One of the greatest challenges psychotherapists face when working with justice-involved outpatients is a lack of familiarity with the criminal legal system, according to Debra A. Pinals, MD.

“It’s certainly nothing we learned about in medical school or in our mental health training, per se,” said Dr. Pinals, director of the program in psychiatry, law, and ethics at the University of Michigan, Ann Arbor, during an annual psychopharmacology update held by the Nevada Psychiatric Association.

“Another challenge is a lack of comfort with some patient personality styles, particularly those with antisocial personality styles,” she said. “We may have countertransference issues that emerge in our work with this population. That can lead to concerns about our own safety, which may at times be reasonable but often because of stereotypes often becomes of mythical proportion. The population is a high-demand population with limited resources, usually tapping public mental health services. That becomes a challenge as well. And there can be burnout when the challenges of our patient population exceed our capacity.”

Despite such obstacles, Dr. Pinals described the outpatient treatment of individuals involved in the criminal justice system as exciting, interesting, and intellectually challenging. But she acknowledged the role that stigma and fear can play.

“Though there are some unique challenges, the benefits of working with criminal justice–involved persons with serious mental illness are often not discussed,” Dr. Pinals said. “There is a tendency to overvalue the risk they may present without really looking at the specific nuances that would be involved in conducting true risk assessments and understanding that not all of these patients will be as risky as we might believe due to stigma and fear.”

Separate from how patients with criminal histories may be perceived in clinical settings. There is much to learn about the role of mental illness in crime. In a 2014 study, researchers reviewed the records of criminal arrests in 143 people with mental illness and tried to discern whether the crime itself was completely independent or completely directly connected to the symptoms of mental illness the individual was experiencing. They found that 65% were completely independent of mental illness symptoms while 8% were directly related to mental illness symptoms.

“This means that as clinicians working with outpatients, we have to understand the whole person, and what might be going on in their lives that leads them down this criminal pathway,” said Dr. Pinals, who is also a clinical professor of psychiatry at the medical school.

According to the risk-need-responsivity (RNR) paradigm, eight criminogenic risk factors are associated with recurrent involvement in the criminal legal system (Crime & Delinquency. 2006;52:7-27). The big four include history of antisocial behavior, antisocial personality pattern, antisocial cognition, and antisocial attitudes. “These are the factors that certain cognitive-behavioral therapy approaches try to address, in an effort to reduce those antisocial cognitive tendencies,” Dr. Pinals said. The other four risk factors include family or marital discord, poor school and/or work performance, few leisure or recreation activities, and substance misuse.

“You’ll notice that mental illness is not listed,” she said. “Mental illness is not considered a major driver of crime, although it might be considered a responsivity factor within this RNR paradigm. This means it’s important to address it because it may help people better respond to criminal justice supervision and thereby have an indirect effect in reducing criminal recidivism. For example, if somebody has a social anxiety disorder or agoraphobia and therefore can’t make their probation appointment, probation won’t be able to help them adhere to the terms of their probation conditions. So, we do have to treat the illnesses underlying responsivity to how the criminal justice system operates.”

To optimally serve this population, Dr. Pinals recommends that psychotherapists become familiar with the Sequential Intercept Model, which was first published in 2006. “It takes the premise that individuals move through the criminal legal system in logical steps, and if we could identify those with mental health or substance use conditions and redirect them out of the criminal legal system and into treatment, we could reduce the overall penetration of those individuals from the criminal legal system,” she said. “We know that individuals with mental illness are overrepresented in the criminal legal system.”

By understanding what happens when a patient is arrested, mental health professionals can foster communication that could facilitate treatment for their patients.

“It’s important that we remember that these are people who are going through a challenging time,” Dr. Pinals said. “Maybe we don’t like what they did. Maybe we don’t like that they were accused of committing some kind of crime. However, it is important to realize that they are patients, and we want them to achieve the best outcome, whatever setting they’re in, that continuity of care and communication across systems might be beneficial. It might reduce their chance of returning to the criminal system and having other people victimized.”

copyright/Kuzma/iStockphoto

Mental health services vary across jails and prisons, she continued, but they are generally required to be commensurate with community standards.

“Of course, that’s often fraught with complexity and may not be available in particular jurisdictions” she said. Prisons, unlike local county jails, tend to have more levels of outpatient care, including inpatient, outpatient, and residential services. “Persons with mental illness can be moved in and out of these levels of care as needed,” Dr. Pinals said. “However, persons with mental illness can be at more risk for disciplinary infractions, especially if they’re not able to follow directions or if they’re psychotic or manic.”

Reentry creates certain risks to be mindful of, including social isolation, recurrent symptoms, problems acquiring medications and housing, suicide, violence, and a return to substance use. A reentry approach she recommended is the APIC model, which stands for Assess, Plan, Identify, and Coordinate. “That means individuals approaching release should be screened and assessed for their needs with a plan to meet the needs, identify critical periods and needed policies, and coordinate across systems,” Dr. Pinals said. “So, if you get a call as an outpatient provider from the reentry coordinator at a local jail trying to help you coordinate a patient’s reentry, that’s something to pay attention to.”

When first meeting with patients after a criminal justice experience, Dr. Pinals recommends asking them to discuss their arrest and criminal justice experience, and to address any emerging psychiatric or clinical issues, including trauma and adjustment associated with the arrests, incarceration, and legal processes. “The risks of rearrest are higher for those who have already touched the criminal justice system, so we want to help minimize that risk of rearrest,” she said.

Some clinics won’t allow patients with a criminal record to return, “which means you have to help potentially find alternative places for them to be seen,” she noted. “You may want to consult a specialist if you have doubts about your capacity to work with the patient. You also want to support staff who might have concerns about how to continue to treat this patient and you want to advocate for the patient’s needs and help them return to a stable treatment setting.”

Dr. Pinals concluded her presentation by underscoring the importance of delivering treatment services that are trauma informed. “There are high levels of trauma for those receiving care in psychiatric settings and among those who have spent time in jails and prisons,” she said. “We want to be sensitive to the fact that any of our patients who were involved in the criminal legal system might have a strong trauma history. Help instill a sense of safety and community, and hold hope for positive change.”

She reported consulting to jurisdictions and attorneys pertaining to behavioral health and justice, and forensic psychiatry. She reported having no relevant commercial financial disclosures.

[email protected]

One of the greatest challenges psychotherapists face when working with justice-involved outpatients is a lack of familiarity with the criminal legal system, according to Debra A. Pinals, MD.

“It’s certainly nothing we learned about in medical school or in our mental health training, per se,” said Dr. Pinals, director of the program in psychiatry, law, and ethics at the University of Michigan, Ann Arbor, during an annual psychopharmacology update held by the Nevada Psychiatric Association.

