Background The aim of this cross-sectional study was to assess risk factors for bleeding in immune thrombocytopenia (ITP) adults, including the determination of platelet count thresholds. Methods We selected all newly diagnosed ITP adults included in the Cytopénies Auto-immunes Registre Midi-PyrénéEN (CARMEN) register and at the French referral center for autoimmune cytopenias. The frequencies of any bleeding, mucosal bleeding and severe bleeding (gastrointestinal, intracranial, or macroscopic hematuria) at ITP onset were assessed. Platelet count thresholds were assessed by the use of receiver operating characteristic curves. All potential risk factors were included in logistic regression models. Results Among the 302 patients, the frequencies of any, mucosal and severe bleeding were 57.9%, 30.1%, and 6.6%, respectively. The best discriminant threshold of platelet count for any bleeding was 20 × 10 L . In multivariate analysis, factors associated with any bleeding were platelet count (< 10 × 10 L versus ≥ 20 × 10 L , odds ratio [OR] 48.2, 95% confidence interval [CI] 20.0-116.3; between 10 × 10 L and 19 × 10 L versus ≥ 20 × 10 L , OR 5.2, 95% CI 2.3-11.6), female sex (OR 2.6, 95% CI 1.3-5.0), and exposure to non-steroidal anti-inflammatory drugs (NSAIDs) (OR 4.8, 95% CI 1.1-20.7). A low platelet count was also the main risk factor for mucosal bleeding. Exposure to anticoagulant drugs was associated with severe bleeding (OR 4.3, 95% CI 1.3-14.1). Conclusions Platelet counts of < 20 × 10 L and < 10 × 10 L were thresholds for major increased risks of any and mucosal bleeding. Platelet count, female sex and exposure to NSAIDs should be considered for assessment of the risk of any bleeding. Exposure to anticoagulant drugs was a major risk factor for severe bleeding.

Anti-PD-1 therapy provides high response rates in Hodgkin lymphoma (HL) patients who have relapsed or are refractory (R/R) to autologous stem cell transplantation (ASCT) and brentuximab vedotin (BV), but median progression free survival (PFS) is only one year. The efficacy of treatment following anti-PD-1 is not well known. We retrospectively investigated the efficacy of salvage therapies for unsatisfactory response to anti-PD-1 therapy, assessed by PET-CT according to the Lugano criteria, in 30 R/R HL patients. Patients were highly pre-treated before anti-PD-1 (70% received ASCT and 93% BV). Unsatisfactory responses to anti-PD1 therapy were progressive disease (PD) (n=24) and partial response (PR) (n=6). For the 24 PD patients, median anti-PD-1 related PFS was 7.5 months (95%CI, 5.7-11.6); 17 received subsequent CT alone (Group 1) and 7 received CT in addition to anti-PD-1 (Group 2). 16/24 patients (67%) obtained an objective response. In the 15 patients treated with the same CT, twelve obtained PR or complete response (CR). In Group 1, there were 7 CR (41%), 3 PR (18%), and 7 PD (41%). In Group 2, there were 4 CR (57%), 2 PR (29%), and 1 SD (14%). No unexpected toxicity was observed. Six patients who achieved response proceeded to allogeneic SCT. With a median follow-up of 12.1 months (7-14.7), the median PFS following the initiation of CT was 11 months (95%CI, 6.3; not reached) and the median of overall survival was not reached. These observations in highly pre-treated HL patients suggest that anti-PD-1 therapy might re-sensitize tumor cells to CT. This article is protected by copyright. All rights reserved.

FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia (F/P+ MN-eo) is a rare disease: robust epidemiological data are lacking and reported issues are scarce, of low sample-size and limited follow-up. Imatinib mesylate (IM) is highly efficient but no predictive factor of relapse after discontinuation has yet been identified. One hundred and fifty-one patients with F/P+ MN-eo (143 males; mean age at diagnosis 49 years; mean annual incidence: 0.18 case per million population) were included in this retrospective nationwide study involving all French laboratories who perform the search of F/P fusion gene (study period: 2003-2019). The main organs involved included the spleen (44%), skin (32%), lungs (30%), heart (19%) and central nervous system (9%). Serum vitamin

© F e r r a t a S t o r t i F o u n d a t i o nfrequently described as malignancy-or infection-associated hemophagocytic syndrome. [9][10][11] In patients with acute myeloid leukemia (AML), HLH has been occasionally described in case-reports. AML patients may be prone to develop HLH due to their disease-and/or treatment-related impaired immune response and their high susceptibility to severe infections, which act as triggering factors.12 Alerted by several cases of HLH in our department, we sought to determine the frequency and patterns of HLH presentation as well as its impact on prognosis in a series of consecutive AML patients treated with intensive chemotherapy. Methods PatientsBetween January 1, 2006, and December 31, 2010, all consecutive patients with a new diagnosis of AML (except acute promyelocytic leukemia) admitted to our center and eligible for intensive chemotherapy were registered for this study. The diagnostic workup and treatment modalities have been described elsewhere. 13,14 All patients had a central venous catheter placed and were given bacterial digestive tract decontamination, antibiotic therapy for febrile neutropenia (piperacillin-tazobactam/amikacin and imipenem/vancomycin/ciprofloxacin as first-and second-line treatments, respectively) and antifungal prophylaxis with posaconazole. Clinical and biological data were recorded by four of the authors (KD, AS, SB and CR). Biological data, including fibrinogen, C-reactive protein, ferritin and triglyceride levels were assessed at diagnosis and every week thereafter. Bone marrow aspiration was performed routinely at diagnosis, on day 15 of induction chemotherapy (for patients <60 years old), assessment of response (~day 35), in cases of unexpected prolonged cytopenias (> 35 days) or in suspected cases of HLH (i.e, patients receiving antimicrobial treatments for febrile neutropenia, and/or sudden increases in ferritinemia and/or unexpected cytopenias). The presence of features of hemophagocytosis was recorded regardless of clinical presentation. Cytological analysis of MayGrünwald-Giemsa-stained bone marrow smears was performed routinely. Hemophagocytosis was defined by evidence of macrophage-dependent phagocytosis of erythrocytes, leukocytes, platelets and/or their precursors, regardless of the percentage of macrophages (Online Supplementary Figure S1). The findings of the bone marrow aspirates for each patient were discussed between cytologists and physicians during weekly meetings. This study was approved by the Institutional Ethics Committee. Study populationThree hundred and forty-three patients were included. Their characteristics at diagnosis of AML are shown in Table 1. The criteria used to assign patients to the HLH group were hemophagocytosis in the bone marrow with unexplained fever under broad antimicrobial treatment, and/or sudden increases in ferritin and/or unexpected non-blastic pancytopenia. Twenty-nine patients fulfilled these criteria. Three other patients without bone marrow hemophagocytosis had bio-clinical evidenc...