Zanubrutinib (BGB-3111) is a next-generation Bruton tyrosine kinase inhibitor designed to be more selective with fewer off-target effects. We conducted a phase 1 study to assess the safety of its combination with obinutuzumab and evaluate early efficacy in 81 patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) or relapsed/refractory (R/R) follicular lymphoma (FL). In this phase 1b study, zanubrutinib was tolerable at 160 mg twice daily or 320 mg once daily combined with IV obinutuzumab in patients with CLL/SLL (n = 45) and FL (n = 36). Common adverse events (AEs) included upper respiratory tract infection (51%; n = 23), neutropenia (44%; n = 20), contusion (33%; n = 15), cough, diarrhea, or fatigue (27%; n = 12 each), and pyrexia (22%; n = 10) in CLL/SLL patients and upper respiratory tract infection (39%; n = 14), contusion (28%; n = 10), fatigue (25%; n = 9), and cough (22%; n = 8) in FL patients. Neutropenia was the most common grade 3/4 AE (CLL/SLL, 31% [n = 14]; FL, 14% [n = 5]). Five patients required temporary dose reductions, and 5 discontinued the study drug because of AEs. Overall response rate (ORR) was 100% (n = 20) in treatment-naïve CLL patients and 92% (n = 23) in R/R CLL patients. ORR in 36 R/R FL patients was 72% (n = 26), with 14 complete and 12 partial responses. Median follow-up was 29 months (range, 8-37) for CLL patients and 20 months (range, 2-37) for FL patients. Zanubrutinib and obinutuzumab combination therapy was generally well tolerated. This trial was registered at www.clinicaltrials.gov as #NCT02569476.

Constrictive pericarditis (CP) after allogeneic SCT may develop after infective pericarditis or pericardial GVHD. Primary effusion lymphoma (PEL), also a rare disease, is usually seen in immunocompromised patients and has a poor prognosis.We describe a case of CP and PEL developing in a patient after allo-SCT for CML. We believe it is the first documented case of these complications in this setting, and include rare FDG-PET images of PEL.A 42-year-old Italian-born man underwent a sibling allograft in 1987 for CML in chronic phase. Myeloablative conditioning was given with CY (60 mg/kg on days À6 and À5) and TBI (2 cGy twice daily on days À4, À3 and À2); complete donor engraftment ensued, with complete cytogenetic remission. Moderately severe chronic GVHD involving skin, oral mucosa, eyes and liver was treated with CYA, prednisolone and PUVA treatment before thalidomide was commenced, with good effect.Twenty-four months post allograft there were no other manifestations of GVHD, but he developed symptoms of pericarditis including chest pain, fever, tachycardia, hypotension and raised inflammatory markers. The electrocardiogram showed widespread ST elevation without elevation of creatine kinase MB, and chest X-ray showed a large pericardial effusion. No infective or autoimmune cause was identified and he improved with symptomatic management. Thalidomide was ceased, with no obvious immediate recurrence of GVHD.At subsequent follow --up the patient was hypotensive and complained of lethargy, dizziness and general malaise. After 6 months he developed right upper quadrant pain and abnormal liver function tests (LFTs), with alkaline phosphatase (ALP) 250 U/L (20 --175 U/L), gamma-glutamyl transferase (GGT) 550 U/L (o45 U/L) and normal transaminases and bilirubin. Ultrasound showed no cholelithiasis; liver biopsy demonstrated micronodular cirrhosis with no other specific features. Some months later, he developed ascites and peripheral oedema, managed with diuretic therapy. Symptoms and signs of chronic liver disease persisted for the next 20 years and were attributed to chronic hepatic GVHD. Cortisone acetate 37.5 mg daily caused marked improvement in appetite, energy and well being (although no improvement in LFTs), and was therefore continued despite normal adrenocorticotropic hormone levels.In 2010, 23 years post transplant, the patient deteriorated rapidly over 3 months. He was admitted to hospital with extreme lethargy, nausea, 10-kg weight loss and worsening ascites, peripheral oedema and hypotension, which did not respond to medical management.On examination he was hypotensive (systolic blood pressure 85 mm Hg), with a sinus tachycardia (100 b.p.m.) and elevated jugular venous pressure (9 cm). He had small pleural effusions, marked ascites and peripheral oedema to the groin. He was afebrile without palpable lymphadenopathy or hepatosplenomegaly.He had mild renal impairment, with creatinine level of 167 mmol/L (30 --120 mmol/L) and normal electrolytes.

Diffuse large B‐cell lymphoma (DLBCL) is the most common lymphoma subtype, accounting for 30–40% of lymphoma diagnoses. Although aggressive, cure is achievable in approximately 60% of cases with primary chemoimmunotherapy, and in a further substantial minority by salvage therapy and autologous stem cell transplantation. Despite promising activity in early phase clinical trials, no intensified or novel treatment regimen has improved outcomes over R‐CHOP21 in randomised studies. However, there remain several areas of controversy including the most appropriate prognostic markers, central nervous system prophylaxis and the optimal treatment for patients with high‐risk disease. This position statement presents an evidence‐based synthesis of the literature for application in Australasian practice.

The treatment of chronic pain could benefit from additional non-opioid interventions. Virtual reality (VR) has been shown to be effective in decreasing pain for procedural or acute pain but to date there have been few studies on its use in chronic pain. The present study was an investigation of the impact of a virtual reality application for chronic pain. Thirty (30) participants with various chronic pain conditions were offered a five-minute session using a virtual reality application called Cool! Participants were asked about their pain using a 0-10 visual analog scale rating before the VR session, during the session and immediately after the session. They were also asked about immersion into the VR world and about possible side effects. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. These changes were both statistically significant at the p < .001 level. Three participants (10%) reported no change between pre and post pain ratings. Ten participants (33%) reported complete pain relief while doing the virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. The virtual reality experience was found here to provide a significant amount of pain relief. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects. VR seems to have promise as a non-opioid treatment for chronic pain and further investigation is warranted.