“Another challenge is a lack of comfort with some patient personality styles, particularly those with antisocial personality styles,” she said. “We may have countertransference issues that emerge in our work with this population. That can lead to concerns about our own safety, which may at times be reasonable but often because of stereotypes often becomes of mythical proportion. The population is a high-demand population with limited resources, usually tapping public mental health services. That becomes a challenge as well. And there can be burnout when the challenges of our patient population exceed our capacity.”

Despite such obstacles, Dr. Pinals described the outpatient treatment of individuals involved in the criminal justice system as exciting, interesting, and intellectually challenging. But she acknowledged the role that stigma and fear can play.

“Though there are some unique challenges, the benefits of working with criminal justice–involved persons with serious mental illness are often not discussed,” Dr. Pinals said. “There is a tendency to overvalue the risk they may present without really looking at the specific nuances that would be involved in conducting true risk assessments and understanding that not all of these patients will be as risky as we might believe due to stigma and fear.”

Separate from how patients with criminal histories may be perceived in clinical settings. There is much to learn about the role of mental illness in crime. In a 2014 study, researchers reviewed the records of criminal arrests in 143 people with mental illness and tried to discern whether the crime itself was completely independent or completely directly connected to the symptoms of mental illness the individual was experiencing. They found that 65% were completely independent of mental illness symptoms while 8% were directly related to mental illness symptoms.

“This means that as clinicians working with outpatients, we have to understand the whole person, and what might be going on in their lives that leads them down this criminal pathway,” said Dr. Pinals, who is also a clinical professor of psychiatry at the medical school.

According to the risk-need-responsivity (RNR) paradigm, eight criminogenic risk factors are associated with recurrent involvement in the criminal legal system (Crime & Delinquency. 2006;52:7-27). The big four include history of antisocial behavior, antisocial personality pattern, antisocial cognition, and antisocial attitudes. “These are the factors that certain cognitive-behavioral therapy approaches try to address, in an effort to reduce those antisocial cognitive tendencies,” Dr. Pinals said. The other four risk factors include family or marital discord, poor school and/or work performance, few leisure or recreation activities, and substance misuse.

“You’ll notice that mental illness is not listed,” she said. “Mental illness is not considered a major driver of crime, although it might be considered a responsivity factor within this RNR paradigm. This means it’s important to address it because it may help people better respond to criminal justice supervision and thereby have an indirect effect in reducing criminal recidivism. For example, if somebody has a social anxiety disorder or agoraphobia and therefore can’t make their probation appointment, probation won’t be able to help them adhere to the terms of their probation conditions. So, we do have to treat the illnesses underlying responsivity to how the criminal justice system operates.”

To optimally serve this population, Dr. Pinals recommends that psychotherapists become familiar with the Sequential Intercept Model, which was first published in 2006. “It takes the premise that individuals move through the criminal legal system in logical steps, and if we could identify those with mental health or substance use conditions and redirect them out of the criminal legal system and into treatment, we could reduce the overall penetration of those individuals from the criminal legal system,” she said. “We know that individuals with mental illness are overrepresented in the criminal legal system.”

By understanding what happens when a patient is arrested, mental health professionals can foster communication that could facilitate treatment for their patients.

“It’s important that we remember that these are people who are going through a challenging time,” Dr. Pinals said. “Maybe we don’t like what they did. Maybe we don’t like that they were accused of committing some kind of crime. However, it is important to realize that they are patients, and we want them to achieve the best outcome, whatever setting they’re in, that continuity of care and communication across systems might be beneficial. It might reduce their chance of returning to the criminal system and having other people victimized.”

copyright/Kuzma/iStockphoto

Mental health services vary across jails and prisons, she continued, but they are generally required to be commensurate with community standards.

“Of course, that’s often fraught with complexity and may not be available in particular jurisdictions” she said. Prisons, unlike local county jails, tend to have more levels of outpatient care, including inpatient, outpatient, and residential services. “Persons with mental illness can be moved in and out of these levels of care as needed,” Dr. Pinals said. “However, persons with mental illness can be at more risk for disciplinary infractions, especially if they’re not able to follow directions or if they’re psychotic or manic.”

Reentry creates certain risks to be mindful of, including social isolation, recurrent symptoms, problems acquiring medications and housing, suicide, violence, and a return to substance use. A reentry approach she recommended is the APIC model, which stands for Assess, Plan, Identify, and Coordinate. “That means individuals approaching release should be screened and assessed for their needs with a plan to meet the needs, identify critical periods and needed policies, and coordinate across systems,” Dr. Pinals said. “So, if you get a call as an outpatient provider from the reentry coordinator at a local jail trying to help you coordinate a patient’s reentry, that’s something to pay attention to.”

When first meeting with patients after a criminal justice experience, Dr. Pinals recommends asking them to discuss their arrest and criminal justice experience, and to address any emerging psychiatric or clinical issues, including trauma and adjustment associated with the arrests, incarceration, and legal processes. “The risks of rearrest are higher for those who have already touched the criminal justice system, so we want to help minimize that risk of rearrest,” she said.

Some clinics won’t allow patients with a criminal record to return, “which means you have to help potentially find alternative places for them to be seen,” she noted. “You may want to consult a specialist if you have doubts about your capacity to work with the patient. You also want to support staff who might have concerns about how to continue to treat this patient and you want to advocate for the patient’s needs and help them return to a stable treatment setting.”

Dr. Pinals concluded her presentation by underscoring the importance of delivering treatment services that are trauma informed. “There are high levels of trauma for those receiving care in psychiatric settings and among those who have spent time in jails and prisons,” she said. “We want to be sensitive to the fact that any of our patients who were involved in the criminal legal system might have a strong trauma history. Help instill a sense of safety and community, and hold hope for positive change.”

She reported consulting to jurisdictions and attorneys pertaining to behavioral health and justice, and forensic psychiatry. She reported having no relevant commercial financial disclosures.

[email protected]

One of the greatest challenges psychotherapists face when working with justice-involved outpatients is a lack of familiarity with the criminal legal system, according to Debra A. Pinals, MD.

“It’s certainly nothing we learned about in medical school or in our mental health training, per se,” said Dr. Pinals, director of the program in psychiatry, law, and ethics at the University of Michigan, Ann Arbor, during an annual psychopharmacology update held by the Nevada Psychiatric Association.

“Another challenge is a lack of comfort with some patient personality styles, particularly those with antisocial personality styles,” she said. “We may have countertransference issues that emerge in our work with this population. That can lead to concerns about our own safety, which may at times be reasonable but often because of stereotypes often becomes of mythical proportion. The population is a high-demand population with limited resources, usually tapping public mental health services. That becomes a challenge as well. And there can be burnout when the challenges of our patient population exceed our capacity.”

