Hematologic Response Research Articles

Clinical Efficacy and Safety of Flumatinib in the Treatment of Patients with Newly Diagnosed Chronic Myeloid Leukemia in Chronic Phase

To explore the clinical efficacy and safety of flumatinib mesylate produced in China in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML-CP). 32 newly diagnosed CML-CP patients admitted to the Hematology Department of the Affiliated Hospital of Southwest Medical University from March 1, 2020 to March 31, 2022, who had never received any tyrosine kinase inhibitor (TKI) were included in the study. The patients were treated by flumatinib mesylate 600mg once daily. The hematologic, cytogenetic and molecular responses were assessed at 3-, 6- and 12-month, and adverse effects of the drug were evaluated. 31 patients were treated with flumatinib for≥3 months, of which 24 patients were treated for ≥6 months and 14 patients were treated for≥12 months. At 3rd month of treatment, 30 out of 31 patients achieved complete hematologic response (CHR); 24 patients underwent cytogenetic testing and 22 cases achieved major cytogenetic response(MCyR), of which 21 cases achieved complete cytogenetic response (CCyR); Among 25 patients who underwent molecular testing, 22 patients had BCR-ABLIS≤10%, including 10 patients with BCR-ABLIS≤0.1%, and 6 patients with BCR-ABLIS≤0.01%. At 6th month of treatment, 23 out of 24 patients achieved CHR; 17 patients underwent cytogenetic testing and all achieved CCyR; Among 23 patients who underwent molecular testing, 20 patients had BCR-ABLIS≤1%, including 16 patients with BCR-ABLIS≤0.1% and 12 patients with BCR-ABLIS≤0.01%. At 12nd month of treatment, all 14 patients achieved CHR and CCyR; Among them, 10 patients had BCR-ABLIS≤0.1%, including 9 patients with BCR-ABLIS≤0.01%. The grade Ⅲ/Ⅳ leukopenia, thrombocytopenia and anemia rates in the patients were 13.3%, 20.0% and 3.3%, respectively. One patient stopped flumatinib therapy due to severe and persistent hematologic toxicity. The major non-hematologic adverse events were abnormal liver function (20%), diarrhea (10%), bone/joint pain (10%), muscle spasm (10%), rash (6.7%), acute kidney injury (6.7%) and nausea(3.3%), most of which were grade I-II. No patient experienced grade Ⅳ non-hematologic adverse events. No drug toxicity-related death occurred. Flumatinib mesglate, as the first-line treatment for newly diagnosed CML-CP, can enable the patients to achieve early and deep molecular and cytogenetic responses, and shows good safety.

Hematological Response of Clarias batrachus to Sodium Fluoride-Induced Toxicity

Hematological Response of Clarias batrachus to Sodium Fluoride-Induced Toxicity

Novel Four-Way Variant Translocation, t(1;9;22;16)(q21;q34;q11.2;q24), in a Patient with Chronic Myeloid Leukemia

Chronic myeloid leukemia (CML) is characterized by the Philadelphia (Ph) chromosome resulting from the translocation of t(9;22)(q34;q11), producing the BCR::ABL1 fusion gene. Variant Ph chromosome translocations, involving rearrangements in chromosomes other than 9 and 22, occur in 5–10% of CML cases. Herein, we report a unique case of a 36-year-old male with a four-way variant Ph chromosome. Conventional chromosomal analysis performed on bone marrow aspirate samples showed 46, XY, t(1;9;22;16)(q21;q34;q11.2;q24). Nested RT-PCR of the BCR::ABL1 gene revealed a major BCR::ABL rearrangement. The treatment with nilotinib achieved a complete hematologic, cytogenetic, and molecular response after 12 months.

