Most research published on psoriatic arthritis (PsA) in the month of June 2021 were related to treatment. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and anti-tumour necrosis factor (TNF) remain the most used drugs to treat PsA worldwide. However, the benefits of combining csDMARDs and anti-TNF therapies have been less well studied. Lindström et al studied this question using data from 15,332 patients with PsA from 13 European countries participating in the EuroSpA collaboration who initiated a first anti-TNF treatment in 2006–2017.  Sixty-two percent of the patients were on combined therapy, while 38% were no anti-TNF monotherapy. Overall, combined treatment was associated with better remission rates, pooled odds ratio (OR) 1.25 (1.12–1.41). Methotrexate (MTX) comedication was associated with improved rates of remission with adalimumab (OR 1.45 [1.23–1.72]) and infliximab (OR 1.55 [1.21–1.98]) and improved drug retention with infliximab. No effect of comedication could be demonstrated for etanercept. Thus, in clinical practice there may be an advantage to combine MTX with infliximab or adalimumab.

Biosimilars provide similar efficacy and safety to originator biologics at lower cost. Many jurisdictions are mandating nonmedical switch from a biologic to a biosimilar but concerns about such administrative switches remain among patients and physicians. Giunta et al report their observations in patients undergoing nonmedical switch from originator adalimumab to biosimilar adalimumab (ABP 501/ adalimumab-atto). In this retrospective study of 94 patients, 46 of whom underwent nonmedical switch from originator adalimumab to ABP 501, they found no significant differences in PASI or DAS-28 ESR at before and after switch in patients undergoing nonmedical switch from adalimumab originator to ABP 501. This study, although small and observational, adds to the growing body of literature on the effectiveness and safety of biosimilars including nonmedical switching.

About newer therapies, Mease et al reported the 52-week results of the phase 2b trial with tildrakizumab (an anti-IL23 biologic) in PsA. In this study, 391 patients with PsA who were randomly assigned to tildrakizumab 200 mg every 4 weeks (Q4W), tildrakizumab 200 mg, 100 mg, or 20 mg every 12 weeks or placebo Q4W. At week 24, the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response was significantly higher for any dose of tildrakizumab vs placebo (71.4%-79.5% vs 50.6%; all P ≤.0125). However, improvement in dactylitis and enthesitis was not observed. No new safety signals were observed through W52. Tildrakizumab may be another option for the management of PsA but requires further evaluation in phase 3 trials.

About gender differences, Prior-Español et al using the Spanish BIOBADASER III registry demonstrated that women with PsA were at greater risk of discontinuing DMARDs because of both lack of efficacy and adverse events. Finally, Ferguson et al reported results from a prospective, open label study of adults receiving apremilast 30 mg as part of routine care for psoriatic disease. They show that in addition to reduction in disease activity, apremilast treatment was significantly associated with a mean weight loss of 2.2 kg and a mean body mass index decrease of 0.8 kg/m² (both P < .001). Improvement in disease activity did not correlate with weight change.

Most research published on psoriatic arthritis (PsA) in the month of June 2021 were related to treatment. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and anti-tumour necrosis factor (TNF) remain the most used drugs to treat PsA worldwide. However, the benefits of combining csDMARDs and anti-TNF therapies have been less well studied. Lindström et al studied this question using data from 15,332 patients with PsA from 13 European countries participating in the EuroSpA collaboration who initiated a first anti-TNF treatment in 2006–2017.  Sixty-two percent of the patients were on combined therapy, while 38% were no anti-TNF monotherapy. Overall, combined treatment was associated with better remission rates, pooled odds ratio (OR) 1.25 (1.12–1.41). Methotrexate (MTX) comedication was associated with improved rates of remission with adalimumab (OR 1.45 [1.23–1.72]) and infliximab (OR 1.55 [1.21–1.98]) and improved drug retention with infliximab. No effect of comedication could be demonstrated for etanercept. Thus, in clinical practice there may be an advantage to combine MTX with infliximab or adalimumab.

Biosimilars provide similar efficacy and safety to originator biologics at lower cost. Many jurisdictions are mandating nonmedical switch from a biologic to a biosimilar but concerns about such administrative switches remain among patients and physicians. Giunta et al report their observations in patients undergoing nonmedical switch from originator adalimumab to biosimilar adalimumab (ABP 501/ adalimumab-atto). In this retrospective study of 94 patients, 46 of whom underwent nonmedical switch from originator adalimumab to ABP 501, they found no significant differences in PASI or DAS-28 ESR at before and after switch in patients undergoing nonmedical switch from adalimumab originator to ABP 501. This study, although small and observational, adds to the growing body of literature on the effectiveness and safety of biosimilars including nonmedical switching.

About newer therapies, Mease et al reported the 52-week results of the phase 2b trial with tildrakizumab (an anti-IL23 biologic) in PsA. In this study, 391 patients with PsA who were randomly assigned to tildrakizumab 200 mg every 4 weeks (Q4W), tildrakizumab 200 mg, 100 mg, or 20 mg every 12 weeks or placebo Q4W. At week 24, the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response was significantly higher for any dose of tildrakizumab vs placebo (71.4%-79.5% vs 50.6%; all P ≤.0125). However, improvement in dactylitis and enthesitis was not observed. No new safety signals were observed through W52. Tildrakizumab may be another option for the management of PsA but requires further evaluation in phase 3 trials.

