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CML-1296: Asciminib Monotherapy in Chronic Myeloid Leukemia: A Systematic Review of Efficacy and Safety From Phase 1–3 Trials
No full textAlthough adenosine triphosphate–competitive tyrosine kinase inhibitors (TKIs) have transformed the treatment of chronic myeloid leukemia (CML), long-term outcomes remain limited by resistance, intolerance, and off-target toxicities. Objective: To evaluate the efficacy and safety of asciminib monotherapy across treatment lines, including newly diagnosed, multi-TKI–resistant, and T315I-mutated chronic-phase CML (CML-CP). Design: Systematic review of phase 1–3 interventional trials published or presented through May 2025. Setting: International academic and clinical trial sites. Patients or Other Participants: Adult patients with CML-CP treated with asciminib as monotherapy, including subgroups with prior TKI exposure and T315I mutation. Interventions: Oral asciminib monotherapy across various doses and settings, including 200 mg twice a day in T315I-mutated CML. Main Outcome Measures: Major molecular response (MMR) rates, treatment discontinuation, grade ≥3 adverse events. Results: Ten studies met inclusion criteria. In heavily pretreated CML-CP, the ASCEMBL trial showed superior MMR at 96 weeks with asciminib versus bosutinib (37.6% vs 15.8%), along with lower discontinuation and toxicity rates. In newly diagnosed patients, the ASC4FIRST trial showedMMRof 67.7% vs 49.0% (P \u3c 0.001) at 48 weeks with fewer severe adverse events compared with standard TKIs. For patients with the T315I mutation, asciminib 200 mg twice a day achieved nearly 49%MMRat 2 years, with higher rates in ponatinib-naive patients. A 4-year phase 1 update confirmed durable molecular responses and low vascular toxicity in those with ≥2 prior TKIs. Real-world data supported these findings. Grade ≥3 adverse events were uncommon and primarily included asymptomatic lipase elevation, cardiovascular events, and thrombocytopenia. Conclusions: Asciminib achieves robust molecular responses and exhibits a favorable safety profile across diverse CML-CP populations. Its utility spans frontline use and resistant/mutated settings, supporting its integration into clinical practice. Ongoing trials are evaluating treatment sequencing and treatment-free remission strategies
TCT-286 Outcomes of Cardiogenic Shock Patients in Medicare Beneficiaries Compared with Medicaid: Insights from the National Inpatient Sample 2016-2021
No full textBackground: Cardiogenic shock (CS) is associated with a high degree of morbidity and mortality. Although outcomes of CS are well studied, outcomes across patients with different types of health insurance are not known. This study aimed to compare the outcomes of patients admitted with CS in Medicare beneficiaries versus Medicaid insurance using the National Inpatient Sample (NIS) database. Methods: We conducted a retrospective cohort analysis using the NIS database from 2016-2021 utilizing ICD-10-CM codes to identify patients with CS classified based on payer status. We included baseline demographic characteristics and compared in-hospital outcomes. Propensity score matching (PSM) and Pearson’s Chi-squared test was applied to the matched cohorts to compare outcomes between Medicare and Medicaid patients. Results: Our analysis included 10,635 patients admitted with CS (8,655 with Medicare, 1,980 with Medicaid). After PSM, patients with Medicaid were found to have significantly higher in-hospital mortality (p\u3c0.05) and acute kidney injury (p\u3c0.05) than patients with Medicare. There were no significant differences in the two groups for acute stroke, sudden cardiac arrest, pulmonary embolism, sepsis and cardiac arrhythmias (p\u3e0.05). [Formula presented] Conclusion: Medicare beneficiaries with CS had better clinical outcomes in terms of In-hospital mortality and acute kidney Injury compared to patients with Medicaid. Additional studies elucidating the reasons behind disparities in CS outcomes are needed. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arres
Disparities in survival among younger breast cancer patients: A SEER database analysis (2000-2021)