Hematological response in patients with paroxysmal nocturnal hemoglobinuria treated with C5-inhibitor

Background. Paroxysmal nocturnal hemoglobinuria is a rare clonal disease of the hematopoietic system, with the key manifestations of hemolytic anemia, a high thrombosis rate, and bone marrow failure. Despite the high efficacy of C5‑inhibitors in intravascular hemolysis cessation, a significant proportion of patients remain anemic. Causes of a sub‑optimal response may include C3‑mediated extravascular (intracellular) hemolysis, residual intravascular hemolysis, or bone marrow failure.Aim. To analyze the results of pathogenetic therapy in patients with paroxysmal nocturnal hemoglobinuria.Materials and methods. The study included 55 patients with paroxysmal nocturnal hemoglobinuria receiving complement C5 inhibitors for at least 6 months. Results. Suboptimal hematological response was observed in 31/55 (56 %) patients. The most common cause of anemia in the partial response group was C3‑mediated extravascular hemolysis in 8/10 (80 %), while bone marrow failure predominated (57 %) in the minor response group.Conclusion. The study showed a high frequency of suboptimal response to pathogenetic therapy and necessity of ac‑curate determination of leading cause of persistent anemia in order to modify therapy or switch to other drugs.

Post-Chemotherapy Cardiotoxicity in Women With Breast Cancer

Chemotherapy (CT) with anthracyclines can generate cardiotoxicity. The immunological system is part of the response to treatment with CT. Women with breast cancer were evaluated during their CT treatment, assessing their response to cardiotoxicity according to the treatment regimens and the classification of the cancer. Single CT and combined CT groups were made up (anthracyclines, Trastuzumab, and taxanes). Cardiotoxicity was measured as the Left Ventricle Expulsion Function (LVEF). The hematological response was measured start and at the end of treatment as the Lymphocyte/Macrophage Index (L/M) and the Lymphocyte/Platelet Index (L/P) The study included 451 women with breast cancer, among whom 230 underwent follow-up with LVEF on at least three occasions. Eight study groups were conformed based on their CT treatment. The comparison with LVEF was obtained between the baseline and the last LVEF. Combined CT diminished the LVEF, contrary to the CT of a single compound, which in addition showed a recovery from LVEF. The combined CT caused functional loss in terms of LVEF in 27% of the studied population. The L/M increased, and the L/P diminished in patients with the combined therapy. This suggests the participation of inflammation processes and vascular damage. Human epidermal growth factor receptor 2-positive (HER2+) and triple- negative patients have less survival, above all when the LVEF baseline was <55%. Anthracycline CT combined with other CT reduced the LVEF in women with breast cancer due to cardiotoxicity associated LVEF dysfunction. The use of only taxanes not exerted cardiotoxicity effect.

Effects of Background Color on Growth, Stress, Biochemical, Hematological, and Immunological Responses, and Expression of Growth-Related Genes in Oscar Fish (Astronotus ocellatus)

The aim of the current study was to assess the impacts of tank color on the growth, stress, biochemical, hematological, and immunological responses, and expression of growth-related genes in juvenile Oscar (Astronotus ocellatus). Therefore, a total of 120 fish (9.14 ± 0.34 g) were distributed into 12 aquariums (60 × 50 × 35 cm) and divided into four treatments (aquariums with blue, white, yellow, and red colors) in three replicates (10 fish per aquarium). The fish were daily hand-fed ad libitum in three meals at 7:00, 12:00, and 17:00 hr for 56 days. Results showed that Oscar fish cultured in the red aquariums had higher final weight and weight gain and lower feed conversion ratio. Plasma cortisol, glucose, and lactate values of fish were significantly higher, and the amount of white blood cells was lower in the blue aquariums compared to other tank colors. Plasma triglyceride values were significantly higher in the white and yellow groups than the blue aquariums. Moreover, fish cultured in yellow and red aquariums had significantly higher melatonin levels than the blue aquariums. Plasma cholesterol, total protein, albumin, complement 3, and total immunoglobulin values were highest in Oscar fish cultured in the red aquariums. Also, lysozyme and alternative complement (ACH50) activities and complement 4 values of fish cultured in yellow and red aquariums were meaningfully higher compared to blue and white groups. Growth hormone relative gene expression levels were meaningfully higher in Oscar fish cultured in white, yellow, and red aquariums than the blue aquariums. Furthermore, insulin-like growth factor-1 (IGF-1) relative gene expression levels were significantly higher in fish cultured in yellow and red aquariums compared to those cultured in blue and white tank colors. Thus, the most suitable tank color for rearing juvenile A. ocellatus is red, while blue tank color is unsuitable.

