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Current treatment guidelines of myeloma cast nephropathy (MCN) recommend the institution of plasma cell‐directed therapy and consideration of therapeutic plasma exchange (TPE), with the goal of rapid reduction of the serum free light chain (sFLC). However, the role of TPE continues to remain a subject of debate. The goal of this retrospective bi‐institutional study was to evaluate the clinical outcomes of TPE in combination with systemic therapy. Eighty patients were included in this analysis, of whom 72.5% had ≥50% drop in their initial involved sFLC. At 3 months from TPE initiation, the overall hematologic response rate (ORR) was 67.5% with a very good partial response or better (≥VGPR) rate of 40%. At 6 months, ORR was 57.5%, with ≥VGPR rate of 49%. The renal response rate at 3 and 6 months was 47.5% and 43.75%, respectively; the overall renal response rate was 48.75%. On multivariable analysis, every one unit increase in baseline creatinine (odds ratio [OR] 0.76, p = 0.006), and achievement of ≥VGPR (OR 21.7 p < 0.0001) were significantly associated with renal response. Also, a ≥50% drop in sFLC was favorably associated with renal response (OR 3.39, p = 0.09). With a median follow‐up of 36.4 months, the median overall survival (OS) was 11 months. On multivariable analysis, achievement of renal response (hazard ratio [HR] 0.3, p < 0.0001) and newly diagnosed disease (NDMM; HR 0.43, p = 0.0055) were associated with improved OS. Among NDMM patients, those treated with daratumumab‐based regimens had a trend for better OS (p = 0.15), compared to other regimens, but the difference was not significant. At the end of follow‐up, an estimated 40.4% of patients who were on dialysis were able to become dialysis independent. In conclusion, our study highlights the poor survival of patients with MCN. Achievement of early renal response is crucial for prolonged OS, with daratumumab‐based therapies showing promise. [ABSTRACT FROM AUTHOR]

Background: Environmental tobacco smoke (ETS) has adverse effects on the health of asthmatics, however the harmful consequences of ETS in relation to asthma severity are unknown. Methods: In a multicenter study of severe asthma, we assessed the impact of ETS exposure on morbidity, health care utilization and lung functions; and activity of systemic superoxide dismutase (SOD), a potential oxidative target of ETS that is negatively associated with asthma severity. Findings: From 2002-2006, 654 asthmatics (non-severe 366, severe 288) were enrolled, among whom 109 non-severe and 67 severe asthmatics were routinely exposed to ETS as ascertained by history and validated by urine cotinine levels. ETS-exposure was associated with lower quality of life scores; greater rescue inhaler use; lower lung function; greater bronchodilator responsiveness; and greater risk for emergency room visits, hospitalization and intensive care unit admission. ETS-exposure was associated with lower levels of serum SOD activity, particularly in asthmatic women of African heritage. Interpretation: ETS-exposure of asthmatic individuals is associated with worse lung function, higher acuity of exacerbations, more health care utilization, and greater bronchial hyperreactivity. The association of diminished systemic SOD activity to ETS exposure provides for the first time a specific oxidant mechanism by which ETS may adversely affect patients with asthma. [ABSTRACT FROM AUTHOR]

Background Study Design and Methods Results Discussion Volume‐reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out‐of‐group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD‐A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue.This report compares corrected count increments (CCIs) from full‐volume and ACD‐A acidified volume‐reduced human platelets in a retrospective study at a single hospital and in a mouse model.At a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20‐month study period. Among all patients, the expected 4‐h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full‐volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD‐acidified volume‐reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24‐h mean CCI: 6.3 (95% CI: 5.5–7.0) with full‐volume platelet, 4.7 (95% CI: 3.6–6.0) with ACD‐acidified volume‐reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4‐ and 24‐h predicted CCIs, showing lower CCIs in ACD‐acidified volume‐reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count‐adjusted, volume‐reduced platelets was significantly lower in mice, suggesting a procedure‐related defect.ACD‐A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4‐h and 24‐h platelet increments. [ABSTRACT FROM AUTHOR]