No full textBackground: Breast cancer is a leading cause of cancer-related mortality, with survival influenced by stage at diagnosis. Early detection improves prognosis, yet ethnic and socioeconomic disparities persist, particularly among patients under 65. This study evaluates survival disparities stratified by stage, focusing on the impact of age, race, and income to inform targeted interventions and health policy reforms. Methods: This retrospective cohort study analyzed 862,290 breast cancer cases in patients aged 20-65 years from the SEER database (2000-2021). Cases were stratified by stage (localized, regional, distant), and survival outcomes were assessed using Kaplan-Meier analysis for median survival and 5-year overall survival (OS). Log-rank tests evaluated subgroup differences. Multivariate Cox proportional hazards models assessed impact of age, race, and income. Disparities were identified by Stagestratified analyses. Results: The 5-year OS was 94.8% for localized, 85.1% for regional, and 34.6% for distant-stage disease (p \u3c 0.001). Non-Hispanic (NH) Black patients had the worst distant-stage 5-year OS (23.0%), compared to NH White (37.5%) and NH Asian (39.6%) (p \u3c 0.001). Among distant-stage patients, those aged,35 years had the highest 5-year OS (40.1%), and 50-64 years old had the lowest (31.2%). Also, lower-income patients ( \u3c $50,000) had the lowest 5-year OS (28.8%), while those earning .≥100,000 had the highest (38.4%) (p\u3c0.001). Cox regression models demonstrated significant survival disparities across all stages. Black patients had higher mortality risk (HR: 1.40-1.54, p \u3c 0.001). Older patients (50-64 years) had worse survival compared to younger (HR: 1.14-1.40, p \u3c 0.001). Lower-income patients ( , ≥50,000) faced worse survival (HR: 1.09-1.24, p \u3c 0.001). Stage-stratified analysis confirmed that these disparities were most pronounced in distant-stage disease, in Black and lowerincome individuals. Conclusions: Racial and socioeconomic disparities persist in breast cancer survival among younger patients, particularly in advanced-stage disease. Black patients and lower-income individuals consistently face the worst outcomes. Expanding insurance coverage, improving access to early detection, increasing financial support for underserved populations, and ensuring equitable access to novel therapies are essential to reducing disparities. Systemic policy reforms and targeted interventions are needed to improve survival outcomes equitably
MM-581: Tracking Mortality in Multiple Myeloma-Associated Acute Kidney Injury: U.S. Trends (1999–2023) and ARIMA-Based Projections Through 2050
No full textAcute kidney injury (AKI) affects up to 20% of patients with multiple myeloma (MM), rendering it a significant contributor to the mortality burden of the disease. Our hypothesis posits that MM-associated AKI mortality demonstrates significant socioeconomic and regional disparities. Objectives: This study aims to assess MM-associated AKI mortality trends in U.S. adults (≥65 years) from 1999 to 2023 and project overall trends through 2050 using the CDC WONDER database, focusing on socioeconomic disparities. Methods: Mortality data were obtained from the CDC WONDER database (1999–2023) using ICD-10 codes C90 (MM) and N17 (AKI). Age-adjusted mortality rates (AAMR) were calculated per million and standardized to the 2000 U.S. population. Joinpoint regression analysis estimated annual percent change (APC) and AAMR with 95% confidence intervals (CIs). Stratifications included sex, race, state, region, and urbanization zone. Future AAMR trends were forecasted using ARIMA after ADF-based stationarity testing. Results: From 1999 to 2023, 11,414 deaths occurred due to AKI-associated MM. AAMR increased from 7.7 (95% CI: 6.8–8.7) to 14.1 (95% CI: 13.1–15.1) per million. The ARIMA model fit well (AIC 50.28, RMSE 3.19) and forecasted AAMR values of 10.32 in 2030 (CI: 7.12–13.52), 2040 (CI: 5.49–15.15), and 2050 (CI: 4.29–16.35). In 2050, the projected AAMR for males was 13.56 (95% CI: 5.11–22.02), compared with 8.12 (95% CI: 4.12–12.13) for females. Historically, males had higher AAMR (18.4 per million, 95% CI: 16.7–20.1) than females (11 per million, 95% CI: 9.8–12.1). Non-Hispanic Whites saw a consistent increase in mortality (APC 2.83%, 95% CI 1.92–5.70, P = 0.002), particularly in the South (APC 2.55%, 95% CI 1.77–3.57, P \u3c 0.001), where AAMR rose from 7.3 (95% CI: 5.8–9) to 14 (95% CI: 12.5–15.6). Rural non-core areas had the highest AAMR (13.8 per million, 95% CI 10.2–18.3). South Dakota had the highest state-specific AAMR (16.2 per million, 95% CI: 11.8–21.9). Conclusion: MM-associated AKI mortality among older U.S. adults has increased significantly, particularly affecting males, non-Hispanic Whites, and residents of the southern U.S. and South Dakota. Given the disparities, targeted public health interventions are required to mitigate these inequalities. Grant/Funding Acknowledgements: Nil
