Venetoclax plus azacitidine improves survival in older or unfit patients with newly diagnosed acute myeloid leukemia (AML), as demonstrated in the VIALE-A trial. 2 However, real-world data in hospitalized patients—particularly those with secondary AML or adverse-risk mutations—remain limited. We conducted a retrospective study of exclusively hospitalized patients with treatment-naïve AML who completed at least one full 28-day cycle of azacitidine and venetoclax at Baylor University Medical Center between October 2019 and October 2024, with the aim of evaluating outcomes at a clinically relevant treatment inflection point. Risk stratification was performed using ELN 2022 criteria, and safety was assessed using CTCAE v5.0. Fifty-six patients met inclusion criteria (median age 71 years); 51.8% had secondary AML, and 53.7% had adverse-risk disease. Among 43 evaluable patients, the composite complete remission (CRc) rate after one cycle was 55.8%. Median overall survival (OS) was 17.6 months. Patients with TP53 mutations had significantly shorter median OS (3.8 months) compared with those without TP53 mutations (20.2 months). Common grade ≥ 3 toxicities included leukopenia (67.8%) and febrile neutropenia (57.6%). By focusing on patients who completed an initial treatment cycle, this study provides conditional survival estimates that may inform decisions regarding continuation of therapy. Despite the predominance of secondary and adverse-risk AML in this cohort, OS was comparable to that observed in VIALE-A, supporting the effectiveness of azacitidine plus venetoclax in hospitalized AML patients ineligible for intensive chemotherapy.
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Hematologic malignancies are known precipitants of disseminated intravascular coagulation (DIC), and the coexistence of these conditions is associated with poor outcomes; however, large-scale data specifically examining concurrent DLBCL and DIC are limited. We performed a retrospective cohort study using the National Inpatient Sample (NIS) to evaluate in-hospital mortality among adult hospitalizations with DIC and/or DLBCL identified using ICD-10 codes. Adults aged ≥ 18 years with a diagnosis of DLBCL and/or DIC were included. In-hospital mortality among patients with concurrent DLBCL and DIC was 54.1%, significantly higher than mortality observed in patients with either condition alone (p < 0.001). In multivariable analysis restricted to patients with both DLBCL and DIC, independent predictors of increased mortality included HIV/AIDS (aOR 4.266, 95% CI: 1.886-9.649; p < 0.001), septic shock (aOR 3.201, 95% CI: 2.305-4.443; p < 0.001), mechanical ventilation (aOR 2.948, 95% CI: 2.175-3.995; p < 0.001), vasopressor use (aOR 2.759, 95% CI: 1.789-4.255; p < 0.001), chronic kidney disease (aOR 2.523, 95% CI: 1.596-3.989; p < 0.001), acute kidney injury (aOR 1.884, 95% CI: 1.347-2.637; p < 0.001), Black race (aOR 2.221, 95% CI: 1.418-3.477; p < 0.001), and Asian or Pacific Islander race (aOR 2.383, 95% CI: 1.329-4.271; p = 0.004) compared to White patients. Bleeding events, thromboembolic complications, stem cell transplantation, and CAR-T therapy were not independently associated with mortality. These findings demonstrate that among patients with DLBCL, the development of DIC is associated with markedly elevated in-hospital mortality, driven predominantly by critical illness, organ dysfunction, and comorbidity burden rather than bleeding or thrombosis alone. Racial disparities in outcomes were independently observed after adjusting for illness severity and comorbidities, warranting further investigation. Early recognition of DIC in patients with DLBCL and aggressive management of systemic complications, particularly septic shock, respiratory failure, and renal dysfunction, may help mitigate disease severity and improve outcomes.