Results from phase 1 of the MANIFEST clinical trial to evaluate the safety and tolerability of pelabresib in patients with myeloid malignancies

Pelabresib (CPI-0610), a BET protein inhibitor, is in clinical development for hematologic malignancies, given its ability to target NF-κB gene expression. The MANIFEST phase 1 study assessed pelabresib in patients with acute leukemia, high-risk myelodysplastic (MDS) syndrome, or MDS/myeloproliferative neoplasms (MDS/MPNs) (NCT02158858). Forty-four patients received pelabresib orally once daily (QD) at various doses (24–400 mg capsule or 225–275 mg tablet) on cycles of 14 d on and 7 d off. The most frequent drug-related adverse events were nausea, decreased appetite, and fatigue. The maximum tolerated dose (MTD) was 225 mg tablet QD. One patient with chronic myelomonocytic leukemia (CMML) showed partial remission. In total, 25.8% of acute myeloid leukemia (AML) patients and 38.5% of high-risk MDS patients had stable disease. One AML patient and one CMML patient showed peripheral hematologic response. The favorable safety profile supports the ongoing pivotal study of pelabresib in patients with myelofibrosis using the recommended phase 2 dose of 125 mg tablet QD. CLINICAL TRIAL REGISTRATION: NCT02158858

Change in absolute neutrophil count after COVID-19 infection in patients using clozapine versus other antipsychotics.

It was reported that patients who contracted COVID-19 while taking clozapine exhibited a distinct hematological response. However, the absence of control groups made it difficult to attribute it to clozapine. The changes in absolute neutrophil counts (ANCs) during the 4 weeks after COVID-19 infection were compared between the two groups of patients with severe mental illnesses (SMIs) (49 patients using clozapine and 54 using other antipsychotics) using generalized additive modeling. Although the pattern of a transient drop in ANC followed by gradual recovery could be demonstrated in both groups, it was more pronounced in the clozapine group ( P = 0.00025). Nevertheless, overall ANC remained at a higher level in the clozapine group. The results suggested potential interaction between clozapine and COVID-19 at the level of hematological dynamics. However, it did not necessarily indicate that such interaction is inevitably harmful or dangerous. It was more of a concern that some patients using other antipsychotics exhibited decreased ANC, which did not easily recover. Traditionally, clinicians have been concerned about the worsening of hematological side effects in clozapine patients after COVID-19 infection. However, the obtained result highlighted the necessity of hematological monitoring in patients using any type of antipsychotics for SMIs.

Infusional fluorouracil and weekly docetaxel as first-line therapy for gastric cancer with bone marrow metastasis and disseminated intravascular coagulation: A multi-center, phase II trial (Zhen Long).

337 Background: Gastric cancer (GC) with bone marrow metastasis (BMM) and disseminated intravascular coagulation (DIC) constitute a highly aggressive GC (HAGC) sub-type with distinctive features. The prognosis is poor and most HAGC patients die in weeks without effective treatment. Undue concerns about the myelosuppression mitigate against the application of cytotoxics in HAGC which is characterized by thrombocytopenia. Retrospective analysis showed low dose chemotherapy might relieve the DIC and bring with survival benefit but the standard of care (SOC) has not yet been established without a prospective study available. We completed a multi-center phase II trial evaluating the safety and efficacy of infusional fluorouracil and weekly docetaxel as first-line (1L) treatment for HAGC. Methods: This was a single-arm trial. A Simon's two-stage optimal design was applied. Eligible cases were: 18-75 years old, histologically confirmed GC, established BMM, overt DIC, platelet ≤ 50*109/L and Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 3. Fluorouracil 200mg/m2/d continuous infusion on days 1-21 and docetaxel 25mg/m2/d on days 1, 8, 15 were given every four weeks. Hematological response (HeR) was defined as the platelet restored to normal range. The primary end point was HeR rate. Secondary end points were time to HeR (TTHeR), one month mortality (OMM), overall survival (OS), adverse events (AEs) and quality of life (QoL). Results: From Jan 2021 to Sep 2022, 24 HAGC cases from three Chinese centers were enrolled (details shown in table below). 20 HeRs were achieved and the HeR rate was 83.3%. Median TTHeR was 13 days and OMM was 12.5%. Till the data cut-off date (Jul 31, 2023), 3 patients were still alive with a median follow-up of 403 days. The median OS was 242 days. Totally, twelve Grade 3 AEs were recorded in 7 (29.2%) patients, among which stomatitis (4, 16.7%) and aminotransferase elevation (3, 12.5%) were the most frequent. No drug-related grade 4 or 5 AEs were observed. QoL outcomes were significantly improved both during and after the treatment. Conclusions: Anti-cancer treatment is the key point to control DIC of HAGC. The Zhen Long regimen was well tolerated and showed promising efficacy in the 1L setting. It should be considered as the SOC in current practice, but further randomized trials are still needed. Clinical trial information: NCT04547153 . [Table: see text]

