Hospital Privado Centro Medico de Cordoba. aletreras@hotmail.com MTSAC Miembro Titular de la Sociedad Argentina de Cardiologia 1 Servicio de Cardiologia. Hospital Privado Centro Medico de Cordoba. Cordoba, Argentina 2 Servicio de Resonancia Magnetica Nuclear. Instituto Oulton. Cordoba, Argentina Fig. 1. Igualdad de presiones de fin de diastole por medicion invasiva. Paciente masculino de 75 anos. Es internado por insuficiencia cardiaca congestiva. Presenta antecedentes de reemplazo valvular aortico con protesis biologica realizado hace 6 anos y sindrome ascitico edematoso de 3 anos de evolucion, con enfermedad hepatica descartada. Un ecocardiograma realizado hace un ano mostraba derrame pericardico moderado sin signos de taponamiento. En la presente internacion se realizo un nuevo ecocardiograma, que revelo imagen pericardica ecodensa, en cara diafragmatica, de aproximadamente 3 centimetros de diametro. Mediante cateterismo cardiaco (Figura 1) se diagnostico constriccion pericardica. Se efectuo una resonancia magnetica nuclear para precisar la situacion anatomica y programar el abordaje quirurgico (Figura 2). El paciente rehuso ser intervenido quirurgicamente y es tratado con diureticos por via oral.
Resumen es: Introduccion A pesar de que la morbimortalidad en el trasplante cardiaco ha sido motivo de extenso analisis, la mayoria de los estudios y registros de mo...
Abstract Introduction: In RRMM, increasing rates of pt attrition and decreasing durability of responses with each line of therapy (LOT) necessitate early treatment (tx) with the most effective therapies. Immunotherapies that are widely accessible across different MM tx settings have the potential to change the trajectory of RRMM. Teclistamab (Tec), the first approved BCMA×CD3 bispecific antibody (BsAb) for heavily pretreated RRMM, provided deep, durable responses in MajesTEC-1, with improved efficacy and safety in earlier LOTs. Daratumumab (Dara), a standard-of-care (SoC) foundational CD38 targeted therapy with direct on-tumor activity, has been shown to deplete immunosuppressive T-cells and expand cytotoxic T-cells, creating an immune-permissive microenvironment for synergistic Tec-mediated killing of MM cells. MajesTEC-3 (NCT05083169) evaluates Tec-Dara vs SoC DPd/DVd in RRMM. We report initial results for this first phase 3 study of BsAb therapy in MM. Methods: Eligible pts had 1-3 prior LOTs including a PI and lenalidomide (Len; pts with 1 prior LOT must have been Len-refractory) with progressive disease (PD) on or after the last LOT. Pts with prior BCMA-directed therapy or refractory to anti-CD38 were excluded; prior anti-CD38 exposure was permitted. Pts were randomized 1:1 to Tec-Dara or DPd/DVd. The Tec-Dara group received 28-day cycles (C) of Tec (1.5 mg/kg QW in C1-2 [C1 preceded by the approved step-up dose schedule]; 3 mg/kg Q2W in C3-6; and 3 mg/kg Q4W in C7+) with Dara; steroids were not required after C1 Day 8. Tec and Dara dosing were aligned with the approved Dara schedule. DPd/DVd were administered per approved schedules. Progression-free survival (PFS) by IRC was the primary endpoint; secondary endpoints included complete response or better (≥CR), overall response, minimal residual disease (MRD) negativity (10–5; next-generation sequencing), overall survival (OS), time to worsening of symptoms (MySIm-Q), and safety. Results: 587 pts were randomized (Tec-Dara, n=291; DPd/DVd, n=296). Median (range) age was 64 (25-88) yrs, median number of prior LOTs was 2 (1-3). With 34.5-mo median follow-up, Tec-Dara significantly improved PFS vs DPd/DVd (HR, 0.17; 95% CI, 0.12-0.23; P<0.0001); mPFS was NR and 18.1 mo, and 36-mo PFS rate was 83.4% and 29.7%, respectively. PFS benefit was consistent across all prespecified and clinically relevant pt subgroups, including age ≥75 yrs, Len-refractory, high-risk cytogenetics, ≥60% bone marrow plasma cells, soft-tissue plasmacytomas, and anti-CD38 exposed. Significantly higher rates of ≥CR (81.8% vs 32.1%; OR, 9.56; 95% CI, 6.47-14.14), overall response (89.0% vs 75.3%; OR, 2.65; 95% CI, 1.68-4.18), and MRD-negativity (58.4% vs 17.1%; OR, 6.78; 95% CI, 4.53-10.15) were observed with Tec-Dara (P<0.0001). There were 45 deaths with Tec-Dara and 96 with DPd/DVd, primarily due to PD (4.6%; 20.3%). OS significantly favored Tec-Dara (HR, 0.46; 95% CI, 0.32-0.65; P<0.0001), including across all prespecified subgroups. The 36-mo OS rates were 83.3% and 65.0%, respectively and >90% of Tec-Dara pts alive at 6 mo were also alive at 30 mo. Median time to worsening of MM symptoms was NR with Tec-Dara vs 39.9 mo with DPd/DVd (HR, 0.50; 95% CI, 0.34-0.72; P=0.0002). At data cutoff, 49.4% of pts remained on study tx (Tec-Dara, 71.0%; DPd/DVd, 28.3%). Median tx duration was twice as long with Tec-Dara vs DPd/DVd (32.4 vs 16.1 mo). Frequency of grade 3/4 (Tec-Dara, 95.1%; DPd/DVd, 96.6%) and grade 5 (7.8%; 6.2%) treatment-emergent adverse events (TEAEs), were comparable (safety set: Tec-Dara, n=283; DPd/DVd, n=290). Serious TEAEs occurred in 70.7% Tec-Dara and 62.4% DPd/DVd pts; tx discontinuations due to TEAEs were low (4.6% vs 5.5%). Any grade infections occurred in 96.5% and 84.1% of Tec-Dara and DPd/DVd pts, respectively; grade 3/4 infections occurred in 54.1% and 43.4%. New onset grade ≥3 infections decreased over time, coinciding with transition to Q4W dosing and supported by antimicrobial and Ig prophylaxis guidance. CRS rate was 60.1% (grade 1/2: 44.2%/15.9%) and ICANS was 1.1% with Tec-Dara. Conclusion: We demonstrate the clinically remarkable and statistically significant PFS and OS benefits of Tec-Dara vs SoC triplets in RRMM, with 83.4% of Tec-Dara pts alive and progression-free at 3 yrs. Infections with Tec-Dara were well managed with established protocols. This highly effective, off-the-shelf, immunotherapy combination represents a new SoC for RRMM as early as first relapse.
