American Journal of Hematology最新文献

{"title":"Sharpening the Tools to Get the Edge on Leukemia","authors":"Shai Shimony, Jacqueline S. Garcia","doi":"10.1002/ajh.27622","DOIUrl":"10.1002/ajh.27622","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 5","pages":"750-751"},"PeriodicalIF":10.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143084115","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":"Balancing the Scales: Optimizing Reporting of Infection Rates in Clinical Trials of Bispecific Antibodies in Multiple Myeloma","authors":"Joshua Richter, Madhav V. Dhodapkar, Mengying Li, Mina Awad, Christian Hampp, Kate Knorr, Glenn Kroog, Tito Roccia, Naresh Bumma","doi":"10.1002/ajh.27618","DOIUrl":"10.1002/ajh.27618","url":null,"abstract":"<p>Infections are a major complication of multiple myeloma (MM) and are a significant contributor to early mortality in patients with MM [<span>1</span>]. While the introduction of new treatments over the past several decades has led to improved survival of patients with MM, it is also associated with increased risk of infections [<span>1</span>]. This is particularly true as it pertains to the novel and highly efficacious B-cell maturation antigen (BCMA)-directed bispecific antibodies (BsAbs) [<span>2</span>]. Putative causes for the heightened risk of infections with BCMA-directed BsAbs are: (1) most patients treated with these agents have at-least triple refractory disease [<span>3-5</span>] and prior MM treatments further compromised their immune system against the setting of an existing background of MM-associated immunosuppression [<span>1</span>], and (2) the inherent immunosuppression associated with targeting plasma cells and potential for T cell dysfunction with ongoing BsAb therapy [<span>2, 6</span>]. To better understand the etiology and prevalence of infections in patients with MM treated with BCMA-directed BsAbs, and in order to provide appropriate treatment and prophylaxis to these patients, a comprehensive and consistent reporting of infections is critical [<span>7-9</span>].</p><p>Conventionally, clinical trials report the <i>incidence</i> of an adverse event (AE). Incidence is defined as the “proportion of people experiencing an event” [<span>10</span>] while receiving treatment or within a short time after discontinuing treatment. One limitation of the incidence metric is its inability to reflect multiple events per patient. An AE is counted only once for each patient, at first occurrence. This aspect of the incidence metric greatly compromises its ability to serve as a measure of AE burden, which in our case is the overall burden of infections associated with each of the BCMA-directed BsAbs treatments for MM. To illustrate this point, consider the following: 20% of patients each having one infection episode will translate to an incidence of 20%, whereas 10% of patients each having two infection episodes will translate to an incidence of 10%, although the total burden of infection in the two scenarios is the same. A concern regarding this limitation of the incidence metric was expressed in the CONSORT Harms 2022 statement [<span>10</span>].</p><p>A second limitation of the incidence metric is that the incidence of an AE will generally increase with longer study follow-up. Indeed, when reviewing monotherapy trials that tested the clinical benefit of various BCMA-directed BsAbs as treatment for MM [<span>2, 6, 11</span>], the incidence of all grade, and of grade ≥ 3, infections which ranged between 15% and 55%, tended to increase with increased duration of follow up, which ranged from 1.7 to 22.8 months. This correlation between duration of follow-up and incidence of infection makes the interpretation and comparison of these dat","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"548-551"},"PeriodicalIF":10.