About gender differences, Prior-Español et al using the Spanish BIOBADASER III registry demonstrated that women with PsA were at greater risk of discontinuing DMARDs because of both lack of efficacy and adverse events. Finally, Ferguson et al reported results from a prospective, open label study of adults receiving apremilast 30 mg as part of routine care for psoriatic disease. They show that in addition to reduction in disease activity, apremilast treatment was significantly associated with a mean weight loss of 2.2 kg and a mean body mass index decrease of 0.8 kg/m² (both P < .001). Improvement in disease activity did not correlate with weight change.

Most research published on psoriatic arthritis (PsA) in the month of June 2021 were related to treatment. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and anti-tumour necrosis factor (TNF) remain the most used drugs to treat PsA worldwide. However, the benefits of combining csDMARDs and anti-TNF therapies have been less well studied. Lindström et al studied this question using data from 15,332 patients with PsA from 13 European countries participating in the EuroSpA collaboration who initiated a first anti-TNF treatment in 2006–2017.  Sixty-two percent of the patients were on combined therapy, while 38% were no anti-TNF monotherapy. Overall, combined treatment was associated with better remission rates, pooled odds ratio (OR) 1.25 (1.12–1.41). Methotrexate (MTX) comedication was associated with improved rates of remission with adalimumab (OR 1.45 [1.23–1.72]) and infliximab (OR 1.55 [1.21–1.98]) and improved drug retention with infliximab. No effect of comedication could be demonstrated for etanercept. Thus, in clinical practice there may be an advantage to combine MTX with infliximab or adalimumab.

Biosimilars provide similar efficacy and safety to originator biologics at lower cost. Many jurisdictions are mandating nonmedical switch from a biologic to a biosimilar but concerns about such administrative switches remain among patients and physicians. Giunta et al report their observations in patients undergoing nonmedical switch from originator adalimumab to biosimilar adalimumab (ABP 501/ adalimumab-atto). In this retrospective study of 94 patients, 46 of whom underwent nonmedical switch from originator adalimumab to ABP 501, they found no significant differences in PASI or DAS-28 ESR at before and after switch in patients undergoing nonmedical switch from adalimumab originator to ABP 501. This study, although small and observational, adds to the growing body of literature on the effectiveness and safety of biosimilars including nonmedical switching.

About newer therapies, Mease et al reported the 52-week results of the phase 2b trial with tildrakizumab (an anti-IL23 biologic) in PsA. In this study, 391 patients with PsA who were randomly assigned to tildrakizumab 200 mg every 4 weeks (Q4W), tildrakizumab 200 mg, 100 mg, or 20 mg every 12 weeks or placebo Q4W. At week 24, the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response was significantly higher for any dose of tildrakizumab vs placebo (71.4%-79.5% vs 50.6%; all P ≤.0125). However, improvement in dactylitis and enthesitis was not observed. No new safety signals were observed through W52. Tildrakizumab may be another option for the management of PsA but requires further evaluation in phase 3 trials.

About gender differences, Prior-Español et al using the Spanish BIOBADASER III registry demonstrated that women with PsA were at greater risk of discontinuing DMARDs because of both lack of efficacy and adverse events. Finally, Ferguson et al reported results from a prospective, open label study of adults receiving apremilast 30 mg as part of routine care for psoriatic disease. They show that in addition to reduction in disease activity, apremilast treatment was significantly associated with a mean weight loss of 2.2 kg and a mean body mass index decrease of 0.8 kg/m² (both P < .001). Improvement in disease activity did not correlate with weight change.

As doctors struggled through several surges of COVID-19 infections, most of what we learned was acquired through real-life experience. While many treatment options were promoted, most flat-out failed to be real therapeutics at all. Now that we have a safe and effective vaccine, we can prevent many infections from this virus. However, we are still left to manage the many post-COVID symptoms our patients continue to suffer with.

Symptoms following infection can last for months and range widely from “brain fog,” fatigue, dyspnea, chest pain, generalized weakness, depression, and a host of others. Patients may experience one or all of these symptoms, and there is currently no good way to predict who will go on to become a COVID “long hauler”.

Following the example of being educated by COVID as it happened, the same is true for managing post-COVID symptoms. The medical community still has a poor understanding of why some people develop it and there are few evidence-based studies to support any treatment modalities.

Earlier this month, the Centers for Disease Control and Prevention issued a set of clinical guidelines addressing treatment of post-COVID symptoms, which they define as “new, recurring, or ongoing symptoms more than 4 weeks after infection, sometimes after initial symptom recovery.” It is important to note that these symptoms can occur in any degree of sickness during the acute infection, including in those who were asymptomatic. Even the actual name of this post-COVID syndrome is still being developed, with several other names being used for it as well.

While the guidelines are quite extensive, the actual clinical recommendations are still vague. For example, it is advised to let the patient know that post-COVID symptoms are still not well understood. While it is important to be transparent with patients, this does little to reassure them. Patients look to doctors, especially their primary care physicians, to guide them on the best treatment paths. Yet, we currently have none for post-COVID syndrome.

It is also advised to treat the patients’ symptoms and help improve functioning. For many diseases, doctors like to get to the root cause of the problem. Treating a symptom often masks an underlying condition. It may make the patient feel better and improve what they are capable of doing, which is important, but it also fails to unmask the real problem. It is also important to note that symptoms can be out of proportion to clinical findings and should not be dismissed: we just don’t have the answers yet.

