Lancet Haematology最新文献

{"title":"The impact of patient ethnicity on haematopoietic cell transplantation outcome: a retrospective cohort study on the UK experience.","authors":"Neema P Mayor, Richard M Szydlo, Yasmin Sheikh, Julia Lee, Rachel M Pearce, Caitlin Farrow, Michaela Agapiou, Kanchan Rao, Kim Orchard, Eduardo Olavarria, Steven G E Marsh, John A Snowden","doi":"10.1016/S2352-3026(24)00312-0","DOIUrl":"10.1016/S2352-3026(24)00312-0","url":null,"abstract":"<p><strong>Background: </strong>Patient ethnicity has been correlated with different outcomes after haematopoietic cell transplantation (HCT), with patients from minority ethnic backgrounds reported to have worse outcomes compared with White patients. To date, studies have been predominantly done in the USA, where health-care models are different to many European countries, including the UK. We aimed to evaluate the impact of patient-reported ethnicity on autologous and allogeneic HCT outcomes in the UK.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients who had autologous or allogeneic HCT between Jan 1, 2009, and Dec 31, 2019, and were registered in the British Society of Blood and Marrow Transplantation and Cellular Therapy patient registry were analysed as full cohorts and as separate adult (≥18 years) and paediatric (0-17·9 years) cohorts. Patient ethnicity was self-defined and grouped into four broad categories: Asian, Black, Other, and White. The outcome was 5-year overall survival, with overall survival defined as the time from transplantation to death from any cause.</p><p><strong>Findings: </strong>20 119 first autologous HCTs and 13 978 first allogeneic HCTs were analysed. Median times to follow-up were 60 months (IQR 35-89) for patients receiving autologous HCT and 32 months (10-68) for patients receiving allogeneic HCT. 5-year overall survival for the full allogeneic HCT cohort was 55% (95% CI 51-58). After adjustment for prognostic factors, Asian patients undergoing allogeneic HCT (n=1081) had significantly worse 5-year overall survival (hazard ratio [HR] 1·16 [95% CI 1·03-1·30], p=0·012) than White patients (n=11 705). Differences in overall survival between White (n=1489) and Asian patients (n=384) were most pronounced in paediatric patients (HR 1·67 [95% CI 1·28-2·19], p=0·00018). In the autologous HCT cohort, there were no associations between ethnicity and 5-year overall survival.</p><p><strong>Interpretation: </strong>This large UK-based analysis suggests significant variation in outcomes after allogeneic HCT between patients of different ethnicities. The causes are unclear, and further research to elucidate and improve these health inequalities is warranted.</p><p><strong>Funding: </strong>Anthony Nolan Charity and British Society of Blood and Marrow Transplantation and Cellular Therapy.</p>","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 12","pages":"e916-e926"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The story of my zebra.","authors":"Ariana Mihan","doi":"10.1016/S2352-3026(24)00311-9","DOIUrl":"10.1016/S2352-3026(24)00311-9","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":" ","pages":"e889-e890"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time trends in antithrombotic therapy during pregnancy and maternal and perinatal outcomes in the Netherlands (2013-19): a nationwide cohort study.","authors":"Qingui Chen, Nienke van Rein, Lisa Broeders, Saskia Middeldorp, Kitty W M Bloemenkamp, Suzanne C Cannegieter, Luuk J J Scheres","doi":"10.1016/S2352-3026(24)00313-2","DOIUrl":"https://doi.org/10.1016/S2352-3026(24)00313-2","url":null,"abstract":"<p><strong>Background: </strong>Considering the paucity of data, we aimed to describe nationwide time trends in antithrombotic therapy during pregnancy and risks of maternal and perinatal outcomes in the Netherlands.