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Background: Role of erythropoietin (EPO) in the treatment of late anemia in patients with Chronic Myeloid Leukemia (CML) is still undefined. Methods: Fifty CML patients treated at 14 institutions with frontline imatinib for at least 12 months and in stable complete cytogenetic response who developed a late chronic anemia treated with EPO were retrospectively evaluated. Results: Median time from imatinib start to EPO treatment was 42.2 months [interquartile range (IQR) 20.8‐91.9]. Median Hb value at EPO starting time was 9.9 g/dL (IQR 8.9‐10.3): Eleven patients (22.0%) were transfusion dependent. Alpha‐EPO (40 000 UI weekly) was employed in 37 patients, beta‐EPO (30 000 UI weekly) in 9 patients, zeta‐EPO (40 000 UI weekly) in 2 patients, and darbepoetin (150 mcg/weekly) in the remaining 2 patients. On the whole, 41 patients (82.0%) achieved an erythroid response, defined as a stable (>3 months) improvement >1.5 g/dL of Hb level, and 9 patients (18.0%) indeed resulted resistant. Among responding patients, 10 relapsed after a median time from EPO start of 20.7 months (IQR 10.8‐63.7). No EPO‐related toxicity was observed. Conclusions: Results of EPO treatment for late chronic anemia during long‐lasting imatinib therapy are encouraging, with a high rate of response. [ABSTRACT FROM AUTHOR]

Pulmonary infections (PIs) are a major complication of patients with myelodysplastic syndromes (MDS). We retrospectively evaluated 234 MDS patients treated with azacytidine (AZA). The total number of AZA cycles was 2886 (median 8 cycles per patient). There were 111 episodes of PI (3.8% of AZA cycles) in 81 patients (34.6%). PIs were considered of fungal origin in 27 cases (24.3%), associated to bacteremia in 11 cases (9.9%), to influenza infection in two cases (1.8%) and of unknown origin in the remaining 71 cases (64.0%). Forty-five PI episodes were documented in cycles 1 to 4 of AZA (5.1% of 875 cycles) and the remaining 66 episodes beyond the fourth cycle (3.2% of 2011 cycles) (P = .017). Overall, a fungal PI was documented in 13/875 (1.5%) cycles 1 to 4 and in 13/2011 (0.6%) cycles beyond the fourth cycle (P = .001). A baseline chronic pulmonary disease was significantly associated to a higher risk of severe PIs. In the survival analysis, cases of PI in patients who progressed to acute leukemia (PAL) were excluded, in view of the predominant influence of PAL on the outcome of the patients. A PI unrelated to PAL documented during the first 4 AZA cycles was an independent factor predicting lower survival (OR, 2.13; 95% CI, 1.37-3.33; P = .001). In conclusion, PIs are common in MDS patients receiving AZA, in particular during the first cycles of treatment and are associated with an unfavorable outcome. The results of our study raise the issue of the need of a tailored infection prevention strategy. [ABSTRACT FROM AUTHOR]

Although ibrutinib is generally well tolerated, it has been associated with atrial fibrillation (AF) in 6-16% of cases.[1] Most CLL patients are elderly and suffer of several comorbidities[[2]] that may trigger AF regardless of ibrutinib. A prior history of AF was present in only 21 patients (2.4%) at CLL diagnosis, while, among the remaining 839 patients without a previous history of AF, 47 (5.6%) developed AF after a median follow-up of 9.4 years (Figure A). Although none of the 137 patients at score 0 developed AF, the 545 patients with score of 1-2 had a 10-year TTAF of 6%, while the risk for the 103 and 75 patients at score 3-4 and >=5 was 12% and 29%, respectively ( I p i < 0.001, Figure C). Our model was also able to identify patients at a higher risk of AF during ibrutinib; in fact, the 2-year risk of AF was 0%, 5%, 17%, and 40% for patients with score 0, 1-2, 3-4, and >=5, respectively ( I p i < 0.001, Figure F). [Extracted from the article]

Objectives: To evaluate differences in clinical results according to age among patients with chronic myeloid leukemia (CML). Methods: 207 consecutive CML patients treated with imatinib frontline were revised, dividing them in young adults (>20 < 45 years) (YA), middle‐aged adults (≥45 < 65 years) (MA) and elderly (≥65 years) (EL). Results: Cumulative incidence of complete cytogenetic response (CCyR) and major molecular response (MMolR) were significantly higher in MA compared with YA and EL (P < .001 for CCyR and P = .001 for MMolR). Number of total events was lower in MA (8 [11.1%] vs 21 [34.4%] in YA and 28 [37.8%] in EL, P = .001): no difference was observed for blastic evolution (P = .478). Number of deaths was higher in the EL (12 [16.2%] vs 2 [3.2%] in YA and 0 in MA, P < .001): however, 11/12 deaths in EL were not related to CML. The PFS curve in MA was significantly longer than in YA and in EL (P = .02). The OS curve in EL was significantly shorter than in YA and in MA (P < .001). Conclusions: Age at diagnosis influences significantly the course of CML patients treated with imatinib: a possible explanation of the counterintuitive worse course in YA is the delayed diagnosis compared to elderly. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the addition of cyclophosphamide in relapsed-refractory multiple myeloma patients (RRMM) who experienced biochemical relapse or progression without CRAB, during treatment with lenalidomide and dexamethasone (Rd), to slow down the progression in active relapse. Methods: This analysis included 31 patients with RRMM treated with Rd who received cyclophosphamide (CRd) at biochemical relapse. The CRd regimen was continued until disease progression. Results: The median number of CRd cycles administered was 8 (range: 1-35). A response was observed in 9 (29%) patients. After a median observation time of 11 months, the median overall survival (OS) from the beginning of CRd was 17.7 months. The median progression-free survival (PFS) from the beginning of CRd was 13.1 months. Conclusion: The addition of cyclophosphamide delays the progression in patients who present a biochemical relapse during Rd treatment. The response rate and the duration of PFS obtained with minimal toxicities and low costs induced us to setting up a randomized clinical trial. [ABSTRACT FROM AUTHOR]