It is June and most of us are looking forward to a more normal summer than the one we had in 2020. Many Americans have been vaccinated and states are rolling back some (or all) masking requirements and restrictions on gatherings. In many sectors, including the US Department of Defense (DoD) and the US Department of Veterans Affairs (VA), worries from public health officials about vaccine supply and how to ethically allocate demand have given way to a new set of concerns: We have the shots, but for widespread protection we have to get them into arms.

The reluctance to roll up the sleeve is known as vaccine hesitancy. The National Academies of Science comments on vaccine hesitancy in its report on COVID-19 vaccination allocation. “Potential consequences of vaccine hesitancy—which the committee views as an attitude, preference, or motivational state—are the behaviors of vaccine refusal or delay.”²

On that count, there was encouraging albeit unexpected news in waning days of May. Media reported a sharp increase in the COVID-vaccination of military personnel. Unnamed DoD officials indicated, they had seen a 55% increase in the vaccination of active-duty service members over the previous month. This news represents a dramatic turnaround in a trend of vaccine hesitancy among military members that has persisted since the vaccine became available.³ Even last month, this would have been a very different column. The DoD has not disclosed the exact number of service members who have declined COVID-19 vaccination but multiple news outlets have documented that there was widespread and significant vaccine hesitancy among military personnel. In February, Military News reported that one-third of troops who were offered the vaccine declined it; and in April, USA Today stated that 40% of Marines had refused vaccination.^4,5

Still, it is worth examining the data on vaccination among active duty service members. From December 2020 through March 2021, the military conducted the first study to evaluate rates of vaccine initiation and completion in the military in general and for service members from racial/ethnic minorities in particular. Black military personnel were 28% less likely than non-Hispanic White service members to initiate vaccination against coronavirus even after adjusting for other possible confounders. Just 29% of White, 25.5% of Hispanic, and 18.7% of Black service members had initiated the vaccine process in the survey.⁶

The authors suggest that in part, vaccine hesitancy explains the findings.⁴ Vaccine hesitancy among racial and ethnic minorities is even more tragic because these same already disadvantaged cohorts have disproportionately suffered from COVID-19 throughout the pandemic with higher rates of infection, serious illness requiring hospitalization, and infection-related morbidity.⁷

Vaccine hesitancy, delay, or refusal in Black Americans whether military or civilian often is attributed to the historical abuses like the Tuskegee syphilis experiments or the more recent example of cancer cell lines taken from Henrietta Lacks without consent.⁸ Such government sponsored betrayals no doubt are the soil in which hesitancy grows but recent commentators have opined that focusing solely on these infamous examples may ignore current systemic racism that is pervasively feeding Black Americans reluctance to consider or accept COVID-19 vaccination.⁹ Blaming infamous research also provides a convenient excuse for confronting contemporary racial discrimination in health care and taking responsibility as health care practitioners for reversing it. “Framing the conversation about distrust in COVID vaccines in terms of everyday racism rather than historical atrocities may increase underserved communities’ willingness to be vaccinated,” Bajaj and Stanford wrote in a recent recent New England Journal of Medicine commentary. “When we hyperfocus on Sims, Lacks, and Tuskegee, we ascribe the current Black health experience to past racism, rooting our present in immovable historical occurrences and undermining efforts to combat mistrust. Everyday racism, by contrast, can be tackled in the present.”⁹

The study of racial/ethnic disparities in COVID-19 vaccination in active-duty service members was a work product of the Armed Forces Health Surveillance Division. The authors underscore several factors that support the connection between discrimination and vaccine hesitancy in the military. Lack of access to and ability to obtain COVID-19 vaccination continues to be a major barrier that disadvantaged populations must overcome.¹⁰ The COVID-19 vaccine is widely available, easily obtained, and free of charge for all military personnel. Yet the vaccine hesitancy in the military parallels that of the civilian sector. This led the study authors to opine that, “forces external to the U.S. Military, such as interpersonal and societal factors also contribute to vaccine hesitancy among military service members.”⁶

Obviously, any unvaccinated active-duty service member reduces the combat readiness of the fighting force a consideration that led some in Congress to call for mandating vaccination. The vaccine is currently being administered under an emergency use authorization (EUA), which prevents even the military from mandating it.¹¹ Even if President Joseph Biden obtained a waiver to make the vaccine mandatory, the implications of forcing service members who have volunteered to serve their country is ethically problematic. Those problems are exponentially amplified when applied to members of ethnic and racial minorities who have a past and present of health disparities and discrimination. Respecting the decision of those in uniform to decline COVID-19 vaccination is the first and perhaps most important step to rebuilding the trust that is the most promising means of reducing vaccine hesitancy.

Part of the accountability we all bear for health care inequity and racism is to continue the work of this landmark study to better understand vaccine hesitancy among military and veteran cohorts, develop counseling and education that target those attitudes, beliefs, and motivations with education, counseling, and support. All of us can in some small measure follow the ethical mandate “to dispel rumors and provide facts to people” of Secretary Austin, a Black retired 4-star Army general.¹

It is June and most of us are looking forward to a more normal summer than the one we had in 2020. Many Americans have been vaccinated and states are rolling back some (or all) masking requirements and restrictions on gatherings. In many sectors, including the US Department of Defense (DoD) and the US Department of Veterans Affairs (VA), worries from public health officials about vaccine supply and how to ethically allocate demand have given way to a new set of concerns: We have the shots, but for widespread protection we have to get them into arms.

