Patients with hematological malignancies are at greater risk of severe COVID-19 and have been prioritized for COVID-19 vaccination. A significant proportion of them have an impaired vaccine response, ...both due to the underlying disease and to the treatments.
We conducted a prospective observational study to identify the specific risks of the outpatient population with hematological diseases.
Between 22 December 2021 to 12 February 2022, we followed 338 patients of which 16.9% (
= 57) developed SARS-CoV-2 infection despite previous vaccination (94.7%). COVID-19 patients were more likely to have received immunotherapy (85.5% vs. 41%,
< 10
), and particularly anti-CD20 monoclonal antibodies (40% vs. 14.9%,
< 10
) and Bruton's tyrosine kinase inhibitors (BTKi) (7.3% vs. 0.7%,
< 10
). There was no significant difference in demographic characteristics or hematological malignancies between COVID-19-positive and non-positive patients. Patients hospitalized for COVID-19 had more frequently received immunotherapy than patients with asymptomatic or benign forms (100% vs. 77.3%,
< 0.05). Hospitalized COVID-19 patients had a higher proportion of negative or weakly positive serologies than non-hospitalized patients (92.3% vs. 61%,
< 0.05). Patients who received tixagevimab/cilgavimab prophylaxis (
= 102) were less likely to be COVID-19-positive (4.9 vs. 22%,
< 0.05) without significant difference in hospitalization rates.
In the immunocompromised population of patients with hematological malignancies, the underlying treatment of blood cancer by immunotherapy appears to be a risk factor for SARS-CoV-2 infection and for developing a severe form.
Immunotherapy (IT) is a major therapeutic strategy for lymphoma, significantly improving patient prognosis. IT remains ineffective for a significant number of patients, however, and exposes them to ...specific toxicities. The identification predictive factors around efficacy and toxicity would allow better targeting of patients with a higher ratio of benefit to risk. PRONOSTIM is a multicenter and retrospective study using the Clinical Data Warehouse (CDW) of the Greater Paris University Hospitals network. Adult patients with Hodgkin lymphoma or diffuse large-cell B lymphoma treated with immune checkpoint inhibitors or CAR T (Chimeric antigen receptor T) cells between 2017 and 2022 were included. Analysis of covariates influencing progression-free survival (PFS) or the occurrence of grade ≥3 toxicity was performed. In total, 249 patients were included. From this study, already known predictors for response or toxicity of CAR T cells such as age, elevated lactate dehydrogenase, and elevated C-Reactive Protein at the time of infusion were confirmed. In addition, male gender, low hemoglobin, and hypo- or hyperkalemia were demonstrated to be potential predictive factors for progression after CAR T cell therapy. These findings prove the attractiveness of CDW in generating real-world data, and show its essential contribution to identifying new predictors for decision support before starting IT.
Although anti-CD38 monoclonal antibodies have improved the prognosis of relapsed/refractory multiple myeloma (RRMM), some patients still experience early relapses with poor outcomes. This present ...study evaluated the predictive value of FDG PET/CT parameters for RRMM prior to initiating anti-CD38 treatment. We included 38 consecutive RRMM patients who underwent a PET/CT scan treated at our institution at relapse. The median PFS was 12.5 months and the median OS was not reached. 42% of the patients had an initial ISS score of 1, 37% of 2, and 21% of 3. The presence of >3 focal lesions (FLs,
= 19) and the ISS score were associated with inferior PFS (
= 0.0036 and
= 0.0026) and OS (
= 0.025 and
= 0.0098). Patients with >3 FLs had a higher initial ISS score (
= 0.028). In multivariable analysis, the ISS score and >3 FLs were independent prognostic factors for PFS (
= 0.010 and
= 0.025 respectively), and combined they individualized a high-risk group with a median PFS and OS of 3.1 months and 8.5 months respectively vs. not reached for the other patients. The presence of >3 FLs on PET was predictive of survival outcomes in patients with RRMM treated using CD38 targeted therapy. Combined with the initial ISS, an ultra-high-risk RRMM population can thus be identified.
Resumo A intimidade entre dinheiro e voto tem sido exposta nas democracias contemporâneas por meio de sua influência nos resultados eleitorais e na produção de políticas públicas. Estudos apontam que ...a progressiva iniquidade entre os recursos financeiros dos candidatos nas eleições abala a democracia e promove a plutocracia, ou seja, amplia o domínio oligárquico dos processos políticos pelos cidadãos e pelos grupos mais ricos. Contribuindo para esse debate, o presente trabalho analisa a relação entre receitas de financiamento e o desempenho e o sucesso eleitoral de 317.107 candidaturas a vereador nas eleições de 2008, 2012 e 2016, em 441 municípios brasileiros com mais de 50 mil eleitores. Trata-se de um estudo inédito em sua abrangência temporal, que permite suprir uma carência de exames sobre eleições subnacionais, em especial nas disputas ao Legislativo municipal. Os dados utilizados têm origem no Tribunal Superior Eleitoral, nas tabelas de candidaturas, nos resultados e na prestação de contas. Os testes e as análises de dados e informações utilizam recursos estatísticos de correlação e regressão, além de medidas centrais e razão de chances. Os resultados permitem confirmar uma forte associação entre dinheiro, voto e sucesso eleitoral, inclusive no pleito de 2016, quando estiveram proibidas as doações empresariais. A manutenção de um padrão, tanto temporal quanto geográfico, indica a existência de características estruturais de caráter plutocrático no financiamento eleitoral dos candidatos a vereador nas cidades pesquisadas e, consequentemente, sobre a produção de políticas públicas no Brasil.