Building repositories in the NHS: Practical approaches and best practices
No full textWithin the UK’s National Health Service (NHS), the role of repositories is becoming increasingly important for advancing open science, ensuring compliance with funder mandates, and supporting staff in disseminating their work. Our presentation will highlight practical approaches to setting up and running repositories in NHS trusts, drawing from concrete experiences and best practices within the NHS landscape. We will first explore why a repository is crucial for medical institutions: from improving visibility of staff research and grey literature (such as audits, reports, and policy documents) to enhancing institutional reputation and supporting evidence-based care. Key steps to get started will be outlined, including defining repository goals and aligning with governance and compliance requirements. The session will then discuss recommended approaches for uploading both published articles (PubMed) and internal outputs, with guidance on metadata standards, copyright, and staff engagement. Finally, we will share NHS-specific best practices for sustainable implementation and adoption. Participants will leave with some practical use cases of building repositories from an NHS perspective, which could bring insights to other medical institutions across the globe
TCTAP C-238 Fish and CHIP: Concurrent Percutaneous Left-Ventricular Thrombus Retrieval and Complex Coronary Intervention With Hemodynamic Support
No full textClinical Information Relevant Clinical History and Physical Exam: A77-year-old female with ACS, LM-triple vessel disease, LVEF 20% and a 1.8cm LVT(Figure 1), with prohibitive surgical risk and cardiac index of 1.5 L/min/m2on inotropic support, was offered percutaneous coronary intervention (PCI) with concurrent thrombus aspiration with the AngioVAC system (AngioDynamic, USA) per heart team decision. [Formula presented] Relevant Test Results Prior to Catheterization: ECG: TWI I, V5-V6, late precordial R transition Echo: LVEF 20%. Apical aneurysm. 1.8 LV apical thrombus. Moderate mitral regurgitation. Relevant Catheterization Findings: Elevated filling pressures. RA 10mmHg PA 52/12 mmHg mean 32 mmHg, PCWP 28 mmHg Fick Cardiac output/index 2.6 / 1.5 Coronary arteriogram: LM bifurcation medina 1,1,1 disease mLAD subtotal occlusion pLCx 70-80% calcified lesion pRCA CTO, left-to-right collaterals [Formula presented] Interventional Management Procedural Step: Right femoral vein access with a 26-French sheath with hemostatic valve (DrySeal, Gore Medical USA) preclosed with two proglides (Abbott Cardiovascular, USA) was obtained. Biradial accesses were used for cerebral embolic protection (figure 2, panel A). Transeptal puncture(B) and septostomy(C) followed by balloon-assisted tracking(D) brought a 22 French AngioVAC cannula into the left atrium (E), followed by mitral valve crossing to reach the LV apex via a Confida wire(G-I) (Medtronic, USA), followed by thrombectomy, all under transesophageal echocardiography (TEE) guidance (H-J). Blood was returned through an oxygenator into a 15 French cannula place in 16 French Dryseal sheath via right femoral artery access preclosed with proglides. After thrombectomy, the suction cannula was pulled back into the right atrium with the funnel retracted. At a flow rate of 3.5 liters-per-minute, it served as a venoarterial-extracorporeal membranous oxygenation (VA-ECMO) circuit (figure 3, panel A). Complex high-risk indicated PCI (CHIP) was performed via left femoral artery access to left anterior descending artery (LAD), left circumflex artery (LCx) and LM bifurcation (B-P) with good result on final angiogram (figure 4, panel A). Contrast