This phase 1b open-label, dose-finding study evaluated acalabrutinib in combination with rituximab plus lenalidomide 15 or 20 mg in 29 patients with relapsed or refractory follicular lymphoma. The combination treatment had acceptable toxicity with promising clinical activity. At a median acalabrutinib exposure of 21 months, the most common grade ≥3 treatment-emergent adverse event was neutropenia, occurring in 11 (38%) patients, with no cases of febrile neutropenia. Among all treated patients, the overall response rate was 76% at a median follow-up of 34.1 months. A numerically higher complete response rate was seen in patients in the lenalidomide 20-mg group (43%) versus the 15-mg group (25%). Results from this study led to the selection of the 20-mg lenalidomide dose for further study.

Hodgkin lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA) yet no treatment specifically tailored to this age group currently exists. This study compared 148 patients aged 15 to 25 treated at Saint-Louis Hospital between 2012 and 2018, using either pediatric or adult protocols. A higher risk of short-term steroid and vincristine-related toxicities was observed in pediatric regimen, whereas a higher risk of late toxicities was expected in adult regimen, due to higher anthracyclines, procarbazine, bleomycin and radiotherapy exposure. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 100% and 85%, respectively, with no significant difference between the two approaches. These findings emphasize the importance of personalized care in specialized units to optimize treatment outcomes while minimizing short- and long-term toxicities.

Depression, disrupted sleep and pain are common comorbidities in sickle cell disease. These comorbidities were associated with patient-reported difficulties in processing speed and attention/executive functioning when controlling for stroke and demographics. The indirect effects of attention/executive functioning and processing speed were significant in mediation models that examined pathways between disease-related comorbidities and instrumental activities of daily living (IADLs), which represent complex skills required to support independence. Difficulties with attention/executive functioning accounted for nearly 20% of the relationship between depression and IADLs and sleep and IADLs. Managing comorbidities in adults may assist in minimizing cognitive symptoms and improving IADLs.

The results of these proteomic analyses reveal 50 proteins involved in inflammation and angiogenesis that are differentially expressed in patients with sickle cell disease in steady state as compared to healthy ethnicity-matched controls. These included proteins involved in angiogenesis (i.e. ANGPT1, ANGPT2 and VEGFA), the IL-18 signalling pathway (i.e. IL-6, IL-10, IL-18), T-cell activation (i.e. LAG3, PDCD1) and NK-cell activation (CD244, NCR1, GZMB). While proteins involved in angiogenesis and the IL-18 signalling pathway were further upregulated during a vaso-occlusive episode, levels of several proteins involved in the IL-18 pathway, T-cell and NK-cell activation and angiogenesis, restored towards levels detected in HCs after curative or disease-modifying treatment.

The use of tranexamic acid (TXA) to reduce surgical bleeding is highly variable with scope for improvement. Effective implementation strategies should be based on an understanding of clinical behaviour. We interviewed a range of clinicians involved in perioperative care to elicit key influences on TXA use. These included the clinical context, variable familiarity with TXA, the availability of both TXA and checklists to support decision-making, professional expectations and perceived responsibilities, confidence in administering TXA and perceived benefits and risks. These influences, which varied across participants and specialities, offer targets for coordinated implementation strategy.