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Tyrosine kinase inhibitors (TKI) have changed the natural course of chronic myeloid leukemia (CML). With the advent of second-generation TKI safety and efficacy issues have gained interest. The randomized CML - Study IV was used for a long-term evaluation of imatinib (IM). 1503 patients have received IM, 1379 IM monotherapy. After a median observation of 7.1 years, 965 patients (64%) still received IM. At 10 years, progression-free survival was 82%, overall survival 84%, 59% achieved MR 5 , 72% MR 4.5 , 81% MR 4 , 89% major molecular remission and 92% MR 2 (molecular equivalent to complete cytogenetic remission). All response levels were reached faster with IM800 mg except MR 5 . Eight-year probabilities of adverse drug reactions (ADR) were 76%, of grades 3–4 22%, of non-hematologic 73%, and of hematologic 28%. More ADR were observed with IM800 mg and IM400 mg plus interferon α (IFN). Most patients had their first ADR early with decreasing frequency later on. No new late toxicity was observed. ADR to IM are frequent, but mostly mild and manageable, also with IM 800 mg and IM 400 mg+IFN. The deep molecular response rates indicate that most patients are candidates for IM discontinuation. After 10 years, IM continues to be an excellent initial choice for most patients with CML.

Disruption of intestinal microbial communities appears to underlie many human illnesses, but the mechanisms that promote this dysbiosis and its adverse consequences are poorly understood. In patients who received allogeneic hematopoietic cell transplantation (allo-HCT), we describe a high incidence of enterococcal expansion, which was associated with graft-versus-host disease (GVHD) and mortality. We found that Enterococcus also expands in the mouse gastrointestinal tract after allo-HCT and exacerbates disease severity in gnotobiotic models. Enterococcus growth is dependent on the disaccharide lactose, and dietary lactose depletion attenuates Enterococcus outgrowth and reduces the severity of GVHD in mice. Allo-HCT patients carrying lactose-nonabsorber genotypes showed compromised clearance of postantibiotic Enterococcus domination. We report lactose as a common nutrient that drives expansion of a commensal bacterium that exacerbates an intestinal and systemic inflammatory disease.

We aimed at demonstrating non-inferiority of bortezomib/cyclophosphamide/dexamethasone (VCD) compared to bortezomib/doxorubicin/dexamethasone (PAd) induction therapy with respect to very good partial response rates or better (⩾VGPR) in 504 newly diagnosed, transplant-eligible multiple myeloma patients. VCD was found to be non-inferior to PAd with respect to ⩾VGPR rates (37.0 versus 34.3%, P =0.001). The rates of progressive disease (PD) were 0.4% (VCD) versus 4.8% (PAd; P =0.003). In the PAd arm, 11 of 12 patients with PD had either renal impairment (creatinine ⩾2 mg/dl) at diagnosis or the cytogenetic abnormality gain 1q21, whereas no PD was observed in these subgroups in the VCD arm. Leukocytopenia/neutropenia (⩾3°) occurred more frequently in the VCD arm (35.2% versus 11.3%, P <0.001). Neuropathy rates (⩾2°) were higher in the PAd group (14.9 versus 8.4%, P =0.03). Serious adverse events, both overall and those related to thromboembolic events, were higher in the PAd group (32.7 versus 24.0%, P =0.04 and 2.8 versus 0.4%, P =0.04). Stem cell collection was not impeded by VCD. VCD is as effective as PAd in terms of achieving ⩾VGPR rates with fewer PD and has a favorable toxicity profile. Therefore, VCD is preferable to PAd as induction therapy.

Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD ( n =54, all grades III or IV) or SR-cGVHD ( n =41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1–7) and SR-cGVHD (1–10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3–90.7%, 95% confidence interval (CI)) and 97.4% (92.3–100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.

The high PET consume, mainly as bottles, associated with rapid disposal and high resistance to ambient conditions and biological degradation lead to accumulation in the enviromental, constituting a worrying scenario in world level. Chemical recycle PET by glycolysis is an important alternative, once bis(hydroxiethyl)terephthalate (BHET), high added value monomer, can be obtained. In this context, this study approaches the use of titanate nanotubes ( i.e . sodium/protonated titanate nanotubes) as catalyst for PET glycolysis. Reactional conditions, the origin and granulometry of PET flakes were evaluated (at 196 °C). Best results (BHET yield > 80%) were obtained for both catalyst in 3 h of reaction. The protonated titanate nanotubes catalyst were more efficient than sodium titanate nanotubes due to greater concentration of Brönsted and Lewis acid sites, indicated by TPD analyzes. Graphical Abstract

Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are highly susceptible to infections. The consequent use of masks on wards for allo-HSCT has been controversial in the past decades and was not common before the COVID-19 pandemic. We retrospectively compared incidence and outcomes of viral respiratory infections during allo-HSCT on our specialized ward between 01/2018 and 09/2020 to the era of FFP2 masking between 10/2020 and 10/2022 covering similar seasons of the year. Each group consisted of 150 matched patients. The usage of FFP2 masks reduced the incidence of viral respiratory infections from 20,7% to 2,0% (p < 0.001). This reduced the time on ward from a median of 26 days to 23.5 days (p = 0.002). It also resulted in less use of CT-scans (p = 0.003) and bronchoalveolar lavage procedures (p = 0.057). Median time to proof of infection was 21 days after admission in both groups. No difference was detected in progression free survival, hospital survival or non-relapse mortality (p = 0.78). Our retrospective results indicate that FFP2 masks worn by patients and hospital staff may help to significantly reduce the incidence of viral respiratory infections, including COVID-19, shorten the in-hospital time, and reduce costs without affecting survival.

Background Renal insufficiency is one of the most common complications in the treatment of multiple myeloma (MM). The administration of isatuximab showed improved patient outcome regarding the occurrence of renal insufficiency. Building on the results of the ICARIA-MM study, the aim of this study was to quantify the potential cost savings due to a prevented progress of renal insufficiency. Methods Real-life accounting data of the University Hospital Cologne (Germany) of inpatients with MM between 2016 and 2020 were analyzed regarding the presence of renal insufficiency. The health-economic impact of a less severe renal insufficiency due to improved renal filtration on German Diagnosis-Related Groups (G-DRG) tariffs was modelled. Results The analysis revealed a total of 74 hospital cases with MM. The vast majority ( n  = 64; 86.5%) were allocated to the G-DRG code R61, summarizing patients with “lymphoma and non-acute leukemia”. Based on a reduction of stage 3 renal failure to stage 2, the model showed cost saving potential in patients with acute renal failure ranging from € 3,101 to € 4,642 per case. Conclusion The analysis quantifies for the first time the economic saving potential of improved renal function in patients with relapsed/refractory multiple myeloma in the German healthcare system through the administration of isatuximab.