One helpful recommendation is having a patient keep a diary of their symptoms. This will help both the patient and doctor learn what may be triggering factors. If it is, for example, exertion that induces breathlessness, perhaps the patient can gradually increase their level of activity to minimize symptoms. Additionally, a “comprehensive rehabilitation program” is also advised and this can greatly assist addressing all the issues a patient is experiencing, physically and medically.

It is also advised that management of underlying medical conditions be optimized. While this is very important, it is not something specific to post-COVID syndrome: All patients should have their underlying medical conditions well controlled. It might be that the patient is paying more attention to their overall health, which is a good thing. However, this does not necessarily reduce the current symptoms a patient is experiencing.

The CDC makes a good attempt to offer guidance in the frustrating management of post-COVID syndrome. However, their clinical guidelines fail to offer specific management tools specific to treating post-COVID patients. The recommendations offered are more helpful to health in general. The fact that more specific recommendations are lacking is simply caused by the lack of knowledge of this condition at present. As more research is conducted and more knowledge obtained, new guidelines should become more detailed.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].

As doctors struggled through several surges of COVID-19 infections, most of what we learned was acquired through real-life experience. While many treatment options were promoted, most flat-out failed to be real therapeutics at all. Now that we have a safe and effective vaccine, we can prevent many infections from this virus. However, we are still left to manage the many post-COVID symptoms our patients continue to suffer with.

Symptoms following infection can last for months and range widely from “brain fog,” fatigue, dyspnea, chest pain, generalized weakness, depression, and a host of others. Patients may experience one or all of these symptoms, and there is currently no good way to predict who will go on to become a COVID “long hauler”.

Following the example of being educated by COVID as it happened, the same is true for managing post-COVID symptoms. The medical community still has a poor understanding of why some people develop it and there are few evidence-based studies to support any treatment modalities.

Earlier this month, the Centers for Disease Control and Prevention issued a set of clinical guidelines addressing treatment of post-COVID symptoms, which they define as “new, recurring, or ongoing symptoms more than 4 weeks after infection, sometimes after initial symptom recovery.” It is important to note that these symptoms can occur in any degree of sickness during the acute infection, including in those who were asymptomatic. Even the actual name of this post-COVID syndrome is still being developed, with several other names being used for it as well.

While the guidelines are quite extensive, the actual clinical recommendations are still vague. For example, it is advised to let the patient know that post-COVID symptoms are still not well understood. While it is important to be transparent with patients, this does little to reassure them. Patients look to doctors, especially their primary care physicians, to guide them on the best treatment paths. Yet, we currently have none for post-COVID syndrome.

It is also advised to treat the patients’ symptoms and help improve functioning. For many diseases, doctors like to get to the root cause of the problem. Treating a symptom often masks an underlying condition. It may make the patient feel better and improve what they are capable of doing, which is important, but it also fails to unmask the real problem. It is also important to note that symptoms can be out of proportion to clinical findings and should not be dismissed: we just don’t have the answers yet.

One helpful recommendation is having a patient keep a diary of their symptoms. This will help both the patient and doctor learn what may be triggering factors. If it is, for example, exertion that induces breathlessness, perhaps the patient can gradually increase their level of activity to minimize symptoms. Additionally, a “comprehensive rehabilitation program” is also advised and this can greatly assist addressing all the issues a patient is experiencing, physically and medically.

It is also advised that management of underlying medical conditions be optimized. While this is very important, it is not something specific to post-COVID syndrome: All patients should have their underlying medical conditions well controlled. It might be that the patient is paying more attention to their overall health, which is a good thing. However, this does not necessarily reduce the current symptoms a patient is experiencing.

The CDC makes a good attempt to offer guidance in the frustrating management of post-COVID syndrome. However, their clinical guidelines fail to offer specific management tools specific to treating post-COVID patients. The recommendations offered are more helpful to health in general. The fact that more specific recommendations are lacking is simply caused by the lack of knowledge of this condition at present. As more research is conducted and more knowledge obtained, new guidelines should become more detailed.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].

As doctors struggled through several surges of COVID-19 infections, most of what we learned was acquired through real-life experience. While many treatment options were promoted, most flat-out failed to be real therapeutics at all. Now that we have a safe and effective vaccine, we can prevent many infections from this virus. However, we are still left to manage the many post-COVID symptoms our patients continue to suffer with.

Symptoms following infection can last for months and range widely from “brain fog,” fatigue, dyspnea, chest pain, generalized weakness, depression, and a host of others. Patients may experience one or all of these symptoms, and there is currently no good way to predict who will go on to become a COVID “long hauler”.

Following the example of being educated by COVID as it happened, the same is true for managing post-COVID symptoms. The medical community still has a poor understanding of why some people develop it and there are few evidence-based studies to support any treatment modalities.

Earlier this month, the Centers for Disease Control and Prevention issued a set of clinical guidelines addressing treatment of post-COVID symptoms, which they define as “new, recurring, or ongoing symptoms more than 4 weeks after infection, sometimes after initial symptom recovery.” It is important to note that these symptoms can occur in any degree of sickness during the acute infection, including in those who were asymptomatic. Even the actual name of this post-COVID syndrome is still being developed, with several other names being used for it as well.

While the guidelines are quite extensive, the actual clinical recommendations are still vague. For example, it is advised to let the patient know that post-COVID symptoms are still not well understood. While it is important to be transparent with patients, this does little to reassure them. Patients look to doctors, especially their primary care physicians, to guide them on the best treatment paths. Yet, we currently have none for post-COVID syndrome.

