Early results of the randomized placebo-controlled SORAML trial showed that, in patients with newly diagnosed acute myeloid leukaemia (AML), sorafenib led to a significant improvement in event-free (EFS) and relapse-free survival (RFS). In order to describe second-line treatments and their implications on overall survival (OS), we performed a study after a median follow-up time of 78 months. Newly diagnosed fit AML patients aged ≤60 years received sorafenib (n = 134) or placebo (n = 133) in addition to standard chemotherapy and as maintenance treatment. The 5-year EFS was 41 versus 27% (HR 0.68; p = 0.011) and 5-year RFS was 53 versus 36% (HR 0.64; p = 0.035). Allogeneic stem cell transplantation (allo SCT) was performed in 88% of the relapsed patients. Four years after salvage allo SCT, the cumulative incidence of relapse was 54 versus 35%, and OS was 32 versus 50%. The 5-year OS from randomization in all study patients was 61 versus 53% (HR 0.82; p = 0.282). In conclusion, the addition of sorafenib to chemotherapy led to a significant prolongation of EFS and RFS. Although the OS benefit did not reach statistical significance, these results confirm the antileukaemic activity of sorafenib.

Radiation-induced effects may damage various cardiac structures chronically and cause heart valve dysfunction as well as occlusive lesions of coronary and other arteries exposed to radiation. A 72-year-old woman with a history of radiation treatment after breast cancer was admitted 25 years later with symptoms of tachycardia and acute dyspnea. We found valvular thickening, medium to severe valvular dysfunction and high grade occlusive coronary artery disease in proximal portions. The left subclavian artery also was affected. Surgical treatment was required immediately. Long-term follow-up cardiac evaluation even in asymptomatic patients is mandatory to uncover cardiac injuries by radiation. To lower the risk and maximize the benefit, early intervention by valvular replacement and myocardial revascularization is indicated. Restrictive myopathy and chronic pericarditis increase risk and have to be clarified. Diagnosis in these radiation exposed patients can be made by typical findings. Echocardiography is of eminent relevancy.

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Die 66-jährige Patientin mit Rezidiv eines Non-Hodgkin-Lymphoms wurde stationär mit Fieber in Neutropenie aufgenommen. 7 Tage zuvor erhielt die Patientin den 4. Kurs R-CHOP. Seit dem ersten Chemotherapie-Kurs nahm die Patientin eigenständig, ohne Kenntnis des behandelnden Onkologen, täglich hochdosiert Kortison ein. Bei progredienter respiratorischer Insuffizienz und auffälliger radiologischer Diagnostik (▶ Abb. 1 a, b) erfolgte die Verlegung auf die Intensivstation. Am 7. Tag stiegen die Infektparameter. Ein klinischer Befund veranlasste uns zur Durchführung einer Kontrollcomputertomografie (▶ Abb. 1 c, d).

In 2022, the ELN risk stratification for patients (pts) with acute myeloid leukemia (AML) has been updated. The key changes of the revised ELN recommendations are as follows: i) bZIP in-frame CEBPA mutations are now considered favorable-risk (ELN22 fav ), irrespective of monoallelic/biallelic mutation status; ii) pts with FLT3-ITD are now considered intermediate-risk (ELN22 int ), irrespective of allelic ratio or NPM1 status; and iii) pts with