ObjectiveTo assess the effect of antimalarials (AMs) on overall damage and on its most frequently affected domains, as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) in patients from the GLADEL cohort.MethodsNew damage was defined as a ≥1 point increase in SDI since cohort entry. AMs users were those who received AMs for at least 6 months after entering the cohort. AMs users and non-users were matched for age, sex, ethnicity, and baseline SDI using stratified random sampling. Two comparisons were carried out: patients with and without new damage, and AM users versus non-users. Propensity score matching was used to determine the effect of AM use on the most frequently affected damage domains.ResultsA total of 850 patients were included; 419 (49.3%) were AM users and 431 (50.7%) non-users. During a median follow-up of 48.5 (IQR 19.3, 69.0) months, 472 (55.5%) developed damage. The most affected domains were skin (18.4%), renal (14.6%), neuropsychiatric (10.8%), musculoskeletal (6.9%), and cardiovascular (4.5%). AMs use was associated with a lower proportion of patients accruing damage at follow-up (170 [40.6%] vs 208 [48.3%]; p = .028). AMs were protective against overall damage (HR 0.7, 95% CI [0.5-0.9]; p = .002), renal (HR 0.4, 95% CI [0.3-0.6]; p < .001), and neuropsychiatric damage (HR 0.5, 95% CI [0.3-0.9]; p = .022).ConclusionAM use is independently associated with a lower probability of overall, renal, and neuropsychiatric damage accrual. These findings support early and sustained AM treatment in lupus patients, unless contraindicated.
e24047 Background: Systemic anticancer therapy (SACT) near the end of life is considered a negative quality-of-care indicator, associated with limited survival benefit, increased toxicity, higher health care utilization, and delayed palliative care integration. Despite international recommendations, SACT close to death remains common. Multicenter Latin American data across different health care settings are scarce; a binational approach may help identify modifiable factors to improve the quality and value of end-of-life cancer care. Methods: This retrospective multicenter binational observational study (Argentina–Uruguay) included adults with advanced cancer who died between January 2022 and December 2023 and received systemic anticancer therapy during the last 90 days of life. The primary objective was to describe SACT exposure within 30 and 90 days before death as markers of therapeutic intensity. Clinical and treatment-related variables, as well as between-country differences, were analyzed. Results: A total of 249 patients were included (Argentina n = 173; Uruguay n = 76). Clinical characteristics and SACT use by country are shown in Table 1. Median age at death was similar between countries; however, patients in Uruguay more frequently had preserved ECOG performance status and were receiving first-line SACT, whereas patients in Argentina more often had ECOG PS ≥2 and received SACT in later treatment lines. In Uruguay, end-of-life SACT was mainly concentrated in tumors traditionally considered chemo-responsive (breast, colon, lung, gynecologic), while in Argentina it was distributed across a broader range of tumor types, affecting older and more heavily pretreated patients. Conclusions: SACT near the end of life was frequent in this binational cohort. Variability between Argentina and Uruguay suggests differences in health care contexts and clinical decision-making processes, with patterns of treatment intensity not explained solely by performance status or line of therapy. The high proportion of patients receiving first-line SACT followed by death shortly thereafter may reflect late diagnosis or delayed recognition of poor prognosis in the Uruguayan cohort. Conversely, more frequent SACT use in later lines in Argentina may be influenced by longer therapeutic trajectories and delayed integration of palliative care. These findings highlight the need to improve prognostic assessment, shared decision-making, and earlier palliative care integration to enhance the quality and value of end-of-life cancer care. Clinical characteristics and use of TOES by countr. Characteristics Argentina (n=173) Uruguay (n=76) Median age at death, years (range) 63 (23–92) 60 (30–85) ECOG PS 0–1 at last SACT (%) 42.4 64.5 ECOG PS ≥2 at last SACT (%) 57.2 35.5 First-line SACT at last treatment (%) 25.4 75.0 SACT ≤30 days before death (%) 31.2 39.5 SACT ≤90 days before death (%) 100 100
