Prognostic significance of FLT3-ITD length in AML patients treated with intensive regimens

FLT3-ITD mutations are detected in approximately 25% of newly diagnosed adult acute myeloid leukemia (AML) patients and confer an adverse prognosis. The FLT3-ITD allelic ratio has clear prognostic value. Nevertheless, there are numerous manuscripts with contradictory results regarding the prognostic relevance of the length and insertion site (IS) of the FLT3-ITD fragment. We aimed to assess the prognostic impact of these variables on the complete remission (CR) rates, overall survival (OS) and relapse-free survival (RFS) of AML patients with FLT3-ITDmutations. We studied the FLT3-ITD length of 362 adult AML patients included in the PETHEMA AML registry. We tried to validate the thresholds of ITD length previously published (i.e., 39 bp and 70 bp) in intensively treated AML patients (n = 161). We also analyzed the mutational profile of 118 FLT3-ITD AML patients with an NGS panel of 39 genes and correlated mutational status with the length and IS of ITD. The AUC of the ROC curve of the ITD length for OS prediction was 0.504, and no differences were found when applying any of the thresholds for OS, RFS or CR rate. Only four out of 106 patients had ITD IS in the TKD1 domain. Our results, alongside previous publications, confirm that FLT3-ITD length lacks prognostic value and clinical applicability. © 2021, The Author(s)

Mechanistic studies on the N -alkylation of amines with alcohols catalysed by iridium(i) complexes with functionalised N-heterocyclic carbene ligands

Iridium(i) cyclooctadiene complexes featuring O- and N-donor functionalised NHC ligands efficiently catalyse the C-N coupling of amines with alcohols through a borrowing hydrogen mechanism. These catalysts have been applied for the N-alkylation of several aromatic and aliphatic primary amines with a range of alcohols including benzyl alcohol derivatives, straight-chain primary alcohols and secondary alcohols. The cationic complex [Ir(NCCH)(cod){MeIm(2-methoxybenzyl)}] (cod = 1,5-cyclooctadiene, MeIm = 3-methylimidazol-2-ylidene) having a rigid O-donor wingtip exhibits the best catalytic performance for the N-alkylation of aniline with benzyl alcohol giving a quantitative conversion to N-benzylaniline in 3 h. Experimental and theoretical studies at the DFT level on the N-alkylation of aniline with benzyl alcohol catalysed by the model compound [IrCl(cod)(IMe)] (IMe = 1,3-dimethyl-imidazol-2-ylidene) support the participation of the iridium catalyst not only in the alcohol dehydrogenation and imine hydrogenation steps but also in the key step leading to the formation of the new C-N bond. Nucleophilic attack of an iridium-amido species generated in basic medium on the electrophilic aldehyde results in a hemiaminolate intermediate species from which the hemiaminal is released by alcoholysis. The free hemiaminal dehydrates to give the corresponding intermediate imine product that is hydrogenated by the iridium catalyst to the N-alkylated amine product. The iridium(i) complexes featuring functionalised NHC ligands are more active than [IrCl(cod)(IMe)] which highlights the positive influence of the functional group on the N-alkylation catalytic activity.Financial support from the Spanish Ministry of Economy and Competitiveness (MINECO/FEDER, Projects CTQ2013-42532-P and CTQ2016-75884-P) and the Diputación General de Aragón (DGA/FSE-E07) is gratefully acknowledged.Peer Reviewe

The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study

Background Medication-overuse headache (MOH) is a chronic disabling condition associated with a high rate of relapse. Methods We evaluated whether the adoption of electronic-assisted monitoring, advice and communication would improve the outcome over a follow-up of 6 months in a controlled, multicentre, multinational study conducted in six headache centres located in Europe and Latin America. A total of 663 MOH subjects were enrolled and divided into two groups: the Comoestas group was monitored with an electronic diary associated with an alert system and a facilitated communication option, and the Classic group with a paper headache diary. Results We observed a significantly higher percentage of overuse-free subjects in the Comoestas group compared with the Classic group: 73.1 vs 64.1% (odds ratio 1.45, 95% confidence interval 1.07-2.09, p = 0.046). The Comoestas group performed better also regarding the number of days/month with intake of acute drugs and the level of disability [Migraine Disability Assessment Score: Comoestas group - 42.5 ± 53.6 (35.5-49.3) and Classic group - 27.5 ± 56.1 (20.6-34.3) ( p < 0.003)]. Conclusion The adoption of the electronic tool improved the outcome of patients suffering from MOH after withdrawal from overused drugs. Information and communication technology represents a valid aid for optimizing the management of chronic conditions at risk of worsening or of relapsing. Trial registration The trial was registered at ClinicalTrials.gov (no. NCT02435056)

Supplementary material Consensus protocol - Supplemental material for The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study

<p>Supplemental material, Supplementary material Consensus protocol for The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study by Cristina Tassorelli, Rigmor Jensen, Marta Allena, Roberto De Icco, Zaza Katsarava, J Miguel Lainez, Jorge A Leston, Ricardo Fadic, Santiago Spadafora, Marco Pagani and Giuseppe Nappi; the COMOESTAS Consortium in Cephalalgia</p