The reluctance to roll up the sleeve is known as vaccine hesitancy. The National Academies of Science comments on vaccine hesitancy in its report on COVID-19 vaccination allocation. “Potential consequences of vaccine hesitancy—which the committee views as an attitude, preference, or motivational state—are the behaviors of vaccine refusal or delay.”²

On that count, there was encouraging albeit unexpected news in waning days of May. Media reported a sharp increase in the COVID-vaccination of military personnel. Unnamed DoD officials indicated, they had seen a 55% increase in the vaccination of active-duty service members over the previous month. This news represents a dramatic turnaround in a trend of vaccine hesitancy among military members that has persisted since the vaccine became available.³ Even last month, this would have been a very different column. The DoD has not disclosed the exact number of service members who have declined COVID-19 vaccination but multiple news outlets have documented that there was widespread and significant vaccine hesitancy among military personnel. In February, Military News reported that one-third of troops who were offered the vaccine declined it; and in April, USA Today stated that 40% of Marines had refused vaccination.^4,5

Still, it is worth examining the data on vaccination among active duty service members. From December 2020 through March 2021, the military conducted the first study to evaluate rates of vaccine initiation and completion in the military in general and for service members from racial/ethnic minorities in particular. Black military personnel were 28% less likely than non-Hispanic White service members to initiate vaccination against coronavirus even after adjusting for other possible confounders. Just 29% of White, 25.5% of Hispanic, and 18.7% of Black service members had initiated the vaccine process in the survey.⁶

The authors suggest that in part, vaccine hesitancy explains the findings.⁴ Vaccine hesitancy among racial and ethnic minorities is even more tragic because these same already disadvantaged cohorts have disproportionately suffered from COVID-19 throughout the pandemic with higher rates of infection, serious illness requiring hospitalization, and infection-related morbidity.⁷

Vaccine hesitancy, delay, or refusal in Black Americans whether military or civilian often is attributed to the historical abuses like the Tuskegee syphilis experiments or the more recent example of cancer cell lines taken from Henrietta Lacks without consent.⁸ Such government sponsored betrayals no doubt are the soil in which hesitancy grows but recent commentators have opined that focusing solely on these infamous examples may ignore current systemic racism that is pervasively feeding Black Americans reluctance to consider or accept COVID-19 vaccination.⁹ Blaming infamous research also provides a convenient excuse for confronting contemporary racial discrimination in health care and taking responsibility as health care practitioners for reversing it. “Framing the conversation about distrust in COVID vaccines in terms of everyday racism rather than historical atrocities may increase underserved communities’ willingness to be vaccinated,” Bajaj and Stanford wrote in a recent recent New England Journal of Medicine commentary. “When we hyperfocus on Sims, Lacks, and Tuskegee, we ascribe the current Black health experience to past racism, rooting our present in immovable historical occurrences and undermining efforts to combat mistrust. Everyday racism, by contrast, can be tackled in the present.”⁹

The study of racial/ethnic disparities in COVID-19 vaccination in active-duty service members was a work product of the Armed Forces Health Surveillance Division. The authors underscore several factors that support the connection between discrimination and vaccine hesitancy in the military. Lack of access to and ability to obtain COVID-19 vaccination continues to be a major barrier that disadvantaged populations must overcome.¹⁰ The COVID-19 vaccine is widely available, easily obtained, and free of charge for all military personnel. Yet the vaccine hesitancy in the military parallels that of the civilian sector. This led the study authors to opine that, “forces external to the U.S. Military, such as interpersonal and societal factors also contribute to vaccine hesitancy among military service members.”⁶

Obviously, any unvaccinated active-duty service member reduces the combat readiness of the fighting force a consideration that led some in Congress to call for mandating vaccination. The vaccine is currently being administered under an emergency use authorization (EUA), which prevents even the military from mandating it.¹¹ Even if President Joseph Biden obtained a waiver to make the vaccine mandatory, the implications of forcing service members who have volunteered to serve their country is ethically problematic. Those problems are exponentially amplified when applied to members of ethnic and racial minorities who have a past and present of health disparities and discrimination. Respecting the decision of those in uniform to decline COVID-19 vaccination is the first and perhaps most important step to rebuilding the trust that is the most promising means of reducing vaccine hesitancy.

Part of the accountability we all bear for health care inequity and racism is to continue the work of this landmark study to better understand vaccine hesitancy among military and veteran cohorts, develop counseling and education that target those attitudes, beliefs, and motivations with education, counseling, and support. All of us can in some small measure follow the ethical mandate “to dispel rumors and provide facts to people” of Secretary Austin, a Black retired 4-star Army general.¹

It is June and most of us are looking forward to a more normal summer than the one we had in 2020. Many Americans have been vaccinated and states are rolling back some (or all) masking requirements and restrictions on gatherings. In many sectors, including the US Department of Defense (DoD) and the US Department of Veterans Affairs (VA), worries from public health officials about vaccine supply and how to ethically allocate demand have given way to a new set of concerns: We have the shots, but for widespread protection we have to get them into arms.