It is also advised to treat the patients’ symptoms and help improve functioning. For many diseases, doctors like to get to the root cause of the problem. Treating a symptom often masks an underlying condition. It may make the patient feel better and improve what they are capable of doing, which is important, but it also fails to unmask the real problem. It is also important to note that symptoms can be out of proportion to clinical findings and should not be dismissed: we just don’t have the answers yet.

One helpful recommendation is having a patient keep a diary of their symptoms. This will help both the patient and doctor learn what may be triggering factors. If it is, for example, exertion that induces breathlessness, perhaps the patient can gradually increase their level of activity to minimize symptoms. Additionally, a “comprehensive rehabilitation program” is also advised and this can greatly assist addressing all the issues a patient is experiencing, physically and medically.

It is also advised that management of underlying medical conditions be optimized. While this is very important, it is not something specific to post-COVID syndrome: All patients should have their underlying medical conditions well controlled. It might be that the patient is paying more attention to their overall health, which is a good thing. However, this does not necessarily reduce the current symptoms a patient is experiencing.

The CDC makes a good attempt to offer guidance in the frustrating management of post-COVID syndrome. However, their clinical guidelines fail to offer specific management tools specific to treating post-COVID patients. The recommendations offered are more helpful to health in general. The fact that more specific recommendations are lacking is simply caused by the lack of knowledge of this condition at present. As more research is conducted and more knowledge obtained, new guidelines should become more detailed.

Dr. Girgis practices family medicine in South River, N.J., and is a clinical assistant professor of family medicine at Robert Wood Johnson Medical School, New Brunswick, N.J. You can contact her at [email protected].

Key clinical point: Cluster of differentiation 33 (CD33) single-nucleotide polymorphism (SNP) rs12459419 predicts the rate of relapse in patients with nucleophosmin1 (NPM1)-mutated acute myeloid leukemia (AML) treated with gemtuzumab ozogamicin (GO).

Major finding: Complete remission, event-free survival, and cumulative incidence of death were not significantly different between genotypes in the treatment arms. However, patients with c.41 C/C genotype for rs12459419 in the GO vs. standard arm showed significant improvement in relapse-free survival (P = .03) and cumulative incidence of relapse (P = .023).

Study details: Findings are from the phase 3 AMLSG 09-09 trial including 588 adult patients with NPM1-mutated AML who were eligible for intensive therapy. Patients were randomly allocated to receive 2 cycles of induction chemotherapy with (n=273) or without (n=272) GO.

Disclosures: This work was supported by grants from the Deutsche José Carreras Leukämie-Stiftung e.V., German Federal Ministry of Education and Research, and Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Teich K et al. Haematologica. 2021 May 27. doi: 10.3324/haematol.2021.278894.

Key clinical point: Cluster of differentiation 33 (CD33) single-nucleotide polymorphism (SNP) rs12459419 predicts the rate of relapse in patients with nucleophosmin1 (NPM1)-mutated acute myeloid leukemia (AML) treated with gemtuzumab ozogamicin (GO).

Major finding: Complete remission, event-free survival, and cumulative incidence of death were not significantly different between genotypes in the treatment arms. However, patients with c.41 C/C genotype for rs12459419 in the GO vs. standard arm showed significant improvement in relapse-free survival (P = .03) and cumulative incidence of relapse (P = .023).

Study details: Findings are from the phase 3 AMLSG 09-09 trial including 588 adult patients with NPM1-mutated AML who were eligible for intensive therapy. Patients were randomly allocated to receive 2 cycles of induction chemotherapy with (n=273) or without (n=272) GO.

Disclosures: This work was supported by grants from the Deutsche José Carreras Leukämie-Stiftung e.V., German Federal Ministry of Education and Research, and Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Teich K et al. Haematologica. 2021 May 27. doi: 10.3324/haematol.2021.278894.

Key clinical point: Cluster of differentiation 33 (CD33) single-nucleotide polymorphism (SNP) rs12459419 predicts the rate of relapse in patients with nucleophosmin1 (NPM1)-mutated acute myeloid leukemia (AML) treated with gemtuzumab ozogamicin (GO).

Major finding: Complete remission, event-free survival, and cumulative incidence of death were not significantly different between genotypes in the treatment arms. However, patients with c.41 C/C genotype for rs12459419 in the GO vs. standard arm showed significant improvement in relapse-free survival (P = .03) and cumulative incidence of relapse (P = .023).

Study details: Findings are from the phase 3 AMLSG 09-09 trial including 588 adult patients with NPM1-mutated AML who were eligible for intensive therapy. Patients were randomly allocated to receive 2 cycles of induction chemotherapy with (n=273) or without (n=272) GO.

Disclosures: This work was supported by grants from the Deutsche José Carreras Leukämie-Stiftung e.V., German Federal Ministry of Education and Research, and Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Teich K et al. Haematologica. 2021 May 27. doi: 10.3324/haematol.2021.278894.

Key clinical point: The detection of measurable residual disease (MRD) using next-generation sequencing (NGS) has a prognostic value before and 1 month after allogeneic hematopoietic stem cell transplantation (allo-HSCT), depending on the conditioning intensity.

