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Summary: The interaction of acute myeloid leukaemic (AML) blasts with the bone marrow (BM) microenvironment is a major determinant governing disease progression and resistance to treatment. The constitutive expression of E‐selectin in the vascular compartment of BM, a key endothelial cell factor, directly mediates chemoresistance via E‐selectin ligand/receptors. Despite the success of hypomethylating agent (HMA)‐containing regimens to induce remissions in older AML patients, the development of primary or secondary resistance is common. We report that following treatment with 5‐azacitidine, promoter regions regulating the biosynthesis of the E‐selectin ligands, sialyl Lewis X, become further hypomethylated. The resultant upregulation of these gene products, in particular α(1,3)‐fucosyltransferase VII (FUT7) and α(2,3)‐sialyltransferase IV (ST3GAL4), likely causes functional E‐selectin binding. When combined with the E‐selectin antagonist uproleselan, the adhesion to E‐selectin is reversed and the survival of mice transplanted with AML cells is prolonged. Finally, we present clinical evidence showing that BM myeloid cells from higher risk MDS and AML patients have the potential to bind E‐selectin, and these cells are more abundant in 5‐azacitidine‐non‐responsive patients. The collective data provide a strong rationale to evaluate 5‐azacitidine in combination with the E‐selectin antagonist, uproleselan, in this patient population. [ABSTRACT FROM AUTHOR]

Simple Summary: Acute myeloid leukaemia (AML) is the most common acute leukaemia affecting adults and has one of the poorest survival rates of all cancers. The disease is often pre-cursed by myelodysplastic neoplasms (MDS), a more benign class of diseases that can last many years but also carry a high risk of progression to AML. Diagnosis requires histological examination of a bone marrow biopsy, an invasive procedure that can be influenced by sampling variations and subjective enumeration. A circulating biomarker that could be measured as part of a routine peripheral blood test would provide a much quicker, safer, and reliable alternative. This study examines the potential use of α-enolase (ENO1) as a potential biomarker and shows that it is highly expressed in bone marrow biopsies from patients with both MDS and AML, and that patients with these diseases also have decreased circulating levels of autoantibodies to ENO1. In solid tumours, high expression of the glycolytic enzyme, α-enolase (ENO1), predicts for poor patient overall survival (OS), and circulating autoantibodies to ENO1 correlate positively with diagnosis and negatively with advanced disease. Although ENO1 is one of the most highly expressed genes in acute myeloid leukaemia (AML), its potential role as a biomarker in AML or its precursor, myelodysplastic neoplasms (MDS), has not been investigated. A meta-analysis of nine AML online datasets (n = 1419 patients) revealed that high ENO1 expression predicts for poor OS (HR = 1.22, 95% CI: 1.10–1.34, p < 0.001). Additionally, when compared to AML in remission (n = 5), ENO1 protein detected by immunohistochemistry was significantly higher at diagnosis in bone marrow from both AML (n = 5, p < 0.01) and MDS patients (n = 12, p < 0.05), and did not correlate with percentage of blasts (r = 0.28, p = 0.21). AML patients (n = 34) had lower circulating levels of ENO1 autoantibodies detected by ELISA compared to 26 MDS and 18 controls (p = 0.003). However, there was no difference in OS between AML patients with high vs. low levels of anti-ENO1 autoantibodies (p = 0.77). BM immunostaining for ENO1 and patient monitoring of anti-ENO1 autoantibody levels may be useful biomarkers for MDS and AML. [ABSTRACT FROM AUTHOR]

Despite widespread vaccination rates, we are living with high transmission rates of SARS‐CoV‐2. Although overall hospitalisation rates are falling, the risk of serious infection remains high for patients who are immunocompromised because of haematological malignancies. In light of the ongoing pandemic and the development of multiple agents for treatment, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID‐19 management in patients with haematological disorders. It is our recommendation that both patients with haematological malignancies and treating specialists be educated regarding the preventive and treatment options available and that patients continue to receive adequate vaccinations, keeping in mind the suboptimal vaccine responses that occur in haematology patients, in particular, those with B‐cell malignancies and on B‐cell‐targeting or depleting therapy. Patients with haematological malignancies should receive treatment for COVID‐19 in accordance with the severity of their symptoms, but even mild infections should prompt early treatment with antiviral agents. The issue of de‐isolation following COVID‐19 infection and optimal time to treatment for haematological malignancies is discussed but remains an area with evolving data. This position statement is to be used in conjunction with advice from infectious disease, respiratory and intensive care specialists, and current guidelines from the National COVID‐19 Clinical Evidence Taskforce and the New Zealand Ministry of Health and Cancer Agency Te Aho o Te Kahu COVID‐19 Guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Digital pathology artificial intelligence (AI) platforms have the capacity to improve over time through "deep machine learning." We have previously reported on the accuracy of peripheral white blood cell (WBC) differential and blast identification by Techcyte (Techcyte, Inc., Orem, UT, USA), a digital scanner‐agnostic web‐based system for blood film reporting. The aim of the current study was to compare AI protocols released over time to assess improvement in cell identification. Methods: WBC differentials were performed using Techcyte's online AI software on the same 124 digitized abnormal peripheral blood films (including 64 acute and 22 chronic leukaemias) in 2019 (AI1), 2020 (AI2), and 2022 (AI3), with no reassignment by a morphologist at any time point. AI results were correlated to the "gold standard" of manual microscopy, and comparison of Lin's concordance coefficients (LCC) and sensitivity and specificity of blast identification were used to determine the superior AI version. Results: AI correlations (r) with manual microscopy for individual cell types ranged from 0.50–0.90 (AI1), 0.66–0.86 (AI2) and 0.71–0.91 (AI3). AI3 concordance with manual microscopy was significantly improved compared to AI1 for identification of neutrophils (LCC AI3 = 0.86 vs. AI1 = 0.77, p = 0.03), total granulocytes (LCC AI3 = 0.92 vs. AI1 = 0.82, p = 0.0008), immature granulocytes (LCC AI3 = 0.67 vs. AI1 = 0.38, p = 0.0014), and promyelocytes (LCC AI3 = 0.53 vs. AI1 = 0.16, p = 0.0008). Sensitivity for blast identification (n = 65 slides) improved from 97% (AI1), to 98% (AI2), to 100% (AI3), while blast specificity decreased from 24% (AI1), to 14% (AI2) to 12% (AI3). Conclusion: Techcyte AI has shown significant improvement in cell identification over time and maintains high sensitivity for blast identification in malignant films. [ABSTRACT FROM AUTHOR]

The article discusses updated treatment options for immune thrombocytopenia (ITP) in Australia, highlighting changes in PBS reimbursement criteria and the availability of new medications, ultimately aiming to improve patient outcomes and quality of life.