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Arsenic trioxide (ATO)-based regimens are standard in acute promyelocytic leukemia (APL). ATO-related nephrotoxicity has not been reported. We reviewed APL patients treated with ATO to identify cases of acute kidney injury (AKI). Clinically significant cases were characterized. Multivariate analysis was performed to identify predictors of idiopathic, clinically significant AKI. One hundred and eight patients were included. ATO dose was 0.15 mg/kg/day using actual body weight with no dose cap. Thirty-one (28.7%) AKI cases were identified, 10 (32.3%) clinically significant. Six were idiopathic; five required dialysis. The proportion with significant, idiopathic AKI was 15.8% in patients receiving >15mg ATO versus 0% in those receiving ≤15mg (p = 0.001). On multivariate analysis, only ATO dose was a significant predictor of clinically significant AKI (odds ratio of 1.91, 95%CI, 1.19–3.07, p = 0.007). High-dose ATO may be associated with significant nephrotoxicity. We recommend that ATO dose be capped at 15 mg to minimize toxicity for this curable disease. [ABSTRACT FROM AUTHOR]

The prognostic value of minimal residual disease (MRD) assessed by multi-parameter flow cytometry (MFC) was investigated among 340 adult patients with B-cell acute lymphoblastic leukaemia (B-ALL) treated between 2004 and 2014 using regimens including the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) backbone. Among them, 323 (95%) achieved complete remission (CR) and were included in this study. Median age was 52 years (range, 15-84). Median white blood cell count (WBC) was 9·35 × 10(9) /l (range, 0·4-658·1 ×1 0(9) /l). MRD by MFC was initially assessed with a sensitivity of 0·01%, using a 15-marker, 4-colour panel and subsequently a 6-colour panel on bone marrow specimens obtained at CR achievement and at approximately 3 month intervals thereafter. MRD negative status at CR was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·004 and P = 0·03, respectively). Similarly, achieving MRD negative status at approximately 3 and 6 months was associated with improved DFS (P = 0·004 and P

BackgroundThe long-term efficacy of a combination of chemotherapy and dasatinib in patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) is not well established.MethodsPatients received dasatinib with 8 cycles of alternating hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone and high-dose cytarabine and methotrexate. Patients in complete remission (CR) continued maintenance dasatinib, vincristine, and prednisone for 2 years, which was followed by dasatinib indefinitely. Patients eligible for allogeneic stem cell transplantation (SCT) received it during their first CR.ResultsSeventy-two patients with a median age of 55 years (range, 21-80 years) were treated; 69 (96%) achieved CR. Among them, 57 (83%) achieved cytogenetic CR after 1 cycle, and 64 (93%) achieved a major molecular response at a median of 4 weeks (range, 2-38 weeks). Sixty-five patients (94%) were negative for minimal residual disease assessed by flow cytometry at a median of 3 weeks (range, 2-37 weeks). Dasatinib-related grade 3 and 4 adverse events included bleeding, pleural/pericardial effusions, and elevated transaminases. With a median follow-up of 67 months (range, 33-97 months), 33 patients (46%) were alive, and 30 (43%) were in CR; 12 underwent allogeneic SCT. Thirty-nine patients died (3 at induction, 19 after relapse, 7 after SCT performed during first CR, and 10 during CR). The median disease-free survival and overall survival were 31 (range, 0.3-97 months) and 47 months (range, 0.2-97 months), respectively. Seven relapsed patients had BCR-ABL kinase domain mutations, including 4 with T315I.ConclusionsA combination of chemotherapy with dasatinib is effective in achieving long-term remission for patients with newly diagnosed Ph + ALL.

BACKGROUND: In 2019, the Hematology/Oncology Pharmacy Association (HOPA) and the Academy of Managed Care Pharmacy (AMCP) convened a forum to discuss the use of value-based care models in oncology, emphasize the importance of pharmacist involvement in implementing value-based care at their institutions, and create a white paper on this topic. OBJECTIVE: To highlight areas of opportunities for oncology pharmacists to participate in the implementation and delivery of value-based care in oncology. DISCUSSION: This white paper summarizes the HOPA/AMCP forum and serves as a call to action to health system pharmacists to engage in the continuum of cancer care as essential providers of value through the implementation of quality processes that inform safe and effective treatment choices, enhance patient satisfaction with care, and reduce unnecessary healthcare costs. Panel discussions provided examples of successful collaborations between health systems and payers, enabling data exchange and risk stratification of patients and subsequent reorganization of pharmacy resources from volume to value-based activities. CONCLUSION: The forum's recommendations urge pharmacists to engage in the practice of value-based oncology care and will be shared with patient groups, providers, and policymakers to move this conversation forward. [ABSTRACT FROM AUTHOR]

The article presents a single‐centre phase I study of moxetumomab pasudotox which is an immunotoxin, in adults with relapsed/refractory B‐cell acute lymphoblastic leukaemia (ALL). It mentions information on determination of dose‐limiting toxicities (DLTs) and maximum tolerated dose (MTD) of moxetumomab pasudoto. It presents information on absence of correlation between presence of anti‐drug antibodies (ADAs) and prior monoclonal antibody exposure.

Background: The occurrence of nephrotoxicity with vancomycin is approximately 17%, but can increase to 35% when combined with other nephrotoxic agents. Patients with hematologic malignancies may be at greater risk for vancomycininduced nephrotoxicity due to nephrotoxic chemotherapy and tumor lysis syndrome. Objective: The primary objective of this study was to determine the occurrence of nephrotoxicity in adult patients with leukemia receiving vancomycin. Methods: A retrospective review approved by the Institutional Review Board was conducted on adult patients with leukemia who received at least one dose of vancomycin during hospital admission between 1 January 2009 and 30 April 2009. Results: Forty patients had an occurrence of nephrotoxicity (16%) while 210 patients did not have an occurrence of nephrotoxicity. In multivariate analysis, variables significantly associated with development of nephrotoxicity included active disease status (odds ratio, 4.38 [95% CI 1.1–29.4], p¼0.0291), concomitant intravenous acyclovir administration (odds ratio, 3.83 [95% CI, 1.6–8.9]; p¼0.0022), and concomitant amphotericin administration (odds ratio, 4.26 [95% CI, 1.9–9.4]; p¼0.0004). Conclusion: The occurrence of nephrotoxicity in patients with leukemia treated with vancomycin was 16% in our study, similar to previously published reports. Active disease status and concomitant use of intravenous acyclovir and amphotericin were identified as significant risk factors for development of nephrotoxicity. The presence of risk factors for vancomycin nephrotoxicity should be evaluated prior to initiation of therapy to determine appropriateness of use. [ABSTRACT FROM AUTHOR]