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November 18, 2024
Myeloid sarcoma and pathological fracture: a case report and review of literature - PubMed

Myeloid sarcoma and pathological fracture: a case report and review of literature - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37707761/

Myeloid sarcoma is a rare clinical entity that presents as an isolated proliferation of leukemic cells, concurrently with or at relapse of acute myeloid leukemia (AML), myelodysplastic syndromes/neoplasms (MDS), chronic...

Myeloid sarcoma, a rare complication of MDS, can lead to pathological fractures, as seen in a case involving trisomy 22. Chromosomal alterations, particularly in chromosomes 9 and 22, require careful management.

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November 11, 2024
Williams-Beuren syndrome in pediatric T-cell acute lymphoblastic leukemia: A rare case report and review of literature - PubMed

Williams-Beuren syndrome in pediatric T-cell acute lymphoblastic leukemia: A rare case report and review of literature - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/38363891/

To the best of our knowledge, this is the first reported case of WBS in T-cell acute lymphoblastic leukemia. We want to emphasize that the occurrence of leukemia in this...

This study presents the first reported case of T-cell acute lymphoblastic leukemia in a male child with Williams-Beuren syndrome, suggesting potential genetic associations and highlighting the need for further research.

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November 11, 2024
Rare case of simultaneous occurrence of chronic neutrophil leukemia and T lymphoblastic lymphoma: case report and literature review - PubMed

Rare case of simultaneous occurrence of chronic neutrophil leukemia and T lymphoblastic lymphoma: case report and literature review - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/39105740/

Chronic neutrophil leukemia (CNL) is a rare and life-threatening disease. Cases of CNL combined with lymphoma are rare. Here, we report a case of CNL with T-acute lymphoblastic leukemia/lymphoma (T-ALL/LBL)...

A 28-year-old with chronic neutrophil leukemia and T-ALL/LBL showed partial response to ruxolitinib and VICLP but relapsed; therapies including selinexor failed to achieve marrow remission. Early intervention is crucial.

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November 08, 2024
Treatment of CLL: What’s next after covalent BTK inhibition?

Venetoclax is a treatment option for chronic lymphocytic leukemia (CLL) after progression or intolerance on a covalent Bruton tyrosine kinase (BTK) inhibitor. However, emergence of noncovalent BTK inhibitors raises concern of whether these agents may be more effective and better tolerated than venetoclax in this setting.

To help answer this question, an unanchored, matching-adjusted indirect comparison estimated the treatment effect of pirtobrutinib, a noncovalent BTK inhibitor, versus venetoclax after covalent BTK inhibitor therapy. This comparison used data from 146 patients with CLL naïve to venetoclax but previously treated with a covalent BTK inhibitor in a phase 1/2 trial (NCT03740529) and data from a trial of patients with CLL (n=91) receiving venetoclax monotherapy after a covalent BTK inhibitor (NCT02141282). Patients in the pirtobrutinib cohort were reweighted to match characteristics reported for venetoclax.

The comparison yielded objective response rates of 80.2% and 64.8% for pirtobrutinib and venetoclax, respectively (P=0.01). No meaningful differences were seen between pirtobrutinib and venetoclax for progression-free or overall survival rates. Each grade 3 or higher treatment-emergent adverse event was statistically significantly lower for pirtobrutinib (P<0.05 for all), except for pneumonia, but the rate of pneumonia was not significant.

These data suggest that noncovalent BTK inhibition provides greater response and lower toxicity than venetoclax after a covalent BTK inhibitor. Confirmation by comparative trials could lead to a paradigm shift.

What additional data are needed for your patients with CLL? What do you think the study design should look like?

