients with unresectable HCC who were treated with TACE-MWA compared to those treated with TACE alone.

Major finding:  After propensity score matching, the 1-, 2-, and 3-year overall survival rates for patients treated with TACE-MWA were 93.6%, 80.5%, and 61.6%, respectively, compared to 72.4%, 48.9%, and 41.9%, respectively, in patients treated with TACE alone group, respectively.

Study details: The data come from a propensity score matching study of 91 adults with unresectable HCC who underwent transarterial chemoembolization (TACE) plus percutaneous microwave ablation (MWA) and 140 who underwent TACE alone at four medical centers.

Disclosures: The study was supported by the National Natural Science Foundation of China. The researchers had no financial conflicts to disclose.

Source: Li H-Z et al. J Hepatocell Carcinoma. 2021 Nov 1. doi: 10.2147/JHC.S338456.

Key clinical point: Hepatocellular carcinoma patients who achieved complete remission with postoperative treatment after reduction hepatectomy fared better than those who achieved remission without postoperative treatment.

Major finding:  The 5-year overall survival rate and mean survival time after reduction hepatectomy were 15.7% and 28.40 months for the entire study population. The 5-year overall survival and mean survival times were 37.5% and 56.55 months, respectively, for patients who achieved complete remission with postoperative treatment, compared to 6.3% and 14.84 months, respectively, for those who achieved complete remission without postoperative treatment (P = 0.0041).

Study details: The data come from a review of 30 adults with advanced hepatocellular carcinoma who underwent reduction hepatectomy at a single center between 2000 and 2018.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Asahi Y et al. World J Gastrointest Surg. 2021 Oct 27. doi: 10.4240/wjgs.v13.i10.1245.

Key clinical point: Hepatocellular carcinoma patients who achieved complete remission with postoperative treatment after reduction hepatectomy fared better than those who achieved remission without postoperative treatment.

Major finding:  The 5-year overall survival rate and mean survival time after reduction hepatectomy were 15.7% and 28.40 months for the entire study population. The 5-year overall survival and mean survival times were 37.5% and 56.55 months, respectively, for patients who achieved complete remission with postoperative treatment, compared to 6.3% and 14.84 months, respectively, for those who achieved complete remission without postoperative treatment (P = 0.0041).

Study details: The data come from a review of 30 adults with advanced hepatocellular carcinoma who underwent reduction hepatectomy at a single center between 2000 and 2018.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Asahi Y et al. World J Gastrointest Surg. 2021 Oct 27. doi: 10.4240/wjgs.v13.i10.1245.

Key clinical point: Hepatocellular carcinoma patients who achieved complete remission with postoperative treatment after reduction hepatectomy fared better than those who achieved remission without postoperative treatment.

Major finding:  The 5-year overall survival rate and mean survival time after reduction hepatectomy were 15.7% and 28.40 months for the entire study population. The 5-year overall survival and mean survival times were 37.5% and 56.55 months, respectively, for patients who achieved complete remission with postoperative treatment, compared to 6.3% and 14.84 months, respectively, for those who achieved complete remission without postoperative treatment (P = 0.0041).

Study details: The data come from a review of 30 adults with advanced hepatocellular carcinoma who underwent reduction hepatectomy at a single center between 2000 and 2018.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Asahi Y et al. World J Gastrointest Surg. 2021 Oct 27. doi: 10.4240/wjgs.v13.i10.1245.

Key clinical point: A combination of atezolizumab plus bevacizumab (ATZ+BV) caused less fatigue in HCC patients as a first-line therapy than when given as a later line therapy, based on the IMbrave150 criteria.

Major finding:  Treatment interruption due to fatigue was significantly higher in Child-Pugh B patients who received later treatment compared to Child-Pugh A patients who received early treatment (P = 0.030). In a multivariate analysis, neutrophil lymphocyte ratios and B-IMbrave150 criteria were independent predictors of objective response to the combination therapy (hazard ratios 4.591 and 4.108, respectively).