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dirt Under the Finger-Nails—More Malignant Than Malignancy","authors":"Sumeet Mirgh, Sujata Lall, Sachin Punatar, Anant Gokarn, Nishant Jindal, Akanksha Chichra, Vivek Bhat, Navin Khattry","doi":"10.1002/ajh.27615","DOIUrl":"https://doi.org/10.1002/ajh.27615","url":null,"abstract":"A young boy developed steroid refractory GVHD post haploidentical transplant for relapsed B-ALL. He was on systemic immunosuppression with two immunosuppressants, and had history of CMV reactivation and tuberculosis. Eight months post-transplant, he was hospitalized with multi-drug-resistant gram-negative sepsis, and during the same episode, he developed penile lesions which progressed to dry gangrene of glans-penis. Fusarium grew in blood and penile lesions. On retrospective thinking, it was discerned that his onychomycoses were the probable cause of his penile lesions with hematogenous dissemination, as nails also grew Fusarium. This case highlights the need for a vigilant skin and nail examination in immunocompromised patients. This is important for two perspectives. First, cultures from potential colonized sources can help early identification and escalation of treatment. Secondly, appropriate precautions and treatment of superficial infections can help prevent dissemination.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"36 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056320","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":"Non-Transfusion-Dependent Thalassemia: An Image Gallery Worth a Thousand Words","authors":"Khaled M. Musallam, Sujit Sheth, Thomas D. Coates, Hanny Al-Samkari, Maria Domenica Cappellini, Kevin H. M. Kuo, Vip Viprakasit, Ali T. Taher","doi":"10.1002/ajh.27621","DOIUrl":"10.1002/ajh.27621","url":null,"abstract":"<p>Our understanding of the molecular pathways and associated clinical presentations characterizing various thalassemia phenotypes has substantially improved over the years. Non-transfusion-dependent thalassemia (NTDT) refers to patients who present with mild–moderate anemia, which does not necessitate lifelong, regular transfusion therapy. This typically includes patients with β-thalassemia intermedia, mild–moderate hemoglobin E/β-thalassemia, and α-thalassemia intermedia (hemoglobin H disease) (Figure 1) [<span>1-7</span>]. The underlying α/non-α globin chain imbalance and subsequent ineffective erythropoiesis and peripheral hemolysis lead to chronic anemia, primary iron overload, and a hypercoagulable state. These, in turn, are associated with a range of clinical morbidities that can impact quality of life and lead to premature death (Figure 2) [<span>2, 8-22</span>]. In view of the growing evidence on the negative impact of untreated anemia in these patients, long-term management becomes key. However, the only options that have been available so far include transfusions which can worsen iron overload and introduce transfusion-dependence burden, off-label use of hydroxyurea based on data from small trials or observational studies, and splenectomy which is associated with increased risks of infections and thrombosis (Figure 3) [<span>6, 9, 23, 24</span>]. Beyond anemia, cumulative iron overload due to increased intestinal iron absorption needs to be regularly monitored and managed with iron chelation therapy. Multimorbidity in NTDT also requires close monitoring and early intervention through a multidisciplinary team approach (Figure 4) [<span>2, 6, 25-27</span>]. In the last decade, we have witnessed several novel agents being developed to manage anemia in NTDT. Agents targeting hepcidin dysregulation have not been successful in clinical trials, despite encouraging data in animal models. Luspatercept, an erythroid maturation agent, showed efficacy in improving hemoglobin level in adults with β-NTDT and is now approved in Europe (but not the United States). Mitapivat, a pyruvate kinase activator, has also shown efficacy in improving hemoglobin level and functional status in a recent phase 3 trials in adult patients with both α- and β-NTDT (Figure 5) [<span>24, 28-30</span>]. Clinical management guidelines are now available, but awareness of the various morbidities and treatment options in NTDT, especially among patients remains essential (a patient friendly summary is provided in the Appendix S1).