Complete responses in AL amyloidosis are unequal: the impact of free light chain mass spectrometry in AL amyloidosis

AbstractAmyloidogenic serum free light chains (sFLCs) drive disease progression in AL amyloidosis. Matrix-assisted laser desorption/ionization time of flight mass spectrometry–based FLC assay (FLC-MS) has greater sensitivity than conventional sFLC assays allowing for the detection of serological residual disease. We report the utility of FLC-MS in a large series of patients with AL amyloidosis assessing the impact of FLC-MS negativity after treatment on overall survival (OS) and organ response rates. Serum samples were analyzed using FLC-MS at diagnosis and at 6 and 12 months after treatment. The impact of FLC-MS negativity over standard hematologic responses on survival and organ response was assessed. A total of 487 patients were included; 290 (59%) and 349 (71.5%) had cardiac and renal involvement, respectively. There was 100% concordance between the light chain (LC) fibril type and LC isotype identified by FLC-MS. At 6 and 12 months, 81 (16.6%) and 101 (20.7%) were FLC-MS negative. Of those achieving a conventional hematologic complete response (CR) at 6 and 12 months, 45 (27.7%) and 64 (39%) were FLC-MS negative. At 12 months, median OS for CR + FLC-MS negative was not reached vs 108 months in CR + FLC-MS positive (P = .024). At 12 months, 70% of patients with FLC-MS negativity (vs 50% FLC-MS positive) achieved a cardiac response (P = .015). In a multivariate analysis, FLC-MS negativity at 12 months was an independent predictor of better outcomes. FLC-MS can detect persistent monoclonal light chains in a significant proportion of patients in a conventional hematologic CR. FLC-MS assessment promises to be a new standard for response assessment in AL amyloidosis.

Silybum marianum promotes growth, hepatic antioxidative activity, and splenic immunity but does not influence the intestinal barrier function of Nile tilapia, Oreochromis niloticus

Alternative additives such as phytobiotics have been a research priority to promote chemotherapeutic-free and disease-resistant aquaculture. Hence, various Silybum marianum (SM) extract levels, including 1, 2, 3, and 4 g kg−1, were supplemented with a reference diet, and the reference diet containing no SM was considered a control. Each test diet was fed in triplicate to experimental fish for 60 days. The effects were observed on growth, liver, lymphoid organs (kidney and spleen), and intestinal health in relation to a panel of blood biochemical responses of Nile tilapia, Oreochromis niloticus. Better growth performance in Nile tilapia fed any supplementation levels of SM resulted from improved feed utilization and feed conversion ratio. Microscopic observations found normal kidney, liver, and spleen microstructure across all treatments. Of interest, the antioxidative capacity of the liver was stimulated by SM supplementation, supported by higher expression of CAT, SOD, and GPx genes coupled with higher levels of hepatic GST and T-AOC and lower levels of hepatic MDA concentrations. This was further aligned with lower levels of serum ALP, AST, and ALT relevant to liver function. Meanwhile, splenic immune relevant gene expression (IFN-γ1, LYZ, and hepcidin) increased significantly in all SM-treated fish compared to the control group. Also, hematological responses, including red blood cell indices (RBCs, Hb, HTC, PCV, MCV, MCH, and MCHC) and white blood cell indices (WBCs, lymphocytes, eosinophils, basophils, and heterophils), except monocytes, were improved by SM supplementation. Intestinal microstructures were normal, and their barrier functions were unchanged by dietary supplementation. Hence, SM extract could be used as a promising avenue for enhancing the functionality of aquadiet, leading to improving overall health performance. However, the mode of action of the bioactive ingredients present in SM extract is warranted to be further studied to consider SM as a functional additive for aquafeeds.