Resumen La intimidad entre dinero y voto ha sido expuesta en las democracias contemporáneas a través de su influencia en los resultados electorales y en la producción de políticas públicas. Los estudios muestran que la desigualdad progresiva entre los recursos financieros de los candidatos en las elecciones debilita la democracia y promueve la plutocracia, es decir, aumenta el dominio oligárquico en los procesos políticos por parte de los ciudadanos y grupos más ricos. Contribuyendo a este debate, el presente trabajo analiza la relación entre los ingresos por financiamiento y el desempeño y el éxito electoral de 317.107 candidatos a concejal en las elecciones de 2008, 2012 y 2016 en 441 municipios brasileños con más de 50 mil votantes. Es un estudio sin precedentes en su alcance temporal que permite suplir la falta de estudios sobre elecciones subnacionales, especialmente en disputas relacionadas con el Poder Legislativo Municipal. Los datos utilizados provienen del Tribunal Superior Electoral, de los cuadros de candidaturas, resultados y rendición de cuentas. Las pruebas y análisis de datos e información utilizan recursos estadísticos de correlación y regresión, además de medidas centrales y razón de probabilidades. Los resultados confirman una fuerte asociación entre dinero, votación y éxito electoral, incluso en las elecciones de 2016, cuando se prohibieron las donaciones corporativas. El mantenimiento de un patrón tanto temporal como geográfico indica la existencia de características estructurales de carácter plutocrático en el financiamiento electoral de los candidatos a concejal en las ciudades encuestadas y, en consecuencia, en la producción de políticas públicas en Brasil.
Abstract The close relationship between money and votes has been exposed in contemporary democracies through the influence of the former in election results and in the creation of public policies. Studies have pointed out that the progressive inequity of financial resources available to the candidates running for elections unbalances democracy and promotes plutocracy, increasing the oligarchical ruling over the political processes by the wealthiest citizens and groups. This work contributes to this debate by analyzing the relationship between fundraising and electoral performance and the success of 317,107 candidates running in local legislative elections in 2008, 2012, and 2016 in 441 Brazilian municipalities with over 50,000 inhabitants. This is an unprecedented study regarding its period, filling a gap in electoral studies on sub-national elections, particularly regarding elections for the legislative branch. Data was collected from the Brazilian Superior Electoral Court, from candidate lists, results, and accounting. The tests and data analysis and information employed correlation and regression statistical resources, along with central measures and odds ratio. The results confirmed a strong association between money, vote, and electoral success, including in the 2016 election when company donations had been prohibited. The maintenance of a pattern, regarding both time and geography, indicates the existence of structural characteristics of a plutocratic character in the election funding of those running for the council in the municipalities studied and, consequently, in the creation of public policies in Brazil.
Immunocompromised patients have an increased risk of a severe form of COVID-19. The clinical efficacy of the tixagevimab/cilgavimab monoclonal antibody combination as pre-exposure prophylaxis against ...BA.1 and BA.2 SARS-CoV-2 Omicron sublineages is unknown. We aimed to describe the incidence and outcomes of COVID-19 among immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis during the Omicron wave in France.
This was an observational multicentre cohort study of immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis between December 28, 2021 and March 31, 2022. Patients received tixagevimab/cilgavimab 150/150 mg intramuscularly if they had impaired vaccine response and a high risk of severe form of COVID-19.
Tixagevimab/cilgavimab was administered to 1112 immunocompromised patients. After a median (range) follow-up of 63 (49–73) days, COVID-19 was confirmed in 49/1112 (4.4%) ≥5 days after treatment. During the study period, mean weekly incidence rate was 1669 in 100 000 inhabitants in Ile-de-France and 530 in 100 000 among patients who received tixagevimab/cilgavimab prophylaxis. Among infected patients, 43/49 (88%) had a mild-to-moderate form and 6/49 (12%) had a moderate-to-severe form of COVID-19. Patients with moderate-to-severe illnesses were less likely to have received early therapies than patients with mild forms (53.5% vs. 16.7% respectively) and 2/49 (4%) patients died from COVID-19.
Our study reported a low rate of infections and severe illnesses among immunocompromised patients treated with tixagevimab/cilgavimab. A global preventive strategy including vaccines, preexposure prophylaxis with monoclonal antibodies, and early therapies might be effective to prevent severe forms of COVID-19 among severely immunocompromised patients.
Summary
Myeloproliferative neoplasm‐unclassifiable (MPN‐U) presents an MPN‐type phenotype that fails to meet diagnostic criteria for other MPN variants. Variability in the clinicopathological ...phenotypes presents many challenges. Amongst a registry cohort of 1512 patients with MPN, 82 with MPN‐U were included, with a median (range) age of 49·7 (13–79) years. Albeit heterogeneous, common presentation features included raised lactate dehydrogenase, thrombocytosis and clustered/pleomorphic megakaryocytes on trephine biopsy. Thrombosis was common (21%), necessitating vigilance. The median event‐free survival was 11·25 years (95% confidence interval 9·3–not reached), significantly shortened in cases with lower platelet counts (<500 × 109/l) and a leucocytosis (≥12 × 109/l) at presentation. Generation of potential MPN‐U prognostic scores is required.
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