No abstract

Chimeric antigen receptor modified T (CAR‐T) cell therapy against the CD19 antigen has revolutionized the therapeutic landscape for patients with relapsed, refractory B cell non‐Hodgkin lymphoma (NHL). Currently, there are two FDA approved products (axicabtagene ciloleucel and tisagenlecleucel) for B cell NHL, with several other constructs under clinical investigation. This review will focus on the clinical outcomes, toxicity profile, and differences among candidate CD19 CAR‐T cell products for major subtypes of B cell NHL including diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. Lastly, we will describe novel CAR‐T constructs currently under exploration in B cell NHL.

IMPORTANCE Hematopoietic cell transplantation (HCT) is a therapeutic strategy in the management of several hematological cancers. Limited data exist on the incidence and predictors of 30-day readmission after HCT. OBJECTIVE To measure the incidence of and risk factors associated with 30-day readmission following HCT in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined patient data from the US population-based Nationwide Readmissions Database. All adults (age Ն18 years) who underwent autologous (auto-) or allogenic (allo-) HCT in US hospitals between January 1, 2012, and November 30, 2014, were included. The analysis was performed from June 2018 to February 2019. MAIN OUTCOMES AND MEASURES The main outcome was 30-day readmission rates for auto-HCT and allo-HCT. Factors associated with readmission, including baseline demographic characteristics and disease-and hospital-related characteristics (including annual case volume), were measured. RESULTS A total of 28 356 index admissions for auto-HCT in 244 centers (191 low-volume, 38 medium-volume, and 15 high-volume centers) and 17 217 index admissions for allo-HCT in 211 centers (161 low-volume, 37 medium-volume, and 13 high-volume centers) were identified during the study period. The overall 30-day readmission rates were 11.6% for auto-HCT and 24.4% for allo-HCT. The odds of readmission were significantly higher in low-volume hospitals compared with high-volume hospitals (adjusted odds ratio [aOR], 1.69; 95% CI, 1.08-2.64 for auto-HCT and aOR, 1.41; 95% CI, 1.09-1.82 for allo-HCT) but comparable to medium-volume hospitals (aOR, 1.06; 95% CI, 0.62-1.83 for auto-HCT and aOR, 1.19; 95% CI, 0.90-1.57 for allo-HCT). Other factors associated with readmission for auto-HCT included younger age (aOR for age Ն50 vs <49 years, 0.82; 95% CI, 0.68-0.98), female sex (aOR, 1.21; 95% CI, 1.06-1.36), disease type (aOR for other vs myeloma, 1.37; 95% CI, 1.06-1.77), and Elixhauser comorbidity index score (aOR for Ն20 vs 0, 1.5; 95% CI, 1.17-1.93). For allo-HCT, factors associated with readmission included disease type (aOR for acute lymphoblastic leukemia vs acute myelogenous leukemia, 1.30; 95% CI, 1.04-1.62), insurance (aOR for Medicare vs private, 1.18; 95% CI, 1.02-1.36), and Elixhauser comorbidity index score (aOR for 1-9 vs 0, 1.2; 95% CI, 1.04-1.39). Infections, neutropenic fever, and gastrointestinal symptoms were the most common reasons for readmission for both types of HCT. CONCLUSIONS AND RELEVANCE This study found substantial rates of readmission for both types of HCT and an inverse association between hospital HCT volume and 30-day readmission. These results may provide guidance when developing quality indicators and policies penalizing hospitals for HCT readmission.

Copyright 0 2003, The Parthenon Publishing Group 53 J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by The University of Manchester on 11/02/14 For personal use only.

This paper attempts to present a context in which nephrologists can re-evaluate definitions of acceptable haemoglobin levels in renal populations, and re-examine previous notions about the impact of relative and absolute anaemia on patients with progressive renal insufficiency. Also, the nephrology community needs to examine rigorously treatment strategies aimed at reversing anaemia specifically in this population. Data are presented to support the notion that anaemia is disadvantageous to the patients with progressive renal insufficiency, and does need to be treated. The ongoing poor prognosis of patients receiving renal replacement therapy may well be due to our previous inattention to this correctable cause of morbidity early in the course of progressive renal disease. Long-term studies addressing these important clinical issues need to be supported, and evaluated within both immediate and future economic implications.