The reluctance to roll up the sleeve is known as vaccine hesitancy. The National Academies of Science comments on vaccine hesitancy in its report on COVID-19 vaccination allocation. “Potential consequences of vaccine hesitancy—which the committee views as an attitude, preference, or motivational state—are the behaviors of vaccine refusal or delay.”²

On that count, there was encouraging albeit unexpected news in waning days of May. Media reported a sharp increase in the COVID-vaccination of military personnel. Unnamed DoD officials indicated, they had seen a 55% increase in the vaccination of active-duty service members over the previous month. This news represents a dramatic turnaround in a trend of vaccine hesitancy among military members that has persisted since the vaccine became available.³ Even last month, this would have been a very different column. The DoD has not disclosed the exact number of service members who have declined COVID-19 vaccination but multiple news outlets have documented that there was widespread and significant vaccine hesitancy among military personnel. In February, Military News reported that one-third of troops who were offered the vaccine declined it; and in April, USA Today stated that 40% of Marines had refused vaccination.^4,5

Still, it is worth examining the data on vaccination among active duty service members. From December 2020 through March 2021, the military conducted the first study to evaluate rates of vaccine initiation and completion in the military in general and for service members from racial/ethnic minorities in particular. Black military personnel were 28% less likely than non-Hispanic White service members to initiate vaccination against coronavirus even after adjusting for other possible confounders. Just 29% of White, 25.5% of Hispanic, and 18.7% of Black service members had initiated the vaccine process in the survey.⁶

The authors suggest that in part, vaccine hesitancy explains the findings.⁴ Vaccine hesitancy among racial and ethnic minorities is even more tragic because these same already disadvantaged cohorts have disproportionately suffered from COVID-19 throughout the pandemic with higher rates of infection, serious illness requiring hospitalization, and infection-related morbidity.⁷

Vaccine hesitancy, delay, or refusal in Black Americans whether military or civilian often is attributed to the historical abuses like the Tuskegee syphilis experiments or the more recent example of cancer cell lines taken from Henrietta Lacks without consent.⁸ Such government sponsored betrayals no doubt are the soil in which hesitancy grows but recent commentators have opined that focusing solely on these infamous examples may ignore current systemic racism that is pervasively feeding Black Americans reluctance to consider or accept COVID-19 vaccination.⁹ Blaming infamous research also provides a convenient excuse for confronting contemporary racial discrimination in health care and taking responsibility as health care practitioners for reversing it. “Framing the conversation about distrust in COVID vaccines in terms of everyday racism rather than historical atrocities may increase underserved communities’ willingness to be vaccinated,” Bajaj and Stanford wrote in a recent recent New England Journal of Medicine commentary. “When we hyperfocus on Sims, Lacks, and Tuskegee, we ascribe the current Black health experience to past racism, rooting our present in immovable historical occurrences and undermining efforts to combat mistrust. Everyday racism, by contrast, can be tackled in the present.”⁹

The study of racial/ethnic disparities in COVID-19 vaccination in active-duty service members was a work product of the Armed Forces Health Surveillance Division. The authors underscore several factors that support the connection between discrimination and vaccine hesitancy in the military. Lack of access to and ability to obtain COVID-19 vaccination continues to be a major barrier that disadvantaged populations must overcome.¹⁰ The COVID-19 vaccine is widely available, easily obtained, and free of charge for all military personnel. Yet the vaccine hesitancy in the military parallels that of the civilian sector. This led the study authors to opine that, “forces external to the U.S. Military, such as interpersonal and societal factors also contribute to vaccine hesitancy among military service members.”⁶

Obviously, any unvaccinated active-duty service member reduces the combat readiness of the fighting force a consideration that led some in Congress to call for mandating vaccination. The vaccine is currently being administered under an emergency use authorization (EUA), which prevents even the military from mandating it.¹¹ Even if President Joseph Biden obtained a waiver to make the vaccine mandatory, the implications of forcing service members who have volunteered to serve their country is ethically problematic. Those problems are exponentially amplified when applied to members of ethnic and racial minorities who have a past and present of health disparities and discrimination. Respecting the decision of those in uniform to decline COVID-19 vaccination is the first and perhaps most important step to rebuilding the trust that is the most promising means of reducing vaccine hesitancy.

Part of the accountability we all bear for health care inequity and racism is to continue the work of this landmark study to better understand vaccine hesitancy among military and veteran cohorts, develop counseling and education that target those attitudes, beliefs, and motivations with education, counseling, and support. All of us can in some small measure follow the ethical mandate “to dispel rumors and provide facts to people” of Secretary Austin, a Black retired 4-star Army general.¹

Key clinical point: Protein tyrosine phosphatase receptor gamma (PTPRG), a tumor suppressor gene, could serve as a new biomarker to evaluate therapeutic response to tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia (CML).

Major finding: In patients with CML, PTPRG expression was significantly lower at diagnosis vs. follow-up (P less than .001). Patients with optimal response to TKI had significantly higher PTPRG expression during follow-up vs. diagnosis (P less than .0005); however, no difference was observed in patients with a failed response to TKI (P = .312).

Study details: This study assessed PTPRG expression in 21 patients with CML (chronic phase, n=18; accelerated phase, n=3) treated with imatinib (n=12) or nilotinib (n=9) and 7 healthy individuals.

Disclosures: This study was funded by the Qatar National Research Fund, and open access funding was enabled by the Qatar National Library. The authors declared no conflicts of interest.

Source: Ismail MA et al. Sci Rep. 2021 Apr 23. doi: 10.1038/s41598-021-86875-y.