</p><p>All authors contributed to conceptualization and manuscript drafting or critical review. K.M.M. was also involved in the creation of visualizations. All authors validated the manuscript and gave final approval for submission.</p><p>Ethics approval not applicable as no patients were involved in this work.</p><p>K.M.M. reports consultancy fees from Novartis, Bristol Myers Squibb (Celgene Corp), Agios Pharmaceuticals, CRISPR Therapeutics, Vifor Pha","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"687-694"},"PeriodicalIF":10.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27621","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Sleep Traits With Venous Thromboembolism: Prospective Cohort and Mendelian Randomization Studies","authors":"Yuqian Li,&nbsp;Feifei Sun,&nbsp;Chao Ji,&nbsp;Honghao Yang,&nbsp;Zheng Ma,&nbsp;Yuhong Zhao,&nbsp;Zhiying Zhao,&nbsp;Yang Xia","doi":"10.1002/ajh.27620","DOIUrl":"10.1002/ajh.27620","url":null,"abstract":"<div>\u0000 \u0000 <p>Previous research indicates an association between sleep traits and venous thromboembolism (VTE) risk, though causal relationships remain uncertain. This study evaluated combined and independent associations between sleep traits and VTE risk using UK Biobank data and explored the causal associations between sleep traits and VTE through two-sample Mendelian randomization (MR) analyses. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations between the healthy sleep score, as well as individual sleep traits (including sleep duration, insomnia, daytime sleepiness, snoring, and chronotype), and VTE risk were calculated using Cox proportional hazards regression models. Additionally, the two-sample MR analyses used the inverse-variance weighted method to determine odds ratios (ORs) and 95% CIs for causal associations. In the cohort analysis, 314 077 VTE–free participants were followed for a median of 12.3 years, during which 7176 VTE cases occurred. In comparison to those with a sleep score of 0–1, participants with a score of 5 were associated with a 30% lower risk of VTE (HR: 0.70; 95% CI: 0.61–0.80). A U-shaped association was noted between sleep duration and VTE risk. Both short (≤ 6 h) and long (≥ 9 h) sleep durations increased VTE risk. Excessive daytime sleepiness, snoring, and evening chronotype also elevated VTE risk. MR analyses supported a causal relationship for short sleep duration (OR: 1.24; 95% CI: 1.04–1.47) with VTE risk, while other sleep traits showed no causal association. These findings underscore the importance of optimal sleep in reducing VTE risk.</p>\u0000 </div>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"616-625"},"PeriodicalIF":10.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056316","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":"Elderly Patients With Aplastic Anemia: Treatment Patterns and Outcomes in the Real World","authors":"Bruno Fattizzo,&nbsp;Carmelo Gurnari,&nbsp;Sabrina Giammarco,&nbsp;Antony Ricchiuti,&nbsp;Hussein Awada,&nbsp;Marta Bortolotti,&nbsp;Nicole Galli,&nbsp;Giacinto Luca Pedone,&nbsp;Francesco Versino,&nbsp;Dario Consonni,&nbsp;Roochi Trikha,&nbsp;Shreyans Gandhi,&nbsp;Simona Sica,&nbsp;Jaroslaw P. Maciejewski,&nbsp;Austin Kulasekararaj,&nbsp;Wilma Barcellini","doi":"10.1002/ajh.27611","DOIUrl":"10.1002/ajh.27611","url":null,"abstract":"<p>We retrospectively analyzed a large international cohort of 1113 patients with aplastic anemia to evaluate treatment choice and outcome in elderly patients as compared with a younger population. Overall, 319 (29%) patients were &gt; 60 years old at diagnosis (60–64 years (<i>n</i> = 85), 106 65–69 years (<i>n</i> = 106), and 128 &gt; 70 years (<i>n</i> = 128)). Elderly patients showed a more severe thrombocytopenia at onset and a significantly lower overall response (complete plus partial) to first-line therapy at 6 months as compared to younger patients (47% vs. 65%, <i>p</i> &lt; 0.0001), irrespective of treatment modality (ATG or CyA combinations, eltrombopag, or androgens); 27 (8%) received transplant as second line therapy and 11 (41%) died, mainly due to transplant complications. The rate of evolution to MDS was greater in elderly patients (12% vs. 7% in younger AA, <i>p</i> = 0.002), whilst the rate of evolution to AML was similar (1.8 vs. 1.3%). By multivariable analysis, older age remained the main factor associated with mortality [HR 1.64 (95% CI 1.5–1.7), <i>p</i> &lt; 0.001], followed by disease severity by Camitta classification [HR 2.24 (95% CI 1.6–3.1) for severe AA; HR 3.8 (95% CI 2.4–6) for very severe AA], and male gender [1.45 (95% CI 1.1–1.8), <i>p</i> &lt; 0.001]. In this large study, elderly AA was associated with inferior outcome even in the TPO-RA era, highlighting the need for further optimization of clinical management.