Study details: The data come from 94 adults with unresectable HCC treated with ATZ+BV at multiple centers. Of these, 46 Child-Pugh A patients received treatment early (B-IMbrave150-in) and 48 Child-Pugh B patients received the combination as first-line or later line therapy (B-IMbrave150-out).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chuma M et al. Hepatol Res. 2021 Nov 10. doi: 10.1111/hepr.13732. 

Key clinical point: A combination of atezolizumab plus bevacizumab (ATZ+BV) caused less fatigue in HCC patients as a first-line therapy than when given as a later line therapy, based on the IMbrave150 criteria.

Major finding:  Treatment interruption due to fatigue was significantly higher in Child-Pugh B patients who received later treatment compared to Child-Pugh A patients who received early treatment (P = 0.030). In a multivariate analysis, neutrophil lymphocyte ratios and B-IMbrave150 criteria were independent predictors of objective response to the combination therapy (hazard ratios 4.591 and 4.108, respectively).

Study details: The data come from 94 adults with unresectable HCC treated with ATZ+BV at multiple centers. Of these, 46 Child-Pugh A patients received treatment early (B-IMbrave150-in) and 48 Child-Pugh B patients received the combination as first-line or later line therapy (B-IMbrave150-out).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chuma M et al. Hepatol Res. 2021 Nov 10. doi: 10.1111/hepr.13732. 

Key clinical point: A combination of atezolizumab plus bevacizumab (ATZ+BV) caused less fatigue in HCC patients as a first-line therapy than when given as a later line therapy, based on the IMbrave150 criteria.

Major finding:  Treatment interruption due to fatigue was significantly higher in Child-Pugh B patients who received later treatment compared to Child-Pugh A patients who received early treatment (P = 0.030). In a multivariate analysis, neutrophil lymphocyte ratios and B-IMbrave150 criteria were independent predictors of objective response to the combination therapy (hazard ratios 4.591 and 4.108, respectively).

Study details: The data come from 94 adults with unresectable HCC treated with ATZ+BV at multiple centers. Of these, 46 Child-Pugh A patients received treatment early (B-IMbrave150-in) and 48 Child-Pugh B patients received the combination as first-line or later line therapy (B-IMbrave150-out).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chuma M et al. Hepatol Res. 2021 Nov 10. doi: 10.1111/hepr.13732. 

Key clinical point: Complete response after initial treatment with TACE was significantly associated with improved survival in adults with newly diagnosed hepatocellular carcinoma.

Major finding:  After their first treatment with TACE, 22.3% of the patients achieved complete response, and these patients had a better overall survival rate over a median follow-up period of 26.6 months than those who did not achieve complete response (35.8 months vs 24.0 months, P < 0.001).

Study details: The data come from 699 adults with newly diagnosed hepatocellular carcinoma who were initially treated with transarterial chemoembolization (TACE) between 2010 and 2013.

Disclosures: The study was supported by the Chang Gung Medical Research Fund and the National Science Council, Taiwan. The researchers had no financial conflicts to disclose.

Source: Peng C-W et al. Am J Cancer Res. 2021 Oct 15. 11(10): 4956–4965. PMID: 34765303. PMCID: PMC8569367.

Key clinical point: Complete response after initial treatment with TACE was significantly associated with improved survival in adults with newly diagnosed hepatocellular carcinoma.

Major finding:  After their first treatment with TACE, 22.3% of the patients achieved complete response, and these patients had a better overall survival rate over a median follow-up period of 26.6 months than those who did not achieve complete response (35.8 months vs 24.0 months, P < 0.001).

Study details: The data come from 699 adults with newly diagnosed hepatocellular carcinoma who were initially treated with transarterial chemoembolization (TACE) between 2010 and 2013.