Key clinical point: Protein tyrosine phosphatase receptor gamma (PTPRG), a tumor suppressor gene, could serve as a new biomarker to evaluate therapeutic response to tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia (CML).

Major finding: In patients with CML, PTPRG expression was significantly lower at diagnosis vs. follow-up (P less than .001). Patients with optimal response to TKI had significantly higher PTPRG expression during follow-up vs. diagnosis (P less than .0005); however, no difference was observed in patients with a failed response to TKI (P = .312).

Study details: This study assessed PTPRG expression in 21 patients with CML (chronic phase, n=18; accelerated phase, n=3) treated with imatinib (n=12) or nilotinib (n=9) and 7 healthy individuals.

Disclosures: This study was funded by the Qatar National Research Fund, and open access funding was enabled by the Qatar National Library. The authors declared no conflicts of interest.

Source: Ismail MA et al. Sci Rep. 2021 Apr 23. doi: 10.1038/s41598-021-86875-y.

Key clinical point: Protein tyrosine phosphatase receptor gamma (PTPRG), a tumor suppressor gene, could serve as a new biomarker to evaluate therapeutic response to tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia (CML).

Major finding: In patients with CML, PTPRG expression was significantly lower at diagnosis vs. follow-up (P less than .001). Patients with optimal response to TKI had significantly higher PTPRG expression during follow-up vs. diagnosis (P less than .0005); however, no difference was observed in patients with a failed response to TKI (P = .312).

Study details: This study assessed PTPRG expression in 21 patients with CML (chronic phase, n=18; accelerated phase, n=3) treated with imatinib (n=12) or nilotinib (n=9) and 7 healthy individuals.

Disclosures: This study was funded by the Qatar National Research Fund, and open access funding was enabled by the Qatar National Library. The authors declared no conflicts of interest.

Source: Ismail MA et al. Sci Rep. 2021 Apr 23. doi: 10.1038/s41598-021-86875-y.

Key clinical point: High cancerous inhibitor of protein phosphatase 2A (CIP2A) levels at diagnosis predicts subsequent disease progression and treatment failure in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with imatinib or dasatinib.

Major finding: High vs. low CIP2A levels were associated with poor progression-free survival (P = .04) and freedom from progression (P = .03). Patients with high vs. low CIP2A levels had a higher chance of treatment failure at 5 years (41% vs. 7.5%; P = .002) in both imatinib- (45% vs. 11%; P = .02) and dasatinib-treated (36% vs. 4%; P = .007) patients.

Study details: Data come from an analysis of 172 patients with newly diagnosed CML-CP enrolled in phase 3 SPIRIT2 trial who were randomly allocated to frontline imatinib (n=90) or dasatinib (n=82).

Disclosures: This study was funded by Bristol Myers Squibb (BMS). The lead author reported research support and/or honoraria from Novartis, BMS, and Pfizer. Other authors declared no conflicts of interest.

Source: Clark RE et al. Cancers (Basel). 2021 Apr 29. doi: 10.3390/cancers13092155.

Key clinical point: High cancerous inhibitor of protein phosphatase 2A (CIP2A) levels at diagnosis predicts subsequent disease progression and treatment failure in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with imatinib or dasatinib.

Major finding: High vs. low CIP2A levels were associated with poor progression-free survival (P = .04) and freedom from progression (P = .03). Patients with high vs. low CIP2A levels had a higher chance of treatment failure at 5 years (41% vs. 7.5%; P = .002) in both imatinib- (45% vs. 11%; P = .02) and dasatinib-treated (36% vs. 4%; P = .007) patients.

Study details: Data come from an analysis of 172 patients with newly diagnosed CML-CP enrolled in phase 3 SPIRIT2 trial who were randomly allocated to frontline imatinib (n=90) or dasatinib (n=82).

Disclosures: This study was funded by Bristol Myers Squibb (BMS). The lead author reported research support and/or honoraria from Novartis, BMS, and Pfizer. Other authors declared no conflicts of interest.

Source: Clark RE et al. Cancers (Basel). 2021 Apr 29. doi: 10.3390/cancers13092155.

Key clinical point: High cancerous inhibitor of protein phosphatase 2A (CIP2A) levels at diagnosis predicts subsequent disease progression and treatment failure in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with imatinib or dasatinib.

Major finding: High vs. low CIP2A levels were associated with poor progression-free survival (P = .04) and freedom from progression (P = .03). Patients with high vs. low CIP2A levels had a higher chance of treatment failure at 5 years (41% vs. 7.5%; P = .002) in both imatinib- (45% vs. 11%; P = .02) and dasatinib-treated (36% vs. 4%; P = .007) patients.

Study details: Data come from an analysis of 172 patients with newly diagnosed CML-CP enrolled in phase 3 SPIRIT2 trial who were randomly allocated to frontline imatinib (n=90) or dasatinib (n=82).

Disclosures: This study was funded by Bristol Myers Squibb (BMS). The lead author reported research support and/or honoraria from Novartis, BMS, and Pfizer. Other authors declared no conflicts of interest.

Source: Clark RE et al. Cancers (Basel). 2021 Apr 29. doi: 10.3390/cancers13092155.