</p>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"584-591"},"PeriodicalIF":10.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27611","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Lymphocytic Leukemia: 2025 Update on the Epidemiology, Pathogenesis, Diagnosis, and Therapy","authors":"Michael Hallek","doi":"10.1002/ajh.27546","DOIUrl":"10.1002/ajh.27546","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Disease Overview&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Chronic lymphocytic leukemia (CLL) is the most frequent type of leukemia. It typically occurs in older patients and has a highly variable clinical course. Leukemic transformation is initiated by specific genomic alterations that interfere with the regulation of proliferation and apoptosis in clonal B-cells.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Diagnosis&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The diagnosis is established by blood counts, blood smears, and immunophenotyping of circulating B-lymphocytes, which identify a clonal B-cell population carrying the CD5 antigen as well as typical B-cell markers.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Prognosis and Staging&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Two clinical staging systems, Rai and Binet, provide prognostic information by using the results of physical examination and blood counts. Various biological and genetic markers provide additional prognostic information. Deletions of the short arm of chromosome 17 (del(17p)) and/or mutations of the &lt;i&gt;TP53&lt;/i&gt; gene predict a shorter time to progression with most targeted therapies. The CLL international prognostic index (CLL-IPI) integrates genetic, biological, and clinical variables to identify distinct risk groups of patients with CLL. The CLL-IPI retains its significance in the era of targeted agents, but the overall prognosis of CLL patients with high-risk stages has improved.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Therapy&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Only patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. When treatment is indicated, several therapeutic options exist: combinations of the BCL2 inhibitor venetoclax with obinutuzumab, or venetoclax with ibrutinib, or monotherapy with one of the inhibitors of Bruton tyrosine kinase (BTK). At relapse, the initial treatment may be repeated if the treatment-free interval exceeds 3 years. If the leukemia relapses earlier, therapy should be changed using an alternative regimen.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Future Challenges&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Combinations of targeted agents now provide efficient therapies with a fixed duration that generate deep and durable remissions. These fixed-duration therapies have gained territory in the management of CLL, as they are cost-effective, avoid the emergence of resistance, and offer treatment free time to the patient. The cure rate of these novel combination regimens is unknown. Moreover, the optimal sequencing of targeted therapies remains to be determined. A medical challenge is to treat patien","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 3","pages":"450-480"},"PeriodicalIF":10.