Waiting as probation: selecting self-disciplining asylum seekers

This article diagnoses and critiques a type of governmentality associated with waiting during protracted asylum appeal procedures by drawing upon data from a multi-methodological study of asylum adjudication in Europe. Focusing on Austria, Germany and Italy, we explore the use of integration-related considerations in asylum appeal processes by looking at the ways in which these considerations permeate judges’ decision-making, particularly, but not exclusively, on the granting of national, non-EU harmonised protection statuses. Building on insights from the literature on conditional integration we question the implicit socio-political biases and moral assumptions that underpin this permeation. We show that the use of integration-related considerations in asylum appeals transforms migrant waiting into a period of probation during which rejected asylum seekers’ conducts are governed and tested in relation to the use of time. More than simply waiting patiently, rejected asylum seekers are expected to wait productively, whereby productivity is assessed through the neoliberal imperatives of entrepreneurship, autonomy and self-improvement. We thus contribute to scholarship on migrant waiting by showing how time is capitalised by state authorities even when–and actually because–it offers opportunities for migrants

Waiting as probation: selecting self-disciplining asylum seekers

This is the final version. Available on open access from Taylor and Francis via the DOI in this recordData Availability Statement: There are no datasets available for this paper.This article diagnoses and critiques a type of governmentality associated with waiting during protracted asylum appeal procedures by drawing upon data from a multi-methodological study of asylum adjudication in Europe. Focusing on Austria, Germany and Italy, we explore the use of integration-related considerations in asylum appeal processes by looking at the ways in which these considerations permeate judges’ decision-making, particularly, but not exclusively, on the granting of national, non-EU harmonised protection statuses. Building on insights from the literature on conditional integration we question the implicit socio-political biases and moral assumptions that underpin this permeation. We show that the use of integration-related considerations in asylum appeals transforms migrant waiting into a period of probation during which rejected asylum seekers’ conducts are governed and tested in relation to the use of time. More than simply waiting patiently, rejected asylum seekers are expected to wait productively, whereby productivity is assessed through the neoliberal imperatives of entrepreneurship, autonomy and self-improvement. We thus contribute to scholarship on migrant waiting by moving beyond an emphasis on the contradictory character of waiting, as both imposition and potentiality, and showing how time is capitalised by state authorities even when – and actually because – it offers opportunities for migrants

Using multi-member panels to tackle RSD complexities

This is the final version. Available on open access from the Refugee Studies Centre, University of Oxford via the link in this recordEuropean Commissio

Legal geographies of irregular migration : An outlook on immigration detention

In this article, I discuss legal geographies of irregular migration, drawing on a case study on immigration detention in Finland. Based on analysis of detention records, four different types of legal geographies are identified, relating to south–north movement of third‐country nationals inside Europe, criminalised Eastern European EU citizens, irregularity during the asylum process (in particular, related to the Dublin Regulation) and irregularly residing foreign nationals, including deportable long‐term residents. The analysis focuses on the relations between space, law and persons during detainees' irregular migration trajectories, paying attention to their varying entry routes, residence times, legal grounds for removal and detention and removal countries. I argue for the need for empirically contextualised analysis that addresses the complex relations between law and geography beyond a particular national context, in order to better understand the dynamics of irregular migration in all its variety.In this article, I discuss legal geographies of irregular migration, drawing on a case study on immigration detention in Finland. Based on analysis of detention records, four different types of legal geographies are identified, relating to south–north movement of third‐country nationals inside Europe, criminalised Eastern European EU citizens, irregularity during the asylum process (in particular, related to the Dublin Regulation) and irregularly residing foreign nationals, including deportable long‐term residents. The analysis focuses on the relations between space, law and persons during detainees' irregular migration trajectories, paying attention to their varying entry routes, residence times, legal grounds for removal and detention and removal countries. I argue for the need for empirically contextualised analysis that addresses the complex relations between law and geography beyond a particular national context, in order to better understand the dynamics of irregular migration in all its variety.Peer reviewe

Immune thrombotic thrombocytopenic purpura: Personalized therapy using ADAMTS-13 activity and autoantibodies

Recently, treatment of immune-mediated thrombotic thrombocytopenic purpura (ITTP) has changed with the advent of caplacizumab in clinical practice. The International Working Group (IWG) has recently integrated the ADAMTS-13 activity/autoantibody monitoring in consensus outcome definitions. We report three ITTP cases during the coronavirus disease 2019 pandemic, that received a systematic evaluation of ADAMTS-13 activity and autoantibodies. We describe how the introduction of caplacizumab and ADAMTS-13 monitoring could change the management of ITTP patients and discuss whether therapeutic choices should be based on the clinical response alone. ADAMTS-13 activity/antibodies were assessed every 5 days. Responses were evaluated according to updated IWG outcome definitions. These kinetics, rather than clinical remission, guided the therapy, allowing early and safe caplacizumab discontinuation and sensible administration of rituximab. Caplacizumab was cautiously discontinued after achieving ADAMTS-13 complete remission. These cases illustrate that prospective ADAMTS-13 evaluation and use of updated IWG definitions may improve real-life patients’ management in the caplacizumab era

Life after ruxolitinib: Reasons for discontinuation, impact of disease phase, and outcomes in 218 patients with myelofibrosis