  • November 08, 2024
    I agree with my colleagues that a randomized blinded trial comparing the 2 is needed. otherwise, we will draw from our own experience or use cross trial comparison which may not be the best although we tend to do that often. prior treatment exposure is important as well. i think it's a worthwhile question that should be answered, however
  • November 07, 2024
    This is interesting and nice to have this in your back pocket for our patients who may not be venetoclax eligible for some reason.
    To really answer the question a study may look at pirtobrutinib vs venetoclac+ antiCD20. I doubt such a study will be done and if done would require many patients followed for many years. Since the field is advancing at a rapid clip our patients can probably be better served by participating in other trials. My take away is that both approaches are valid and valuable.
  • November 07, 2024
    We would need a prospective randomized trial between the 2 classes showing significant improvement with non-covalent BTK inhibitor.
  • October 24, 2024
    definitely hard to assess unless there is a prospective randomized trial between the 2 classes that shows significant improvement with covalent BTK inhibitor. Otherwise, doubt this will hold up in clinical practice
  • October 24, 2024
    This is not a randomized, double blinded clinical trial and therefore the results need to be taken with caution. The treatment in this particular data set is with single agent Venetoclax. The standard of care for patients with relapsed after: B TKI's is venetoclax plus anti-CD20. The time-limited option is also very attractive. I would not change my current treatment approach, i.e Pirtobrutinib only after failure of both covalent BTKi and Venetoclax.
  • October 19, 2024
    study design is good and data is interesting but I still need to see OS data. In CLL, still prefer to sat prito till after Ven than use Pirto upfront and not know what to do after tat
  • October 19, 2024
    since this is a MAIC trial, a retrospective study, it certainly meets the proof of concept. Hpwvwee, we need to do a prospective study to see if the results surely hold true .
  • October 18, 2024
    Data is certainly intriguing. I think phase 3 head to head study is warranted to determine best sequencing.
  • October 17, 2024
    i think it is most debated topic.
  • October 17, 2024
    Sequencing will become important as more new agents with different mechanisms of actions become available. Would need a trial comparing venetoclax/obino vs pirtobrutinib in the second line after progression on a covalent BTK inhibitor
  • October 17, 2024
    Head to head comparison if efficacy and safety in second line patients post BTK
  • October 17, 2024
    Using the Matched Analysis - there was no difference in PFS, but there was an improvement in less toxicity. While not a true head to head trial this would potentially sway me to use pirtobrutinib - this is balanced against fixed duration of therapy of Ven combination regimen.
  • October 17, 2024
    Only advantage is mainly the Side effect profile of non covalent BTK inhibitor is better then venetoclax would use them in trial in first line setting in randomizes trial
  • October 17, 2024
    Right now I'd say it is roughly equivalent overall with 2nd line venetoclax after prior covalent BTKi. However it is logistically much easier to use, doesn't require anti-CD20 antibody given IV, and has fewer toxicities. So it is preferred to venetoclax second line after covalent BTKi. Now just need the FDA to approve so it'll be paid for.
  • October 17, 2024
    In addition to RR I would like to see the CR rate and PFS data
  • October 17, 2024
    Likely to bring it upfront front line, also possible to see if CD20 addition or other combination would be better than monotherapy.
  • October 17, 2024
    Hypothesis generating - if you do the proper trial then this can be practice changing
  • October 17, 2024

    I think a randomized clinical trial comparing covalent versus non-covalent Btk in the front line would be the best trial
  • October 17, 2024
    using matched indirect comparison is not a way to do clinical trials ,these attempts are fraught with bias as well as are waste of resources ,if it gives some insight there needs to be a proper randomized trial ,in later lines also ven is for a fixed duration ,without balancing other factors ,this discussion is a mute point
  • October 17, 2024
    It all depends upon what we are using in the frontline, currently if you are doing a fixed duration treatment with venetoclax and obinutuzumab in an first-line versus a BTK inhibitor indefinitely particularly in patients with high risk, multiple clinical trials evaluating, covalent BTK with venetoclax fixed duration regimens with ibrutinib plus venetoclax already approved as first-line in Europe. I am not sure whether this information will change the management as both pirtobrutinib and venetoclax are excellent options after progression on covalent BTK inhibitors tailored to the patients comorbidites, but currently pirtobrutinib is only FDA approved after prior covalent BTK and BCL-2 Inhibitor.
  • October 12, 2024
    Since in the same class as front line why not see how dose versus upfront covalent BTK?
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November 05, 2024
Relapsed Acute Lymphoblastic Leukemia - PubMed

Relapsed Acute Lymphoblastic Leukemia - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/37341952/

Outcomes for children with acute lymphoblastic leukemia (ALL) have improved worldwide to >85%. For those who relapse, outcomes have remained static at ~50% making relapsed acute lymphoblastic leukemia one of...

Outcomes for relapsed acute lymphoblastic leukemia (ALL) remain poor at ~50%. Innovative therapies, precision oncology, and global partnerships are essential for improving treatment effectiveness and individualizing care.

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