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Arsenic trioxide (ATO)-based regimens are the standard of care for treating acute promyelocytic leukaemia (APL) and have replaced chemotherapy-based approaches. However, the cost of "patented" ATO is prohibitive because of patent rights. "Generic" ATO has been used in a few countries, but its implications for health resource utilization (HRU) and cost of treatment are unknown. We hypothesized that treating APL patients using generic ATO (APL-ATO) will be cost effective compared to the chemotherapy-based regimen (APL-CT). In a single-centre retrospective study, we used a bottom-up costing method to compare the direct medical cost of treatment and HRU between APL-ATO and APL-CT. These costs and the survival and relapse probabilities were imputed in a threestate Markov decision model to estimate the cost effectiveness of APL-ATO compared to APL-CT. The mean cost of treatment for APL-ATO (n = 30, $8500 AE 2078) was significantly less than for APL-CT (n = 30, $22 600 AE 5528) (P < 0Á001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P < 0Á001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11 131) than for APL-CT ($17 926) (P < 0Á001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.

Repurposed drugs may reduce morbidity and mortality in patients with hematological disorders who develop COVID-19 illness. 112 patients with predominantly hematological illnesses were randomized to receive standard of care, ivermectin 12 mg [Iv 12] or 24 mg [Iv24] for asymptomatic, mild, or moderate COVID 19 illness. Serial respiratory samples for rRT-PCR samples were sent on Day 3, 5 and 7. rRT-PCR negativity and ≥ 2 log 10 reduction in viral loads on day 3, 5 and 7 were similar between the 3 treatment groups across all disease categories. Symptom progression occurred in 26 patients [21.6%] with no difference across 3 treatment groups. Twenty-two patients [18.3%] have expired while 98 [81.7%] survived. Survival rates were similar across treatment groups [controls—80.5%, Iv12—77.5%, Iv24—87.2% respectively]. Overall, poorer survival was seen with moderate illness compared to others [51.6% vs 92.1%; p = 0.000] and was the only significant risk factor identified on multivariate analysis. In this Phase II randomised trial, single dose of 12 or 24 mg of ivermectin did not reduce viral loads, prevent symptom progression, or reduce mortality in patients with predominantly haematological illnesses who develop mild to moderate COVID 19 illness.

Background: Hematopoietic Stem Cell Transplant (HSCT) is a well-established therapeutic modality for hematological and non-hematological diseases among different age groups. However, the characteristics, causes and trends of HSCT in pediatric population below 2 years are not well identified. We aimed to evaluate the most important features of HSCT in this age group Methods: We used the Nationwide Inpatient Sample (NIS) 1997-2014 to identify patients with HSCT by using the International Classification of Diseases, Ninth Revision ICD-9 codes. We excluded patients >2 years. Through using ICD-9 codes, patients were grouped to autologous bone marrow transplant, allogenic bone marrow transplant, and cord blood transplant. In-patient all-cause mortality and trends over years were identified. Results: A total of 958 Hematopoietic Stem Cell Transplant HSCT patients were identified through Nationwide Inpatient Sampling NIS database from 1997 À 2014. Among HSCT recipients 60.6% were male, 39.4% were female, and 58.6% were white race. Allogenic transplant was the most common 515 /958 (53.7%), autologous transplant 289/958 (30.2%), and cord blood transplant 154/958 (16.1%). The most common indications for transplant were Combined Immunodeficiency (n = 180), Acute myeloid leukemia (n = 106), Brain neoplasm (n = 116), Acute lymphoblastic leukemia (n = 82), Neuroblastoma (n = 92), Mucopolysaccharidosis MPS (n = 52), Wiskott Aldrich Syndrome WAS (n = 32) and Myelodysplastic syndrome MDS (n = 6), figure 1. Sixty-three HSCT recipients had in-patient graft versus host disease GvHD post-transplant (6.6%); 18 cases were detected in cord blood transplant, 44 cases in allogenic transplant and one case was detected with autologous transplant in acute myeloid leukemia patient. Overall hospital mortality of the whole cohort was 8.9% (85/ 958), of which 9.4% (8/85) occurred among GvHD patients. Trends over years are shown in figure 2. Conclusion: Leukemia, combined immunodeficiency, brain tumors, neuroblastoma, and MPS are the top five indications for Hematopoietic Stem Cell Transplant in the first two years of life. Inpatient hospital mortality burden in this group was 8.9% and it is trending down over the years. Graft versus host disease wasn't associated with high percentage of in-hospital mortality and it is interesting that no cases of in-patient Graft versus host disease post-transplant were identified before 2008. 469

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