Disclosures: The study was supported by the Chang Gung Medical Research Fund and the National Science Council, Taiwan. The researchers had no financial conflicts to disclose.

Source: Peng C-W et al. Am J Cancer Res. 2021 Oct 15. 11(10): 4956–4965. PMID: 34765303. PMCID: PMC8569367.

Key clinical point: Complete response after initial treatment with TACE was significantly associated with improved survival in adults with newly diagnosed hepatocellular carcinoma.

Major finding:  After their first treatment with TACE, 22.3% of the patients achieved complete response, and these patients had a better overall survival rate over a median follow-up period of 26.6 months than those who did not achieve complete response (35.8 months vs 24.0 months, P < 0.001).

Study details: The data come from 699 adults with newly diagnosed hepatocellular carcinoma who were initially treated with transarterial chemoembolization (TACE) between 2010 and 2013.

Disclosures: The study was supported by the Chang Gung Medical Research Fund and the National Science Council, Taiwan. The researchers had no financial conflicts to disclose.

Source: Peng C-W et al. Am J Cancer Res. 2021 Oct 15. 11(10): 4956–4965. PMID: 34765303. PMCID: PMC8569367.

Key clinical point: Baseline neutrophil-to-lymphocyte ratio (NLR), and delta NLR were predictors of overall survival in HCC patients treated with stereotactic body radiation therapy; however, neither platelet-to-lymphocyte ratio (PLR) nor delta PLR were predictive of survival.

Major finding:  Elevations in NLR and delta-NLR (dNLR) prior to SBRT in hepatocellular carcinoma patients were significant predictors of worse overall survival (P <0.001 and P = 0.011, respectively). 

Study details: The data come from a retrospective study of 93 adult HCC patients treated with stereotactic body radiation therapy (SBRT), with a median follow-up of 10.7 months.

Disclosures: The study was supported by the Tri-Service General Hospital. The researchers had no financial conflicts to disclose.  

Source: Hsiang C-W et al. J Hepatocell Carcinoma. 2021 Oct 29. doi: 10.2147/JHC.S334933.

Key clinical point: Baseline neutrophil-to-lymphocyte ratio (NLR), and delta NLR were predictors of overall survival in HCC patients treated with stereotactic body radiation therapy; however, neither platelet-to-lymphocyte ratio (PLR) nor delta PLR were predictive of survival.

Major finding:  Elevations in NLR and delta-NLR (dNLR) prior to SBRT in hepatocellular carcinoma patients were significant predictors of worse overall survival (P <0.001 and P = 0.011, respectively). 

Study details: The data come from a retrospective study of 93 adult HCC patients treated with stereotactic body radiation therapy (SBRT), with a median follow-up of 10.7 months.

Disclosures: The study was supported by the Tri-Service General Hospital. The researchers had no financial conflicts to disclose.  

Source: Hsiang C-W et al. J Hepatocell Carcinoma. 2021 Oct 29. doi: 10.2147/JHC.S334933.

Key clinical point: Baseline neutrophil-to-lymphocyte ratio (NLR), and delta NLR were predictors of overall survival in HCC patients treated with stereotactic body radiation therapy; however, neither platelet-to-lymphocyte ratio (PLR) nor delta PLR were predictive of survival.

Major finding:  Elevations in NLR and delta-NLR (dNLR) prior to SBRT in hepatocellular carcinoma patients were significant predictors of worse overall survival (P <0.001 and P = 0.011, respectively). 

Study details: The data come from a retrospective study of 93 adult HCC patients treated with stereotactic body radiation therapy (SBRT), with a median follow-up of 10.7 months.

Disclosures: The study was supported by the Tri-Service General Hospital. The researchers had no financial conflicts to disclose.  

Source: Hsiang C-W et al. J Hepatocell Carcinoma. 2021 Oct 29. doi: 10.2147/JHC.S334933.

Key clinical point: Fever following radiofrequency ablation in hepatocellular carcinoma patients was independently associated with younger age, low serum albumin level, general anesthesia, tumor size, and tumor number.