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Prognostic Significance of Additional Chromosomal Abnormalities at Diagnosis of Chronic Myeloid Leukemia","authors":"Jiří Mayer,&nbsp;Petra Čičátková,&nbsp;Lenka Kováčová,&nbsp;Marie Jarošová,&nbsp;Michal Karas,&nbsp;Pavel Jindra,&nbsp;Hana Klamová,&nbsp;Kateřina Machová Poláková,&nbsp;Olga Černá,&nbsp;Eduard Cmunt,&nbsp;Petra Bělohlávková,&nbsp;Pavel Žák,&nbsp;Edgar Faber,&nbsp;Tomáš Papajík,&nbsp;Lukáš Stejskal,&nbsp;Ivana Ježíšková,&nbsp;Barbora Weinbergerová,&nbsp;Tomáš Jurček,&nbsp;Tomáš Horňák,&nbsp;Daniela Žáčková,&nbsp;Šárka Ransdorfová,&nbsp;Milena Holzerová,&nbsp;Tomáš Pavlík","doi":"10.1002/ajh.27608","DOIUrl":"10.1002/ajh.27608","url":null,"abstract":"<p>The influence of t(v;22) sole, major route ACAs all (+8, <i>n</i> = 14; +Ph, <i>n</i> = 10; +19, <i>n</i> = 1), and -Y sole on progression-free survival. Survival curves are compared with those of patients with the standard t(9;22) translocation. Other ACAs or complex karyotypes did not influence survival.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </p>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"729-734"},"PeriodicalIF":10.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TP53 Mutations in Myeloproliferative Neoplasms: Context-Dependent Evaluation of Prognostic Relevance","authors":"Ayalew Tefferi,&nbsp;Maymona Abdelmagid,&nbsp;Giuseppe G. Loscocco,&nbsp;Saubia Fathima,&nbsp;Kebede H. Begna,&nbsp;Aref Al-Kali,&nbsp;James Foran,&nbsp;Jeanne Palmer,&nbsp;Talha Badar,&nbsp;Mrinal M. Patnaik,&nbsp;Kaaren K. Reichard,&nbsp;Rong He,&nbsp;Cinthya J. Zepeda Mendoza,&nbsp;Mithun Shah,&nbsp;Attilio Orazi,&nbsp;Daniel A. Arber,&nbsp;Animesh Pardanani,&nbsp;Alessandro M. Vannucchi,&nbsp;Devendra Hiwase,&nbsp;Naseema Gangat,&nbsp;Paola Guglielmelli","doi":"10.1002/ajh.27609","DOIUrl":"10.1002/ajh.27609","url":null,"abstract":"<p>The clinical relevance of <i>TP53</i> mutations (<i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000}) in myeloproliferative neoplasms (MPN) and their prognostic interaction with MPN subtype designation has not been systematically studied. In the current study, 114 patients with MPN harboring <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} (VAF ≥ 2%) were evaluated for overall survival (OS), calculated from the time of <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} detection: chronic phase myelofibrosis (MF-CP; <i>N</i> = 61); blast-phase (MPN-BP; <i>N</i> = 31) or accelerated-phase (MPN-AP; <i>N</i> = 16) MPN, and polycythemia vera/essential thrombocythemia (PV/ET; <i>N</i> = 6). Sixty-five (57%) patients harbored International Consensus Classification (ICC)-defined multihit <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} and 56 (49%) monosomal/complex karyotype (MK/CK). Majority of MPN-BP (90%) and MPN-AP (81%) while 39% of MF-CP and none of PV/ET patients harbored multihit <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000}. OS in MPN-BP and MPN-AP was equally dismal (median 6 vs. 4.5 months, respectively; <i>p</i> = 1.0), regardless of multihit configuration (<i>p</i> = 0.44), while OS in <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} MPN-BP/AP (<i>N</i> = 47; median 4 months) was inferior to that of a separate cohort (<i>N</i> = 49) with <i>TP53</i> wild-type MPN-BP/AP (median 11 months; <i>p</i> &lt; 0.01). OS in MF-CP was significantly shorter with multihit versus non-multihit <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} (median 10 vs. 35 months; HR 2.9; <i>p</i> &lt; 0.01), independent of other MF-relevant genetic risk factors, including <i>ASXL1/SRSF2/U2AF1</i> mutations. Multihit <i>TP53</i>\u0000 ^{\u0000 <i>MUT</i>\u0000} was also associated with inferior survival following allogeneic stem cell transplant (ASCT): median 9 months versus “not reached” in patients with (<i>N</i> = 9) versus without (<i>N</i> = 8) multihit <i>TP53</i>\u0000 ^MUT (<i>p</i> &lt; 0.01). The presence of multihit or non-multihit <i>TP53</i>\u0000 ^MUT in MPN-BP/AP or multihit <i>TP53</i>\u0000 ^MUT in MF-CP is associated with exceptionally poor prognosis and justifies inclusion into the ICC category of “myeloid neoplasms with mutated <i>TP53</i>.” By contrast, detection of non-multihit <i>TP53</i>\u0000 ^MUT, by itself, might not endanger short-term survival in MF-CP, PV, or ET.</p>","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"552-560"},"PeriodicalIF":10.