echocardiography showed no further LV thrombus (B) and unchanged mitral regurgitation (C) after the thrombus was fished out (D). The patient recovered and was discharged. [Formula presented] [Formula presented] [Formula presented] Conclusions: Acute coronary syndrome (ACS) with concurrent left main bifurcation disease, reduced left ventricular ejection fraction (LVEF) and left-ventricular thrombus (LVT) is a challenging situation where the micro axial flow pump for supporting coronary intervention is contraindicated owing to embolic risk. Off-label AngioVAC use for concurrent left-sided thrombectomy and hemodynamic support for CHIP is possible. Operator proficiency with large bore access and careful cannula positioning to avoid suctioning is require
Cardiac Computed Tomography To Predict Transesophageal Echocardiographic Acoustic Windows In Transcatheter Tricuspid Valve Replacement
No full textIntroduction: Transcatheter tricuspid valve replacement (TTVR) with the Evoque valve (Edwards Lifesciences, USA) is a highly complex procedure, requiring meticulous interrogation of nine anchors of the valve to ensure adequate capture within the native leaflets of the tricuspid valve. Procedural success is highly dependent on excellent fidelity on transesophageal echocardiogram (TEE) to guide the procedure. Methods: A retrospective analysis was conducted on 36 patients who underwent commercial TTVR at a single-center. All patients had pre-procedural CCT analysis done for planning purposes. Patient baseline TEE imaging was separately and blindly retrospectively reviewed by two cardiac imaging specialists and adjudicated image quality on a 5-point Likert scale. Images graded at multiple views and pooled grading of the mid-esophageal TEE windows was classified as either “high-quality” or “low-quality”, depending on ability to view tricuspid leaflets in systole, diastole, and three-dimensional multi-planar reformatting. CCT images were analyzed for hypothesized predictors of TEE imaging quality, including distance from esophagus to tricuspid valve (TV), distance from stomach to TV, right atrial height, and intra-atrial septal thickness. Results: After TEE adjudication, 13 patients were deemed to have low-quality TEE acoustic windows, and 26 were deemed to have high-quality acoustic windows. Amongst the analysis of CCT measurements, trends are shown in figure 1. The strongest trend predicting high quality TEE imaging was an increasing distance from stomach to right ventricle (AdjR2 = 0.15). Increasing septal thickness (AdjR2 = 0.03), increasing right atrial height (AdjR2 = 0.03), and increasing distance from esophagus to right ventricle (AdjR2 = 0.01) did not have any strong correlation with acoustic windows on TEE. Conclusions: TTVR relies on skilled specialists from both a procedural and imaging perspective. Utilization of pre-procedural CCT to predict intra-procedural TEE quality may assist procedure planning, such as anticipating need for access to deploy adjunctive imaging modalities such as intra-cardiac echocardiography. We did not identify a strong correlation of CT imaging with TEE image quality, although early trends suggest that larger studies may provide improved delineation. [Formula presented
TCT-744 Risk of Recurrent Gastrointestinal Bleeding in Patients with Atrial Fibrillation Treated With or Without Left Atrial Appendage Occlusion: A Propensity-Matched Analysis
No full textBackground: Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative strategy, but its impact on recurrent GI bleeding remains unknown. Methods: This retrospective, multicenter cohort study used the TriNetX database to identify adults with AF on oral anticoagulation and history of GI bleeding. Patients were stratified by treatment with or without LAAO. 1:1 propensity score-matching (PSM) was employed. The primary outcome was recurrent GI bleeding. Cox regression analysis was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Odds ratios (ORs) were used to evaluate effect sizes between groups. Kaplan-Meier curves were used for time-to-event analyses. Results: After PSM, 9259 patients were compared in each group. Mean age was 76.2±7.9 years in the LAAO group and 76.1±9.5 years in the no LAAO group. Approximately 56% of patients in both cohorts were male. Odds of recurrent GI bleeding were consistently lower in patients undergoing LAAO than without LAAO across all follow-up intervals (Figure 1A): at 3 months (OR 0.84; 95%CI 0.78–0.91), 6 months, 1 year, 3 years and 5 years (OR 0.87; 95%CI 0.82–0.92). Kaplan–Meier analysis demonstrated significantly lower risk of recurrent GI bleeding with LAAO (HR 0.80; 95%CI 0.76–0.84; p\u3c0.01; Figure 1B). [Formula presented] Conclusion: In patients with AF and prior GI bleeding, LAAO was associated with significantly lower risk of recurrent GI bleeding at short-term and long-term time intervals. Categories: STRUCTURAL: Left Atrial Appendage Exclusio
