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Although treatment outcomes of multiple myeloma patients have improved significantly during the last two decades, myeloma is still an incurable disease. There are newly emerging immunotherapies to treat multiple myeloma including monoclonal antibodies, antibody-drug conjugate, bispecific antibodies, and chimeric antigen receptor (CAR) T cell therapy. Impressive response rate and clinical efficacy in heavily pretreated myeloma patients led to the FDA approval of the first myeloma CAR-T therapy in March 2021. Among many different targets for myeloma CAR-T therapies, B Cell Maturation Antigen (BCMA) has been the most successful target so far, but other targets which can be used either for single-target or dual-target CAR-T's are actively being explored. Clinical efficacy and safety of current myeloma CAR-T therapies will be presented here. Potential mechanisms leading to resistance include clearance of CAR-T cells, antigenic escape, and immunosuppressive tumor microenvironment. Novel strategies to enhance myeloma CAR-T will also be described. In this article, we provide a comprehensive review of the current data and the future directions of myeloma CAR-T therapies. [ABSTRACT FROM AUTHOR]

Simple Summary: There is preclinical evidence that abnormalities in lipid metabolism promote cancer development, and a few studies show the association between lipid levels and multiple myeloma (MM). However, to our knowledge, the role of lipid variability as a risk factor for MM has not been evaluated. We investigated whether lipid level and its variability are associated with the development of MM at a population level. Lower baseline lipid levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides, and high variability in high-density lipoprotein cholesterol were all associated with increased risk of developing MM. These findings support the role of lipid metabolism in MM risk. (1) Background: There is evidence that abnormality in lipid metabolism promotes cancer development. This study investigated whether lipid level and its variability are associated with the development of MM at a population level. (2) Methods: A retrospective cohort study included a total of 3,527,776 subjects aged 40 and above who participated in ≥3 health examinations within the previous five years, including the index year (2012–2013). Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were measured, and visit-to-visit lipid variability were calculated by variability independent of the mean (VIM) method. The study population was followed from the health examination date in the index year until the diagnosis of MM, death, or the last follow-up date (31 December 2017). (3) Results: During a median (5–95%) 5.1 years of follow-up, 969 subjects developed MM. A lower risk of MM was observed with higher quartiles of baseline lipid levels compared to the lowest quartile group (Q4 vs. Q1: adjusted hazard ratios (aHRs) 0.51, 95% confidence interval (CI) (0.42–0.61) for TC; 0.50 (0.41–0.61) for HDL-C; 0.65 (0.54–0.77) for LDL-C; and 0.72 (0.60–0.87) for TG in model (3). Among all lipid measures, only variability in HDL-C was associated with risk of MM: aHRs (95% CI) were 1.12 (0.91–1.38), 1.19 (0.97–1.46), and 1.34 (1.09–1.65) in the Q2, Q3, and Q4, respectively, compared to the Q1 of VIM of HDL-C. (4) Conclusions: This study shows that patients with lower lipid levels and high HDL-C variability are at increased risk of developing MM. [ABSTRACT FROM AUTHOR]

Despite the growing interest in Alzheimer's disease, issues of ethnicity and culture associated with dementia are still under-studied. In this study, particular attention was given to Korean caregivers who seem to suffer the most in terms of family burdens and emotional distress. Content analysis was performed on 798 messages posted to online support groups for dementia caregivers. The results indicated that Korean caregivers expressed more family burden (“impact on finance” and “sense of entrapment”) than U.S. caregivers. Also, the Korean caregivers expressed more negative emotions than the U.S. caregivers, and consequently sought more emotional support from online support groups than the U.S. caregivers. [ABSTRACT FROM AUTHOR]

• Delirium is common following hematopoietic stem cell transplantation. • In this select sample, greater age, treatment regimen intensity, and greater white matter burden were all associated with greater delirium incidence. Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P =.002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P =.031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P <.001) but was unrelated to cortical atrophy (P =.777). Delirium was associated with fewer hospital-free days (P =.023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P =.844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted. [ABSTRACT FROM AUTHOR]

Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible. [ABSTRACT FROM AUTHOR]