Despite such obstacles, Dr. Pinals described the outpatient treatment of individuals involved in the criminal justice system as exciting, interesting, and intellectually challenging. But she acknowledged the role that stigma and fear can play.

“Though there are some unique challenges, the benefits of working with criminal justice–involved persons with serious mental illness are often not discussed,” Dr. Pinals said. “There is a tendency to overvalue the risk they may present without really looking at the specific nuances that would be involved in conducting true risk assessments and understanding that not all of these patients will be as risky as we might believe due to stigma and fear.”

Separate from how patients with criminal histories may be perceived in clinical settings. There is much to learn about the role of mental illness in crime. In a 2014 study, researchers reviewed the records of criminal arrests in 143 people with mental illness and tried to discern whether the crime itself was completely independent or completely directly connected to the symptoms of mental illness the individual was experiencing. They found that 65% were completely independent of mental illness symptoms while 8% were directly related to mental illness symptoms.

“This means that as clinicians working with outpatients, we have to understand the whole person, and what might be going on in their lives that leads them down this criminal pathway,” said Dr. Pinals, who is also a clinical professor of psychiatry at the medical school.

According to the risk-need-responsivity (RNR) paradigm, eight criminogenic risk factors are associated with recurrent involvement in the criminal legal system (Crime & Delinquency. 2006;52:7-27). The big four include history of antisocial behavior, antisocial personality pattern, antisocial cognition, and antisocial attitudes. “These are the factors that certain cognitive-behavioral therapy approaches try to address, in an effort to reduce those antisocial cognitive tendencies,” Dr. Pinals said. The other four risk factors include family or marital discord, poor school and/or work performance, few leisure or recreation activities, and substance misuse.

“You’ll notice that mental illness is not listed,” she said. “Mental illness is not considered a major driver of crime, although it might be considered a responsivity factor within this RNR paradigm. This means it’s important to address it because it may help people better respond to criminal justice supervision and thereby have an indirect effect in reducing criminal recidivism. For example, if somebody has a social anxiety disorder or agoraphobia and therefore can’t make their probation appointment, probation won’t be able to help them adhere to the terms of their probation conditions. So, we do have to treat the illnesses underlying responsivity to how the criminal justice system operates.”

To optimally serve this population, Dr. Pinals recommends that psychotherapists become familiar with the Sequential Intercept Model, which was first published in 2006. “It takes the premise that individuals move through the criminal legal system in logical steps, and if we could identify those with mental health or substance use conditions and redirect them out of the criminal legal system and into treatment, we could reduce the overall penetration of those individuals from the criminal legal system,” she said. “We know that individuals with mental illness are overrepresented in the criminal legal system.”

By understanding what happens when a patient is arrested, mental health professionals can foster communication that could facilitate treatment for their patients.

“It’s important that we remember that these are people who are going through a challenging time,” Dr. Pinals said. “Maybe we don’t like what they did. Maybe we don’t like that they were accused of committing some kind of crime. However, it is important to realize that they are patients, and we want them to achieve the best outcome, whatever setting they’re in, that continuity of care and communication across systems might be beneficial. It might reduce their chance of returning to the criminal system and having other people victimized.”

copyright/Kuzma/iStockphoto

Mental health services vary across jails and prisons, she continued, but they are generally required to be commensurate with community standards.

“Of course, that’s often fraught with complexity and may not be available in particular jurisdictions” she said. Prisons, unlike local county jails, tend to have more levels of outpatient care, including inpatient, outpatient, and residential services. “Persons with mental illness can be moved in and out of these levels of care as needed,” Dr. Pinals said. “However, persons with mental illness can be at more risk for disciplinary infractions, especially if they’re not able to follow directions or if they’re psychotic or manic.”

Reentry creates certain risks to be mindful of, including social isolation, recurrent symptoms, problems acquiring medications and housing, suicide, violence, and a return to substance use. A reentry approach she recommended is the APIC model, which stands for Assess, Plan, Identify, and Coordinate. “That means individuals approaching release should be screened and assessed for their needs with a plan to meet the needs, identify critical periods and needed policies, and coordinate across systems,” Dr. Pinals said. “So, if you get a call as an outpatient provider from the reentry coordinator at a local jail trying to help you coordinate a patient’s reentry, that’s something to pay attention to.”

When first meeting with patients after a criminal justice experience, Dr. Pinals recommends asking them to discuss their arrest and criminal justice experience, and to address any emerging psychiatric or clinical issues, including trauma and adjustment associated with the arrests, incarceration, and legal processes. “The risks of rearrest are higher for those who have already touched the criminal justice system, so we want to help minimize that risk of rearrest,” she said.

Some clinics won’t allow patients with a criminal record to return, “which means you have to help potentially find alternative places for them to be seen,” she noted. “You may want to consult a specialist if you have doubts about your capacity to work with the patient. You also want to support staff who might have concerns about how to continue to treat this patient and you want to advocate for the patient’s needs and help them return to a stable treatment setting.”

Dr. Pinals concluded her presentation by underscoring the importance of delivering treatment services that are trauma informed. “There are high levels of trauma for those receiving care in psychiatric settings and among those who have spent time in jails and prisons,” she said. “We want to be sensitive to the fact that any of our patients who were involved in the criminal legal system might have a strong trauma history. Help instill a sense of safety and community, and hold hope for positive change.”

She reported consulting to jurisdictions and attorneys pertaining to behavioral health and justice, and forensic psychiatry. She reported having no relevant commercial financial disclosures.

[email protected]

For patients with myelodysplastic syndromes (MDS), allogeneic stem cell transplantation (SCT) is currently the only curative treatment, however, is associated with risk of transplant-related mortality, as well as relapse. Reduced intensity conditioning (RIC) regimens may decrease toxicity yet there may be increased risk of relapse compared to myeloablative conditioning (MAC) regimens. In an analysis of MDS patients enrolled on the BMT CTN 0901 study, which was a phase III randomized clinical trial comparing outcomes by conditioning intensity prior to allogeneic stem cell transplantation in adult patients with myeloid malignancy, 42% of patients had detectable mutations in a set of 10 genes prior to conditioning with RIC or MAC. Presence of mutations prior to conditioning was associated with increased risk of relapse (3 year relapse, 40% vs 11%, p=0.022) and decreased overall survival (3 year OS 55% vs 79%, p=0.045). Among those with detectable mutations, receiving RIC had higher relapse rates (3 year relapse 75% vs 17%, p=0.003) and lower relapse-free survival (3 year RFS 13% vs 49%, p=0.003) compared to receiving MAC, although there was no difference in overall survival. Further investigation is warranted given small sample size of MDS patients, however, there may be benefit of considering MAC conditioning in MDS patients with detectable mutations prior to conditioning for allogeneic SCT.

