Publications by authors named "D'Sa S"

Lymphoplasmacytic lymphoma (LPL) is a relatively rare form of indolent B-cell non-Hodgkin's lymphoma, termed Waldenström's macroglobulinaemia (WM) in the presence of an IgM paraprotein. Although traditionally treated with combination chemoimmunotherapy, the management is evolving in the era of targeted molecular therapies including Bruton's tyrosine kinase inhibitors (BTKi). However, intolerance and refractoriness to BTKi mean newer agents are required, and the prognosis of so-called quadruple-refractory patients is poor.

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The optimal therapeutic approach for relapsed/refractory (R/R) Waldenström's Macroglobulinaemia (WM) has not been clearly defined, especially after treatment with chemoimmunotherapy (CIT) and covalent Bruton's tyrosine kinase inhibitors (cBTKi). The PembroWM trial is a multi-centre, phase II, single-arm study assessing the safety, tolerability and efficacy of rituximab with pembrolizumab in R/R WM patients who had received at least one prior line of treatment, with all having relapsed post-CIT and most also exposed to cBTKi. A total of 17 patients were enrolled, with a median age of 70, and median of three prior lines of therapy with 15 either refractory or intolerant of a cBTKi.

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  • Cold agglutinin disease (CAD) is a rare autoimmune condition causing anemia, and sutimlimab, which inhibits a key part of the immune system, showed effectiveness in reducing symptoms like hemolysis and fatigue in the CADENZA Part A study.
  • In Part B of the CADENZA study, 32 out of 39 patients continued treatment for about 99 weeks, showing sustained improvements in hemoglobin, bilirubin levels, and quality of life measures, with no severe adverse effects reported.
  • Despite the promising results, stopping sutimlimab led to a return of disease symptoms, indicating that while the treatment is effective, continuous management is necessary to maintain its benefits.
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Introduction: During the last decades, the pathogenesis of cold agglutinin disease (CAD) has been well elucidated and shown to be complex. Several documented or investigational therapies have been made available. This development has resulted in major therapeutic advances, but also in challenges in choice of therapy.

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is a relatively uncommon cause of foodborne infection in the general population. Most cases of Listeriosis occur among newborns, pregnant women, the elderly and those with impairment of cellular immunity. Neonatal Listeria meningitis is rare.

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  • The study focuses on the prognosis of patients with Waldenström macroglobulinemia (WM) and reassesses traditional prognostic scoring systems in light of new therapies and genetic data.
  • Researchers analyzed records of 889 treatment-naïve WM patients to identify clinical predictors influencing overall survival, leading to a new prognostic model based on factors like age and serum levels.
  • The newly developed Modified Staging System for WM (MSS-WM) successfully categorizes patients into four distinct risk groups based on their clinical data, demonstrating significant differences in 5-year overall survival rates.
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Autoimmune hemolytic anemia (AIHA) is a rare autoantibody-mediated disease. For steroid and/or rituximab-refractory AIHA, there is no consensus on optimal treatment. Daratumumab, a monoclonal antibody targeting CD38, could be beneficial by suppression of CD38+ plasma cells and thus autoantibody secretion.

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There remains a lack of consensus as to the most appropriate primary therapy in Waldenstrőm macroglobulinemia (WM). We evaluated a novel bortezomib-based combination and developed a sensitive WM-specific flow cytometry assay (limit of detection 0.004% of leucocytes) to assess bone marrow (BM) response.

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  • The phase 3 ASPEN trial compared the effectiveness of two BTK inhibitors, zanubrutinib and ibrutinib, in treating Waldenström macroglobulinemia, analyzing genetic mutations' impact on treatment response.
  • The study found that patients with mutations in CXCR4 and TP53 had poorer responses and survival rates but those treated with zanubrutinib generally showed better outcomes than those given ibrutinib.
  • Overall, the research indicated that zanubrutinib offers improved clinical outcomes for patients with specific mutations compared to ibrutinib, highlighting the importance of genetic testing in treatment decision-making.
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Heterotopic gastric mucosa (HGM) involving the rectum is an uncommon finding. It is especially rare in young children. Rectal prolapse is an uncommon presentation of HGM.

