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Background: Cardiac magnetic resonance (CMR) has demonstrated its utility in the noninvasive diagnosis of cardiac amyloidosis (CA). Our aim was to evaluate the ability of standard Look-Locker sequences to quantify amyloid deposition in CA.Methods and Results: Consecutive patients referred for CMR for possible CA were retrospectively evaluated. Positive cardiac biopsy and/or typical pattern of late gadolinium enhancement were required for the diagnosis of CA. Postcontrast T1 values were obtained from Look-Locker sequences and correlated with markers of severity of disease and major events. When cardiac biopsies were available, histological validation was determined. A total of 174 patients were included. A final diagnosis of CA was reached in 37.4%. Myocardial and endocardial T1 times, as well as the respective ratios with blood and skeletal muscle, were lower among patients with CA and demonstrated good diagnostic performance. The best parameters were myocardial/blood (area under the curve  0.83; P < .001) and endocardial/blood (area under the curve 0.84; P < .001) T1 ratios. Among patients with CA, no associations were found between T1 ratios either with markers of amyloid burden or with prognostic variables. However, all T1 indexes showed significant correlations with histological quantification of amyloid deposition.Conclusions: Look-Looker derived postcontrast T1 shows good diagnostic accuracy to detect CA and correlation with histological amyloid burden. [ABSTRACT FROM AUTHOR]

Chimeric Antigen Receptor (CAR) T cell therapy is an FDA approved treatment for diffuse large B cell lymphoma-not otherwise specified (DLBCL-NOS), primary mediastinal large B cell lymphoma (PMLBCL), high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma with two commercial products currently in clinical use: Tisagenlecleucel and Axicabtagene ciloleucel (axi-cel). A number of products are in clinical trials for other indications including multiple myeloma. The long-term consequences of cellular therapy are largely unknown. Grade 3 or higher cytopenias have been reported in 17% of patients treated with axi-cell [1]. We sought to further characterize the duration and intensity of cytopenias following cellular therapy using commercial and research products i.e, axi-cell, anti-BCMA bb2121 and anti-BCMA bb21217. We also aimed to assess current practice regarding management of cytopenias in patients treated with cellular therapy. We evaluated patients with DLBCL and multiple myeloma treated at the Mount Sinai Hospital between April 2017 and September 2019. Counts at apheresis, and days 0, 7, 15, 30, 90 and 180 post-treatment were recorded. Administration of G-CSF, erythropoiesis-stimulating agents (ESA), thrombopoietin receptor agonists (TPO-agonist); and red blood cell and platelet transfusions between days 0 and 180 were also recorded. The data was censored at last follow up, progression or death. A total of fifty patients were identified; 41 with multiple myeloma and nine with DLBCL. At day 30, grade 3-4 neutropenia, anemia and thrombocytopenia were present in 54% (26/48), 17% (8/48) and 50% (24/48) of patients, respectively (table 1). G-CSF, ESA, TPO-agonist, PRBC and platelet utilization beyond day 30 is shown in table 2. 70.8% (34/48) patients required G-CSF support beyond day 30. Prolonged cytopenias can be seen in over 50% of patients beyond day 30 after cellular therapy and require frequent monitoring for management. By day 90, majority of the patients had improvement in their counts. We will be further examining data to determine the relationship of cytopenias with risk of infectious complications, antibiotic therapy utilization, re-hospitalization and duration of hospital stay. [ABSTRACT FROM AUTHOR]

The acute respiratory distress syndrome (ARDS) resulting from coronavirus disease 2019 (COVID-19) is associated with a massive release of inflammatory cytokines and high mortality. Mesenchymal stromal cells (MSCs) have anti-inflammatory properties and have shown activity in treating acute lung injury. Here the authors report a case series of 11 patients with COVID-19-associated ARDS (CARDS) requiring mechanical ventilation who were treated with remestemcel-L, an allogeneic MSC product, under individual patient emergency investigational new drug applications. Patients were eligible if they were mechanically ventilated for less than 72 h prior to the first infusion. Patients with pre-existing lung disease requiring supplemental oxygen or severe liver or kidney injury were excluded. Each patient received two infusions of remestemcel-L at a dose of 2 million cells/kg per infusion given 48–120 h apart. Remestemcel-L infusions were well tolerated in all 11 patients. At the end of the 28-day follow-up period, 10 (91%, 95% confidence interval [CI], 59–100%) patients were extubated, nine (82%, 95% CI, 48–97%) patients remained liberated from mechanical ventilation and were discharged from the intensive care unit and two (18%, 95 CI%, 2–52%) patients died. The median time to extubation was 10 days. Eight (73%, 95% CI, 34–100%) patients were discharged from the hospital. C-reactive protein levels significantly declined within 5 days of MSC infusion. The authors demonstrate in this case series that remestemcel-L infusions to treat moderate to severe CARDS were safe and well tolerated and resulted in improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Therapeutic strategies for multiple myeloma (MM) have changed dramatically over the past decade. Thus, the role of hematopoietic stem cell transplantation (HCT) must be considered in the context of this evolution. In this evidence-based review, we have critically analyzed the data from the most recent clinical trials to better understand how to incorporate HCT and when HCT is indicated. We have provided our recommendations based on strength of evidence with the knowledge that ongoing clinical trials make this a dynamic field. Within this document, we discuss the decision to proceed with autologous HCT, factors to consider before proceeding to HCT, the role of tandem autologous HCT, post-HCT maintenance therapy, and the role of allogeneic HCT for patients with MM. [ABSTRACT FROM AUTHOR]