Major finding: In patients receiving myeloablative conditioning, pre-allo-HSCT NGS-MRD detection was associated with posttransplant relapse. Conversely, in patients receiving reduced intensity conditioning 1 month post-allo-HSCT, NGS-MRD was associated with posttransplant relapse (both P less than .001).

Study details: This study included 146 patients with AML who underwent allo-HSCT in complete remission between 2013 and 2018.

Disclosures: This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea. The authors declared no conflicts of interest.

Source: Kim HJ et al. Blood Cancer J. 2021 Jun 4. doi: 10.1038/s41408-021-00500-9.

Key clinical point: The detection of measurable residual disease (MRD) using next-generation sequencing (NGS) has a prognostic value before and 1 month after allogeneic hematopoietic stem cell transplantation (allo-HSCT), depending on the conditioning intensity.

Major finding: In patients receiving myeloablative conditioning, pre-allo-HSCT NGS-MRD detection was associated with posttransplant relapse. Conversely, in patients receiving reduced intensity conditioning 1 month post-allo-HSCT, NGS-MRD was associated with posttransplant relapse (both P less than .001).

Study details: This study included 146 patients with AML who underwent allo-HSCT in complete remission between 2013 and 2018.

Disclosures: This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea. The authors declared no conflicts of interest.

Source: Kim HJ et al. Blood Cancer J. 2021 Jun 4. doi: 10.1038/s41408-021-00500-9.

Key clinical point: The detection of measurable residual disease (MRD) using next-generation sequencing (NGS) has a prognostic value before and 1 month after allogeneic hematopoietic stem cell transplantation (allo-HSCT), depending on the conditioning intensity.

Major finding: In patients receiving myeloablative conditioning, pre-allo-HSCT NGS-MRD detection was associated with posttransplant relapse. Conversely, in patients receiving reduced intensity conditioning 1 month post-allo-HSCT, NGS-MRD was associated with posttransplant relapse (both P less than .001).

Study details: This study included 146 patients with AML who underwent allo-HSCT in complete remission between 2013 and 2018.

Disclosures: This work was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare, Republic of Korea. The authors declared no conflicts of interest.

Source: Kim HJ et al. Blood Cancer J. 2021 Jun 4. doi: 10.1038/s41408-021-00500-9.

Key clinical point: Clonal hematopoiesis (CH) persisted after complete remission (CR) in patients with acute myeloid leukemia (AML) and was resistant to consolidation and maintenance therapies, except for allogeneic stem cell transplantation (allo-SCT). However, the presence of postremission CH did not affect clinical outcomes.

Major finding: Following induction chemotherapies, 48% of patients had post-CR CH, and it persisted in 91% of patients during and postremission chemotherapies, but disappeared in 95% of patients after allo-SCT. However, the risk for relapse (P = .174) and nonrelapse mortality (P = .827) was similar in patients with vs. without post-CR CH.

Study details: Findings are from assessment of 164 patients with AML who achieved morphological CR following induction chemotherapies.

Disclosures: This work was supported by grants from the Cancer Prevention and Research Institute of Texas, Welch Foundation, University of Texas System STARS Award, Lyda Hill Foundation, Charif Souki Cancer Research Fund, Japan Society for the Promotion of Science, Sabin Family Foundation Fellowship, and various funding programs at the MD Anderson Cancer Center. The authors declared no conflicts of interest.

Source: Tanaka T et al. Blood. 2021 Jun 3. doi: 10.1182/blood.2020010483.

Key clinical point: Clonal hematopoiesis (CH) persisted after complete remission (CR) in patients with acute myeloid leukemia (AML) and was resistant to consolidation and maintenance therapies, except for allogeneic stem cell transplantation (allo-SCT). However, the presence of postremission CH did not affect clinical outcomes.

Major finding: Following induction chemotherapies, 48% of patients had post-CR CH, and it persisted in 91% of patients during and postremission chemotherapies, but disappeared in 95% of patients after allo-SCT. However, the risk for relapse (P = .174) and nonrelapse mortality (P = .827) was similar in patients with vs. without post-CR CH.

Study details: Findings are from assessment of 164 patients with AML who achieved morphological CR following induction chemotherapies.

Disclosures: This work was supported by grants from the Cancer Prevention and Research Institute of Texas, Welch Foundation, University of Texas System STARS Award, Lyda Hill Foundation, Charif Souki Cancer Research Fund, Japan Society for the Promotion of Science, Sabin Family Foundation Fellowship, and various funding programs at the MD Anderson Cancer Center. The authors declared no conflicts of interest.

Source: Tanaka T et al. Blood. 2021 Jun 3. doi: 10.1182/blood.2020010483.

Key clinical point: Clonal hematopoiesis (CH) persisted after complete remission (CR) in patients with acute myeloid leukemia (AML) and was resistant to consolidation and maintenance therapies, except for allogeneic stem cell transplantation (allo-SCT). However, the presence of postremission CH did not affect clinical outcomes.

Major finding: Following induction chemotherapies, 48% of patients had post-CR CH, and it persisted in 91% of patients during and postremission chemotherapies, but disappeared in 95% of patients after allo-SCT. However, the risk for relapse (P = .174) and nonrelapse mortality (P = .827) was similar in patients with vs. without post-CR CH.

Study details: Findings are from assessment of 164 patients with AML who achieved morphological CR following induction chemotherapies.

