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Ibrutinib is an established treatment for relapsed/refractory (R/R) mantle cell lymphoma (MCL) and clinical trial data supports use at second line compared to later relapse. We aimed to investigate outcomes and tolerability for ibrutinib when given second line in a real-world setting. Our multicentre retrospective analysis included 211 R/R MCL patients, median age 73 years, receiving ibrutinib second-line within the United Kingdom's National Health Service. Overall response to ibrutinib was 69% (complete response 27%). The median progression-free survival (PFS) was 17Á8 months (95% CI 13Á1-22Á2) and median overall survival (OS) 23Á9 months (95% CI 15Á0-32Á8). Drug-related adverse event led to dose reduction in 10% of patients and discontinuation in 5%. In patients with progressive disease, accounting for 100 of 152 patients stopping ibrutinib, 43% received further systemic therapy. Post-ibrutinib rituximab, bendamustine and cytarabine (R-BAC) showed a trend toward improved survival compared to alternative systemic treatments (post-ibrutinib median OS 14Á0 months, 95% CI 8Á1-19Á8, vs. 3Á6 months, 95% CI 2Á6-4Á5, P = 0Á06). Our study confirms the clinical benefit and good tolerability of ibrutinib at first relapse in a real-world population. Patients progressing on ibrutinib had limited survival but outcomes with R-BAC in select patients were promising.

Objectives We sought to characterise the outcomes of patients with haematological malignancy and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in hospital in our regional network of 7 hospitals. Methods Consecutive hospitalised patients with haematological malignancy and SARS‐CoV‐2 infection were identified from 01/03/2020 to 06/05/2020. Outcomes were categorised as death, resolved or ongoing. The primary outcome was preliminary case fatality rate (pCFR), defined as the number of cases resulting in death as a proportion of all diagnosed cases. Analysis was primarily descriptive. Results 66 Patients were included, overall pCFR was 51.5%. Patients ≥ 70 years accounted for the majority of hospitalised cases (42, 63%) and fatalities (25, 74%). Mortality was similar between females (52%) and males (51%). Immunosuppressive or cytotoxic treatment within 3 months of the diagnosis of SARS‐CoV‐2 infection was associated with a significantly higher pCFR of 70%, compared with 28% in those not on active treatment (P = .0013, 2 proportions z test). Conclusions Mortality rates in patients with haematological malignancy and SARS‐CoV‐2 infection in hospital are high supporting measures to minimise the risk of infection in this population.

A 26-year-old primigravid achondroplastic dwarf was to be delivered by elective Caesarean Section at 36 weeks gestation. At 21 weeks gestation she had suffered a deep venous thrombosis and pulmonary embolism, and was treated initially with intravenous heparin followed by warfarin. At 33 weeks gestation, she was re-admitted to the maternity unit and the warfarin was substituted by intravenous heparin to continue until delivery. The pregnancy was further complicated by polyhydramnios. Examination revealed the typical features of achondroplasia. She weighed 44 kg, and was 117 cm tall with a relatively normal spinal length of 52 cm. Subarachnoid block using a microspinal catheter was chosen to provide anaesthesia for the section. Heparin was stopped 24 h before surgery, and a clotting screen was normal on the day. Oral ranitidine 150 mg was given the night before, and on the morning of surgery. A circulatory preload of 6 ml.kg-' of Ringer lactate solution was given. With the patient in the left lateral position, a 32 gauge catheter was passed 4 cm into the subarachnoid space via a 25 gauge needle at the L2-3 interspace. An initial infusion of 0.5 ml hyperbaric 0.5% plain bupivacaine was given through the catheter. Within 20 min, a bilateral T, block had developed. Blood pressure decreased to 60/34 mmHg and was treated with 12 mg intravenous ephedrine. There was a delay in starting surgery during which the block receded over a 15 min period to T, on the left and T,, on the right. A further 0.5 ml local anaesthetic was given which restored the block to T, bilaterally. Surgery was begun with the patient in the wedged supine position.A lower uterine segment Caesarean section was performed, and a live, female achondroplastic child, with good Apgar scores, was delivered 14 min after skin incision. Forty minutes after the second dose o,f bupivacaine, a further 0.3 ml was given. A total of 0.1 mg diamorphine was given via the catheter to provide postoperative analgesia. The motor and sensory blocks wore off within 30 min of the end of the procedure. The diamorphine provided excellent analgesia in the first 24 h. Mother and baby were discharged after I days. There are few reports describing the use of central blockade in the anaesthetic management of achondroplastic patients [l, 21. If spinal anaesthesia is to be undertaken, we would recommend the use of a microspinal catheter, since this allows small incremental doses of local anaesthetic to be given when necessary.

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