</p><p><strong>Methods: </strong>In this nationwide cohort study, all female individuals aged 16-45 years with delivery records in the Dutch perinatal registry between Jan 1, 2013, and Dec 31, 2019, and their infants, were included. Individually linked data from Statistics Netherlands on outpatient medication prescriptions, in-hospital diagnoses, and mortality were used to evaluate time trends in antithrombotic therapy during pregnancy, and risks of maternal and perinatal outcomes (including thromboembolism, bleeding, preeclampsia and eclampsia, and low birthweight).</p><p><strong>Findings: </strong>A total of 1 122 711 pregnancies and 1 139 116 infants were included (median maternal age 30·5 years [IQR 27·3-33·7]; 886 085 [78·9%] White; median gravidity 2 (IQR 1-3); and median gestational age at delivery 39 weeks [IQR 38-40]). Low-molecular-weight heparin (LMWH) was the most commonly (more than 99%) prescribed anticoagulants during pregnancy, which slightly increased from 0·7% (1063 of 163 479) in 2013 to 0·9% (1352 of 158 654) in 2019. LMWH was generally started at 5-8 weeks' gestation when oral anticoagulant prescriptions dropped. Antiplatelet drug prescriptions increased from 0·7% (1129 of 163 479) to 4·8% (7671 of 158 654), which primarily initiated around week 12. Maternal risks of venous and arterial thromboembolism and bleeding remained constant from 2013 to 2019; the risk of preeclampsia and eclampsia gradually increased from 1·70% (95% CI 1·63-1·76) in 2013 to 2·05% (1·98-2·13) in 2017, after which it decreased to 1·83% (1·77-1·90) in 2019. There was a significant decrease (2019 vs 2013) in low birthweight (adjusted odds ratio 0·92 [0·90-0·94]; p<0·0001), whereas 28-day neonatal bleeding risk remained unchanged.</p><p><strong>Interpretation: </strong>Exposure to anticoagulants during pregnancy is not uncommon, and health-care providers and female individuals of reproductive age should be mindful of this to avoid unintended oral anticoagulant exposure. Adhering to guidelines for aspirin use to prevent preeclampsia might lead to a population-level reduction in disease burden and potential improvement in neonatal prognosis.</p><p><strong>Funding: </strong>None.</p><p><strong>Translation: </strong>For the Dutch translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 12","pages":"e905-e915"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyone is a potential lifesaving stem cell donor.","authors":"The Lancet Haematology","doi":"10.1016/S2352-3026(24)00352-1","DOIUrl":"https://doi.org/10.1016/S2352-3026(24)00352-1","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 12","pages":"e879"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Haematol 2024; 11: e830-38.","authors":"","doi":"10.1016/S2352-3026(24)00340-5","DOIUrl":"10.1016/S2352-3026(24)00340-5","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":" ","pages":"e886"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Haematol 2024; 11: e580-92.","authors":"","doi":"10.1016/S2352-3026(24)00342-9","DOIUrl":"10.1016/S2352-3026(24)00342-9","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":" ","pages":"e886"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call to action: equitable comprehensive care for patients with sickle cell disease in the USA.","authors":"Onyebuchi Ononogbu, Modupe Idowu","doi":"10.1016/S2352-3026(24)00321-1","DOIUrl":"https://doi.org/10.1016/S2352-3026(24)00321-1","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 12","pages":"e887-e888"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health inequity has no boundaries.","authors":"Jeffery J Auletta","doi":"10.1016/S2352-3026(24)00316-8","DOIUrl":"https://doi.org/10.1016/S2352-3026(24)00316-8","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 12","pages":"e883-e884"},"PeriodicalIF":15.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron deficiency as a marker of inequality.","authors":"The Lancet Haematology","doi":"10.1016/S2352-3026(24)00318-1","DOIUrl":"https://doi.org/10.1016/S2352-3026(24)00318-1","url":null,"abstract":"","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":"11 11","pages":"e803"},"PeriodicalIF":15.