Disclosures: This work was supported by grants from the Cancer Prevention and Research Institute of Texas, Welch Foundation, University of Texas System STARS Award, Lyda Hill Foundation, Charif Souki Cancer Research Fund, Japan Society for the Promotion of Science, Sabin Family Foundation Fellowship, and various funding programs at the MD Anderson Cancer Center. The authors declared no conflicts of interest.

Source: Tanaka T et al. Blood. 2021 Jun 3. doi: 10.1182/blood.2020010483.

Key clinical point: Increased accumulation of unconventional CD56⁻CD16⁺ natural killer (NK) cells in patients with newly diagnosed acute myeloid leukemia (AML) was associated with poor clinical outcomes.

Major finding: Accumulation of CD56⁻CD16⁺ NK cells, representing up to 80.8% of total NK cells, was observed in 27.1% of patients with AML. Overall survival (hazard ratio [HR], 0.13; P less than .001) and event-free survival (HR, 0.33; P less than .05) were significantly reduced in patients with high CD56⁻CD16⁺ vs. patients with conventional NK cell profile.

Study details: This study conducted deep phenotyping of NK cells using peripheral blood from 48 patients with newly diagnosed nonacute promyelocytic leukemia AML and 18 healthy control participants.

Disclosures: This work was supported by grants from the Institut National du Cancer, Fondation de France, Sites de Recherche Intégrée sur le Cancer Marseille, Cancéropôle Provence-Alpes-Côte d’Azur, Groupement d’intérêt scientifique-Infrastructures pour la Biologie, la Santé et l’Agronomie, and Agence Nationale de la Recherche. The authors declared no conflicts of interest.

Source: Chretien AS et al. Proc Natl Acad Sci USA. 2021 May 28. doi: 10.1073/pnas.2020459118.

Key clinical point: Increased accumulation of unconventional CD56⁻CD16⁺ natural killer (NK) cells in patients with newly diagnosed acute myeloid leukemia (AML) was associated with poor clinical outcomes.

Major finding: Accumulation of CD56⁻CD16⁺ NK cells, representing up to 80.8% of total NK cells, was observed in 27.1% of patients with AML. Overall survival (hazard ratio [HR], 0.13; P less than .001) and event-free survival (HR, 0.33; P less than .05) were significantly reduced in patients with high CD56⁻CD16⁺ vs. patients with conventional NK cell profile.

Study details: This study conducted deep phenotyping of NK cells using peripheral blood from 48 patients with newly diagnosed nonacute promyelocytic leukemia AML and 18 healthy control participants.

Disclosures: This work was supported by grants from the Institut National du Cancer, Fondation de France, Sites de Recherche Intégrée sur le Cancer Marseille, Cancéropôle Provence-Alpes-Côte d’Azur, Groupement d’intérêt scientifique-Infrastructures pour la Biologie, la Santé et l’Agronomie, and Agence Nationale de la Recherche. The authors declared no conflicts of interest.

Source: Chretien AS et al. Proc Natl Acad Sci USA. 2021 May 28. doi: 10.1073/pnas.2020459118.

Key clinical point: Increased accumulation of unconventional CD56⁻CD16⁺ natural killer (NK) cells in patients with newly diagnosed acute myeloid leukemia (AML) was associated with poor clinical outcomes.

Major finding: Accumulation of CD56⁻CD16⁺ NK cells, representing up to 80.8% of total NK cells, was observed in 27.1% of patients with AML. Overall survival (hazard ratio [HR], 0.13; P less than .001) and event-free survival (HR, 0.33; P less than .05) were significantly reduced in patients with high CD56⁻CD16⁺ vs. patients with conventional NK cell profile.

Study details: This study conducted deep phenotyping of NK cells using peripheral blood from 48 patients with newly diagnosed nonacute promyelocytic leukemia AML and 18 healthy control participants.

Disclosures: This work was supported by grants from the Institut National du Cancer, Fondation de France, Sites de Recherche Intégrée sur le Cancer Marseille, Cancéropôle Provence-Alpes-Côte d’Azur, Groupement d’intérêt scientifique-Infrastructures pour la Biologie, la Santé et l’Agronomie, and Agence Nationale de la Recherche. The authors declared no conflicts of interest.

Source: Chretien AS et al. Proc Natl Acad Sci USA. 2021 May 28. doi: 10.1073/pnas.2020459118.

Key clinical point: No association was observed between runt-related transcription factor 1 gene mutation (RUNX1+) and inferior outcomes after allogeneic stem cell transplantation (alloSCT) in the first complete remission (CR). These findings suggest that early cell transplantation could probably overcome the negative effects of RUNX1 mutation on patients with acute myeloid leukemia (AML).

Major finding: Patients with vs. without RUNX1 mutation had similar rates of overall survival (OS; P = .65), leukemia-free survival (P = .60), and relapse (P = .83) after alloSCT in the first CR.

Study details: Findings are from a retrospective analysis of 674 adult patients with AML (de novo AML, n=584) who underwent alloSCT in the first CR between January 2013 and June 2019.

Disclosures: Open Access funding was enabled and organized by Projekt DEAL. The authors declared no conflicts of interest.

Source: Waidhauser J et al. Bone Marrow Transplant. 2021 May 31. doi: 10.1038/s41409-021-01322-w.

Key clinical point: No association was observed between runt-related transcription factor 1 gene mutation (RUNX1+) and inferior outcomes after allogeneic stem cell transplantation (alloSCT) in the first complete remission (CR). These findings suggest that early cell transplantation could probably overcome the negative effects of RUNX1 mutation on patients with acute myeloid leukemia (AML).