Background: After discontinuing ruxolitinib, the outcome of patients with myelofibrosis reportedly has been poor. The authors investigated whether disease characteristics before the receipt of ruxolitinib may predict drug discontinuation in patients with myelofibrosis and whether reasons for drug discontinuation, disease phase at discontinuation, and salvage therapies may influence the outcome. Methods: A centralized electronic clinical database was created in 20 European hematology centers, including clinical and laboratory data for 524 patients who received ruxolitinib for myelofibrosis. Results: At 3\ua0years, 40.8% of patients had stopped ruxolitinib. Baseline predictors of drug discontinuation were: intermediate-2\u2013risk/high-risk category (Dynamic International Prognostic Score System), a platelet count <100 7109 per liter, transfusion dependency, and unfavorable karyotype. At last contact, 268 patients (51.1%) had discontinued therapy, and the median drug exposure was 17.5\ua0months. Fifty patients (18.7%) died while taking ruxolitinib. The reasons for discontinuation in the remaining 218 patients were the lack (22.9%) or loss (11.9%) of a spleen response, ruxolitinib-related adverse events (27.5%), progression to blast phase (23.4%), ruxolitinib-unrelated adverse events (9.2%), and allogeneic transplantation during response (5.1%). The median survival after ruxolitinib was 13.2\ua0months and was significantly better in the 167 patients who discontinued ruxolitinib in chronic phase (27.5 vs 3.9\ua0months for those who discontinued in blast phase; P\ua0<.001). No survival differences were observed among patients who discontinued ruxolitinib in chronic phase because of lack of response, loss of response, or ruxolitinib-related adverse events. The use of investigational agents and/or ruxolitinib rechallenge were associated with improved outcome. Conclusions: The survival of patients with myelofibrosis after discontinuation of ruxolitinib is poor, particularly for those who discontinue in blast phase. Salvage therapies can improve outcome, emphasizing the need for novel therapies

Ruxolitinib discontinuation syndrome: incidence, risk factors, and management in 251 patients with myelofibrosis

none36Ruxolitinib discontinuation syndrome: incidence, risk factors, and management in 251 patients with myelofibrosisopenPalandri F.; Palumbo G.A.; Elli E.M.; Polverelli N.; Benevolo G.; Martino B.; Abruzzese E.; Tiribelli M.; Tieghi A.; Latagliata R.; Cavazzini F.; Bergamaschi M.; Binotto G.; Crugnola M.; Isidori A.; Caocci G.; Heidel F.; Pugliese N.; Bosi C.; Bartoletti D.; Auteri G.; Cattaneo D.; Scaffidi L.; Trawinska M.M.; Stella R.; Ciantia F.; Pane F.; Cuneo A.; Krampera M.; Semenzato G.; Lemoli R.M.; Iurlo A.; Vianelli N.; Cavo M.; Breccia M.; Bonifacio M.Palandri, F.; Palumbo, G. A.; Elli, E. M.; Polverelli, N.; Benevolo, G.; Martino, B.; Abruzzese, E.; Tiribelli, M.; Tieghi, A.; Latagliata, R.; Cavazzini, F.; Bergamaschi, M.; Binotto, G.; Crugnola, M.; Isidori, A.; Caocci, G.; Heidel, F.; Pugliese, N.; Bosi, C.; Bartoletti, D.; Auteri, G.; Cattaneo, D.; Scaffidi, L.; Trawinska, M. M.; Stella, R.; Ciantia, F.; Pane, F.; Cuneo, A.; Krampera, M.; Semenzato, G.; Lemoli, R. M.; Iurlo, A.; Vianelli, N.; Cavo, M.; Breccia, M.; Bonifacio, M

Ruxolitinib in cytopenic myelofibrosis: Response, toxicity, drug discontinuation, and outcome

BackgroundPatients with cytopenic myelofibrosis (MF) have more limited therapeutic options and poorer prognoses compared with patients with the myeloproliferative phenotype. Aims and MethodsPrognostic correlates of cytopenic phenotype were explored in 886 ruxolitinib-treated patients with primary/secondary MF (PMF/SMF) included in the RUX-MF retrospective study. Cytopenia was defined as: leukocyte count &lt;4 x 10(9)/L and/or hemoglobin &lt;11/&lt;10 g/dL (males/females) and/or platelets Overall, 407 (45.9%) patients had a cytopenic MF, including 249 (52.4%) with PMF. In multivariable analysis, high molecular risk mutations (p = .04), intermediate 2/high Dynamic International Prognostic Score System (p &lt; .001) and intermediate 2/high Myelofibrosis Secondary to Polycythemia Vera and Essential Thrombocythemia Prognostic Model (p &lt; .001) remained associated with cytopenic MF in the overall cohort, PMF, and SMF, respectively. Patients with cytopenia received lower average ruxolitinib at the starting (25.2 mg/day vs. 30.2 mg/day, p &lt; .001) and overall doses (23.6 mg/day vs. 26.8 mg/day, p &lt; .001) and achieved lower rates of spleen (26.5% vs. 34.1%, p = .04) and symptom (59.8% vs. 68.8%, p = .008) responses at 6 months compared with patients with the proliferative phenotype. Patients with cytopenia also had higher rates of thrombocytopenia at 3 months (31.1% vs. 18.8%, p &lt; .001) but lower rates of anemia (65.6% vs. 57.7%, p = .02 at 3 months and 56.6% vs. 23.9% at 6 months, p &lt; .001). After competing risk analysis, the cumulative incidence of ruxolitinib discontinuation at 5 years was 57% and 38% in patients with cytopenia and the proliferative phenotype (p &lt; .001), whereas cumulative incidence of leukemic transformation was similar (p = .06). In Cox regression analysis adjusted for Dynamic International Prognostic Score System score, survival was significantly shorter in patients with cytopenia (p &lt; .001). ConclusionsCytopenic MF has a lower probability of therapeutic success with ruxolitinib as monotherapy and worse outcome. These patients should be considered for alternative therapeutic strategies