Real-world efficacy of single-agent belantamab mafodotin in relapsed systemic AL amyloidosis.

Systemic light chain (AL) amyloidosis is a relapsing plasma cell disorder. Therapy is limited, particularly for triple-class refractory disease. We report the use of belantamab mafodotin, a BCMA-directed drug-antibody conjugate, for relapsed AL amyloidosis, including patients traditionally excluded from clinical trials. Thirty-one patients were reviewed, with a median of three prior lines of therapy. The median follow-up was 12 months (95% CI 4-19), and a median of five doses were delivered. The best haematological overall response rate was 71%, and the complete/very good partial response was 58%. Sixty-eight percent had keratopathy and improved in all. Belantamab mafodotin has high efficacy and good tolerability in patients with relapsed AL amyloidosis.

Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis.

Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.

Comparative Haematological Responses in Rumenotomy: Impact of Diazepam and Xylazine Pre-medication in West African Dwarf Goats Undergoing Propofol Anaesthesia

Aim:In small ruminant surgery, an understanding of the haematological responses to different anesthetic protocols is crucial for optimizing post-operative outcomes. In this study, the haematological responses of West African Dwarf (WAD) goats undergoing rumenotomy under different anaesthetic protocols were investigated. Methods:Goats were categorized into three groups: Group A received Diazepam pre-medication and Propofol anesthesia, Group B received xylazine pre-medication and Propofol anesthesia, while Group C served as a control with only Propofol anesthesia during rumenotomy. Blood samples were collected at various time points post-rumenotomy for hematological analyses. Results: Results revealed no significant (P&gt;0.05) differences in the packed cell volume (PCV) between groups, except at 24 hours post-surgery where Group A had a higher PCV than in Groups B and C. Haemoglobin (Hb) and total red blood cell count (TRBC) showed no significant (P&gt;0.05) differences across all groups throughout the study. Total white blood cell count (TWBC) did not differ pre-surgery, but Group A displayed a significant increase immediately and 24 hours post-surgery. Neutrophil counts in Group A were elevated during intra-surgery and up to 48 hours post-surgery compared to Groups B and C. The lymphocyte count in Group A was significantly decreased immediately post-surgery. Conclusion:These findings highlight the impact of anaesthetic and pre-medication protocols on specific haematological parameters in WAD goats undergoing rumenotomy, thus, emphasizing the importance of considering these factors in surgical interventions for optimal postoperative outcomes. Hence, further research is recommended to elucidate the mechanisms associated with these haematological variations.

Haematological Responses in Tilapia Guineensis Exposed to Butachlor in the Laboratory

Haematological Responses in Tilapia Guineensis Exposed to Butachlor in the Laboratory

Efficacy and safety of avatrombopag in combination with immunosuppressive therapy in treatment-naïve and relapsed/refractory severe aplastic anaemia: protocol for the DIAAMOND-Ava-FIRST and DIAAMOND-Ava-NEXT Bayesian Optimal Phase II trials

IntroductionImmunosuppressive therapy (IST) with antithymocyte globulin (ATG) and ciclosporin is standard of care for patients with severe aplastic anaemia (sAA) not eligible or suitable for allogeneic stem cell transplant. While...

Effects of the replacement corn meal by whole mango meal on tambaqui (Colossoma macropomum) diet: Digestibility, growth performance, biochemical, and hematological responses.