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venetoclax plus decitabine as a bridge to allogeneic haematopoietic stem-cell transplantation in older patients with acute myeloid leukaemia (VEN-DEC GITMO): final report of a multicentre, single-arm, phase 2 trial.","authors":"Domenico Russo, Nicola Polverelli, Simona Bernardi, Stella Santarone, Mirko Farina, Erika Borlenghi, Francesco Onida, Luca Castagna, Stefania Bramanti, Angelo Michele Carella, Roberto Sorasio, Massimo Martino, Caterina Alati, Attilio Olivieri, Germana Beltrami, Antonio Curti, Calogero Vetro, Salvatore Leotta, Valentina Mancini, Elisabetta Terruzzi, Massimo Bernardi, Piero Galieni, Pellegrino Musto, Raffaella Cerretti, Luisa Giaccone, Cristina Skert, Vera Radici, Marika Vezzoli, Stefano Calza, Alessandro Leoni, Luca Garuffo, Cristian Bonvicini, Simone Pellizzeri, Michele Malagola, Fabio Ciceri","doi":"10.1016/S2352-3026(24)00241-2","DOIUrl":"10.1016/S2352-3026(24)00241-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Access to allogeneic haematopoietic stem-cell transplantation (HSCT) remains challenging for older patients (aged &gt;60 years) with acute myeloid leukaemia. We aimed to evaluate the efficacy of venetoclax plus decitabine as first-line therapy and bridge to transplantation in this patient population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicentre, single-arm, phase 2 trial was conducted in 20 Gruppo Italiano Trapianto Midollo Osseo (GITMO) centres in Italy. Patients aged ≥60 and &lt;75 years, with newly diagnosed acute myeloid leukaemia categorised as intermediate or high risk according to 2016 WHO and 2017 European LeukemiaNet, an ECOG performance status of less than 2, and considered fit for allogeneic HSCT were included. Patients received oral venetoclax with a 3-day ramp-up: 100 mg on day 1, 200 mg on day 2, and 400 mg once per day from day 3 of cycle one, and then every 28 days of each cycle (two to four in total). Decitabine was administered intravenously at a dose of 20 mg/m&lt;sup&gt;2&lt;/sup&gt; from days 1 to 5 every 28 days. At cycle one, patients were admitted to hospital for a minimum of 24 h, whereas subsequent cycles could be administered on an outpatient basis. Two additional cycles were allowed while waiting for allogeneic HSCT or for those with no response or partial response after cycle two. The primary endpoint was the proportion of patients who had allogeneic HSCT performed during first complete remission, assessed in all patients who received at least one dose of the study medication. This study was registered with ClinicalTrials.gov (NCT04476199, ongoing) and EudraCT (2020-002297-26).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Between June 1, 2021, and Dec 30, 2022, 93 patients were enrolled and started venetoclax plus decitabine induction (44 [47%] at intermediate risk and 49 [53%] at high risk). The median age was 68·5 (IQR 60·3-74·7). All 93 participants were White, of whom 43 (46%) were female and 50 (54%) were male. The median follow-up was 236 days (IQR 121-506). 64 (69%) of 93 patients reached complete remission and 53 (57%) underwent allogeneic HSCT in complete remission. 53 (83%) of 64 with a complete remission underwent allogeneic HSCT. Five (8%) of 64 patients in complete remission relapsed before transplantation and four died as a consequence. Adverse events (grade ≥3) occurred in 49 (53%) of 93 patients. The most common adverse events were infections (including pneumonia, bacterial sepsis, and SARS-CoV-2 causing seven deaths among 28 [57%] of 49 patients), neutropenia (17 [35%]), thrombocytopenia (two [4%], including one fatal CNS bleeding), and cardiac events (four [8%], including one fatal heart failure). No treatment-related deaths were observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Venetoclax plus decitabine induction can significantly enhance the feasibility of allogeneic HSCT in older patients with acute myeloid leukaemia who are deemed fit for transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;Abb","PeriodicalId":48726,"journal":{"name":"Lancet Haematology","volume":" ","pages":"e830-e838"},"PeriodicalIF":15.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}