Objectives: Erwinia asparaginase is used as a second-line formulation after a neutralizing hypersensitivity reaction to the first-line formulation of asparaginase. Here, we have performed a costeffectiveness analysis of Erwinia asparaginase treatment. Methods: Children with acute lymphoblastic leukemia treated according to the Dutch ChildhoodOncology ALL-10 or ALL-11 protocol were included and initially treated with PEGasparaginase in the intensification phase. The total treatment costs of this treatment phase, quality of life (QoL), and life years saved (LYS) were studied for two scenarios: (a) patients were switched to Erwinia asparaginase treatment after a hypersensitivity reaction, or (b) asparaginase would have been permanently stopped. Results: Sixty-eight patients were included. There was no difference in QoL between patients with and without a hypersensitivity reaction. The mean costs of the intensification phase per patient were $40,925 if PEGasparaginase could be continued, $175,632 if patients had to switch to Erwinia asparaginase, and $21,190 if asparaginase would have been permanently stopped. An extrapolation of the literature suggests that the 5-year event-free survival would be 10.3% lower without intensive asparaginase treatment if asparaginase is stopped after a reaction. Thus, the costs per LYS were $1892 for scenario 1 and $872 for scenario 2.Conclusions: Switching to Erwinia asparaginase increases the costs per LYS by $1020, which is modest in view of the total costs. Moreover, when asparaginase treatment can be completed by switching to Erwinia asparaginase, relapses-and consequential costs-will be avoided. Therefore, from a cost perspective, we recommend a switch to Erwinia asparaginase to complete asparaginase treatment. K E Y W O R D Sasparaginase, cost-effectiveness analysis, pediatric ALL

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Aims Lung tissue from COVID‐19 patients shares similar histomorphological features with chronic lung allograft disease, also suggesting activation of autoimmune‐related pathways in COVID‐19. To more clearly understand the underlying spectrum of pathophysiology in COVID‐19 pneumonia, we analysed mRNA expression of autoimmune‐related genes in post‐mortem lung tissue from COVID‐19 patients. Methods and results Formalin‐fixed, paraffin‐embedded lung tissue samples of 18 COVID‐19 patients and eight influenza patients were used for targeted gene expression profiling using NanoString technology. Multiplex immunofluorescence for tryptase and chymase was applied for validation. Genes related to mast cells were significantly increased in COVID‐19. This finding was strengthened by multiplex immunofluorescence also showing a significant increase of tryptase‐ and chymase‐positive cells in COVID‐19. Furthermore, receptors for advanced glycation end‐products (RAGE) and pro‐platelet basic protein (PPBP) were up‐regulated in COVID‐19 compared to influenza. Genes associated with Type I interferon signalling showed a significant correlation to detected SARS‐CoV2 pathway‐related genes. The comparison of lung tissue samples from both groups based on the presence of histomorphological features indicative of acute respiratory distress syndrome did not result in finding any specific gene or pathways. Conclusion Two separate means of measuring show a significant increase of mast cells in SARS‐CoV‐2‐infected lung tissue compared to influenza. Additionally, several genes involved in fibrosis and thrombosis, among which are RAGE and PPBP, are up‐regulated in COVID‐19. As mast cells are able to induce thrombosis and fibrosis, they may play an important role in the pathogenesis of COVID‐19.

The effect of preoperative chemotherapy and chemoradiotherapy on pancreatic fistula and other surgical complications after pancreatic resection: a systematic review and meta-analysis of comparative studies

We developed DL-based MODEL-P to identify prognosis-correlated PDAC subtypesThe identified subtypes related to DNA damage repair and immune response processes MODEL-P stratified patients from independent datasets into distinct survival groups MODEL-P could be used in clinics to aid treatment decision-making