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Summary: Azacitidine (AZA) is important in the management of patients with acute myeloid leukaemia (AML) who are ineligible for intensive chemotherapy. Romidepsin (ROM) is a histone deacetylase inhibitor which synergises with AZA in vitro. The ROMAZA trial established the maximum tolerated dose (MTD) of combined ROM/AZA therapy in patients with AML, as ROM 12 mg/m2 on Days 8 and 15, with AZA 75 mg/m2 administered for 7/28 day cycle. Nine of the 38 (23·7%) patients treated at the MTD were classified as responders by Cycle 6 (best response: complete remission [CR]/incomplete CR n = 7, partial response n = 2). Correlative next‐generation sequencing studies demonstrated important insights into therapy resistance. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a severe impact on people with blood cancers. (A) Percentage of patients with a chronic myeloid malignancy (n = 59) versus healthcare worker (HCW) controls (n = 232) of a similar age (>60 years), with positive anti-spike (anti-S) serology and no evidence of past COVID-19 infection [224/232 (97%) HCW vs 34/59 (58%) patients; P < 0-0001]. Interim results of the safety and immune-efficacy of 1 versus 2 doses of COVID-19 vaccine BNT162b2 for cancer patients in the context of the UK vaccine priority guidelines. medRxiv. While it is expected that a higher proportion of patients will respond following booster vaccine doses, the suboptimal responses observed here to the first vaccine dose highlight an unexpected and potentially important immunocompromise in this patient group, which will be informative for planning our ongoing response to this evolving pandemic. [Extracted from the article]

Objectives: We sought to characterise the outcomes of patients with haematological malignancy and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in hospital in our regional network of 7 hospitals. Methods: Consecutive hospitalised patients with haematological malignancy and SARS‐CoV‐2 infection were identified from 01/03/2020 to 06/05/2020. Outcomes were categorised as death, resolved or ongoing. The primary outcome was preliminary case fatality rate (pCFR), defined as the number of cases resulting in death as a proportion of all diagnosed cases. Analysis was primarily descriptive. Results: 66 Patients were included, overall pCFR was 51.5%. Patients ≥ 70 years accounted for the majority of hospitalised cases (42, 63%) and fatalities (25, 74%). Mortality was similar between females (52%) and males (51%). Immunosuppressive or cytotoxic treatment within 3 months of the diagnosis of SARS‐CoV‐2 infection was associated with a significantly higher pCFR of 70%, compared with 28% in those not on active treatment (P =.0013, 2 proportions z test). Conclusions: Mortality rates in patients with haematological malignancy and SARS‐CoV‐2 infection in hospital are high supporting measures to minimise the risk of infection in this population. [ABSTRACT FROM AUTHOR]

Assessing the impact of lockdown: Fresh challenges for the care of haematology patients in the COVID-19 pandemic Worldwide cases of confirmed COVID-19 are approaching three million, and citizens around the world are experiencing unprecedented changes to their lifestyles due to the measures implemented to slow the spread of the disease. New diagnoses of haematological malignancy There has been a 71% fall in the numbers of full blood counts performed from primary care in the four weeks since the lockdown was introduced, and 57% fewer patients referred by e-referral for specialist haematology review. [Extracted from the article]

Summary: Allogeneic haematopoietic stem cell transplant (allo‐HSCT) offers potentially curative therapy for patients with relapsed/refractory lymphoid malignancies. Reduced‐intensity conditioning (RIC) with Alemtuzumab reduces transplant‐related mortality and graft‐versus‐host disease (GvHD), but may be associated with increased risk of relapse. With the aim of studying the effect of GVHD and donor lymphocyte infusions (DLI) on relapse, we performed a retrospective study of 288 patients (57% non‐Hodgkin lymphoma, 24% Hodgkin lymphoma and 19% chronic lymphocytic leukaemia; 58% were relapsed/refractory) who underwent RIC‐Alemtuzumab‐HSCT between 2000 and 2012. Median follow‐up time for survivors was 64 months. Five‐year overall survival, relapse incidence, GvHD/relapse‐free survival and non‐relapse mortality were 47%, 33%, 37% and 28% respectively. Cumulative incidence of grade II‐IV acute and extensive chronic GvHD was 22% and 21% at 100 days and 5 years respectively. On multivariate analysis, presence of GvHD (P = 0·03) and unrelated donor type (P = 0·03) were protective of relapse. 62/288 patients received DLI for either mixed donor chimerism (prophylactic DLI, n = 37) or clinical relapse (therapeutic DLI, n = 25). Prophylactic and therapeutic DLI successfully converted the patient to full or stable mixed donor chimerism in 78% and 56% of patients respectively. These data demonstrate good long‐term outcomes and support the concept of the graft‐vs‐lymphoma effect as a key protective factor against relapse following RIC‐Alemtuzumab allo‐HSCT for patients with mature lymphoid malignancies. [ABSTRACT FROM AUTHOR]

BACKGROUND Fludarabine plus busulfan (FB) and fludarabine plus melphalan (FM) are 2 widely used reduced-intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (allo-SCT). METHODS The current survey compared transplantation outcomes for a cohort of 394 acute myeloid leukemia (AML) patients given bone marrow or peripheral blood stem cells from human leukocyte antigen-identical siblings after FB (n = 218) or FM (n = 176). Patients given manipulated grafts and those given T-cell-depleting agents (anti-thymocyte globulins or alemtuzumab) were not included. RESULTS At the time of transplantation, 266 patients (68%) were experiencing their first complete remission (CR), 69 (18%) were experiencing a later CR, and 59 (15%) had advanced disease. The incidences of acute and chronic graft-versus-host disease were similar in the 2 groups of patients. The 2-year relapse incidence (RI), nonrelapse mortality (NRM) rate, leukemia-free survival (LFS) rate, and overall survival (OS) rate were 31% ± 3%, 18% ± 3%, 51% ± 4%, and 54% ± 4%, respectively, for FB patients and 20% ± 3% ( P = .007), 20% ± 3% ( P = .4), 60% ± 4% ( P = .08), and 62% ± 4% ( P = .2), respectively, for FM patients. Among FB patients given intravenous busulfan (n = 81), the 2-year RI, NRM, LFS, and OS rates were 26% ± 5% ( P = .43 vs FM patients), 25% ± 6% ( P = .18), 49% ± 7% ( P = .07), and 54% ± 7% ( P = .13), respectively. In multivariate analyses, FM was associated with a lower RI (hazard ratio [HR], 0.5; P = .01) and a trend toward higher NRM (HR, 1.6; P = .1) with similar LFS (HR, 0.8; P = .2) and OS (HR, 0.9; P = .6). CONCLUSIONS These results suggest that although FM provides better AML control than FB as an RIC regimen for allo-SCT, the 2 regimens provide similar survival. Multicenter randomized studies are needed to confirm these findings. Cancer 2015;121:1048-1055. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]