Major finding:  The adjusted odds ratios for the independent predictors of fever in these patients were 0.96 for younger age, 0.49 for low serum albumin level, 2.06 for general anesthesia, 1.52 for tumor size, and 1.71 for tumor number. HCC patients who developed fevers after radiofrequency ablation also had significantly longer hospital stays than those without fevers (9.06 days vs 5.50 days).

Study details: The data come from a retrospective study of 272 adults with new or recurrent hepatocellular carcinoma who underwent ultrasonography-guided radiofrequency ablation (RFA) between April 2014 and February 2019.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chen P-Y et al. Cancers (Basel). 2021 Oct 22. doi: 10.3390/cancers13215303.

Key clinical point: Fever following radiofrequency ablation in hepatocellular carcinoma patients was independently associated with younger age, low serum albumin level, general anesthesia, tumor size, and tumor number.

Major finding:  The adjusted odds ratios for the independent predictors of fever in these patients were 0.96 for younger age, 0.49 for low serum albumin level, 2.06 for general anesthesia, 1.52 for tumor size, and 1.71 for tumor number. HCC patients who developed fevers after radiofrequency ablation also had significantly longer hospital stays than those without fevers (9.06 days vs 5.50 days).

Study details: The data come from a retrospective study of 272 adults with new or recurrent hepatocellular carcinoma who underwent ultrasonography-guided radiofrequency ablation (RFA) between April 2014 and February 2019.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chen P-Y et al. Cancers (Basel). 2021 Oct 22. doi: 10.3390/cancers13215303.

Key clinical point: Fever following radiofrequency ablation in hepatocellular carcinoma patients was independently associated with younger age, low serum albumin level, general anesthesia, tumor size, and tumor number.

Major finding:  The adjusted odds ratios for the independent predictors of fever in these patients were 0.96 for younger age, 0.49 for low serum albumin level, 2.06 for general anesthesia, 1.52 for tumor size, and 1.71 for tumor number. HCC patients who developed fevers after radiofrequency ablation also had significantly longer hospital stays than those without fevers (9.06 days vs 5.50 days).

Study details: The data come from a retrospective study of 272 adults with new or recurrent hepatocellular carcinoma who underwent ultrasonography-guided radiofrequency ablation (RFA) between April 2014 and February 2019.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Chen P-Y et al. Cancers (Basel). 2021 Oct 22. doi: 10.3390/cancers13215303.

Key clinical point: A multi-dimensional “combined index” model using artificial intelligence and SHG/TPEF microscopy was a stronger predictor of HCC recurrence than alpha fetoprotein levels in HCC patients who underwent curative hepatectomy.

Major finding:  The sensitivity and specificity of the combined index model was 81.8% and 90.5%, respectively, compared to 68.2% and 47.6%, respectively, for alpha fetoprotein level as a predictor of recurrent HCC.

Study details: The data come from a study of 81 adults with hepatocellular carcinoma who underwent curative intent hepatectomy. Researchers used fibrotic features of resected tissue to create a recurrence prediction model.

Disclosures: The study was supported by the Taiwan Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Liu I-T et al. Cancers (Basel). 2021 Oct 23. doi: 10.3390/cancers13215323.

Key clinical point: A multi-dimensional “combined index” model using artificial intelligence and SHG/TPEF microscopy was a stronger predictor of HCC recurrence than alpha fetoprotein levels in HCC patients who underwent curative hepatectomy.

Major finding:  The sensitivity and specificity of the combined index model was 81.8% and 90.5%, respectively, compared to 68.2% and 47.6%, respectively, for alpha fetoprotein level as a predictor of recurrent HCC.

Study details: The data come from a study of 81 adults with hepatocellular carcinoma who underwent curative intent hepatectomy. Researchers used fibrotic features of resected tissue to create a recurrence prediction model.