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Pharmacokinetic Evaluation of Venetoclax in AML Supports Re-Evaluation of Recommended Dose Adjustments With Azole Antifungals","authors":"Jitesh D. Kawedia,&nbsp;Caitlin R. Rausch,&nbsp;Xiaoqian Liu,&nbsp;Wei Qiao,&nbsp;Courtney D. Dinardo,&nbsp;Naval Daver,&nbsp;Gautam Borthakur,&nbsp;Naveen Pemmaraju,&nbsp;Patrick Reville,&nbsp;Dimitrios P. Kontoyiannis,&nbsp;Nicholas Short,&nbsp;Marina Konopleva,&nbsp;Elias Jabbour,&nbsp;Guillermo Garcia-Manero,&nbsp;Farhad Ravandi,&nbsp;Hagop Kantarjian,&nbsp;Tapan M. Kadia","doi":"10.1002/ajh.27613","DOIUrl":"10.1002/ajh.27613","url":null,"abstract":"&lt;p&gt;Incorporation of the BCL-2 inhibitor, venetoclax (VEN), into the treatment paradigm of acute myelogenous leukemia (AML) has led to a dramatic improvement in outcomes for older and unfit patients, demonstrating an overall survival benefit when added to azacitidine in patients with newly diagnosed (ND) AML ≥ 75 years, or otherwise ineligible for intensive chemotherapy [&lt;span&gt;1&lt;/span&gt;]. Posaconazole prophylaxis has improved overall survival in patients with ND AML undergoing remission induction chemotherapy anticipated to experience neutropenia for &gt; 7 days [&lt;span&gt;2&lt;/span&gt;]. As a result, prophylaxis with any mold-active triazole antifungal is recommended [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The triazole antifungals inhibit CYP3A4, the enzyme responsible for VEN metabolism, to varying degrees. As a result, specific VEN dose reductions are recommended when co-administered with CYP3A4 inhibitors (CYP3A4i). A pharmacokinetic (PK) analysis of 11 patients receiving VEN with posaconazole 300 mg daily demonstrated an increase in mean &lt;i&gt;C&lt;/i&gt;\u0000 &lt;sub&gt;max&lt;/sub&gt; by 53% and AUC by 76% with VEN 50 mg daily (VEN50), and a 93% increase in &lt;i&gt;C&lt;/i&gt;\u0000 &lt;sub&gt;max&lt;/sub&gt; and 155% increase in AUC with VEN 100 mg (VEN100) [&lt;span&gt;4&lt;/span&gt;]. As a result, the FDA recommends VEN 70 mg daily in combination with posaconazole. Notably, in the VIALE-A trial, all patients receiving any strong CYP3A4i were dose-reduced to VEN50 [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We and others have reported a delay in time to platelet count recovery among patients with ND AML receiving increased VEN exposure as a result of increased VEN doses or when VEN is given in combination with azole antifungals, particularly posaconazole [&lt;span&gt;5, 6&lt;/span&gt;]. As a result, we hypothesized that VEN serum levels may be supratherapeutic when given in combination with posaconazole and that higher VEN levels could be associated with prolonged myelosuppression.&lt;/p&gt;&lt;p&gt;As part of an ongoing phase 2 study of VEN combined with cladribine and LDAC in older patients with ND AML (NCT03586609), we prospectively characterized VEN pharmacokinetics including &lt;i&gt;C&lt;/i&gt;\u0000 &lt;sub&gt;max&lt;/sub&gt;, AUC, &lt;i&gt;C&lt;/i&gt;\u0000 &lt;sub&gt;trough&lt;/sub&gt; and clearance when given with or without a strong CYP3A4i during induction. VEN100 was administered with voriconazole, VEN50 and VEN100 with posaconazole, and VEN 400 mg (VEN400) with caspofungin. Steady state VEN PK analysis was conducted on day 8. Blood samples were collected prior to the dose, and 2, 4, 8, and 24 h post dose. Trough (24-h post dose) levels were collected on days 12 and 16 of cycle 1 (Figure S1). We also evaluated the association between VEN trough levels and AUC as well as clinical outcomes. Complete methodology is in the Data S1.&lt;/p&gt;&lt;p&gt;Thirty-nine patients, median age 68 years (range, 61–77), were included for PK analysis (Table S1), of whom 33 (85%) achieved CR (&lt;i&gt;n&lt;/i&gt; = 29) or CRi (&lt;i&gt;n&lt;/i&gt; = 4) after induction. Among responders, 28 patients (85%) achieved MRD-negativit","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 4","pages":"740-743"},"PeriodicalIF":10.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27613","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}