Key clinical point: Patients with chronic-phase chronic myeloid leukemia (CML-CP) receiving a second-generation tyrosine kinase inhibitor (TKI) frontline and fulfilling eligibility criteria for European LeukemiaNet 2020 treatment-free remission (TFR) recommendations had the highest molecular recurrence-free survival (MRFS) after TKI discontinuation.

Major finding: MRFS at 2 and 5 years were 51.8% and 43.8%, respectively. MRFS was significantly higher in patients who fulfilled TFR recommendations vs. those who did not (P = .005). Molecular recurrence was highest in patients treated with frontline imatinib not fulfilling TFR recommendations and lowest in patients treated with a second-generation TKI and who fulfilled the eligibility criteria.

Study details: This retrospective study assessed TFR eligibility and outcomes in 398 patients with newly diagnosed CML-CP treated with either imatinib (73%) or a second- or third-generation TKI (27%) as frontline therapy.

Disclosures: No specific funding source was identified. Some investigators including the lead author reported ties with various pharmaceutical companies. The authors declared no conflicts of interest.

Source: Etienne G et al. Cancer Med. 2021 May 14. doi: 10.1002/cam4.3921.

Key clinical point: Patients with chronic-phase chronic myeloid leukemia (CML-CP) receiving a second-generation tyrosine kinase inhibitor (TKI) frontline and fulfilling eligibility criteria for European LeukemiaNet 2020 treatment-free remission (TFR) recommendations had the highest molecular recurrence-free survival (MRFS) after TKI discontinuation.

Major finding: MRFS at 2 and 5 years were 51.8% and 43.8%, respectively. MRFS was significantly higher in patients who fulfilled TFR recommendations vs. those who did not (P = .005). Molecular recurrence was highest in patients treated with frontline imatinib not fulfilling TFR recommendations and lowest in patients treated with a second-generation TKI and who fulfilled the eligibility criteria.

Study details: This retrospective study assessed TFR eligibility and outcomes in 398 patients with newly diagnosed CML-CP treated with either imatinib (73%) or a second- or third-generation TKI (27%) as frontline therapy.

Disclosures: No specific funding source was identified. Some investigators including the lead author reported ties with various pharmaceutical companies. The authors declared no conflicts of interest.

Source: Etienne G et al. Cancer Med. 2021 May 14. doi: 10.1002/cam4.3921.

Key clinical point: Patients with chronic-phase chronic myeloid leukemia (CML-CP) receiving a second-generation tyrosine kinase inhibitor (TKI) frontline and fulfilling eligibility criteria for European LeukemiaNet 2020 treatment-free remission (TFR) recommendations had the highest molecular recurrence-free survival (MRFS) after TKI discontinuation.

Major finding: MRFS at 2 and 5 years were 51.8% and 43.8%, respectively. MRFS was significantly higher in patients who fulfilled TFR recommendations vs. those who did not (P = .005). Molecular recurrence was highest in patients treated with frontline imatinib not fulfilling TFR recommendations and lowest in patients treated with a second-generation TKI and who fulfilled the eligibility criteria.

Study details: This retrospective study assessed TFR eligibility and outcomes in 398 patients with newly diagnosed CML-CP treated with either imatinib (73%) or a second- or third-generation TKI (27%) as frontline therapy.

Disclosures: No specific funding source was identified. Some investigators including the lead author reported ties with various pharmaceutical companies. The authors declared no conflicts of interest.

Source: Etienne G et al. Cancer Med. 2021 May 14. doi: 10.1002/cam4.3921.

Key clinical point: Cognitive behavioral therapy for targeted therapy-related fatigue (CBT-TTF) improved tyrosine kinase inhibitor (TKI)-related fatigue in patients with chronic-phase chronic myeloid leukemia (CML-CP).

Major finding: Patients receiving 18-week CBT-TTF vs. control reported improvements in physical (P = .023), mental (P = .015), and social activity (P = .001), along with enhanced cognitions including self-efficacy (P = .001), helplessness (P = .003), fatigue catastrophizing and focusing on symptoms (both P less than .001).

Study details: Findings are from secondary analysis of a trial including 36 adults with CML-CP treated with a TKI, who reported moderate to severe fatigue and were randomly allocated to receive either CBT-TTF (n=22) or waitlist control (n=14).

Disclosures: This study was funded by the National Cancer Institute. Some coinvestigators reported grants, consultancy, advisory, and speakers’ bureau memberships from various pharmaceutical companies.

Source: Hyland KA et al. Ann Behav Med. 2021 May 15. doi: 10.1093/abm/kaab035.

Key clinical point: Cognitive behavioral therapy for targeted therapy-related fatigue (CBT-TTF) improved tyrosine kinase inhibitor (TKI)-related fatigue in patients with chronic-phase chronic myeloid leukemia (CML-CP).

Major finding: Patients receiving 18-week CBT-TTF vs. control reported improvements in physical (P = .023), mental (P = .015), and social activity (P = .001), along with enhanced cognitions including self-efficacy (P = .001), helplessness (P = .003), fatigue catastrophizing and focusing on symptoms (both P less than .001).

Study details: Findings are from secondary analysis of a trial including 36 adults with CML-CP treated with a TKI, who reported moderate to severe fatigue and were randomly allocated to receive either CBT-TTF (n=22) or waitlist control (n=14).

Disclosures: This study was funded by the National Cancer Institute. Some coinvestigators reported grants, consultancy, advisory, and speakers’ bureau memberships from various pharmaceutical companies.

