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Elderly patients represent the most challenging and hard-to-treat patient population due to dismal characteristics of the disease, such as secondary-acute myeloid leukemia (AML), enrichment of unfavorable molecular genes (TP53) and comorbidities. We conducted a multicentric retrospective study to evaluate activity and safety in a real-life setting of hypomethylating drugs (HMAs) in patients older than 75 years with AML. Between September 2010 and December 2021, 220 patients were treated, 164 (74.5%) received AZAcitidine and 56 DECitabine; most patients (57.8%), received more than four cycles of HMAs. The best response obtained was CR in 51 patients (23.2%), PR in 23 (10.5%) and SD in 45 (20.5%); overall transfusion independence was obtained in 47 patients (34%), after a median of 3.5 months. The median OS (mOs) was 8 months (95% CI 5.9–10.2), with 1- and 2-years OS of 39.4% (95% CI 32.7–46) and 17.4% (95% CI 11.7–23.1), respectively; similar mOS was observed according to HMA treatment (AZA 8.3 vs. DEC 7.8 months, p = 0.810). A subset of 57 long survivors (44 in AZA group and 13 in DEC group) received at least 12 cycles of HMAs, their mOS was 24.3 months. In multivariate analysis, age (≥80), Charlson comorbidity index (≥3), creatinine clearance and the type of best response (≥PR) during treatment maintained independent significance in predicting survival. Infectious complications, most frequently pneumonia (35) and septic shock (12), were lethal in 49 patients (22.2%). Our data show that HMAs have similar efficacy compared to pivotal trials and are well tolerated in a setting of very elderly patients with several co-comorbidities.

Several studies in immunocompromised patients, such as those with HIV infection, undergoing cancer chemotherapy or organ transplant, have led to the development of guidelines on the use of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PJP), in these specific conditions. Instead, since the association between PJP and acute myeloid leukaemia (AML) is not clearly defined, the role of prophylaxis in patients with AML is not yet established.We retrospectively analysed 251 consecutive patients with newly diagnosed non-M3-AML, admitted at the Hematology Unit of University Tor Vergata in Rome, during the period 2010-2020. The aim of the study was to evaluate the incidence of PJP among AML patients during their first hospital admission, and to identify subjects at a high risk to develop PJP.Among 251 consecutive patients with non-M3-AML, 67 bronchoalveolar lavages (BAL) were performed. PJP was proven in 11/67 (16.7%) subjects undergoing BAL (11 males, median age 71 years), with an incidence of 4.3%. The most common reason for BAL execution were radiological findings such as ground-glass opacities (6/11, 55%) and atypical patterns like consolidations and nodules (5/11, 45%). One patient died because of PJP after 11 days of trimethoprim/sulfamethoxazole therapy. In multivariate analysis older age and smoking habit were independent factors significantly associated with PJP (p = .021 and 0.017 respectively).We conclude that PJP infection is not uncommon among patients with AML. If intensive chemotherapy is planned, physicians should be aware of this risk and prophylaxis should be considered, particularly in older patients.

Tracheas from normal and vitamin A-deficient rats were incubated in the presence of l -[3H]fucose and d -[14C]glucosamine to label epithelial and mesenchymal glycoproteins. The epithelium and the cartilage were separated by incubation with testicular hyraluronidase and processed separately for the preparation of glycopeptides. One major epithelial glycopeptide was doubly labeled. In vitamin A deficiency the amount of l -[3H]fucose was reduced to 33% that of the normal. The tracheal fucose-glycopeptide, in molar ratios, contained fucose 1.0, mannonse 1.0, galactose 0.4, hexasamine 4.7, and sialic acid 3.5. Sulfate was absent.

1. 1. Lung and tracheal glycopeptides were isolated from hamsters after tissues were incubated with labeled sugar precursors. The uptake of labeled glucosamine and fucose into the glycopeptides isolated from lung was not affected by either deficiency or excess of vitamin A. On the other hand, in vitamin A deficiency, trachea showed a markedly lower incorporation of [ 3 H]fucose into one glycopeptide fraction eluted by 0.2 M LiCl from DEAE-Sephadex. 2. 2. This fraction did not respond to excess retinyl palmitate feeding, but its labeled fucose uptake increased by more than 100% when the animals were fed excess retinoic acid for 6 weeks. 3. 3. Recovery to normal levels of the depressed [ 3 H]fucose uptake into the 0.2 M fraction occured within 1–2 days after feeding vitamin A to deficient hamsters. 4. 4. Further purification of this 0.2 M fraction on Sephadex G-75 yielded several [ 14 C]glucosamine-containing components, only one of which component [ 3 H]fucose. Uptake of both [ 14 C]glucosamine and [ 3 H]fucose into this component was greatly reduced in vitamin A deficiency. Further purification of this component on Sephadex G-75 and on Sephadex G-50, yielded a single, [ 3 H]fucose-containing peak that contained mannose, galactose, hexosamines, fucose, and sialic acid in the ratio 1 : 1.6 : 2.7 : 0.1 : 0.1. The homogeneity of this peak was confirmed by polyacrylamide gel electrophoresis.