Disparities in neighbourhood characteristics and 10-year dementia risk by nativity status

AIMS

Prior research indicates that neighbourhood disadvantage increases dementia risk. There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment. To our knowledge, our study is the first to analyse how nativity and neighbourhood interact to influence dementia risk.

METHODS

Ten years of prospective cohort data (2011-2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+. Cox regression analysed time to dementia diagnosis using nativity status (foreign- or native-born) and composite scores for neighbourhood physical disorder (litter, graffiti and vacancies) and social cohesion (know, help and trust each other), after applying sampling weights and imputing missing data.

RESULTS

In a weighted sample representing 26.9 million older adults, about 9.5% (n = 2.5 million) identified as foreign-born and 24.4% (n = 6.5 million) had an incident dementia diagnosis. Average baseline neighbourhood physical disorder was 0.19 (range 0-9), and baseline social cohesion was 4.28 (range 0-6). Baseline neighbourhood physical disorder was significantly higher among foreign-born (mean = 0.28) compared to native-born (mean = 0.18) older adults (t = -2.4, p = .02). Baseline neighbourhood social cohesion was significantly lower for foreign-born (mean = 3.57) compared to native-born (mean = 4.33) older adults (t = 5.5, p < .001). After adjusting for sociodemographic, health and neighbourhood variables, foreign-born older adults had a 51% significantly higher dementia risk (adjusted hazard ratio = 1.51, 95% CI = 1.19-1.90, p < .01). There were no significant interactions for nativity with neighbourhood physical disorder or social cohesion.

CONCLUSIONS

Our findings suggest that foreign-born older adults have higher neighbourhood physical disorder and lower social cohesion compared to native-born older adults. Despite the higher dementia risk, we observed for foreign-born older adults, and this relationship was not moderated by either neighbourhood physical disorder or social cohesion. Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.

New Targeted Therapy Combination Holds Promise to Untangle Hairy Cell Leukemia

Hairy cell leukemia (HCL) is an uncommon B-cell neoplasm uniquely characterized by a high prevalence of the BRAFV600E mutation, which leads to constitutive activation of the mitogen-activated protein kinase (MAPK) pathway.1 In fact, the BRAFV600E point mutation is identified in nearly all cases of HCL; however, it is absent in HCL variant (vHCL) and rare in other B-cell neoplasms.2,3 Notably, in contrast to melanoma or other BRAF mutant solid tumors, HCL exhibits very few other mutations, potentially explaining the high response rates observed in patients treated with mutant BRAF-targeted agents, such as vemurafenib.

Targeted Therapies in Cancer: To Be or Not to Be, Selective

Development of targeted therapies in recent years revealed several nonchemotherapeutic options for patients. Chief among targeted therapies is small molecule kinase inhibitors targeting key oncogenic signaling proteins. Through competitive and noncompetitive inhibition of these kinases, and therefore the pathways they activate, cancers can be slowed or completely eradicated, leading to partial or complete remissions for many cancer types. Unfortunately, for many patients, resistance to targeted therapies, such as kinase inhibitors, ultimately develops and can necessitate multiple lines of treatment. Drug resistance can either be de novo or acquired after months or years of drug exposure. Since resistance can be due to several unique mechanisms, there is no one-size-fits-all solution to this problem. However, combinations that target complimentary pathways or potential escape mechanisms appear to be more effective than sequential therapy. Combinations of single kinase inhibitors or alternately multikinase inhibitor drugs could be used to achieve this goal. Understanding how to efficiently target cancer cells and overcome resistance to prior lines of therapy became imperative to the success of cancer treatment. Due to the complexity of cancer, effective treatment options in the future will likely require mixing and matching these approaches in different cancer types and different disease stages.

Outcomes of CNS involvement in blastic plasmacytoid dendritic cell neoplasm (BPDCN)

e19043

Background: BPDCN is rare cancer commonly involving the skin and marrow. Tagraxofusp (Tag), a CD123 targeted therapy, was the first FDA approved drug for BPDCN in 2018. CNS involvement occurs in 10-60% of patients and CNS staging and prophylactic (ppx) practices are variable. The pivotal trial of Tag in BPDCN did not require CNS staging and excluded those patients with known CNS involvement. Here, we describe one of the largest cohorts of BPDCN patients with known CNS involvement, including patients treated with Tag. Methods: We collected data from 4 centers on patients with CNS involvement defined by LP or imaging with high clinical suspicion. Survival was estimated via the Kaplan-Meier method with other analyses being descriptive. Results: CNS involvement was identified in 11 patients. Median age was 74 (range 51–83) and 10 were male. 5 patients had CNS staging at initial diagnosis. At time of CNS involvement, 6/11 patients had neuro symptoms. Prior to diagnosis of CNS involvement, 5 received Tag and none received CNS ppx. Of 9 patients treated for their known CNS involvement (table), one received CNS directed systemic therapy, with all others being treated with intrathecal (IT) chemotherapy. All patients treated with 3 or more doses of IT chemotherapy cleared their CSF, and survived at least 6 months from the diagnosis of CNS involvement, including two patients (#5 and 8) with large burden CNS disease and neuro symptoms. Median survival from time of diagnosis of BPDCN was 13.8 months (2.7-35.5) and from time of diagnosis of CNS involvement was 6.0 months (0.1-25.7). Conclusions: Asymptomatic CNS involvement by BPDCN is common; routine staging and ppx should be considered at diagnosis. Tagraxofusp did not appear to prevent the development of CNS disease. IT therapy effectively cleared and controlled CNS involvement in a majority of patients. IT therapy may be sufficient to control CNS disease and IT prophylaxis should be considered, including in patients on CD123 targeting therapies. Our results provide new insights into BPDCN with CNS involvement and include patients treated with recently developed novel systemic therapies.[Table: see text]

Advances in Acute Myeloid Leukemia: Recently Approved Therapies and Drugs in Development

Acute myeloid leukemia (AML) is a genetically heterogeneous malignancy comprised of various cytogenetic and molecular abnormalities that has notoriously been difficult to treat with an overall poor prognosis. For decades, treatment options were limited to either intensive chemotherapy with anthracycline and cytarabine-based regimens (7 + 3) or lower intensity regimens including hypomethylating agents or low dose cytarabine, followed by either allogeneic stem cell transplant or consolidation chemotherapy. Fortunately, with the influx of rapidly evolving molecular technologies and new genetic understanding, the treatment landscape for AML has dramatically changed. Advances in the formulation and delivery of 7 + 3 with liposomal cytarabine and daunorubicin (Vyxeos) have improved overall survival in secondary AML. Increased understanding of the genetic underpinnings of AML has led to targeting actionable mutations such as FLT3, IDH1/2 and TP53, and BCL2 or hedgehog pathways in more frail populations. Antibody drug conjugates have resurfaced in the AML landscape and there have been numerous advances utilizing immunotherapies including immune checkpoint inhibitors, antibody-drug conjugates, bispecific T cell engager antibodies, chimeric antigen receptor (CAR)-T therapy and the development of AML vaccines. While there are dozens of ongoing studies and new drugs in the pipeline, this paper serves as a review of the advances achieved in the treatment of AML in the last several years and the most promising future avenues of advancement.

Finding Camel-ot: A Holy Grail against pandemic SARS-CoV-2?

Engineered camelid antibody multimers can potently block SARS-CoV-2 viral entry.