Major finding: Patients with vs. without RUNX1 mutation had similar rates of overall survival (OS; P = .65), leukemia-free survival (P = .60), and relapse (P = .83) after alloSCT in the first CR.

Study details: Findings are from a retrospective analysis of 674 adult patients with AML (de novo AML, n=584) who underwent alloSCT in the first CR between January 2013 and June 2019.

Disclosures: Open Access funding was enabled and organized by Projekt DEAL. The authors declared no conflicts of interest.

Source: Waidhauser J et al. Bone Marrow Transplant. 2021 May 31. doi: 10.1038/s41409-021-01322-w.

Key clinical point: No association was observed between runt-related transcription factor 1 gene mutation (RUNX1+) and inferior outcomes after allogeneic stem cell transplantation (alloSCT) in the first complete remission (CR). These findings suggest that early cell transplantation could probably overcome the negative effects of RUNX1 mutation on patients with acute myeloid leukemia (AML).

Major finding: Patients with vs. without RUNX1 mutation had similar rates of overall survival (OS; P = .65), leukemia-free survival (P = .60), and relapse (P = .83) after alloSCT in the first CR.

Study details: Findings are from a retrospective analysis of 674 adult patients with AML (de novo AML, n=584) who underwent alloSCT in the first CR between January 2013 and June 2019.

Disclosures: Open Access funding was enabled and organized by Projekt DEAL. The authors declared no conflicts of interest.

Source: Waidhauser J et al. Bone Marrow Transplant. 2021 May 31. doi: 10.1038/s41409-021-01322-w.

Key clinical point: The second allogeneic hematopoietic cell transplantation (HCT) may be feasible in a selected subset of patients with relapsed acute myeloid leukemia (rAML) after the first HCT (HCT1). Specifically, patients with chronic graft vs. host disease (cGVHD) after HCT1 and high HCT comorbidity score at the second transplant show poor survival following the second HCT.

Major finding: At 2 years after the second HCT, the cumulative incidence of progression, overall survival (OS), progression-free survival (PFS), and nonrelapse mortality was 42%, 36%, 27%, and 18%, respectively. cGVHD after HCT1 and HCT comorbidity index 2 or higher at the second HCT were associated with significantly worse OS (adjusted hazard ratio [aHR], 2.9; P = .001 and aHR, 2.6; P = .003, respectively) and PFS (aHR, 3.4; P less than .001 and aHR, 2.1; P = .01, respectively) after the second HCT.

Study details: Findings are from a retrospective analysis of 91 adult patients who received the second HCT for rAML between January 2000 and August 2019.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Yalniz FF et al. Transplant Cell Ther. 2021 May 20. doi: 10.1016/j.jtct.2021.05.007.

Key clinical point: The second allogeneic hematopoietic cell transplantation (HCT) may be feasible in a selected subset of patients with relapsed acute myeloid leukemia (rAML) after the first HCT (HCT1). Specifically, patients with chronic graft vs. host disease (cGVHD) after HCT1 and high HCT comorbidity score at the second transplant show poor survival following the second HCT.

Major finding: At 2 years after the second HCT, the cumulative incidence of progression, overall survival (OS), progression-free survival (PFS), and nonrelapse mortality was 42%, 36%, 27%, and 18%, respectively. cGVHD after HCT1 and HCT comorbidity index 2 or higher at the second HCT were associated with significantly worse OS (adjusted hazard ratio [aHR], 2.9; P = .001 and aHR, 2.6; P = .003, respectively) and PFS (aHR, 3.4; P less than .001 and aHR, 2.1; P = .01, respectively) after the second HCT.

Study details: Findings are from a retrospective analysis of 91 adult patients who received the second HCT for rAML between January 2000 and August 2019.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Yalniz FF et al. Transplant Cell Ther. 2021 May 20. doi: 10.1016/j.jtct.2021.05.007.

Key clinical point: The second allogeneic hematopoietic cell transplantation (HCT) may be feasible in a selected subset of patients with relapsed acute myeloid leukemia (rAML) after the first HCT (HCT1). Specifically, patients with chronic graft vs. host disease (cGVHD) after HCT1 and high HCT comorbidity score at the second transplant show poor survival following the second HCT.

Major finding: At 2 years after the second HCT, the cumulative incidence of progression, overall survival (OS), progression-free survival (PFS), and nonrelapse mortality was 42%, 36%, 27%, and 18%, respectively. cGVHD after HCT1 and HCT comorbidity index 2 or higher at the second HCT were associated with significantly worse OS (adjusted hazard ratio [aHR], 2.9; P = .001 and aHR, 2.6; P = .003, respectively) and PFS (aHR, 3.4; P less than .001 and aHR, 2.1; P = .01, respectively) after the second HCT.

Study details: Findings are from a retrospective analysis of 91 adult patients who received the second HCT for rAML between January 2000 and August 2019.

Disclosures: No specific funding source was identified. The authors declared no conflicts of interest.

Source: Yalniz FF et al. Transplant Cell Ther. 2021 May 20. doi: 10.1016/j.jtct.2021.05.007.

Key clinical point: In patients with acute myeloid leukemia (AML), in addition to the induction regimen, only mean platelet volume (MPV) at diagnosis influenced all short- and long-term outcomes. Thus, patients with higher MPV at diagnosis need careful evaluation.