Disclosures: The study was supported by the Taiwan Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Liu I-T et al. Cancers (Basel). 2021 Oct 23. doi: 10.3390/cancers13215323.

Key clinical point: A multi-dimensional “combined index” model using artificial intelligence and SHG/TPEF microscopy was a stronger predictor of HCC recurrence than alpha fetoprotein levels in HCC patients who underwent curative hepatectomy.

Major finding:  The sensitivity and specificity of the combined index model was 81.8% and 90.5%, respectively, compared to 68.2% and 47.6%, respectively, for alpha fetoprotein level as a predictor of recurrent HCC.

Study details: The data come from a study of 81 adults with hepatocellular carcinoma who underwent curative intent hepatectomy. Researchers used fibrotic features of resected tissue to create a recurrence prediction model.

Disclosures: The study was supported by the Taiwan Ministry of Health. The researchers had no financial conflicts to disclose.

Source: Liu I-T et al. Cancers (Basel). 2021 Oct 23. doi: 10.3390/cancers13215323.

Key clinical point: Liver decompensation is a common late complication in HCC patients treated with SIRT, although overall survival rates surpass those in patients treated with sorafenib.

Major finding:  Liver decompensation, based on a Child-Pugh (CP) score of B7 or higher, occurred in significantly more HCC patients treated with SIRT compared to those treated with sorafenib (62% vs 27%) in a case-matched analysis. However, the median overall survival was significantly longer in SIRT-treated patients compared with sorafenib patients (16 months vs 9 months).

Study details: The data come from 69 adults with advanced HCC who underwent selective internal radiation therapy (SIRT) and had not developed radioembolization-induced liver disease (REILD).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: van Doorn DJ et al. Cancers (Basel). 2021 Oct 29. doi: 10.3390/cancers13215427.

Key clinical point: Liver decompensation is a common late complication in HCC patients treated with SIRT, although overall survival rates surpass those in patients treated with sorafenib.

Major finding:  Liver decompensation, based on a Child-Pugh (CP) score of B7 or higher, occurred in significantly more HCC patients treated with SIRT compared to those treated with sorafenib (62% vs 27%) in a case-matched analysis. However, the median overall survival was significantly longer in SIRT-treated patients compared with sorafenib patients (16 months vs 9 months).

Study details: The data come from 69 adults with advanced HCC who underwent selective internal radiation therapy (SIRT) and had not developed radioembolization-induced liver disease (REILD).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: van Doorn DJ et al. Cancers (Basel). 2021 Oct 29. doi: 10.3390/cancers13215427.

Key clinical point: Liver decompensation is a common late complication in HCC patients treated with SIRT, although overall survival rates surpass those in patients treated with sorafenib.

Major finding:  Liver decompensation, based on a Child-Pugh (CP) score of B7 or higher, occurred in significantly more HCC patients treated with SIRT compared to those treated with sorafenib (62% vs 27%) in a case-matched analysis. However, the median overall survival was significantly longer in SIRT-treated patients compared with sorafenib patients (16 months vs 9 months).

Study details: The data come from 69 adults with advanced HCC who underwent selective internal radiation therapy (SIRT) and had not developed radioembolization-induced liver disease (REILD).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: van Doorn DJ et al. Cancers (Basel). 2021 Oct 29. doi: 10.3390/cancers13215427.

Key clinical point: Patients who underwent laparoscopic liver resection for HCC had fewer complications and similar long-term outcomes to those who had open resection procedures.

Major finding:  Patients in the laparoscopic group had significantly fewer complications of Clavien-Dindo grade III or higher compared to those in the open group (14% vs 29%, P = .01). Overall survival rates at 1, 3, and 5 years were similar between the laparoscopic group and the open group, 90.9%, 79.3%, 70.5% vs 91.3%, 88.5%, 83.1%, respectively, and cumulative recurrence rates were not significantly different between the groups.