TP53 mutations are found in 10-20% of patients with MDS and confer worse outcomes. Eprenetapopt (APR-246) is a small molecule inhibitor that stabilizes mutant p53 and induces apoptosis in TP53-mutant cells. In a phase Ib/II study of eprenatapopt combined with azacitidine in patients with TP53-mutatnt MDS or acute myeloid leukemia (AML), overall response in MDS patients (n=40) was 73%, with 50% achieving complete remission and 58% achieving a cytogenetic response. Median overall survival was 10.8 months, and no dose limiting toxicities were observed. Despite the promising early trial results, the phase 3 clinical trial evaluating eprenetapopt with azacitidine compared to azacitidine in MDS patients with TP53 mutation did not meet the primary endpoint of complete remission rate (33.3% vs 22.4%, p=0.13) (Aprea Press Release, 12/28/2020). Further results including secondary endpoints from the phase 3 trial will be reported in the future. 

For patients with myelodysplastic syndromes (MDS), allogeneic stem cell transplantation (SCT) is currently the only curative treatment, however, is associated with risk of transplant-related mortality, as well as relapse. Reduced intensity conditioning (RIC) regimens may decrease toxicity yet there may be increased risk of relapse compared to myeloablative conditioning (MAC) regimens. In an analysis of MDS patients enrolled on the BMT CTN 0901 study, which was a phase III randomized clinical trial comparing outcomes by conditioning intensity prior to allogeneic stem cell transplantation in adult patients with myeloid malignancy, 42% of patients had detectable mutations in a set of 10 genes prior to conditioning with RIC or MAC. Presence of mutations prior to conditioning was associated with increased risk of relapse (3 year relapse, 40% vs 11%, p=0.022) and decreased overall survival (3 year OS 55% vs 79%, p=0.045). Among those with detectable mutations, receiving RIC had higher relapse rates (3 year relapse 75% vs 17%, p=0.003) and lower relapse-free survival (3 year RFS 13% vs 49%, p=0.003) compared to receiving MAC, although there was no difference in overall survival. Further investigation is warranted given small sample size of MDS patients, however, there may be benefit of considering MAC conditioning in MDS patients with detectable mutations prior to conditioning for allogeneic SCT.

TP53 mutations are found in 10-20% of patients with MDS and confer worse outcomes. Eprenetapopt (APR-246) is a small molecule inhibitor that stabilizes mutant p53 and induces apoptosis in TP53-mutant cells. In a phase Ib/II study of eprenatapopt combined with azacitidine in patients with TP53-mutatnt MDS or acute myeloid leukemia (AML), overall response in MDS patients (n=40) was 73%, with 50% achieving complete remission and 58% achieving a cytogenetic response. Median overall survival was 10.8 months, and no dose limiting toxicities were observed. Despite the promising early trial results, the phase 3 clinical trial evaluating eprenetapopt with azacitidine compared to azacitidine in MDS patients with TP53 mutation did not meet the primary endpoint of complete remission rate (33.3% vs 22.4%, p=0.13) (Aprea Press Release, 12/28/2020). Further results including secondary endpoints from the phase 3 trial will be reported in the future. 

For patients with myelodysplastic syndromes (MDS), allogeneic stem cell transplantation (SCT) is currently the only curative treatment, however, is associated with risk of transplant-related mortality, as well as relapse. Reduced intensity conditioning (RIC) regimens may decrease toxicity yet there may be increased risk of relapse compared to myeloablative conditioning (MAC) regimens. In an analysis of MDS patients enrolled on the BMT CTN 0901 study, which was a phase III randomized clinical trial comparing outcomes by conditioning intensity prior to allogeneic stem cell transplantation in adult patients with myeloid malignancy, 42% of patients had detectable mutations in a set of 10 genes prior to conditioning with RIC or MAC. Presence of mutations prior to conditioning was associated with increased risk of relapse (3 year relapse, 40% vs 11%, p=0.022) and decreased overall survival (3 year OS 55% vs 79%, p=0.045). Among those with detectable mutations, receiving RIC had higher relapse rates (3 year relapse 75% vs 17%, p=0.003) and lower relapse-free survival (3 year RFS 13% vs 49%, p=0.003) compared to receiving MAC, although there was no difference in overall survival. Further investigation is warranted given small sample size of MDS patients, however, there may be benefit of considering MAC conditioning in MDS patients with detectable mutations prior to conditioning for allogeneic SCT.

TP53 mutations are found in 10-20% of patients with MDS and confer worse outcomes. Eprenetapopt (APR-246) is a small molecule inhibitor that stabilizes mutant p53 and induces apoptosis in TP53-mutant cells. In a phase Ib/II study of eprenatapopt combined with azacitidine in patients with TP53-mutatnt MDS or acute myeloid leukemia (AML), overall response in MDS patients (n=40) was 73%, with 50% achieving complete remission and 58% achieving a cytogenetic response. Median overall survival was 10.8 months, and no dose limiting toxicities were observed. Despite the promising early trial results, the phase 3 clinical trial evaluating eprenetapopt with azacitidine compared to azacitidine in MDS patients with TP53 mutation did not meet the primary endpoint of complete remission rate (33.3% vs 22.4%, p=0.13) (Aprea Press Release, 12/28/2020). Further results including secondary endpoints from the phase 3 trial will be reported in the future. 

Key clinical point: High fibrinogen-albumin ratio index (FARI) is associated with shorter overall survival (OS) in patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) treated with azacitidine.

Major finding: One-year OS was significantly shorter in patients with high (at or above 0.079) vs. low (less than 0.079) FARI (35.6% vs. 77.5%; P less than .001).

Study details: Findings are from a retrospective study of 99 patients with de novo MDS (n=86) and AML-MRC (n=13) treated with azacitidine between May 2011 and June 2019.

Disclosures: The authors did not report any source of funding. The authors declared no potential competing interests.

Source: Akimoto M et al. Ann Hematol. 2021 Feb 1. doi: 10.1007/s00277-021-04440-z.

Key clinical point: High fibrinogen-albumin ratio index (FARI) is associated with shorter overall survival (OS) in patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) treated with azacitidine.

Major finding: One-year OS was significantly shorter in patients with high (at or above 0.079) vs. low (less than 0.079) FARI (35.6% vs. 77.5%; P less than .001).

Study details: Findings are from a retrospective study of 99 patients with de novo MDS (n=86) and AML-MRC (n=13) treated with azacitidine between May 2011 and June 2019.