Source: Hyland KA et al. Ann Behav Med. 2021 May 15. doi: 10.1093/abm/kaab035.

Key clinical point: Cognitive behavioral therapy for targeted therapy-related fatigue (CBT-TTF) improved tyrosine kinase inhibitor (TKI)-related fatigue in patients with chronic-phase chronic myeloid leukemia (CML-CP).

Major finding: Patients receiving 18-week CBT-TTF vs. control reported improvements in physical (P = .023), mental (P = .015), and social activity (P = .001), along with enhanced cognitions including self-efficacy (P = .001), helplessness (P = .003), fatigue catastrophizing and focusing on symptoms (both P less than .001).

Study details: Findings are from secondary analysis of a trial including 36 adults with CML-CP treated with a TKI, who reported moderate to severe fatigue and were randomly allocated to receive either CBT-TTF (n=22) or waitlist control (n=14).

Disclosures: This study was funded by the National Cancer Institute. Some coinvestigators reported grants, consultancy, advisory, and speakers’ bureau memberships from various pharmaceutical companies.

Source: Hyland KA et al. Ann Behav Med. 2021 May 15. doi: 10.1093/abm/kaab035.

Background: With more than 500 cases of NSF reported during 1997-2007, a black box warning advises against use of all GBCAs in at-risk CKD patients. However, newer literature has shown that group II GBCAs may have lower risks of causing NSF. The risk to patients with CKD IV and V is not clear.

Dr. Midha is a hospitalist at Beth Israel Deaconess Medical Center, instructor of medicine, Boston University, and part-time instructor in medicine, Harvard Medical School, all in Boston.

Background: With more than 500 cases of NSF reported during 1997-2007, a black box warning advises against use of all GBCAs in at-risk CKD patients. However, newer literature has shown that group II GBCAs may have lower risks of causing NSF. The risk to patients with CKD IV and V is not clear.

Dr. Midha is a hospitalist at Beth Israel Deaconess Medical Center, instructor of medicine, Boston University, and part-time instructor in medicine, Harvard Medical School, all in Boston.

Background: With more than 500 cases of NSF reported during 1997-2007, a black box warning advises against use of all GBCAs in at-risk CKD patients. However, newer literature has shown that group II GBCAs may have lower risks of causing NSF. The risk to patients with CKD IV and V is not clear.

Dr. Midha is a hospitalist at Beth Israel Deaconess Medical Center, instructor of medicine, Boston University, and part-time instructor in medicine, Harvard Medical School, all in Boston.

Key clinical point: Findings from routine clinical practice are in concordance with results from clinical trials and confirm the efficacy of ponatinib in patients with chronic myeloid leukemia (CML) who were resistant or intolerant to previous tyrosine kinase inhibitors (TKIs) or had T315I mutation. No new safety signals were identified.

Major finding: During a median follow-up of 15 months, major molecular response was achieved in 58% of patients with CML. Estimated 3-year overall survival and progression-free survival were 85.3% and 81.6%, respectively. Treatment termination because of adverse events occurred in 8 patients with CML.

Study details: Findings are from a prospective observational study including 33 patients with CML and 17 patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Patients were initiated on ponatinib following intolerance, relapse, or refractoriness to prior TKIs, disease progression, or T315I mutation.

Disclosures: This study was funded by Incyte Biosciences Benelux BV. Some investigators reported research funding, advisory board memberships, consultancy, honoraria, travel expenses, and membership of the board of directors for various pharmaceutical companies including Incyte Biosciences Benelux BV.

Source: Devos T et al. Ann Hematol. 2021 May 4. doi: 10.1007/s00277-021-04507-x.

Key clinical point: Findings from routine clinical practice are in concordance with results from clinical trials and confirm the efficacy of ponatinib in patients with chronic myeloid leukemia (CML) who were resistant or intolerant to previous tyrosine kinase inhibitors (TKIs) or had T315I mutation. No new safety signals were identified.

Major finding: During a median follow-up of 15 months, major molecular response was achieved in 58% of patients with CML. Estimated 3-year overall survival and progression-free survival were 85.3% and 81.6%, respectively. Treatment termination because of adverse events occurred in 8 patients with CML.

Study details: Findings are from a prospective observational study including 33 patients with CML and 17 patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Patients were initiated on ponatinib following intolerance, relapse, or refractoriness to prior TKIs, disease progression, or T315I mutation.

Disclosures: This study was funded by Incyte Biosciences Benelux BV. Some investigators reported research funding, advisory board memberships, consultancy, honoraria, travel expenses, and membership of the board of directors for various pharmaceutical companies including Incyte Biosciences Benelux BV.

Source: Devos T et al. Ann Hematol. 2021 May 4. doi: 10.1007/s00277-021-04507-x.

Key clinical point: Findings from routine clinical practice are in concordance with results from clinical trials and confirm the efficacy of ponatinib in patients with chronic myeloid leukemia (CML) who were resistant or intolerant to previous tyrosine kinase inhibitors (TKIs) or had T315I mutation. No new safety signals were identified.

Major finding: During a median follow-up of 15 months, major molecular response was achieved in 58% of patients with CML. Estimated 3-year overall survival and progression-free survival were 85.3% and 81.6%, respectively. Treatment termination because of adverse events occurred in 8 patients with CML.

