T-cell redirection therapy with chimeric antigen receptor (CAR)-T cells and bispecific antibodies (BiAbs) has shown promising efficacy in heavily pretreated relapsed/refractory multiple myeloma (RRMM) patients, leading to the approval of two CAR-T cell products and numerous BiAb trials. Data regarding outcomes after relapse following BiAbs are urgently needed to develop strategies for sequencing salvage therapies. We identified fifty-eight patients progressing after a BiAb trial at the Mount Sinai Hospital. Progression-free survival (PFS) to first- (PFS1) and second salvage therapy (PFS2), and overall survival (OS) were estimated using the Kaplan-Meier method. Patients had a median age of 67 years and 78% had high-risk cytogenetics. They had a median of 6 prior therapy lines, 89% were triple-class refractory and 44% were penta-drug refractory. After the BiAb trial, patients were followed for a median of 30.5 months and received a median of two additional salvage therapies (range: 1-9). The most common first salvage was T-cell redirection in nineteen patients (ten BiAb and nine CAR-T). Ten patients received T-cell redirection as second salvage. T-cell redirection therapy as first or second salvage was feasible and associated with a median PFS1 of 28.9 months and PFS2 of 30.9 months and an OS of 62% at 2 years. Sequential use of different T-cell redirection therapies is possible and can lead to deep and durable responses following relapse after BiAb therapy in RRMM.

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Background: Our aim was to determine the usefulness of hepatic transaminases as hematological markers to predict the presence and severity of liver injury in adult patients with abdominal trauma.Methods: This is a retrospective study of patients admitted with abdominal trauma (blunt and penetrating) over a three-year period. Grading of liver injury was based on CT-scan or surgical findings. Patients in whom liver enzymes were estimated in the first 48 hours were included.Results: Out of the 66 patients in the study, 23 (63.89%) patients had minor liver injuries, while 13 (36.11%) had major liver injuries. Injury was blunt in 63 (95.45%) and penetrating in 3 (4.54%) patients. The mortality rate was 7.57% (n=5). The median SGOT and SGPT levels in the liver injury group were higher than those in the non-liver injury group SGOT (209LI vs. 43.5) U/L and SGPT (283.22 vs. 72.97) U/L, respectively, (p=0.001). Receiver operating characteristic (ROC) curve assessment, showed the optimum SGOT and SGPT thresholds to be >112.5 and >120.5U/L respectively, which were strongly associated with the presence of liver injuries. There was significant correlation between liver transaminases with grade of liver injury, SGOT (p=0.013) and SGPT (p=0.004).Conclusions: SGOT and SGPT values >112.5 and >120.5U/L respectively, are strongly suggestive of liver injury. Hepatic transaminases are useful screening hematological markers for liver injuries and should be included in the initial trauma blood test panel and may guide in the decision making especially in medical centers with limited facilities.

Frontline arsenic trioxide (ATO)-based treatment regimens achieve high rates of long-term relapse-free survival in treating acute promyelocytic leukemia (APL) and form the current standard of care. Refining prognostic estimates for newly diagnosed patients treated with ATO-containing regimens remains important to continue to improve outcomes and identify patients achieving suboptimal outcomes. We performed a pooled analysis of exclusively ATO-treated patients at a single academic institution and from the ALLG APML4 and Alliance C9710 studies to determine the prognostic importance of additional cytogenetic abnormalities and/or complex karyotype. We demonstrate inferior event-free survival for patients harboring complex karyotype [hazard ratio (HR): 3.74, 95% confidence interval: 1.63-8.56, P = 0.002] but not for patients harboring additional cytogenetic abnormalities (HR 2.13, 95% CI: 0.78-5.82, P = 0.142). These data support the role for full karyotypic analysis for all patients with APL and indicate a need for novel treatment strategies to overcome this adverse effect for APL harboring complex karyotype.

Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of >60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.