Introduction:Due to limited supportive care, low- and middle-income countries balance delivering intensive, curative chemotherapy with the risk of treatment-related toxicity. Acute lymphoblastic leukaemia (ALL) is the commonest childhood cancer, and induction is the highest risk period for morbidity and mortality. The study describes induction toxicities among children with ALL at Korle Bu Teaching Hospital, Ghana. Methods:This hospital-based cohort study involved children aged 1-17 years newly diagnosed with ALL from August 2021 to January 2023. Demographic, clinical and laboratory data were recorded. Descriptive statistics (median [interquartile range]) were used to summarise continuous variables. Frequency and percentages were used to describe categorical variables. Toxicities were graded using the Common Terminology Criteria for Adverse Events, Version 5.0. Results:Thirty-one children were included. Median age was 5 years (interquartile range [IQR]: 3-10 years). All 31 had at least one induction toxicity of any grade, and 29 (93.4%) had at least one severe (Grade ≥ 3). The most common toxicities were anaemia, thrombocytopenia, sepsis, febrile neutropenia, mucositis and hypertension; bleeding, acute pancreatitis, seizures and hepatotoxicity were less common. Induction mortality rate was 19.3%. There was no association found between age, sex, initial white cell count, treatment protocol and development of any severe toxicity. Conclusion:Severe induction toxicities were common in our cohort with unacceptably high mortality, underscoring the need to prioritise enhanced bedside clinical monitoring for hypertension, improved access to blood products and optimal infection prevention and control practices. Further research exploring the relationship between induction toxicities and patient outcomes is essential.
The COVID-19 pandemic posed significant challenges for patients with hematological malignancies, including multiple myeloma (MM), who experienced increased hospitalization and mortality rates due to frailty and immune suppression. This retrospective, multicenter study aimed to evaluate the impact of antiviral therapies and COVID-19 vaccination doses on clinical outcomes in 206 symptomatic MM patients undergoing active treatment across five Italian regions. The majority (90%) received at least one vaccine dose, and 61% were treated with antiviral agents (nirmatrelvir/ritonavir, molnupiravir, or remdesivir). Of the cohort, 90% were vaccinated, with 89% receiving ≥ 3 doses, and 61% received antiviral agents (nirmatrelvir/ritonavir, molnupiravir, or remdesivir). Patients vaccinated with ≥ 3 doses showed significantly reduced infection severity (p = 0.044), hospitalization rates (p = 0.008), and infection resolution time (p = 0.037). Unvaccinated patients without antiviral therapy had a significantly higher mortality rate (p = 0.004). Antiviral therapy, especially when combined with ≥ 3 vaccine doses, further shortened infection resolution time (p = 0.011) but did not significantly affect hospitalization rates or disease severity. This study highlights the critical role of ≥ 3 vaccine doses combined with antiviral therapy in improving COVID-19 outcomes in MM patients, with a reduced infection duration and lower progression to severe disease. Further investigation is required to optimize treatment strategies in this vulnerable population.
Introduction Sickle cell disease (SCD) is a genetic condition characterized by recurrent vaso‐occlusion and chronic hemolysis, which lead to long‐term irreversible complications, reducing patients’ quality of life and survival. Crizanlizumab is a humanized monoclonal antibody that acts in the pathogenesis of vaso‐occlusive crisis (VOCs) preventing their occurrence. The objective of this study is to describe the effectiveness and safety of crizanlizumab in Brazilian patients with SCD. We conducted a retrospective, multicenter study based on medical chart data. Materials and Methods The study period encompassed 1 year preceding the initiation of crizanlizumab treatment and extended through 1 year of therapy. Eligible patients were identified from the Novartis local cohort, classified as Expanded Access Program (EAP). Demographic information, VOC events, and clinical and follow‐up variables were collected. Results Among the 81 patients with at least one VOC prior to crizanlizumab initiation, 61 patients experienced VOC during the posttreatment period. Despite this reduction in the number of patients with VOCs, event‐based analyses showed a decrease in the number of VOCs requiring hospitalization (from 105 to 74) and emergency care (from 213 to 82) after crizanlizumab initiation. The median time between first and second VOCs requiring a healthcare visit increased from 1.66 to 1.84 months, and the median time between VOCs requiring hospitalization increased from 2.22 to 3.73. Conclusions These results suggest that treatment with crizanlizumab is associated with a reduction in VOC occurrence in all genotypes, SCD general complications, duration of hospitalization (in VOCs that required emergency care), and symptoms during VOCs.