Study details: Findings are from a prospective observational study including 33 patients with CML and 17 patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Patients were initiated on ponatinib following intolerance, relapse, or refractoriness to prior TKIs, disease progression, or T315I mutation.

Disclosures: This study was funded by Incyte Biosciences Benelux BV. Some investigators reported research funding, advisory board memberships, consultancy, honoraria, travel expenses, and membership of the board of directors for various pharmaceutical companies including Incyte Biosciences Benelux BV.

Source: Devos T et al. Ann Hematol. 2021 May 4. doi: 10.1007/s00277-021-04507-x.

Key clinical point: Single nucleotide polymorphisms (SNPs) in the major multidrug resistance (MDR)-ATP-binding cassette (ABC) transporter genes, ABCB1, ABCC2, and ABCG2, influenced the achievement of molecular response (MR)3 and MR4 in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with nilotinib.

Major finding: Patients with ABCB1 rs1045642 TT (P = .01) or ABCC2 rs3740066 CT (P = .004) and CC (P = .02) genotypes achieved significantly higher rates of MR3 in a shorter period. Conversely, patients with ABCG2 rs2231137 GG genotype had a lower probability of achieving MR3 (P = .005). ABCC2 rs3740066 CC (P = .02) and ABCB1 rs1045642 CC (P = .007) and TT (P = .003) genotypes were associated with higher rates of MR4 achievement.

Study details: This observational study assessed 7 SNPs in 4 ABC transporter genes (ABCB1, ABCC1, ABCC2, and ABCG2) in 90 Caucasian adult patients with CML-CP treated with first-or second-line nilotinib.

Disclosures: This study was supported in part by AIL Pesaro Onlus. The authors declared no conflicts of interest.

Source: Loscocco F et al. Front Oncol. 2021 May 13. doi: 10.3389/fonc.2021.672287.

Key clinical point: Single nucleotide polymorphisms (SNPs) in the major multidrug resistance (MDR)-ATP-binding cassette (ABC) transporter genes, ABCB1, ABCC2, and ABCG2, influenced the achievement of molecular response (MR)3 and MR4 in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with nilotinib.

Major finding: Patients with ABCB1 rs1045642 TT (P = .01) or ABCC2 rs3740066 CT (P = .004) and CC (P = .02) genotypes achieved significantly higher rates of MR3 in a shorter period. Conversely, patients with ABCG2 rs2231137 GG genotype had a lower probability of achieving MR3 (P = .005). ABCC2 rs3740066 CC (P = .02) and ABCB1 rs1045642 CC (P = .007) and TT (P = .003) genotypes were associated with higher rates of MR4 achievement.

Study details: This observational study assessed 7 SNPs in 4 ABC transporter genes (ABCB1, ABCC1, ABCC2, and ABCG2) in 90 Caucasian adult patients with CML-CP treated with first-or second-line nilotinib.

Disclosures: This study was supported in part by AIL Pesaro Onlus. The authors declared no conflicts of interest.

Source: Loscocco F et al. Front Oncol. 2021 May 13. doi: 10.3389/fonc.2021.672287.

Key clinical point: Single nucleotide polymorphisms (SNPs) in the major multidrug resistance (MDR)-ATP-binding cassette (ABC) transporter genes, ABCB1, ABCC2, and ABCG2, influenced the achievement of molecular response (MR)3 and MR4 in patients with chronic-phase chronic myeloid leukemia (CML-CP) treated with nilotinib.

Major finding: Patients with ABCB1 rs1045642 TT (P = .01) or ABCC2 rs3740066 CT (P = .004) and CC (P = .02) genotypes achieved significantly higher rates of MR3 in a shorter period. Conversely, patients with ABCG2 rs2231137 GG genotype had a lower probability of achieving MR3 (P = .005). ABCC2 rs3740066 CC (P = .02) and ABCB1 rs1045642 CC (P = .007) and TT (P = .003) genotypes were associated with higher rates of MR4 achievement.

Study details: This observational study assessed 7 SNPs in 4 ABC transporter genes (ABCB1, ABCC1, ABCC2, and ABCG2) in 90 Caucasian adult patients with CML-CP treated with first-or second-line nilotinib.

Disclosures: This study was supported in part by AIL Pesaro Onlus. The authors declared no conflicts of interest.

Source: Loscocco F et al. Front Oncol. 2021 May 13. doi: 10.3389/fonc.2021.672287.

Key clinical point: In patients with chronic-phase chronic myeloid leukemia (CML-CP), imatinib treatment for at least 6 years and molecular response 4 (MR4) duration of a minimum of 4.5 years may be optimal for higher treatment-free remission (TFR) success after imatinib discontinuation.

Major finding: Patients with imatinib treatment duration of 6 years or more vs. less than 6 years (61.8% vs. 36.0%; P = .01) and those with MR4 duration of 4.5 years or longer vs. less than 4.5 years (64.2% vs. 41.9%; P = .003) had a superior molecular relapse-free survival at 12 months after imatinib discontinuation.

Study details: This prospective study reported findings from the TRAD study including 131 patients with CML-CP. Patients were treated with imatinib for at least 3 years (range, 3.0-17.5 years) and had a minimum of 2 years of MR4 or deeper response (range, 2.0-15.8 years) before imatinib discontinuation.