Disclosures: The authors did not report any source of funding. The authors declared no potential competing interests.

Source: Akimoto M et al. Ann Hematol. 2021 Feb 1. doi: 10.1007/s00277-021-04440-z.

Key clinical point: High fibrinogen-albumin ratio index (FARI) is associated with shorter overall survival (OS) in patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) treated with azacitidine.

Major finding: One-year OS was significantly shorter in patients with high (at or above 0.079) vs. low (less than 0.079) FARI (35.6% vs. 77.5%; P less than .001).

Study details: Findings are from a retrospective study of 99 patients with de novo MDS (n=86) and AML-MRC (n=13) treated with azacitidine between May 2011 and June 2019.

Disclosures: The authors did not report any source of funding. The authors declared no potential competing interests.

Source: Akimoto M et al. Ann Hematol. 2021 Feb 1. doi: 10.1007/s00277-021-04440-z.

Key clinical point: Reduced-dose decitabine (DAC) could have a better response than reduced-dose azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) with different prognostic risks.

Major finding: Overall response rate (ORR) was higher in the DAC (62.5%) than AZA (42.1%) group (P = .007). Incidences of neutropenia (P = .016) and infections (P = .032) were higher in the DAC vs. AZA group.

Study details: Findings are from a retrospective study of 158 patients with MDS with varied prognostic risks who were administered reduced-dose of AZA (n=38) or DAC (n=120). Included patients received these hypomethylating agents for the first time between May 2006 and February 2020 and could not tolerate the standard doses.

Disclosures: The study was funded by the National Science and Technology Major Project of China. The authors declared no competing interests.

Source: Hu N et al. Med Sci Monit. 2021 Jan 30. doi: 10.12659/MSM.928454.

Key clinical point: Reduced-dose decitabine (DAC) could have a better response than reduced-dose azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) with different prognostic risks.

Major finding: Overall response rate (ORR) was higher in the DAC (62.5%) than AZA (42.1%) group (P = .007). Incidences of neutropenia (P = .016) and infections (P = .032) were higher in the DAC vs. AZA group.

Study details: Findings are from a retrospective study of 158 patients with MDS with varied prognostic risks who were administered reduced-dose of AZA (n=38) or DAC (n=120). Included patients received these hypomethylating agents for the first time between May 2006 and February 2020 and could not tolerate the standard doses.

Disclosures: The study was funded by the National Science and Technology Major Project of China. The authors declared no competing interests.

Source: Hu N et al. Med Sci Monit. 2021 Jan 30. doi: 10.12659/MSM.928454.

Key clinical point: Reduced-dose decitabine (DAC) could have a better response than reduced-dose azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) with different prognostic risks.

Major finding: Overall response rate (ORR) was higher in the DAC (62.5%) than AZA (42.1%) group (P = .007). Incidences of neutropenia (P = .016) and infections (P = .032) were higher in the DAC vs. AZA group.

Study details: Findings are from a retrospective study of 158 patients with MDS with varied prognostic risks who were administered reduced-dose of AZA (n=38) or DAC (n=120). Included patients received these hypomethylating agents for the first time between May 2006 and February 2020 and could not tolerate the standard doses.

Disclosures: The study was funded by the National Science and Technology Major Project of China. The authors declared no competing interests.

Source: Hu N et al. Med Sci Monit. 2021 Jan 30. doi: 10.12659/MSM.928454.

Key clinical point: Daratumumab provided some clinical activity in patients with low- to intermediate-risk myelodysplastic syndromes (MDS), who relapsed or were refractory to erythropoiesis-stimulating agents (ESA) treatment. No new safety signals were identified.

Major finding: Eight-week transfusion independence (TI) was achieved by 6.1% (95% confidence interval, 0.7%-20.2%) of patients. Time to 8-week TI was 4–5 weeks after the first daratumumab infusion. Daratumumab-related adverse events were reported by 54.5% of patients, of whom 3 patients experienced 4 serious adverse events. Infusion-related reaction was observed, but none led to treatment discontinuation.

Study details: Findings are from a phase 2, randomized, open-label study involving 34 patients with low- or intermediate-1-risk MDS, who were transfusion dependent and who relapsed or were refractory to ESA treatment. Patients received either daratumumab (n=33) or talacotuzumab (n=1); however, recruitment to talacotuzumab arm was closed after the occurrence of a serious adverse event in the first patient.

Disclosures: This study was supported by Janssen Research & Development. The lead author reported receiving research support from Johnson & Johnson. Some of the coinvestigators reported owning stocks, being an employee, serving on an advisory board, receiving support, and consulting for various pharmaceutical companies including Janssen Research & Development. Six of the coinvestigators declared no potential competing interests.

Source: Garcia‐Manero G et al. Am J Hematol. 2021 Jan 15. doi: 10.1002/ajh.26095.

Key clinical point: Daratumumab provided some clinical activity in patients with low- to intermediate-risk myelodysplastic syndromes (MDS), who relapsed or were refractory to erythropoiesis-stimulating agents (ESA) treatment. No new safety signals were identified.

Major finding: Eight-week transfusion independence (TI) was achieved by 6.1% (95% confidence interval, 0.7%-20.2%) of patients. Time to 8-week TI was 4–5 weeks after the first daratumumab infusion. Daratumumab-related adverse events were reported by 54.5% of patients, of whom 3 patients experienced 4 serious adverse events. Infusion-related reaction was observed, but none led to treatment discontinuation.

Study details: Findings are from a phase 2, randomized, open-label study involving 34 patients with low- or intermediate-1-risk MDS, who were transfusion dependent and who relapsed or were refractory to ESA treatment. Patients received either daratumumab (n=33) or talacotuzumab (n=1); however, recruitment to talacotuzumab arm was closed after the occurrence of a serious adverse event in the first patient.

Disclosures: This study was supported by Janssen Research & Development. The lead author reported receiving research support from Johnson & Johnson. Some of the coinvestigators reported owning stocks, being an employee, serving on an advisory board, receiving support, and consulting for various pharmaceutical companies including Janssen Research & Development. Six of the coinvestigators declared no potential competing interests.

Source: Garcia‐Manero G et al. Am J Hematol. 2021 Jan 15. doi: 10.1002/ajh.26095.

Key clinical point: Daratumumab provided some clinical activity in patients with low- to intermediate-risk myelodysplastic syndromes (MDS), who relapsed or were refractory to erythropoiesis-stimulating agents (ESA) treatment. No new safety signals were identified.