Study details: The data come from a retrospective study of 149 adults who underwent either laparoscopic or open liver resection between January 2008 and December 2019. Primary outcomes of overall survival and cumulative incidence of recurrence were assessed after propensity score matching.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ivanics T et al. Surgery. 2021 Nov 3. doi: 10.1016/j.surg.2021.10.017.

Key clinical point: Patients who underwent laparoscopic liver resection for HCC had fewer complications and similar long-term outcomes to those who had open resection procedures.

Major finding:  Patients in the laparoscopic group had significantly fewer complications of Clavien-Dindo grade III or higher compared to those in the open group (14% vs 29%, P = .01). Overall survival rates at 1, 3, and 5 years were similar between the laparoscopic group and the open group, 90.9%, 79.3%, 70.5% vs 91.3%, 88.5%, 83.1%, respectively, and cumulative recurrence rates were not significantly different between the groups.

Study details: The data come from a retrospective study of 149 adults who underwent either laparoscopic or open liver resection between January 2008 and December 2019. Primary outcomes of overall survival and cumulative incidence of recurrence were assessed after propensity score matching.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ivanics T et al. Surgery. 2021 Nov 3. doi: 10.1016/j.surg.2021.10.017.

Key clinical point: Patients who underwent laparoscopic liver resection for HCC had fewer complications and similar long-term outcomes to those who had open resection procedures.

Major finding:  Patients in the laparoscopic group had significantly fewer complications of Clavien-Dindo grade III or higher compared to those in the open group (14% vs 29%, P = .01). Overall survival rates at 1, 3, and 5 years were similar between the laparoscopic group and the open group, 90.9%, 79.3%, 70.5% vs 91.3%, 88.5%, 83.1%, respectively, and cumulative recurrence rates were not significantly different between the groups.

Study details: The data come from a retrospective study of 149 adults who underwent either laparoscopic or open liver resection between January 2008 and December 2019. Primary outcomes of overall survival and cumulative incidence of recurrence were assessed after propensity score matching.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ivanics T et al. Surgery. 2021 Nov 3. doi: 10.1016/j.surg.2021.10.017.

In the new era of the COVID-19 pandemic, patients and physicians still struggle to see how different hematologic conditions may be affected by this viral infection. Although it has been well reported that COVID-19 may not be as lethal in chronic myeloid leukemia (CML) as other malignancies, patients still may be at risk of bad outcomes. A recent publication by Breccia et al¹ collected retrospective information on more than 8000 CML patients followed at different institutions in Italy up to January 2021. The authors recorded 217 patients (2.5%) who were SARS-CO-V2 (COVID-19) positive. More than half of the patients had concomitant comorbidities. Almost 80% were quarantined while the rest required hospitalization, although only 3.6 required intensive care unit care. Twelve patients died, which represents 0.13% of the whole cohort. The main predisposing factors were age > 65 years and cardiovascular disorders, similar to that the general population.  Most of patients continue tyrosine kinase inhibitor (TKI) therapy during the infection.

While the introduction of TKI for the treatment of CML make the number of allogenic transplants decrease significantly due the high mortality in comparison with TKI therapy, it is still an option for certain patients who failed multiple TKI treatments or progressed to more advanced phases of the disease. Although it has already been described that the introduction of imatinib did not affect outcomes for patients that require this therapeutic option, there was not much data about the effect of second generation TKIs. In a publication by Masouridi-Levrat S et al² the authors examine the effect of second generation TKIs in a prospective non-interventional study performed by the European Group for Blood and Marrow Transplantation on 383 consecutive CML patients previously treated with dasatinib or nilotinib undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) from 2009 to 2013. Less than 40% of patients received the transplant in the chronic phase while the rest were in accelerated or blast phase. With a median follow-up of 37 months, 8% of patients developed either primary or secondary graft failure, 34% acute graft-versus-host disease (GvHD), and 60% chronic GvHD. The non-relapse mortality was 18% and 24% at 12 months and at 5 years, respectively. Relapse incidence was 36%, overall survival 56%, and relapse-free survival 40% at 5 years. All these data showed the feasibility of this procedure in patients treated with second generation TKIs with similar post-transplant complications in TKI naive patients or patients treated with imatinib.

