Dapsone (4,4'‐diaminodiphenylsulfone) is the only remaining sulfone used in anthropoid therapeutics and is commercially available as an oral formulation, an inhaled preparation, and a 5% or 7.5% cream. Dapsone has antimicrobial effects stemming from its sulfonamide‐like ability to inhibit the synthesis of dihydrofolic acid. It also has anti‐inflammatory properties such as inhibiting the production of reactive oxygen species, reducing the effect of eosinophil peroxidase on mast cells and down‐regulating neutrophil‐mediated inflammatory responses. This allows for its use in the treatment of a wide variety of inflammatory and infectious skin conditions. Currently in dermatology, the US Food and Drug Administration (FDA)‐approved indications for dapsone are leprosy, dermatitis herpetiformis, and acne vulgaris. However, it proved itself as an adjunctive therapeutic agent to many other skin disorders. In this review, we discuss existing evidence on the mechanisms of action of dapsone, its FDA‐approved indications, off‐label uses, and side effects.

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Psoriasis is an inflammatory skin disorder that is strongly associated with the metabolic syndrome. The sole reliance on clinical examination to guide prognostication and treatment is insufficient at best; accurate diagnostic and prognostic psoriatic molecular biomarkers are needed. Soluble urokinase plasminogen activator receptor (suPAR) has been implicated in inflammation. The aim of this study is to determine whether suPAR plays a role in the pathogenesis of psoriasis and whether an association exists between suPAR levels, disease severity, and other variables like insulin, erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP). This study also compares the pattern of uPAR staining in healthy vs psoriatic skin: 39 psoriatic and 30 control subjects were included. Two biopsies (affected and unaffected skin) and one biopsy were taken from psoriasis patients and healthy controls, respectively, with uPAR staining of all skin biopsies. Blood samples from all subjects were obtained to determine suPAR, ESR, CRP, and fasting insulin levels. uPAR staining was prominent in unaffected skin from psoriasis patients and healthy individuals vs weak/absent uPAR staining in psoriatic skin. CRP, ESR and suPAR levels were not significantly elevated in the mild psoriasis group compared to healthy controls. The loss of epidermal uPAR is suggestive of its tentative role in the pathogenesis of psoriasis. Patients with mild–moderate psoriasis possibly lack the powerful association attributed to metabolic syndrome in psoriatic patients. Further studies on larger cohorts are needed to ascertain the validity of the mentioned conclusions.

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In the current retrospective analysis we assessed the impact of MRD positivity on CBT outcomes. Methods: Inclusion criteria were adult patients with acute myeloid (AML) or lymphoblastic (ALL) leukemia, undergoing CBT as first allogeneic hematopoietic cell transplantation from 2002-2017, first or second complete remission (CR) at transplantation, and available MRD status at the time of transplantation. Results: Data from 506 patients were included in the survey. Among them, 317 patients had AML and 189 ALL (including 102 patients with Phi-pos ALL). Patients received either a single unit (n = 227) or a double CBT (n = 279). MRD positivity was reported in 169 patients (33%) while the remaining 337 patients were MRD negative at CBT. MRD was more frequently detected in ALL than in AML patients (P = 0.02), in patients given single CBT than in those receiving double CBT (P = 0.02), and in those given in vivo T-cell depletion of the graft (P = 0.006). At 2 years, relapse incidence was 18% in patients with MRD negativity versus 33% in those with MRD positivity at transplantation (P < 0.001). Two-year leukemia-free survival (LFS) and overall survival (OS) were 57% and 60%, respectively, in MRD negative patients, versus 38% (P < 0.001) and 48% (P = 0.004), respectively, in those with MRD positivity. There was no statistical interaction between the impact of MRD positivity and disease type (AML versus ALL) nor disease status at transplantation (first versus second CR). In multivariate analyses, MRD positivity was associated with a higher risk of relapse (HR = 1.8, P = 0.003), comparable non-relapse mortality (P = 0.44), worse LFS (HR = 1.4, P = 0.008) and a trend for worse OS (HR = 1.3, P = 0.065). Other factors associated with relapse incidence included reduced-intensity conditionng (RIC) (HR = 1.8, P = 0.01) and in vivo T cell depletion (HR = 2.2, P < 0.001). Other factors associated with worse LFS included CR2 at transplantation (HR = 1.3, P = 0.04) as well as in vivo T cell depletion (HR = 1.9, P < 0.001) Summary/Conclusion: In acute leukemia patients undergoing CBT achieving MRD negativity at time of transplantation is associated with a lower risk of relapse translated into better LFS. Novel strategies are in need for those leukemic patients with positive MRD pre-CBT aiming at achieving MRD negativity and thus improving transplantation results.

BackgroundThe Coronavirus Disease 2019 (COVID-19) was declared a pandemic by WHO in March 2020. The first case of COVID-19 was identified in Lebanon on the 21st of February 2020, amid a national economic crisis. As the numbers of cases increased, ICU admissions and mortality rose, which led hospitals across Lebanon to take certain safety measures to contain the virus. The Naef K. Basile Cancer Institute (NKBCI) at the American University of Beirut Medical Center handles oncology outpatient visits and outpatient treatment protocol infusions. The aim of this study is to evaluate the efficacy of the safety measures put forth by the NKBCI early in the pandemic.MethodsOncology patients are amongst the immunosuppressed population, who are at greatest risk of contracting COVID-19 and consequently suffering its complications. In this manuscript, we evaluated the precautionary measures implemented at the NKBCI of AUBMC from March 1st to May 31st of 2020, by surveying oncology patients on the telephone who had live and virtual appointments in both the oncology outpatient clinics and infusion unit. We conducted a prospective study of 670 oncology patients who had appointments at the NKBCI during this period and used their answers to draw responses about patient satisfaction towards those safety measures.ResultsOur results involved 387 responses of oncology patients who visited the NKBCI during the period of March 1st to May 31st of 2020. 99% of our respondents gave a rating of good to excellent with these new measures. The option of online consultation was given to 35% in the hematology group compared to 19% in those with solid tumors (p=0.001). From the total, 15% of patients opted for the telemedicine experience as a new implemented strategy to provide patient-centered medical care. Of this group of patients, 22% faced problems with connectivity and 19% faced problems with online payment.ConclusionNKBCI was competent in following the WHO guidelines in protecting the oncology patient population. Feedback collected from the surveys will be taken into account by the committee of the NKBCI to develop new safety measures that can better control viral spread while providing patient-centered medical care.