In ASH Clinical News, Dr. Geoffrey Uy, a professor in the Oncology Division at Washington University School of Medicine in St. Louis, discusses treatment options for a transplant-ineligible patient who has Philadelphia chromosome-positive (Ph+) acute lymphocytic leukemia (ALL). The patient under review is a 61-year-old female diagnosed with Ph+ ALL who has multiple comorbidities and is not a candidate for allogeneic hematopoietic cell transplantation.

A phase 2 clinical trial involving 486 patients examined whether fulvestrant or letrozole is more effective in treating advanced breast cancer. The results, published in JAMA Oncology, confirmed that letrozole is the preferred treatment in patients with advanced forms of breast cancer. Although fulvestrant demonstrated significant antitumor activity, it did not significantly impact the overall survival rate of breast cancer patients when compared to letrozole.

Publication: JAMA Internal MedicineDesign: Retrospective cohort study of more than 83,000 propensity-scored matched pairs over a 12-year period.Results: Diabetes progression was significantly greater among diabetes patients using statins vs. those not using statins.

Publication: JAMADesign: Multicenter, randomized, double-blind, placebo-controlled trial performed in six hospices in the Netherlands of 162 patients with a life expectancy of three or more days. Administration of subcutaneous scopolamine butylbromide, 20 mg four times a day (n = 79) or placebo (n=78) in the 157 patients included in the primary analysis.Results: A death rattle occurred in 10 patients (13%) in the scopolamine group compared with 21 patients (27%) in the placebo group.

The exact ways in which COVID-19 is impacting children, particularly those under age 12, is still being examined. Reported at the IDWeek conference, Arkansas health officials presented data demonstrating the severe impact that the fast-moving Delta variant of COVID-19 can have on children. Key findings: From January 2021, the Delta variant led to 42% more hospitalizations, 69% more ICU admissions, and a 300% increase in the use of mechanical ventilation.

In practice, “standard” duration of antibiotic therapy is often based on archaic studies. Newer evidence shows that shorter durations are often a better choice and that antibiotic resistance is more likely to develop with longer durations of therapy. Here are the recommendations applied to four commonly treated infections.