Simple Summary: The present nationwide population-based longitudinal cohort study showed that diabetes was associated with an increased risk of hematologic malignancies independent of obesity. The risk of NHL increased according to the progression of dysglycemia towards a longer diabetes duration, while HL did not. There have been conflicting results regarding the association between diabetes and the risk of hematologic malignancies, and its interaction with obesity is unknown. This study determined the risk of hematologic malignancies according to the glycemic status in a population-based study involving health screening 9,774,625 participants. The baseline glycemic status of the participants was categorized into no diabetes, impaired fasting glucose (IFG), newly detected diabetes, diabetes duration <5 years, and diabetes duration ≥5 year groups. The risks of overall and specific hematologic malignancies were estimated using a Cox regression analysis. During a median follow up of 7.3 years, 14,733 hematologic malignancies developed. The adjusted hazard ratio (aHR) for the risk of all the hematologic malignancies was 0.99 (95% confidence interval (CI) 0.95–1.02) for IFG, 0.99 (95% CI 0.91–1.08) for newly detected diabetes, 1.03 (95% CI 0.96–1.11) for diabetes duration <5 years, and 1.11 (95% CI 1.03, 1.20) for diabetes duration ≥5 year groups. The association was independent from obesity. The risk of non-Hodgkin's lymphoma (NHL) increased according to the progression of dysglycemia towards a longer diabetes duration, while Hodgkin's lymphoma did not. This study in Korea demonstrated diabetes to be associated with an increased risk of hematologic malignancies independent of obesity. The NHL risk increased with the diabetes duration. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) toxicity and acute graft versus host disease (GVHD) are significant morbidities associated with allogeneic hematopoietic stem cell transplantation (HSCT). The somatostatin analogue Octreotide ameliorates mucosal injury from radiation damage in pre-clinical mouse models. We hypothesized that administration of the longer-acting synthetic somatostatin analogue, Pasireotide, in the peri-transplant period would decrease acute GI toxicity and acute GVHD related to allogeneic HSCT. Adult patients who underwent matched allogeneic HSCT with myeloablative conditioning were eligible for this study. Exclusion criteria included severe cardiac and endocrine abnormalities. Pasireotide was administered at 0.9mg twice daily from the day before conditioning began to day +4. The co-primary endpoints were 1) Acute GI toxicity, defined as GI toxicity occurring from the day prior to conditioning to day +30, and 2) Acute GVHD. Results were compared with 50 historical controls matched by Transplant diagnosis, Donor, Graft, GVHD prophylaxis, and Conditioning regimen. 36 patients were consented for the study, 25 patients received the study drug (5 screen failures, 1 insurance denial, 3 withdrew consent, 1 switched trials, 1 enrolled at an alternate center without available follow-up). There was no difference in Acute GI toxicity, which occurred in all patients in both the Pasireotide and Control groups. Grade 3 or 4 GI toxicity was similar, occurring in 20 patients (80%) in the Pasireotide group and 35 patients (70%) in the Control group. Specific GI toxicities varied in incidence between the Control and Pasireotide study groups (Figure 1), most notable for numerically higher rates of the expected toxicities abdominal pain, bloating, and vomiting in the Pasireotide group. Other common toxicities that occurred in the Pasireotide and Control groups are listed in Figure 1. There was no significant difference in incidence of overall Acute GVHD or Acute GI GVHD (Figure 2). The subset of patients who received Total Body Irradiation (TBI) conditioning had numerically lower Acute GVHD in the Pasireotide group (5/9, 55%) compared to the Control group (16/20, 80%), however this was not statistically significant (Fisher's Exact Test, p=0.21); these patients also had a lower rate of combined upper and lower GI GVHD (3/9, 33% in the Pasireotide group versus 11/20, 55% in the Control group), though this was not statistically significant (Fisher's Exact Test, p=0.43). In this Phase 2 study, the somatostatin analogue Pasireotide did not decrease GI toxicity in allogeneic HSCT; however, in the subset of patients who received TBI conditioning, there was a numerically (but not statistically) significant decrease in overall and GI Acute GVHD. Further study in a larger cohort of patients undergoing TBI conditioning is warranted. [ABSTRACT FROM AUTHOR]

Delirium is common among adults undergoing hematopoietic stem cell transplant (HCT), although the clinical predictors and neuroimaging correlates of postoperative delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-HCT delirium in a retrospective cohort of 115 adults undergoing BMT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postoperative delirium. Chart reviews were independently conducted by a team including a HCT physician, a transplant psychiatrist, a transplant psychologist, and a psychiatry resident on consecutive allogeneic HCT patients who underwent neuroimaging assessments, transplanted between January, 2009 December, 2016Y. Neuroimaging markers of cortical volume loss and white matter hyperintensities were also recorded. One hundred fifteen patients were included, ranging in age from 20 to 74 (mean age = 49 [SD = 13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (OR = 1.92 [1.28, 2.87] per decade, P =.002), greater severity of white matter hyperintensities (OR = 1.95 [1.06, 3.57], P =.031), and treatment regimen intensity (OR = 6.37 [2.20, 18.45], P <.001) but was unrelated to cortical atrophy (P =.777). Greater incidence of delirium following BMT was associated with greater age, microvascular burden, and more severe treatment regimen. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted. [ABSTRACT FROM AUTHOR]

Hematopoietic cell transplant (HCT) is an increasingly common and curative treatment strategy to improve survival among individuals malignant and nonmalignant diseases, with over one million HCTs having been performed worldwide. Neurocognitive dysfunction is a common and untoward consequence of HCT for many recipients, although few studies have examined the profile of neurocognitive impairments in HCT or their association with clinical features, such as frailty. We examined the pattern and correlates of pre-transplant neurocognitive dysfunction in a prospective sample of adults undergoing HCT. Neurocognition was assessed using the Montreal Cognitive Assessment Battery. Frailty was assessed using the Short Physical Performance Battery. Linear regression analysis was used to examine the associations between neurocognitive performance and frailty. Profiles of neurocognitive performance were also examined by partitioning MoCA scores into relevant domains of interest, including Executive Function and Memory. Regression analyses controlled for age, gender, education, and disease type. One hundred and ten adults were evaluated across a wide age range (range: 19-75; mean age = 54.7 [SD = 14.1]). Neurocognitive performance tended to fall below published normative levels (mean MoCA = 25.5 [SD = 4.1]), with 20% of participants demonstrating impaired performance compared with medical patients (score < 24) and 34% exhibiting impaired performance relative to healthy normative samples (score <26). Examination of cognitive profiles revealed that while mild impairments in Executive Function were common across the entire sample, greater age was most closely associated with worse Memory performance (r = -0.33, P<.01) and greater levels of short physical performance battery score were most strongly associated with worse Executive Function (r = -0.39, P<.01). Neurocognitive impairments are common among adults undergoing HCT and the pattern of performance varies by age. Frailty is a strong correlate of neurocognitive function and particularly Executive Function components. [ABSTRACT FROM AUTHOR]