Gilteritinib (XOSPATA®) in Turkey: Early Access Program Results

Background And Objectives

Gilteritinib (XOSPATA®, Astellas) is a type I oral FLT3 inhibitor, a tyrosine kinase AXL inhibitor, involved in both c-Kit and FMS-like tyrosine kinase 3 (FLT3) resistance. In the phase 3 ADMIRAL trial, gilteritinib was compared with the standard of care in (R/R) acute myeloid leukemia (AML) patients who harbored any FLT3 mutation and showed superior efficacy with regard to response and survival.

Objectives

This research aimed to investigate the real-life efficacy and safety of gilteritinib in FLT3-positive R/R AML patients who were treated as a part of an early access program held in Turkey in April 2020 (NCT03409081).

Results

The research included 17 R/R AML patients who had received gilteritinib from seven centers. The overall response rate was 100%. The most common adverse events were anemia and hypokalemia (7 patients, 41.2%). Grade 4 thrombocytopenia was observed in one patient only (5.9%), leading to permanent treatment discontinuation. Patients with peripheral edema had a 10.47 (95% CI: 1.64-66.82) times higher risk of death than those without peripheral edema (p<0.05).

Conclusion

This research showed that patients with febrile neutropenia and peripheral edema were at a high risk of death when compared to patients without febrile neutropenia and peripheral edema.

The Real-World Experience With Single Agent Ibrutinib in Relapsed/Refractory CLL

INTRODUCTION/BACKGROUND

The emergence of novel agents targeting the B-cell receptor pathway and BCL-2 has significantly changed the therapeutic landscape of CLL. We evaluated the safety and efficacy of single-agent ibrutinib in relapsed/refractory CLL in real-world settings.

PATIENTS/METHODS

A total of 200 relapsed/refractory CLL patients with a median age of 68 were included in this retrospective, multicenter, non-interventional study. Data of the study were captured from the patient charts of the participating centers.

RESULTS

The median for lines of previous chemotherapy was 2 (1-6); 62 (31.8%) patients had del17p and/or p53 mutations (del17p⁺/p53mut). Of the study group, 146 (75%) patients achieved at least PR, while 16 (8.7%) patients discontinued ibrutinib due to TEA. The most common drug-related adverse events were neutropenia (n: 31; 17.4%) and thrombocytopenia (n: 40; 22.3%), which were ≥ grade 3 in 9 (5%) and 5 (3.9%) patients, respectively. Pneumonia (n: 42; 23.7%) was the most common nonhematologic TEA. Atrial fibrillation (n: 5; 2.8%) and bleeding (n: 11; 6.3%) were relatively rare during the study period. Within a median follow-up period of 17 (1-74) months, 42 (21%) patients died. The estimated median OS of the study cohort was 52 months. Only the response to ibrutinib (CR/PR vs. SD/PD) was significantly associated with OS.

CONCLUSION

Our results indicate good safety and efficacy for single-agent ibrutinib in R/R CLL in daily practice.

Enhanced degradation of micropollutants by zero-valent aluminum activated persulfate: assessment of toxicity and genotoxic activity

Advanced oxidation of the aqueous Triton™ X-45 (TX-45), iopamidol (IOPA), ciprofloxacin (CIP) and bisphenol A (BPA) solutions via activation of persulfate (PS) with zero-valent aluminum (ZVA) was investigated. The study aimed at assessing the effectiveness of the PS/ZVA process in terms of target micropollutants (MPs) and toxicity abatements in raw surface water (RSW) and distilled water (DW). TX-45, CIP and BPA were completely degraded after 90-minute, 120-minute and 40-minute treatment, respectively, with PS/ZVA in DW, whereas 95% IOPA removal was achieved after 120-minute (MPs = 2 mg/L; ZVA = 1 g/L; PS = 0.25 mM for CIP and BPA; PS = 0.50 mM for TX-45 and IOPA; pH = 3). TX-45 (59%), IOPA (29%), CIP (73%) and BPA (46%) removal efficiencies decreased after 120-minute PS/ZVA treatment in RSW. In DW, Vibrio fischeri toxicities of original (untreated) MPs were found as: CIP (51%) > BPA (40%) > TX-45 (15%) > IOPA (1%), and as BPA (100%) > CIP (66%) > IOPA (62%) > TX-45 (35%) in RSW. Acute toxicities of MPs and their degradation products fluctuated during PS/ZVA treatment both in DW and RSW samples and resulted in different relative inhibition values after 120-minute. The original and PS/ZVA-treated TX-45, IOPA and BPA in DW exhibited neither cytotoxic nor genotoxic effects, whereas CIP oxidation ended up in degradation products with genotoxic effects.

Congenital esophageal stenosis

We report 6 new cases of congenital esophageal stenosis (CES) that presented to us with special diagnostic and management problems and review the literature on this subject. Gastroesophageal reflux and achalasia are important differential diagnoses of esophageal stenosis, they may be associated with CES making appropriate management even more difficult. Treatment is also controversial, ranging from simple dilatation to segmental resection. CES should be present in every pediatric surgeon's mind should dysphagia occur on the introduction of semisolid food or esophageal food impaction, with a segmental stenosis demonstrated at esophagogram even when more obvious diagnoses are evoked.

The Kalicinski ureteral folding technique for megaureter in children. Experience in 23 cases

We report our series of 16 children with 23 megaureters: 7 were refluxing, 11 were obstructive (7 primary and 4 secondary), 3 both refluxing and obstructive and 2 nonrefluxing nonobstructive. These patients had a Kalicinski folding-under remodeling of their megaureter and Cohen or Lead-better reimplantation. Success rate was 96% with only 2 failures: 1 recurrent low-grade reflux treated with subureteric Teflon injection and 1 stenosis that necessitated reoperation. Kalicinski's technique with Cohen type reimplantation is one of the best alternatives for megaureters, mainly because it does not present the disadvantages of the excisional procedure.

Congenital cyst of the pancreas. Antenatal diagnosis

We hereby report the third case of antenatal diagnosis of congenital cyst of the pancreas. It is a very rare lesion and could present as a differential diagnosis of any intra-abdominal cystic mass. Early treatment is easy and prevents complications such as ascites and pancreatitis in case of intra-pancreatic enteric duplication.

Congenital prepubic sinus

We report the fifth case of congenital prepubic sinus that goes from the anterior wall of the bladder through the public symphysis to the skin. The various embryological theories that could be responsible for this pathology are discussed, and according to us, it seems to be a variant of dorsal urethral duplication.

Effect of dimethyl sulfoxide on blood-to-brain transfer of alpha-aminoisobutyric acid: examination of regional blood-brain barrier function

The effect of dimethyl sulfoxide (DMSO) on brain capillary permeability has been controversial. We have studied the effect of DMSO on unidirectional transport of alpha-aminoisobutyric acid (AIB) across the blood-brain barrier (BBB) in rats. Rats were treated with 15% DMSO intraperitoneally (i.p.), intravenously (i.v.) or by an i.p. injection in combination with an i.v. injection, or in some cases intra-arterially by rapid infusion into left external carotid artery. The unidirectional blood-to-brain transfer constant (Ki) for AIB was measured in each group after the animals were killed. DMSO administration did not significantly increase Ki as compared to control Kj. These results show that it is unlikely that DMSO increases the permeability of BBB and therefore do not support the proposal that DMSO can act as a carrier at the BBB for compounds with restricted vascular permeability.