Major finding: Eight-week transfusion independence (TI) was achieved by 6.1% (95% confidence interval, 0.7%-20.2%) of patients. Time to 8-week TI was 4–5 weeks after the first daratumumab infusion. Daratumumab-related adverse events were reported by 54.5% of patients, of whom 3 patients experienced 4 serious adverse events. Infusion-related reaction was observed, but none led to treatment discontinuation.

Study details: Findings are from a phase 2, randomized, open-label study involving 34 patients with low- or intermediate-1-risk MDS, who were transfusion dependent and who relapsed or were refractory to ESA treatment. Patients received either daratumumab (n=33) or talacotuzumab (n=1); however, recruitment to talacotuzumab arm was closed after the occurrence of a serious adverse event in the first patient.

Disclosures: This study was supported by Janssen Research & Development. The lead author reported receiving research support from Johnson & Johnson. Some of the coinvestigators reported owning stocks, being an employee, serving on an advisory board, receiving support, and consulting for various pharmaceutical companies including Janssen Research & Development. Six of the coinvestigators declared no potential competing interests.

Source: Garcia‐Manero G et al. Am J Hematol. 2021 Jan 15. doi: 10.1002/ajh.26095.

Key clinical point: A myeloablative, fractionated busulfan (f-Bu) regimen reduces relapse and boosts survival without increasing nonrelapse mortality (NRM) in older patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).

Major finding: At 2 years, the f-Bu group had a significantly better progression-free survival than the nonfractionated, lower dose busalfan (Bu) group (45% vs 24%; hazard ratio [HR], 0.6; P = .004), attributed to a significant reduction in progression (34% vs 59%; HR, 0.5; P = .003) without an increase in NRM (21% vs 15%; HR, 1.4; P = .3). Overall survival also improved in the f-Bu group vs the Bu group (51% vs 31%, HR, 0.6; P = .01).

Study details: In an open-label, phase 2 trial, patients with AML or MDS were randomly assigned to either myeloablative f-Bu over 2 weeks (n = 84; median age, 65 years) or a standard Bu regimen over 4 days (n = 78; median age, 66 years).

Disclosures: This study was supported in part by a grant from the National Cancer Institute. Q Bashir, C Hosing, K Rezvani and UR Popat reported relationships with various pharmaceutical companies and/or research organizations. The remaining authors declared no conflicts of interest.

Source: Oran B et al. Cancer. 2021 Jan 20. doi: 10.1002/cncr.33383

Key clinical point: A myeloablative, fractionated busulfan (f-Bu) regimen reduces relapse and boosts survival without increasing nonrelapse mortality (NRM) in older patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).

Major finding: At 2 years, the f-Bu group had a significantly better progression-free survival than the nonfractionated, lower dose busalfan (Bu) group (45% vs 24%; hazard ratio [HR], 0.6; P = .004), attributed to a significant reduction in progression (34% vs 59%; HR, 0.5; P = .003) without an increase in NRM (21% vs 15%; HR, 1.4; P = .3). Overall survival also improved in the f-Bu group vs the Bu group (51% vs 31%, HR, 0.6; P = .01).

Study details: In an open-label, phase 2 trial, patients with AML or MDS were randomly assigned to either myeloablative f-Bu over 2 weeks (n = 84; median age, 65 years) or a standard Bu regimen over 4 days (n = 78; median age, 66 years).

Disclosures: This study was supported in part by a grant from the National Cancer Institute. Q Bashir, C Hosing, K Rezvani and UR Popat reported relationships with various pharmaceutical companies and/or research organizations. The remaining authors declared no conflicts of interest.

Source: Oran B et al. Cancer. 2021 Jan 20. doi: 10.1002/cncr.33383

Key clinical point: A myeloablative, fractionated busulfan (f-Bu) regimen reduces relapse and boosts survival without increasing nonrelapse mortality (NRM) in older patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS).

Major finding: At 2 years, the f-Bu group had a significantly better progression-free survival than the nonfractionated, lower dose busalfan (Bu) group (45% vs 24%; hazard ratio [HR], 0.6; P = .004), attributed to a significant reduction in progression (34% vs 59%; HR, 0.5; P = .003) without an increase in NRM (21% vs 15%; HR, 1.4; P = .3). Overall survival also improved in the f-Bu group vs the Bu group (51% vs 31%, HR, 0.6; P = .01).

Study details: In an open-label, phase 2 trial, patients with AML or MDS were randomly assigned to either myeloablative f-Bu over 2 weeks (n = 84; median age, 65 years) or a standard Bu regimen over 4 days (n = 78; median age, 66 years).

Disclosures: This study was supported in part by a grant from the National Cancer Institute. Q Bashir, C Hosing, K Rezvani and UR Popat reported relationships with various pharmaceutical companies and/or research organizations. The remaining authors declared no conflicts of interest.

Source: Oran B et al. Cancer. 2021 Jan 20. doi: 10.1002/cncr.33383

Key clinical point: Baseline and serial molecular profiling by next-generation sequencing (NGS) can predict outcomes with hypomethylating agents (HMAs) in myelodysplastic syndromes (MDS). Serial molecular profiling during therapy of patients with mutant TP53 can identify patients who may benefit from allogeneic transplantation.

Major finding: Mutations in TET2 and ASXL1 genes emerged as the most informative variables associated with response to HMA therapy (overall response rate, 62.1%; complete remission rate, 34.5%). The number of mutations detected by NGS (hazard ratio [HR], 1.22; P = .02) and mutations in TP53 (HR, 2.33; P = .001) and EZH2 (HR, 2.41; P = .04) were independent covariates associated with inferior overall survival (OS). Serial molecular profiling demonstrated that clearance of TP53 mutations during HMA therapy was associated with superior OS (HR, 0.28; P = .001) and improved outcome in patients proceeding to allogeneic transplantation.

Study details: This study evaluated response and OS in 247 patients molecularly profiled by NGS before first-line HMA therapy; a subset of 108 patients were sequenced serially during treatment.

Disclosures: This study was supported in part by the S Foundation Young Investigator Grant, the Early Career Award of the Dresner Foundation, and the Edward P. Evans Foundation Award. DA Sallman, E Padron, and AF List received research funding from Celgene. The remaining authors declared no conflicts of interest.

Source: Hunter AM et al. Blood Adv. 2021 Feb 23. doi: 10.1182/bloodadvances.2020003508.

Key clinical point: Baseline and serial molecular profiling by next-generation sequencing (NGS) can predict outcomes with hypomethylating agents (HMAs) in myelodysplastic syndromes (MDS). Serial molecular profiling during therapy of patients with mutant TP53 can identify patients who may benefit from allogeneic transplantation.

