BACKGROUND:Carfilzomib-based regimens brought a significant improvement in the treatment of relapsed/refractory multiple myeloma (RRMM). Even though efficacy and safety profiles of carfilzomib are well-established in several clinical trials, there is limited real-world data with carfilzomib-based protocols. Here we present our real-world experience with carfilzomib-based regimens for treatment of patients with RRMM in Croatia. METHODS:Data on patients with RRMM starting carfilzomib-based protocols in the period between June 2019 and February 2023 was collected by retrospective chart review from 14 Croatian centres. RESULTS:A total of 119 patients with RRMM were included; median age was 66 years (range 45-83 years), 59 (49.6 %) were females, and the median number of previous lines of therapies was 2 (range 1-8). Triplet based regimen was treatment choice in 84 (70.6 %) and 35 (29.4 %) patients were treated with carfilzomib in combination with dexamethasone (Kd). Overall response rate was 61.7 %, with 20 patients (18.7 %) achieving complete response (CR). Median progression free survival (PFS) and overall survival (OS) for entire cohort were 9.4 and 13.2 months, respectively. Median PFS was 12.8 months and 4.1 months for the triplets and doublets, respectively; the corresponding median OS was 18.6 and 7.9 months, respectively. The most common adverse events were anemia and thrombocytopenia; 19 patients (16 %) experienced cardiovascular events. CONCLUSION:This is the first study to analyze clinical outcomes of RRMM patients treated with carfilzomib-based regimens in Croatia. Carfilzomib-based regimens showed substantial efficacy and acceptable toxicity in RRMM, especially in earlier treatment lines and triplet combinations.

Introduction: Background: Decision-making in multiple myeloma (MM) is complex as there are numerous treatment options available across multiple lines of therapy.A recent survey suggested many MM physicians are interested in MRD-guided decision making (Derman et al., 2022).We thus conducted an online survey to investigate physicians' attitudes toward MRD assessments and conventional marrow testing (e.g., FISH or karyotyping) and how these tests modify treatment selection.Methods: Methods: Boardcertified hematologists and/or oncologists (N=75) who had ≥10 patients with MM, spent ≥50% of time in clinical practice in the US, and had been in clinical practice for at least two years completed an online survey.Descriptive statistics assessed practice characteristics, testing procedures, and attitudinal items.Results: Results: Most physicians practiced in a community setting (69%) with a substantial number of MM patients under their care (M=60.5,SD=57.1,Mdn=40.0,IQR 25-75).Most physicians routinely ordered bone marrow karyotyping or FISH (M=77.8%,SD=33.0,Mdn=100.0%,IQR 50-100%), while a significant minority routinely ordered MRD assessments (M=41.3%,SD=36.9,Mdn=30.0%,IQR 10-80%).Among cases where such tests were ordered, physicians chose or modified treatment based on the results of karyotyping/ FISH half the time (M=53.3%,SD=37.5, Mdn=50.0%,IQR 23-100%) and chose or modified treatment based on the results of MRD assessments only a third of the time (M=39.4%,SD=32.5, Mdn=30.0%,IQR 10-60%).On an agreement scale anchored at 1 (prefer personalized treatment approaches) versus 5 (prefer standard treatment approaches that consistently work), physicians reported a slight preference for targeted treatments (M=2.3,SD=1.1, Mdn=2.0,IQR 2-3).On a 1-5 Likert-type agreement scale, physicians reported it is important to educate patients about how specific features of their MM may affect response rates (M=4.1,SD=0.7,Mdn=4.0,IQR 4-5) and time to progression (M=4.1,SD=0.8,Mdn=4.0,IQR 4-5).Conclusions: Conclusions: In our study of physicians primarily based in a community setting, most ordered conventional karyotyping or FISH testing for their patients and utilized these test results to guide treatment choices.MRD assessments were ordered in a third of cases and used to guide management in a third of cases when ordered.These findings highlight the importance of establishing clear pathways to guide decision-making in MM.

The introduction of percutaneous cholecystostomy (PCT) has shifted the paradigm in treatment of acute calculous and acalculous cholecystitis. PCT has high success and low complication rates, but there are still unresolved issues regarding the duration of the procedure. The aim of our study is to determine the characteristics and outcome of patients treated with short-term PCT drainage. Patients who were admitted to the Department of gastroenterology and the Department of Abdominal Surgery at the University Hospital Center Split under the diagnosis of acute cholecystitis and who were treated with the PCT, in a period between January 2015 and January 2020, were retrospectively included in the study. During that timeframe we identified 92 patients and have analyzed their characteristics and clinical outcomes. The statistical analysis included the Kaplan–Meier method for calculating survival curves for grades 2 and 3, the log-rank test for testing the difference between survival rates of grade 2 and 3 patients, and logistic regression to determine variables that affected the outcome of our patients. According to the Tokyo guidelines, most of the patients (74, 80.43%) met the criteria for grade 2 cholecystitis, and the minority had grade 1 (9, 9.78%) and grade 3 (9, 9.78%) cholecystitis. The average drainage duration was 10.1 ± 4.8 (3–28) days. We identified mild complications in 6 cases. Nine patients (10%) had lethal outcome. The mortality in the largest group of patients with grade 2 cholecystitis was 5.48% and as high as 71.43% in patients with grade 3 cholecystitis. The complication rate was 6.5%. One quarter of gallbladder aspirates showed a ciprofloxacin resistance. Short-time PCT lasting approximately 10 days can be used safely and effectively for the treatment of patients with acute cholecystitis.

We report a case of colobronchial fistula as a late consequence of the resection of the colon due to relapse of the gastrointestinal stromal tumor (GIST). A 54-year-old man experiencing pain in the left upper abdominal region underwent double contrast barium enema which revealed a fistulous channel between the splenic flexure of the colon and the bronchial tree. Fiberoptic bronchoscopy, after an extensive washout and aspiration of barium sulphate, confirmed the existence of a fistula in left lower subsegmental bronchi. The patient underwent left lower lobectomy, resection of the colobronchial fistula and resection of the splenic flexure of the colon. A year after the operation, the multidetector computed tomography (MDCT) showed neither signs of malignant abdominal disease, nor signs of pathological changes in the lung bases.