Major finding: In addition to the induction regimen (odds ratio [OR] for hypomethylating agents, 15.879; 95% confidence interval [CI], 4.956-48.881), MPV (OR, 1.694; 95% CI, 1.122-2.556) was the only factor that influenced short- and long-term outcomes including achievement of complete response, overall survival, and progression-free survival.

Study details: This retrospective study included 148 adult patients with AML followed up for a median of 7.4 months.

Disclosures: No source of funding was identified. The authors declared no conflicts of interest.

Source: Tığlıoğlu M et al. Leuk Lymphoma. 2021 May 20. doi: 10.1080/10428194.2021.1929962.

Key clinical point: In patients with acute myeloid leukemia (AML), in addition to the induction regimen, only mean platelet volume (MPV) at diagnosis influenced all short- and long-term outcomes. Thus, patients with higher MPV at diagnosis need careful evaluation.

Major finding: In addition to the induction regimen (odds ratio [OR] for hypomethylating agents, 15.879; 95% confidence interval [CI], 4.956-48.881), MPV (OR, 1.694; 95% CI, 1.122-2.556) was the only factor that influenced short- and long-term outcomes including achievement of complete response, overall survival, and progression-free survival.

Study details: This retrospective study included 148 adult patients with AML followed up for a median of 7.4 months.

Disclosures: No source of funding was identified. The authors declared no conflicts of interest.

Source: Tığlıoğlu M et al. Leuk Lymphoma. 2021 May 20. doi: 10.1080/10428194.2021.1929962.

Key clinical point: In patients with acute myeloid leukemia (AML), in addition to the induction regimen, only mean platelet volume (MPV) at diagnosis influenced all short- and long-term outcomes. Thus, patients with higher MPV at diagnosis need careful evaluation.

Major finding: In addition to the induction regimen (odds ratio [OR] for hypomethylating agents, 15.879; 95% confidence interval [CI], 4.956-48.881), MPV (OR, 1.694; 95% CI, 1.122-2.556) was the only factor that influenced short- and long-term outcomes including achievement of complete response, overall survival, and progression-free survival.

Study details: This retrospective study included 148 adult patients with AML followed up for a median of 7.4 months.

Disclosures: No source of funding was identified. The authors declared no conflicts of interest.

Source: Tığlıoğlu M et al. Leuk Lymphoma. 2021 May 20. doi: 10.1080/10428194.2021.1929962.

Key clinical point: Autologous fecal microbiota transfer (AFMT) was safe and effective for gut microbiota restoration in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy and antibiotics.

Major finding: After AFMT treatment, α-diversity indices returned to their initial median levels (Shannon index, P = .70; Inverse Simpson index, P = .90) and the b-diversity index showed the restoration of microbial communities, particularly for Lachnospiraceae and Ruminococcaceae families. Gut microbiota composition was preserved even after consolidation chemotherapy with high-dose cytarabine. No serious adverse events were reported, and only 3 patients experienced transient gastrointestinal symptoms.

Study details: Findings are from the phase 2 ODYSSEE trial evaluating AFMT treatment in 25 patients with AML treated with intensive chemotherapy and antibiotics.

Disclosures: This study was sponsored by MaaT Pharma. Some investigators including the lead author reported ties with various pharmaceutical companies including MaaT Pharma.

Source: Malard F et al. Nat Commun. 2021 May 25. doi: 10.1038/s41467-021-23376-6.

Key clinical point: Autologous fecal microbiota transfer (AFMT) was safe and effective for gut microbiota restoration in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy and antibiotics.

Major finding: After AFMT treatment, α-diversity indices returned to their initial median levels (Shannon index, P = .70; Inverse Simpson index, P = .90) and the b-diversity index showed the restoration of microbial communities, particularly for Lachnospiraceae and Ruminococcaceae families. Gut microbiota composition was preserved even after consolidation chemotherapy with high-dose cytarabine. No serious adverse events were reported, and only 3 patients experienced transient gastrointestinal symptoms.

Study details: Findings are from the phase 2 ODYSSEE trial evaluating AFMT treatment in 25 patients with AML treated with intensive chemotherapy and antibiotics.

Disclosures: This study was sponsored by MaaT Pharma. Some investigators including the lead author reported ties with various pharmaceutical companies including MaaT Pharma.

Source: Malard F et al. Nat Commun. 2021 May 25. doi: 10.1038/s41467-021-23376-6.

Key clinical point: Autologous fecal microbiota transfer (AFMT) was safe and effective for gut microbiota restoration in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy and antibiotics.

Major finding: After AFMT treatment, α-diversity indices returned to their initial median levels (Shannon index, P = .70; Inverse Simpson index, P = .90) and the b-diversity index showed the restoration of microbial communities, particularly for Lachnospiraceae and Ruminococcaceae families. Gut microbiota composition was preserved even after consolidation chemotherapy with high-dose cytarabine. No serious adverse events were reported, and only 3 patients experienced transient gastrointestinal symptoms.

Study details: Findings are from the phase 2 ODYSSEE trial evaluating AFMT treatment in 25 patients with AML treated with intensive chemotherapy and antibiotics.

Disclosures: This study was sponsored by MaaT Pharma. Some investigators including the lead author reported ties with various pharmaceutical companies including MaaT Pharma.

Source: Malard F et al. Nat Commun. 2021 May 25. doi: 10.1038/s41467-021-23376-6.