Allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly used as a curative option for adult T-cell leukemia (ATL), an intractable mature T-cell neoplasm causally linked with human T-cell leukemia virus type I (HTLV-I). We com-

Virus-infected fruit bats showed no signs of clinical infection.

Favipiravir is an oral broad-spectrum inhibitor of viral RNA-dependent RNA polymerase that is approved for treatment of influenza in Japan. We conducted a prospective, randomized, open-label, multicenter trial of favipiravir for the treatment of COVID-19 at 25 hospitals across Japan. Eligible patients were adolescents and adults admitted with COVID-19 who were asymptomatic or mildly ill and had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Patients were randomly assigned at a 1:1 ratio to early or late favipiravir therapy (the same regimen starting on day 6 instead of day 1). The primary endpoint was viral clearance by day 6. The secondary endpoint was change in viral load by day 6. Exploratory endpoints included time to defervescence and resolution of symptoms. Eighty-nine patients were enrolled, of whom 69 were virologically evaluable. Viral clearance occurred within 6 days in 66.7% and 56.1% of the early and late treatment groups (adjusted hazard ratio [aHR], 1.42; 95% confidence interval [95% CI], 0.76–2.62). Of 30 patients who had a fever (≥37.5°C) on day 1, time to defervescence was 2.1 days and 3.2 days in the early and late treatment groups (aHR, 1.88; 95%CI, 0.81–4.35). During therapy, 84.1% developed transient hyperuricemia. Favipiravir did not significantly improve viral clearance as measured by RT-PCR by day 6 but was associated with numerical reduction in time to defervescence. Neither disease progression nor death occurred to any of the patients in either treatment group during the 28-day participation (Japan Registry of Clinical Trials jRCTs041190120).

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We made a disease-specific comparison of unrelated cord blood (CB) recipients and human leukocyte antigen allelematched unrelated bone marrow (BM) recipients among 484 patients with acute myeloid leukemia (AML; 173 CB and 311 BM) and 336 patients with acute lymphoblastic leukemia (ALL; 114 CB and 222 BM) who received myeloablative transplantations. In multivariate analyses, among AML cases, lower overall survival (hazard ratio [HR] ‫؍‬ 1.5; 95% confidence interval [CI], 1.0-2.0, P ‫؍‬ .028) and leukemia-free survival (HR ‫؍‬ 1.5; 95% CI, 1.1-2.0, P ‫؍‬ .012) were observed in CB recipients. The relapse rate did not differ between the 2 groups of AML (HR ‫؍‬ 1.2; 95% CI, 0.8-1.9, P ‫؍‬ .38); however, the treatment-related mortality rate showed higher trend in CB recipients (HR ‫؍‬ 1.5; 95% CI, 1.0-2.3, P ‫؍‬ .085). In ALL, there was no significant difference between the groups for relapse (HR ‫؍‬ 1.4, 95% CI, 0.8-2.4, P ‫؍‬ .19) and treatment-related mortality (HR ‫؍‬ 1.0; 95% CI, 0.6-1.7, P ‫؍‬ .98), which contributed to similar overall survival (HR ‫؍‬ 1.1; 95% CI, 0.7-1.6, P ‫؍‬ .78) and leukemia-free survival (HR ‫؍‬ 1.2; 95% CI, 0.9-1.8, P ‫؍‬ .28). Matched or mismatched single-unit CB is a favorable alternative stem cell source for patients without a human leukocyte antigen-matched related or unrelated donor. For patients with AML, decreasing mortality, especially in the early phase of transplantation, is required to improve the outcome for CB recipients. (Blood.