Patients under therapy with TKIs may frequently present with elevations of creatine kinase (CK), thought to be in some cases related with the classical associations with muscle and joint pain that is also a common side effect. However the long run effect on treatment outcomes has not been well studied. Bankar A et al.³ recently reported on the relation between CK elevations and overall survival (OS) and event free survival (EFS). Interestingly CK elevations secondary to first or second generation TKIs were associated with a better OS and EFS. As expected, high Sokal score patients had a worse OS and EFS.

References

1. Breccia M et al. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol. 2021 Oct 11.
2. Masouridi-Levrat S et al. Outcomes and toxicity of allogeneic hematopoietic cell transplantation in chronic myeloid leukemia patients previously treated with second-generation tyrosine kinase inhibitors: a prospective non-interventional study from the Chronic Malignancy Working Party of the EBMT. Bone Marrow Transplant. 2021 Oct 1.
3. Bankar A, Lipton JH. Association of creatine kinase elevation with clinical outcomes in chronic myeloid leukemia: a retrospective cohort study Leuk Lymphoma. 2021 Sep 8.

In the new era of the COVID-19 pandemic, patients and physicians still struggle to see how different hematologic conditions may be affected by this viral infection. Although it has been well reported that COVID-19 may not be as lethal in chronic myeloid leukemia (CML) as other malignancies, patients still may be at risk of bad outcomes. A recent publication by Breccia et al¹ collected retrospective information on more than 8000 CML patients followed at different institutions in Italy up to January 2021. The authors recorded 217 patients (2.5%) who were SARS-CO-V2 (COVID-19) positive. More than half of the patients had concomitant comorbidities. Almost 80% were quarantined while the rest required hospitalization, although only 3.6 required intensive care unit care. Twelve patients died, which represents 0.13% of the whole cohort. The main predisposing factors were age > 65 years and cardiovascular disorders, similar to that the general population.  Most of patients continue tyrosine kinase inhibitor (TKI) therapy during the infection.

While the introduction of TKI for the treatment of CML make the number of allogenic transplants decrease significantly due the high mortality in comparison with TKI therapy, it is still an option for certain patients who failed multiple TKI treatments or progressed to more advanced phases of the disease. Although it has already been described that the introduction of imatinib did not affect outcomes for patients that require this therapeutic option, there was not much data about the effect of second generation TKIs. In a publication by Masouridi-Levrat S et al² the authors examine the effect of second generation TKIs in a prospective non-interventional study performed by the European Group for Blood and Marrow Transplantation on 383 consecutive CML patients previously treated with dasatinib or nilotinib undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) from 2009 to 2013. Less than 40% of patients received the transplant in the chronic phase while the rest were in accelerated or blast phase. With a median follow-up of 37 months, 8% of patients developed either primary or secondary graft failure, 34% acute graft-versus-host disease (GvHD), and 60% chronic GvHD. The non-relapse mortality was 18% and 24% at 12 months and at 5 years, respectively. Relapse incidence was 36%, overall survival 56%, and relapse-free survival 40% at 5 years. All these data showed the feasibility of this procedure in patients treated with second generation TKIs with similar post-transplant complications in TKI naive patients or patients treated with imatinib.

Patients under therapy with TKIs may frequently present with elevations of creatine kinase (CK), thought to be in some cases related with the classical associations with muscle and joint pain that is also a common side effect. However the long run effect on treatment outcomes has not been well studied. Bankar A et al.³ recently reported on the relation between CK elevations and overall survival (OS) and event free survival (EFS). Interestingly CK elevations secondary to first or second generation TKIs were associated with a better OS and EFS. As expected, high Sokal score patients had a worse OS and EFS.