Major finding: Mutations in TET2 and ASXL1 genes emerged as the most informative variables associated with response to HMA therapy (overall response rate, 62.1%; complete remission rate, 34.5%). The number of mutations detected by NGS (hazard ratio [HR], 1.22; P = .02) and mutations in TP53 (HR, 2.33; P = .001) and EZH2 (HR, 2.41; P = .04) were independent covariates associated with inferior overall survival (OS). Serial molecular profiling demonstrated that clearance of TP53 mutations during HMA therapy was associated with superior OS (HR, 0.28; P = .001) and improved outcome in patients proceeding to allogeneic transplantation.

Study details: This study evaluated response and OS in 247 patients molecularly profiled by NGS before first-line HMA therapy; a subset of 108 patients were sequenced serially during treatment.

Disclosures: This study was supported in part by the S Foundation Young Investigator Grant, the Early Career Award of the Dresner Foundation, and the Edward P. Evans Foundation Award. DA Sallman, E Padron, and AF List received research funding from Celgene. The remaining authors declared no conflicts of interest.

Source: Hunter AM et al. Blood Adv. 2021 Feb 23. doi: 10.1182/bloodadvances.2020003508.

Key clinical point: Baseline and serial molecular profiling by next-generation sequencing (NGS) can predict outcomes with hypomethylating agents (HMAs) in myelodysplastic syndromes (MDS). Serial molecular profiling during therapy of patients with mutant TP53 can identify patients who may benefit from allogeneic transplantation.

Major finding: Mutations in TET2 and ASXL1 genes emerged as the most informative variables associated with response to HMA therapy (overall response rate, 62.1%; complete remission rate, 34.5%). The number of mutations detected by NGS (hazard ratio [HR], 1.22; P = .02) and mutations in TP53 (HR, 2.33; P = .001) and EZH2 (HR, 2.41; P = .04) were independent covariates associated with inferior overall survival (OS). Serial molecular profiling demonstrated that clearance of TP53 mutations during HMA therapy was associated with superior OS (HR, 0.28; P = .001) and improved outcome in patients proceeding to allogeneic transplantation.

Study details: This study evaluated response and OS in 247 patients molecularly profiled by NGS before first-line HMA therapy; a subset of 108 patients were sequenced serially during treatment.

Disclosures: This study was supported in part by the S Foundation Young Investigator Grant, the Early Career Award of the Dresner Foundation, and the Edward P. Evans Foundation Award. DA Sallman, E Padron, and AF List received research funding from Celgene. The remaining authors declared no conflicts of interest.

Source: Hunter AM et al. Blood Adv. 2021 Feb 23. doi: 10.1182/bloodadvances.2020003508.

Key clinical point: Dysregulated erythroferrone (ERFE) expression in CD71⁺ erythroid progenitors is associated with myelodysplastic syndromes (MDS) outcome and predicts patient survival independently of International Prognostic Scoring System (IPSS) stratification.

Major finding: The expression of ERFE was significantly higher in CD71⁺ cells of MDS patients vs. healthy donors group (median normalized mean fold change, 2.42 vs. 0.78). Elevated expression of ERFE in erythroid progenitors was associated with superior survival (hazard ratio, 0.35; P = .0017) independently of IPSS stratification. For growth/differentiation factor 15, the result was similar, but not statistically significant (P = .0543).

Study details: The data come from a study of 111 patients with MDS (median age, 73 years; 66.7% males).

Disclosures: This study was supported by funds of the Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Riabov V et al. Br J Haematol. 2021 Jan 24. doi: 10.1111/bjh.17314.

Key clinical point: Dysregulated erythroferrone (ERFE) expression in CD71⁺ erythroid progenitors is associated with myelodysplastic syndromes (MDS) outcome and predicts patient survival independently of International Prognostic Scoring System (IPSS) stratification.

Major finding: The expression of ERFE was significantly higher in CD71⁺ cells of MDS patients vs. healthy donors group (median normalized mean fold change, 2.42 vs. 0.78). Elevated expression of ERFE in erythroid progenitors was associated with superior survival (hazard ratio, 0.35; P = .0017) independently of IPSS stratification. For growth/differentiation factor 15, the result was similar, but not statistically significant (P = .0543).

Study details: The data come from a study of 111 patients with MDS (median age, 73 years; 66.7% males).

Disclosures: This study was supported by funds of the Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Riabov V et al. Br J Haematol. 2021 Jan 24. doi: 10.1111/bjh.17314.

Key clinical point: Dysregulated erythroferrone (ERFE) expression in CD71⁺ erythroid progenitors is associated with myelodysplastic syndromes (MDS) outcome and predicts patient survival independently of International Prognostic Scoring System (IPSS) stratification.

Major finding: The expression of ERFE was significantly higher in CD71⁺ cells of MDS patients vs. healthy donors group (median normalized mean fold change, 2.42 vs. 0.78). Elevated expression of ERFE in erythroid progenitors was associated with superior survival (hazard ratio, 0.35; P = .0017) independently of IPSS stratification. For growth/differentiation factor 15, the result was similar, but not statistically significant (P = .0543).

Study details: The data come from a study of 111 patients with MDS (median age, 73 years; 66.7% males).

Disclosures: This study was supported by funds of the Deutsche Forschungsgemeinschaft. The authors declared no conflicts of interest.

Source: Riabov V et al. Br J Haematol. 2021 Jan 24. doi: 10.1111/bjh.17314.

Key clinical point: A novel risk scoring system termed 'mutation combined with revised international prognostic scoring system (MIPSS-R)' was more effective in predicting prognosis and guiding treatment in patients with myelodysplastic syndromes (MDS) than the revised international prognostic scoring system (IPSS-R).

Major finding: Kaplan-Meier survival curves demonstrated superiority of MIPSS-R over IPSS-R in separating patients from different groups in the training cohort (P = 1.71e-08 vs P = 1.363e-04) and in the validation cohort (P = 1.788e-04 vs P = 2.757e-03). Area under the receiver operating characteristic of MIPSS-R was 0.79 in the training cohort and 0.62 in the validation cohort.

Study details: MIPSS-R was developed by integrating IPSS-R and the mutation scores. MIPSS-R was further compared with IPSS-R in a training cohort of 63 MDS patients and a validation cohort of 141 MDS patients. 

Disclosures: The study was supported in part by The National Natural Science Foundation of China, Jiangsu Provincial Special Program of Medical Science, Jiangsu Province “333” project, The Fundamental Research Funds for the Central Universities, Milstein Medical Asian American Partnership Foundation Research Project Award in Hematology, and Key Medical of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gu S et al. BMC Cancer. 2021 Feb 6. doi: 10.1186/s12885-021-07864-y.

Key clinical point: A novel risk scoring system termed 'mutation combined with revised international prognostic scoring system (MIPSS-R)' was more effective in predicting prognosis and guiding treatment in patients with myelodysplastic syndromes (MDS) than the revised international prognostic scoring system (IPSS-R).

