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Summary: We describe the management and the prevalence of iron deficiency anaemia (IDA) during pregnancy by comparison to standards. A cross‐sectional national cohort study of women who had given birth six weeks prior to data collection was conducted at maternity units in the UK and Ireland. Participating centres collected data from 10 consecutive pregnant women. Analysis was descriptive to define the prevalence of IDA in pregnancy and the puerperium, and to compare the outcomes in women who had IDA with women who did not have anaemia anytime during pregnancy. Eighty‐six maternity units contributed data on 860 pregnancies and births. The overall prevalence of IDA during pregnancy was 30.4% and in the puerperium 20%. Anaemic women were more likely to be from ethnic minorities, odds ratio 2.23 (1.50, 3.32). Adherence to national guidance was suboptimal, and the prevalence of anaemia in pregnancy remains very high. There is pressing need to explore barriers to early identification and effective management of iron deficiency. IDA should be considered a major public health problem in the UK. [ABSTRACT FROM AUTHOR]

Summary: Mantle cell lymphoma (MCL) presenting in elderly, unfit patients represents a clinical challenge. Front‐line 'attenuated' or low‐intensity immunochemotherapy is often employed, although outcomes are relatively unexplored. We report outcomes of attenuated immunochemotherapy in 95 patients with MCL across 19 centres in the UK and Ireland considered unfit for full‐dose rituximab‐bendamustine or rituximab‐cyclophosphamide, doxorubicin, vincristine, prednisolone (R‐CHOP). Regimens examined were rituximab‐cyclophosphamide, vincristine, prednisolone (R‐CVP) (n = 19), dose‐attenuated R‐CHOP (n = 22), dose attenuated rituximab‐bendamustine (n = 24) and rituximab‐chlorambucil (n = 30). The primary outcome was progression‐free survival (PFS). The secondary outcomes included overall response, overall survival (OS) and toxicity. The median (range) age was 79 (58–89) years and 50% were aged ≥80 years. The median (range) Cumulative Illness Rating Scale‐Geriatric score was 6 (0–24). The median PFS for all patients was 15 months [95% confidence interval (CI) 8·7–21·2) and median OS was 31·4 months (95% CI 19·7–43·2). By multivariable analysis (MVA), the only clinical factor associated with an inferior PFS was blastoid morphology [hazard ratio (HR) 2·90, P = 0·01). Notably, higher treatment intensity (R‐CHOP/R‐bendamustine composite) provided an independently superior PFS compared with R‐CVP/R‐chlorambucil (MVA HR 0·49, P = 0·02). Factors associated with inferior OS by MVA were Eastern Cooperative Oncology Group Performance Status (HR 2·14, P = 0·04), blastoid morphology (HR 4·08, P = 0·001) and progression of disease at <24 months status (HR 5·68, P < 0·001). Overall, survival after front‐line dose‐attenuated immunochemotherapy is unsatisfactory. Clinical trials investigating novel agents such as Bruton tyrosine kinase and B‐cell lymphoma 2 inhibitors in this specific clinical setting are warranted. [ABSTRACT FROM AUTHOR]

Summary: Idelalisib (IDL) is an oral first‐in‐class phosphatidylinositol 3‐kinase delta (PI3Kδ) inhibitor approved for chronic lymphocytic leukaemia (CLL) alongside rituximab (R) since 2014. However, little data exist on routine practice. The RETRO‐idel was a protocol‐led, retrospective study of 110 patients [n = 27 front‐line (1L)] who received IDL‐R. The primary end‐point was clinical overall response rate (ORR). The median (range) follow‐up of the whole cohort was 30·2 (0·1–51·9) months. The median (range) age was 72 (48–89) years. Tumour protein p53‐disruption was common [100% 1L, 32·5% relapsed/refractory (R/R)]. The best ORR (intention‐to‐treat) was 88·2% (1L 96·3%, R/R 85·5%). Overall, the median event‐free survival (mEFS) was 20·3 months and time‐to‐next treatment was 29·2 months. The mEFS for 1L patients was 18·7 months and R/R patients was 21·7 months. The 3‐year overall survival was 56·1% (95% confidence interval 45·7–65·3). IDL was discontinued in 87·3% (n = 96). More patients discontinued due to adverse events in the front‐line setting (1L 63·0% vs. R/R 44·6%) and due to progressive disease in R/R patients (20·5% vs. 3·7% in 1L). Lower respiratory tract infection/pneumonia were reported in 34·5% (Grade ≥3, 19·1%), diarrhoea in 30·9% (Grade ≥3, 6·4%), and colitis in 9·1% (Grade ≥3, 5·5%). Overall, these data describe clear efficacy for IDL‐R in routine practice. No new safety signals were identified, although careful management of known toxicities is required. [ABSTRACT FROM AUTHOR]

Summary: This is a 5‐year real‐world study of 65 patients treated with ibrutinib for relapsed/refractory mantle cell lymphoma across the UK and Ireland. Ibrutinib was well tolerated with no fatal adverse events. The median progression‐free survival and overall survival (OS) was 12 and 18·5 months, respectively. Overall, 80% of patients discontinued treatment, predominantly for progressive disease. On discontinuation, 20% received alternative immunochemotherapy with a median OS of 24 months. Ibrutinib was used as a bridge to transplant in 8% (median OS not reached). These observations are comparable with trial outcomes with encouraging responses to immunochemotherapy at relapse. [ABSTRACT FROM AUTHOR]

Summary: Unlike AL amyloid and cast nephropathy, the long‐term outcomes of monoclonal gammopathy of renal significance (MGRS) patients with other renal histopathologies remain unclear. It is uncertain if early intervention improves renal outcomes, because of a lack of evidence from prospective studies. In this retrospective study, we examined outcomes of 41 MGRS patients treated between 2004 and 2017 across five centres: four in the UK and one in the Republic of Ireland. The primary outcome measure was renal survival estimated by Kaplan–Meier product‐limit method. Thirty‐three patients (80·5%) were kappa light chain (LC) restricted. Twenty‐seven patients (65·9%) presented with LC deposition disease on renal histology. At 24 months follow‐up, estimated renal survival was 81·6% for the whole cohort. The estimated overall survival was 80·3% at 48 months. At 24 months, patients who had chronic kidney disease (CKD) stage 2–3b at diagnosis showed an estimated renal survival of 100% compared to 80·7% in those with CKD stage 4–5 at diagnosis (P = 0·04). Poorer outcomes in MGRS patients were historically attributed to delayed diagnosis due to small plasma cell clones, as well as the need for renal biopsy. [ABSTRACT FROM AUTHOR]

Treatment of relapsed/refractory B-precursor acute lymphoblastic leukaemia (R/R B-ALL) in children remains a challenge, with only 30-50% of patients being salvaged by intensive chemotherapy and allogeneic haematopoietic stem cell transplantation (HSCT),1 with a dismal survival for those who relapse after HSCT.2 Results of immunotherapy with blinatumomab or autologous/allogeneic chimeric antigen receptor (CAR)-T cells hold out a promise of better outcomes3-6 and are now moving to the front-line of treatment protocols for selected high-risk patients (AALL1721/CASSIOPEIA, NCT03876769). The panel database included 230 patients with B-ALL, and for 138 patients (60%) the referring centre sought advice on curative treatment. The panel recommended antibody therapy for 47 patients (34%): blinatumomab for 34 patients, inotuzumab for eight, either blinatumomab or inotuzumab for five. [Extracted from the article]