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Peripheral T-cell lymphomas are rare heterogeneous haematological malignancies that may also involve peripheral nerves in a very small subset of cases. We report a patient with a diagnostically challenging cutaneous T-cell lymphoma and multifocal mononeuropathies in whom a targeted nerve biopsy identified lymphomatous infiltration of nerves and expedited combination treatment with chemotherapy and an autologous stem cell transplant. She showed an excellent response with a complete metabolic response on positron emission tomography imaging and significant clinical improvement, maintained 5 years post-treatment.

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Cold agglutinin disease is a rare autoimmune hemolytic anemia characterized by complement pathway-mediated hemolysis. Riliprubart (SAR445088, BIVV020), a second-generation classical complement inhibitor, is a humanized monoclonal antibody that selectively inhibits only the activated form of C1s. This Phase 1b study evaluated the safety, tolerability, and effect on hemolysis of riliprubart in adult patients with cold agglutinin disease.

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  • A study screened 534 patients with monoclonal IgM disorders over nine years, revealing that 134 had type I cryoglobulinaemia, predominantly associated with Waldenström macroglobulinaemia (76%).
  • Coexisting clinically relevant disorders were found in 31% of patients, with a significant prevalence in those with IgM monoclonal gammopathy of undetermined significance (MGUS) compared to Waldenström macroglobulinaemia or non-Hodgkin lymphoma.
  • Half of the patients experienced active symptoms related to cryoglobulins, and after a median follow-up of three years, 77% had not required treatment for cryoglobulinaemia, with age being the main factor influencing overall survival.
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  • The phase III ASPEN study showed that zanubrutinib is as effective as ibrutinib but has better safety for treating patients with Waldenström macroglobulinemia (WM).
  • In a long-term follow-up, zanubrutinib demonstrated higher rates of very good partial response and complete response compared to ibrutinib in both cohorts of WM patients.
  • Adverse events like diarrhea, muscle spasms, and hypertension were more common with ibrutinib, while zanubrutinib had a lower risk of treatment-related discontinuation.
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Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia with a substantial burden on patient's quality of life. CARDINAL was a 2-part, open-label, single-arm, multicenter phase 3 study evaluating the C1s inhibitor, sutimlimab, for treatment of CAD. Part A consisted of the pivotal study phase, with the part B extension phase assessing long-term safety and durability of response including patient-reported outcomes, which is the focus of this report.

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  • IgM-associated peripheral neuropathies (PN) are a diverse group of disorders linked to conditions like IgM monoclonal gammopathy of undetermined significance (MGUS) or Waldenström macroglobulinemia.
  • Identifying the relationship between paraproteins and neuropathies is crucial for determining effective treatment strategies.
  • The most common IgM-PN is Antimyelin-Associated-Glycoprotein neuropathy, but many cases have different underlying causes; treatment options include rituximab or chemotherapy, especially when functional impairment worsens.
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Cold agglutinin disease (CAD) is a rare, autoimmune, classical complement pathway (CP)-mediated hemolytic anemia. Sutimlimab selectively inhibits C1s of the C1 complex, preventing CP activation while leaving the alternative and lectin pathways intact. In Part A (26 weeks) of the open-label, single-arm, Phase 3 CARDINAL study in patients with CAD and a recent history of transfusion, sutimlimab demonstrated rapid effects on hemolysis and anemia.

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The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted.

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  • The Consensus Panel 1 (CP1) of IWWM-11 focused on updating guidelines for managing symptomatic, treatment-naïve Waldenstrom's Macroglobulinemia (WM) patients, asserting that watchful waiting is best for asymptomatic cases.
  • Current first-line treatments include chemoimmunotherapy regimens like DRC and Benda-R, which are effective, usually well-tolerated, and cost-effective; covalent BTK inhibitors like zanubrutinib also provide a viable alternative, showing fewer side effects and better remissions compared to ibrutinib.
  • The panel also noted the importance of testing for MYD88 and CXCR4 mutations prior to treatment, as these can influence the effectiveness of certain
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  • Bendamustine and rituximab (BR) therapy is effective for treating Waldenström Macroglobulinemia (WM), but the optimal dose of Bendamustine and its effects in different treatment settings remain unclear.
  • In a study of 250 WM patients, response rates were significantly better in patients treated in the frontline setting compared to those with relapsed disease (91.4% vs 73.9%).
  • Achieving a complete response (CR) or very good partial response (VGPR) improved survival rates, and higher doses of Bendamustine were linked to better progression-free survival (PFS) outcomes in both frontline and relapsed patients.
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