Major finding: Kaplan-Meier survival curves demonstrated superiority of MIPSS-R over IPSS-R in separating patients from different groups in the training cohort (P = 1.71e-08 vs P = 1.363e-04) and in the validation cohort (P = 1.788e-04 vs P = 2.757e-03). Area under the receiver operating characteristic of MIPSS-R was 0.79 in the training cohort and 0.62 in the validation cohort.

Study details: MIPSS-R was developed by integrating IPSS-R and the mutation scores. MIPSS-R was further compared with IPSS-R in a training cohort of 63 MDS patients and a validation cohort of 141 MDS patients. 

Disclosures: The study was supported in part by The National Natural Science Foundation of China, Jiangsu Provincial Special Program of Medical Science, Jiangsu Province “333” project, The Fundamental Research Funds for the Central Universities, Milstein Medical Asian American Partnership Foundation Research Project Award in Hematology, and Key Medical of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gu S et al. BMC Cancer. 2021 Feb 6. doi: 10.1186/s12885-021-07864-y.

Key clinical point: A novel risk scoring system termed 'mutation combined with revised international prognostic scoring system (MIPSS-R)' was more effective in predicting prognosis and guiding treatment in patients with myelodysplastic syndromes (MDS) than the revised international prognostic scoring system (IPSS-R).

Major finding: Kaplan-Meier survival curves demonstrated superiority of MIPSS-R over IPSS-R in separating patients from different groups in the training cohort (P = 1.71e-08 vs P = 1.363e-04) and in the validation cohort (P = 1.788e-04 vs P = 2.757e-03). Area under the receiver operating characteristic of MIPSS-R was 0.79 in the training cohort and 0.62 in the validation cohort.

Study details: MIPSS-R was developed by integrating IPSS-R and the mutation scores. MIPSS-R was further compared with IPSS-R in a training cohort of 63 MDS patients and a validation cohort of 141 MDS patients. 

Disclosures: The study was supported in part by The National Natural Science Foundation of China, Jiangsu Provincial Special Program of Medical Science, Jiangsu Province “333” project, The Fundamental Research Funds for the Central Universities, Milstein Medical Asian American Partnership Foundation Research Project Award in Hematology, and Key Medical of Jiangsu Province. The authors declared no conflicts of interest.

Source: Gu S et al. BMC Cancer. 2021 Feb 6. doi: 10.1186/s12885-021-07864-y.

Key clinical point: In patients with myelodysplastic syndrome (MDS) with less than 5% marrow myeloblasts and no leukemic myeloblasts in blood before allogeneic hematopoietic cell transplant (alloHCT), ultra-deep DNA sequencing for mutations in 10 gene regions previously shown to be high risk in acute myeloid leukemia could help identify which patients are likely to relapse after alloHCT.

Major finding: Twenty (42%) patients had mutations detectable before conditioning treatment. The presence of mutations within a previously identified set of 10 gene regions before alloHCT was associated with increased rates of relapse (3-year relapse, 75% vs. 17%; P = .003) and decreased relapse-free survival (RFS; 3-year RFS, 13% vs. 49%; P = .003) in patients with MDS who received reduced intensity conditioning (RIC) vs. myeloablative conditioning (MAC).

Study details: The researchers performed targeted error-corrected DNA sequencing on preconditioning blood samples from patients with MDS (n=48) from the Blood and Marrow Transplant Clinical Trials Network 0901 phase 3 trial before random assignment to MAC (n=25) or RIC (n=23) for alloHCT.

Disclosures: This study was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and by grants to the Blood and Marrow Transplant Clinical Trials Network from the NHLBI and the National Cancer Institute. The authors declared no conflicts of interest.

Source: Dillon LW et al. JCO Precis Oncol. 2021 Jan 25. doi: 10.1200/PO.20.00355.

Key clinical point: In patients with myelodysplastic syndrome (MDS) with less than 5% marrow myeloblasts and no leukemic myeloblasts in blood before allogeneic hematopoietic cell transplant (alloHCT), ultra-deep DNA sequencing for mutations in 10 gene regions previously shown to be high risk in acute myeloid leukemia could help identify which patients are likely to relapse after alloHCT.

Major finding: Twenty (42%) patients had mutations detectable before conditioning treatment. The presence of mutations within a previously identified set of 10 gene regions before alloHCT was associated with increased rates of relapse (3-year relapse, 75% vs. 17%; P = .003) and decreased relapse-free survival (RFS; 3-year RFS, 13% vs. 49%; P = .003) in patients with MDS who received reduced intensity conditioning (RIC) vs. myeloablative conditioning (MAC).

Study details: The researchers performed targeted error-corrected DNA sequencing on preconditioning blood samples from patients with MDS (n=48) from the Blood and Marrow Transplant Clinical Trials Network 0901 phase 3 trial before random assignment to MAC (n=25) or RIC (n=23) for alloHCT.

Disclosures: This study was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and by grants to the Blood and Marrow Transplant Clinical Trials Network from the NHLBI and the National Cancer Institute. The authors declared no conflicts of interest.

Source: Dillon LW et al. JCO Precis Oncol. 2021 Jan 25. doi: 10.1200/PO.20.00355.

Key clinical point: In patients with myelodysplastic syndrome (MDS) with less than 5% marrow myeloblasts and no leukemic myeloblasts in blood before allogeneic hematopoietic cell transplant (alloHCT), ultra-deep DNA sequencing for mutations in 10 gene regions previously shown to be high risk in acute myeloid leukemia could help identify which patients are likely to relapse after alloHCT.

Major finding: Twenty (42%) patients had mutations detectable before conditioning treatment. The presence of mutations within a previously identified set of 10 gene regions before alloHCT was associated with increased rates of relapse (3-year relapse, 75% vs. 17%; P = .003) and decreased relapse-free survival (RFS; 3-year RFS, 13% vs. 49%; P = .003) in patients with MDS who received reduced intensity conditioning (RIC) vs. myeloablative conditioning (MAC).

Study details: The researchers performed targeted error-corrected DNA sequencing on preconditioning blood samples from patients with MDS (n=48) from the Blood and Marrow Transplant Clinical Trials Network 0901 phase 3 trial before random assignment to MAC (n=25) or RIC (n=23) for alloHCT.

Disclosures: This study was supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and by grants to the Blood and Marrow Transplant Clinical Trials Network from the NHLBI and the National Cancer Institute. The authors declared no conflicts of interest.

Source: Dillon LW et al. JCO Precis Oncol. 2021 Jan 25. doi: 10.1200/PO.20.00355.