A venetoclax and azacitidine bridge-to-transplant strategy for NPM1-mutated acute myeloid leukaemia in molecular failure

NPM1-mutated acute myeloid leukaemia (NPM1mut AML) represents a mostly favourable/intermediate risk disease that benefits from allogeneic haematopoietic stem cell transplantation (HSCT) in case of measurable residual disease (MRD) relapse or persistence after induction chemotherapy. Although the negative prognostic role of pre-HSCT MRD is established, no recommendations are available for the management of peri-transplant molecular failure (MF). Based on the efficacy data of venetoclax (VEN)-based treatment in NPM1mut AML older patients, we retrospectively analysed the off-label combination of VEN plus azacitidine (AZA) as bridge-to-transplant strategy in 11 NPM1mut MRD-positive fit AML patients. Patients were in MRD-positive complete remission (CRMRDpos ) at the time of treatment: nine in molecular relapse and two in molecular persistence. After a median number of two cycles (range 1-4) of VEN-AZA, 9/11 (81.8%) achieved CRMRD -negative (CRMRDneg ). All 11 patients proceeded to HSCT. With a median follow-up from treatment start of 26 months, and a median post-HSCT follow-up of 19 months, 10/11 patients are alive (1 died from non-relapse mortality), and 9/10 patients are in MRDneg status. This patient series highlights the efficacy and safety of VEN-AZA to prevent overt relapse, achieve deep responses and preserve patient fitness before HSCT, in patients with NPM1mut AML in MF.

The fetus in the extrauterine environment

The influence of environmental factors on early development is discussed beginning with studies on the preterm newborn, most of which compare preterms who have reached 40 weeks conceptional age with full term newborns in respect of neuropsychic development. They are therefore open to several methodological criticisms and have supplied often contradictory results. With ultrasound techniques it is now possible to compare the fetus with the preterm in respect of motor development at the same conceptional age. The variety of methods used and the limits of fetal observability, especially in the last weeks of gestation, nonetheless demand great prudence in the interpretation of data obtained by this new means. The incidence of various motor patterns was assessed in a group of 10 preterms at low risk for neurological damage by means of weekly video recordings. The preliminary results seem to indicate that many items in the motor repertoire do not change substantially at the approach to 40 weeks conceptional age and are similar to those described in the fetus.

Providing individualized nutritional care in a state institution for the mentally retarded

The dietary department at Fernald is responsible for providing quality nutritional care to 900 residents with varying dietary needs. Faced with a complex food service system, a diverse population, and an objective to provide quality nutritional care to all the clients, the dietary department assigns each of 7 dietitians the clinical responsibility for approximately 125 to 130 clients housed in several residential buildings. The dietitians' primary responsibilities are clinical. As a liaison between the residential buildings and the dietary department, the dietitians provide important feedback to the food service director on acceptability of menu items. Inservice training of staff is also provided as needed.

Observations on lipid metabolism in chronic renal failure, during conservative and haemodialysis therapy

The main variables of glycolipid metabolism (blood non-esterified fatty acids, triglycerides, cholesterol, insulin, glucose) have been measured in basal conditions in uraemic patients on conservative treatment and on dialysis of different duration and bath glucose concentration (no glucose, 1 g/l, 2 g/l). Basal values for the patients on conservative dietary treatment are not different from normal. In dialysed patients, the blood non-esterified fatty acid and triglyceride concentrations are increased (p less than 0.001) while cholesterol glucose and insulin levels are unchanged. No significant difference is found between the various types of dialysis, having different duration and bath glucose concentration