Disclosures: This study was supported by BMS Canada and the Princess Margaret Cancer Foundation. The lead author reported research funding from BMS and Novartis.

Source: Kim DDH et al. Br J Haematol. 2021 Apr 20. doi: 10.1111/bjh.17447.

Key clinical point: In patients with chronic-phase chronic myeloid leukemia (CML-CP), imatinib treatment for at least 6 years and molecular response 4 (MR4) duration of a minimum of 4.5 years may be optimal for higher treatment-free remission (TFR) success after imatinib discontinuation.

Major finding: Patients with imatinib treatment duration of 6 years or more vs. less than 6 years (61.8% vs. 36.0%; P = .01) and those with MR4 duration of 4.5 years or longer vs. less than 4.5 years (64.2% vs. 41.9%; P = .003) had a superior molecular relapse-free survival at 12 months after imatinib discontinuation.

Study details: This prospective study reported findings from the TRAD study including 131 patients with CML-CP. Patients were treated with imatinib for at least 3 years (range, 3.0-17.5 years) and had a minimum of 2 years of MR4 or deeper response (range, 2.0-15.8 years) before imatinib discontinuation.

Disclosures: This study was supported by BMS Canada and the Princess Margaret Cancer Foundation. The lead author reported research funding from BMS and Novartis.

Source: Kim DDH et al. Br J Haematol. 2021 Apr 20. doi: 10.1111/bjh.17447.

Key clinical point: In patients with chronic-phase chronic myeloid leukemia (CML-CP), imatinib treatment for at least 6 years and molecular response 4 (MR4) duration of a minimum of 4.5 years may be optimal for higher treatment-free remission (TFR) success after imatinib discontinuation.

Major finding: Patients with imatinib treatment duration of 6 years or more vs. less than 6 years (61.8% vs. 36.0%; P = .01) and those with MR4 duration of 4.5 years or longer vs. less than 4.5 years (64.2% vs. 41.9%; P = .003) had a superior molecular relapse-free survival at 12 months after imatinib discontinuation.

Study details: This prospective study reported findings from the TRAD study including 131 patients with CML-CP. Patients were treated with imatinib for at least 3 years (range, 3.0-17.5 years) and had a minimum of 2 years of MR4 or deeper response (range, 2.0-15.8 years) before imatinib discontinuation.

Disclosures: This study was supported by BMS Canada and the Princess Margaret Cancer Foundation. The lead author reported research funding from BMS and Novartis.

Source: Kim DDH et al. Br J Haematol. 2021 Apr 20. doi: 10.1111/bjh.17447.

Key clinical point: Response and survival with current therapies remain poor in patients with atypical chronic myeloid leukemia (aCML), with allogeneic stem cell transplantation (allo-SCT) being the only treatment associated with improved survival.

Major finding: Overall response rate was 29%, with only 3 patients achieving a complete response. The median overall survival (OS) was 25 (95% confidence interval, 20.0-30.0) months, with OS being worst in patients receiving intensive chemotherapy than those receiving hypomethylating agents, ruxolitinib, or hydroxyurea. Allo-SCT was associated with improved survival (hazard ratio, 0.144; P = .007).

Study details: This retrospective study included 65 patients (median age, 67 years) with aCML.

Disclosures: This study was funded by grants from The University of Texas MD Anderson Cancer Center. Some investigators reported financial and/or nonfinancial ties with various pharmaceutical companies.

Source: Montalban-Bravo G et al. Cancer. 2021 Apr 29. doi: 10.1002/cncr.33622.

Key clinical point: Response and survival with current therapies remain poor in patients with atypical chronic myeloid leukemia (aCML), with allogeneic stem cell transplantation (allo-SCT) being the only treatment associated with improved survival.

Major finding: Overall response rate was 29%, with only 3 patients achieving a complete response. The median overall survival (OS) was 25 (95% confidence interval, 20.0-30.0) months, with OS being worst in patients receiving intensive chemotherapy than those receiving hypomethylating agents, ruxolitinib, or hydroxyurea. Allo-SCT was associated with improved survival (hazard ratio, 0.144; P = .007).

Study details: This retrospective study included 65 patients (median age, 67 years) with aCML.

Disclosures: This study was funded by grants from The University of Texas MD Anderson Cancer Center. Some investigators reported financial and/or nonfinancial ties with various pharmaceutical companies.

Source: Montalban-Bravo G et al. Cancer. 2021 Apr 29. doi: 10.1002/cncr.33622.

Key clinical point: Response and survival with current therapies remain poor in patients with atypical chronic myeloid leukemia (aCML), with allogeneic stem cell transplantation (allo-SCT) being the only treatment associated with improved survival.

Major finding: Overall response rate was 29%, with only 3 patients achieving a complete response. The median overall survival (OS) was 25 (95% confidence interval, 20.0-30.0) months, with OS being worst in patients receiving intensive chemotherapy than those receiving hypomethylating agents, ruxolitinib, or hydroxyurea. Allo-SCT was associated with improved survival (hazard ratio, 0.144; P = .007).

Study details: This retrospective study included 65 patients (median age, 67 years) with aCML.

Disclosures: This study was funded by grants from The University of Texas MD Anderson Cancer Center. Some investigators reported financial and/or nonfinancial ties with various pharmaceutical companies.

Source: Montalban-Bravo G et al. Cancer. 2021 Apr 29. doi: 10.1002/cncr.33622.