Transforming Research Discovery: Centralized Systems and Generative Artificial Intelligence for Industry-Ready Collaboration
No full textDo you know the full extent of your institution’s research footprint? And how easily can others discover and engage with it? Today’s research ecosystem encompasses far more than publications, including datasets, abstracts and posters, archived lectures, digital recordings, research services, and equipment, among other assets. To increase visibility and sharing, many institutions now organize their information assets in a single, searchable platform such as a research information management system (RIMS) or institutional repository. These systems serve as central hubs, connecting people with the full breadth of knowledge and resources their researchers produce. To truly unlock opportunities for collaboration and innovation, solutions must extend beyond the campus and be accessible to industry, non-profits, and government sectors. The Ohio Innovation Exchange (OIEx), sponsored by the Ohio Department of Higher Education and powered by Digital Science technologies, was designed to overcome long-standing barriers by providing a modern, statewide digital knowledge-sharing platform. OIEx is transforming how businesses and organizations connect with university experts and access shareable resources across Ohio’s institutions. In this presentation, we will highlight two R&D applications of generative AI technology designed to enhance discovery and help researchers frame their work in industry-relevant terms. Our collaboration yielded promising results and demonstrates how Digital Science is thoughtfully and responsibly combining the strengths of research management systems with the transformative potential of emerging AI tools to drive discovery, collaboration, and innovation
Racial Disparities in Outcomes After Liver Transplantation
No full textRacial disparities in liver transplant outcomes remain an area of concern despite advancements in organ allocation and post-transplant care. This retrospective cohort study analyzed adult liver transplant recipients from the United Network for Organ Sharing (UNOS) registry between 1988 and 2021 to evaluate differences in graft and patient survival between African American (AA) and Caucasian American (CA) recipients. After excluding non-Black and non-White individuals and pediatric cases, a 3:1 matched cohort was created using propensity-type matching for age, sex, body mass index, and ABO type, resulting in 50,584 patients (13,421 AA and 40,263 CA). Median graft survival was significantly lower in AAs compared to CAs (1,466 vs. 1,787 days, p \u3c 0.0001), as was median patient survival (1,480 vs. 1,815 days, p \u3c 0.0001). Graft failure rates at one year were 2,325/12,708 (18.3%) for AA vs. 5,884/37,762 (15.6%) for CA (Chi² = 50.87, df = 1, V = 0.026, p \u3c 0.0001); at five years, 4,326/10,323 (41.9%) vs. 10,172/30,179 (33.7%), respectively (Chi² = 218.35, V = 0.060, p \u3c 0.0001). Similarly, mortality at five years was 3,516/9,152 (38.4%) for AA vs. 8,232/26,291 (31.3%) for CA (Chi² = 154.41, V = 0.066, p \u3c 0.0001). AAs also had higher Model for End-Stage Liver Disease (MELD) scores at listing and transplant and were more likely to be hospitalized or in the ICU at the time of transplant. Insurance coverage differed significantly, with AAs more likely to have public insurance (6,031/12,739, 47.3% vs. 13,055/36,504, 35.8%, p \u3c 0.0001). These findings suggest that AA liver transplant recipients experience significantly worse outcomes, likely due to a combination of advanced disease at presentation and socioeconomic disparities