References

1. Breccia M et al. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol. 2021 Oct 11.
2. Masouridi-Levrat S et al. Outcomes and toxicity of allogeneic hematopoietic cell transplantation in chronic myeloid leukemia patients previously treated with second-generation tyrosine kinase inhibitors: a prospective non-interventional study from the Chronic Malignancy Working Party of the EBMT. Bone Marrow Transplant. 2021 Oct 1.
3. Bankar A, Lipton JH. Association of creatine kinase elevation with clinical outcomes in chronic myeloid leukemia: a retrospective cohort study Leuk Lymphoma. 2021 Sep 8.

In the new era of the COVID-19 pandemic, patients and physicians still struggle to see how different hematologic conditions may be affected by this viral infection. Although it has been well reported that COVID-19 may not be as lethal in chronic myeloid leukemia (CML) as other malignancies, patients still may be at risk of bad outcomes. A recent publication by Breccia et al¹ collected retrospective information on more than 8000 CML patients followed at different institutions in Italy up to January 2021. The authors recorded 217 patients (2.5%) who were SARS-CO-V2 (COVID-19) positive. More than half of the patients had concomitant comorbidities. Almost 80% were quarantined while the rest required hospitalization, although only 3.6 required intensive care unit care. Twelve patients died, which represents 0.13% of the whole cohort. The main predisposing factors were age > 65 years and cardiovascular disorders, similar to that the general population.  Most of patients continue tyrosine kinase inhibitor (TKI) therapy during the infection.

While the introduction of TKI for the treatment of CML make the number of allogenic transplants decrease significantly due the high mortality in comparison with TKI therapy, it is still an option for certain patients who failed multiple TKI treatments or progressed to more advanced phases of the disease. Although it has already been described that the introduction of imatinib did not affect outcomes for patients that require this therapeutic option, there was not much data about the effect of second generation TKIs. In a publication by Masouridi-Levrat S et al² the authors examine the effect of second generation TKIs in a prospective non-interventional study performed by the European Group for Blood and Marrow Transplantation on 383 consecutive CML patients previously treated with dasatinib or nilotinib undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) from 2009 to 2013. Less than 40% of patients received the transplant in the chronic phase while the rest were in accelerated or blast phase. With a median follow-up of 37 months, 8% of patients developed either primary or secondary graft failure, 34% acute graft-versus-host disease (GvHD), and 60% chronic GvHD. The non-relapse mortality was 18% and 24% at 12 months and at 5 years, respectively. Relapse incidence was 36%, overall survival 56%, and relapse-free survival 40% at 5 years. All these data showed the feasibility of this procedure in patients treated with second generation TKIs with similar post-transplant complications in TKI naive patients or patients treated with imatinib.

Patients under therapy with TKIs may frequently present with elevations of creatine kinase (CK), thought to be in some cases related with the classical associations with muscle and joint pain that is also a common side effect. However the long run effect on treatment outcomes has not been well studied. Bankar A et al.³ recently reported on the relation between CK elevations and overall survival (OS) and event free survival (EFS). Interestingly CK elevations secondary to first or second generation TKIs were associated with a better OS and EFS. As expected, high Sokal score patients had a worse OS and EFS.

References

1. Breccia M et al. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol. 2021 Oct 11.
2. Masouridi-Levrat S et al. Outcomes and toxicity of allogeneic hematopoietic cell transplantation in chronic myeloid leukemia patients previously treated with second-generation tyrosine kinase inhibitors: a prospective non-interventional study from the Chronic Malignancy Working Party of the EBMT. Bone Marrow Transplant. 2021 Oct 1.
3. Bankar A, Lipton JH. Association of creatine kinase elevation with clinical outcomes in chronic myeloid leukemia: a retrospective cohort study Leuk Lymphoma. 2021 Sep 8.