This study evaluated the digestibility of whole mango (Mangifera indica) meal (WMM) and determined the growth performance, intestinal enzyme activity, and metabolic and hematologic responses of tambaqui (Colossoma macropomum) juveniles fed diets containing different proportions of corn meal (CM) substitution by WMM. Fish fed with graded levels of WMM (0 (control), 80, 160, 240, and 320 g kg diet-1), replacing part of the dietary CM. The apparent digestibility coefficients of WMM were above 96%. Diets with WMM did not affect growth performance or intestinal enzyme activity. However, they showed a positive linear effect on plasma glucose, amino acids, and albumin levels and a negative linear effect on hepatic aspartate aminotransferase activity and hepatic glycogen, plasma cholesterol, and hemoglobin levels. Increased erythrocyte values and decreased plasma triglyceride levels were verified in fish fed 80 and 160 g WMM kg diet-1. In conclusion, the WMM may be a viable alternative to the tambaqui juveniles' diet, and WMM could replace up to 16% of CM without harming the growth and health of tambaqui juveniles.

Recent findings and advances in treatment of myeloproliferative neoplasms

Many novel agents have been developed for BCR::ABL1-negaive myeloproliferative neoplasms (MPN), namely, polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Some of these agents not only achieve hematologic complete response, reduce spleen size, and alleviate constitutional symptoms, but also induce molecular response, which means that they reduce the allele burden of driver gene mutations. These agents also prevent and alleviate fibrosis in bone marrow, which reduces the incidence of thrombotic events and disease progression and might improve prognosis. This article discusses the latest findings and promising treatments, including ongoing clinical trials, in PV, ET, and PMF.

Amyloid Protein in AL-Amyloidosis. Natural History and Potential for Regression

Amyloid light chain amyloidosis is the most commonly seen form of systemic amyloidosis and is characterized by the accumulation of circulating monoclonal immunoglobulin light chain precursors arising from an abnormal clone of plasma cells. These light chain precursors demonstrate a propensity for misfolding, aggregation and deposition as highly stable fibrillar cross-linked beta sheets in various tissues and organs in a manner characteristic of other forms of systemic amyloidosis. There have been great advances in the treatment of the underlying plasma cell dyscrasia with improved long-term survival but the persistence of extracellular amyloid deposits in the tissues of vital organs, particularly the heart and kidney remains a significant cause of morbidity and mortality even in those patients in whom a hematological complete response has been achieved. This review focuses on the importance of early diagnosis and treatment on limiting the extent of amyloid protein accumulation and organ dysfunction and the current state of knowledge on the potential for resorption and clearance of these amyloid deposits in patients with amyloid light chain amyloidosis. The status of current novel anti-fibrillar agents is reviewed and future strategies for effectively intervening to improve organ function and survival these individuals is discussed.

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy.

Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA. In this prospective study, we enrolled 111 patients with AL-CA (50.5% male; median age, 54 [interquartile range, 49-63] years). Patients underwent longitudinal monitoring using biomarkers and CMR imaging. At follow-up after chemotherapy, patients were categorized into superior and inferior response groups based on their hematological and cardiac laboratory responses to chemotherapy. Changes in CMR findings across therapies and differences between response groups were analyzed. Following chemotherapy (before vs. after), there were significant increases in myocardial T2 (43.6 ± 3.5 ms vs. 44.6 ± 4.1 ms; P = 0.008), recovery in right ventricular (RV) longitudinal strain (median of -9.6% vs. -11.7%; P = 0.031), and decrease in RV extracellular volume fraction (ECV) (median of 53.9% vs. 51.6%; P = 0.048). These changes were more pronounced in the superior-response group. Patients with superior cardiac laboratory response showed significantly greater reductions in RV ECV (-2.9% [interquartile range, -8.7%-1.1%] vs. 1.7% [-5.5%-7.1%]; P = 0.017) and left ventricular ECV (-2.0% [-6.0%-1.3%] vs. 2.0% [-3.0%-5.0%]; P = 0.01) compared with those with inferior response. Cardiac amyloid deposition can regress following chemotherapy in patients with AL-CA, particularly showing more prominent regression, possibly earlier, in the RV. CMR emerges as an effective tool for monitoring associated tissue characteristics and ventricular functional recovery in patients with AL-CA undergoing chemotherapy, thereby supporting its utility in treatment response assessment.