While high-dose therapy and autologous stem cell transplant (ASCT) remain integral to the primary treatment of newly diagnosed transplant-elble multiple myeloma (MM) patients, the challenge of disease progression persists. The primary objective of this meta-analysis is to evaluate the efficacy and safety of tandem ASCT compared to single ASCT. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing tandem ASCT with single ASCT in patients with newly diagnosed MM. We searched PubMed, EMBASE, Cochrane Library, and Clinical Trials databases for studies published up to January 2024. The primary outcomes were progression-free survival (PFS), overall survival (OS), overall response rate (ORR), complete response rate (CRR), and treatment-related mortality (TRM). We used a random-effects model to calculate pooled hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs). Study quality was assessed using the Cochrane risk of bias tool and Newcastle–Ottawa Scale. Twelve studies involving 5057 patients met the inclusion criteria. Tandem ASCT was associated with a significantly higher CRR compared to single ASCT (HR 1.33, 95% CI 1.03–1.71, I2 = 15%), but no significant differences were observed in PFS (HR 0.75, 95% CI 0.42–1.34, I2 = 14%), OS (HR 0.60, 95% CI 0.33–1.10, I2 = 27%), or the ORR (RR 0.80, 95% CI 0.59–1.08, I2 = 33%). However, tandem ASCT was associated with a significantly higher risk of TRM (RR 1.78, 95% CI 1.00–3.18, I2 = 0%). Tandem ASCT improves the CRR but does not provide significant benefits in terms of PFS, OS, or ORR compared to single ASCT in patients with newly diagnosed MM. Moreover, tandem ASCT is associated with a higher risk of TRM. The decision to pursue tandem ASCT should be made on an individual basis, carefully weighing the potential benefits and risks in light of each patient’s unique clinical situation. Future research should focus on identifying patient subgroups most likely to benefit from tandem ASCT and exploring strategies to optimize the efficacy and safety of this approach in the context of novel agent-based therapies.

Background Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising immunotherapy for various malignancies. However, its use is associated with challenges, including cytokine release syndrome (CRS), a potentially severe complication. This retrospective study aims to analyze the risks, outcomes, and healthcare burden of CRS in patients undergoing CAR-T therapy. Method Data from the 2020 National Inpatient Sample (NIS) were utilized, comprising 415 CAR-T-related hospitalizations. They were categorized into those with CRS (n = 68) and those without CRS (n = 347). Baseline characteristics, including age, gender, race, income, insurance status, and comorbidities, were compared. Outcomes of interest included in-hospital mortality, length of stay (LOS), total hospital charges, and access to complications, associations, and interventions. Statistical analyses, including multivariable models, were employed to assess associations. Results Hospitalizations with CRS did not exhibit significant differences in age, gender, race, income, or insurance status compared to those without CRS. The multivariable analysis showed no statistically significant difference in mortality (adjusted odds ratio (aOR) = 2.48, 95% confidence interval (CI): 0.71 to 8.69, p = 0.151), LOS (coefficient = -2.1 days, 95% CI: -5.43 to 1.21, p = 0.207), or total hospital charges (coefficient = $207,456, 95% CI: $6119 to $421,031, p = 0.057) between the two groups. The CRS group had a higher incidence of fever (aOR = 1.91, 95% CI: 1.15 to 3.17, p = 0.014), acute respiratory failure (aOR = 2.10, 95% CI: 1.01 to 4.40, p= 0.049), and the need for intubation/mechanical ventilation (aOR = 2.59, 95% CI: 1.14 to 5.88, p = 0.024). Hemophagocytic lymphohistiocytosis (HLH) was significantly associated with CRS (aOR = 6.72, 95% CI: 2.03 to 22.18, p = 0.002). Conclusion While the development of CRS in CAR-T-treated patients did not significantly increase mortality, LOS, or total hospital charges, it was associated with specific risks and outcomes, including fever, respiratory failure, and HLH. This study emphasizes the importance of vigilance in recognizing and managing CRS in CAR-T therapy to optimize patient outcomes. The findings contribute valuable insights to guide clinical decision-making in the context of CAR-T therapy.

Objective: Acute promyelocytic leukemia (APL) is associated with an elevated risk of developing disseminated intravascular coagulation (DIC). The purpose of this study was to assess the outcomes of hospitalizations related to DIC in APL and their impact on healthcare. Materials and Methods: This study entailed a cross-sectional and retrospective analysis of the US National Inpatient Sample database. We identified adults with APL and categorized them into groups of patients with and without DIC. Our focus areas included in -hospital mortality, length of stay, charges, and complications associated with DIC. Unadjusted odds ratios/coefficients were computed in univariate analysis, followed by adjusted odds ratios (aOR)/coefficients from multivariate analysis that accounted for confounding factors. Results: Our analysis revealed that APL patients with DIC had a substantially higher aOR for mortality (aOR: 6.68, 95% confidence interval [CI]: 4.76-9.37, p<0.001) and a prolonged length of stay (coefficient: 10.28 days, 95% CI: 8.48-12.09, p<0.001) accompanied by notably elevated total hospital charges (coefficient: $215,512 [95% CI: 177,368-253,656], p<0.001), thereby emphasizing the reality of extended medical care and economic burden. The presence of DIC was associated with increased odds of sepsis, vasopressor support, pneumonia, acute respiratory failure, intubation/mechanical ventilation, and acute kidney injury, reflecting heightened vulnerability to these complications. Patients with DIC demonstrated significantly higher odds ratios for major bleeding, intracranial hemorrhage, gastrointestinal bleeding, red blood cell transfusion, platelet transfusion, fresh frozen plasma transfusion, and cryoprecipitate transfusion, highlighting the pronounced hematological risks posed by DIC. Conclusion: This study has revealed the significant associations between DIC in APL and various outcomes, underscoring the clinical and economic implications of these conditions. The hematological risks further increase patients' vulnerability to bleeding events and the need for transfusions.

Objective: The objective of this study is to thoroughly investigate the use of artificial intelligence (AI) and machine learning (ML) techniques for diagnosing and predicting prognosis in gastric cancer, utilizing the latest available data. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines, a systematic review investigated AI and ML applications in gastric cancer diagnosis and prognostic prediction. PubMed and Google Scholar were searched from February 2019 to January 2024 using specific syntax. Eligible trials were selected based on inclusion criteria including recent publication, focus on AI and ML in gastric cancer, and reporting diagnostic or prognostic outcomes. Data were extracted and quality assessed independently, with discrepancies resolved through discussion. Due to design heterogeneity, detailed analysis was omitted, and descriptive summaries of included articles were provided. Results: This review included a total of 8 articles. AI and ML techniques, including convolutional neural networks (CNN) and deep learning models, have played pivotal roles in accurately diagnosing chronic atrophic gastritis, predicting postoperative gastric cancer prognosis, and identifying peritoneal metastasis in gastric cancer patients. These technologies offer potential advantages such as streamlining diagnostic procedures, guiding treatment decisions, and enhancing patient outcomes in gastric cancer management. Conclusion: In the near future, AI applications may have a significant role in the diagnosis and prognosis prediction of gastric cancer.

The objective of this study was to examine the characteristics and utilization patterns of palliative care among the kidney cancer patients using a large-scale representative population-based sample. We retrospectively analyzed National Inpatient Sample hospitalization data from January 2020 to December 2020 to explore disparities in delivering palliative care to deceased kidney cancer patients and assess its impact on healthcare usage, focusing on hospital costs and length of stay (LoS). We used ICD-10 CM codes (International Classification of Diseases-classifying diagnoses and reasons for visits in all healthcare settings) to categorize the study population. We conducted univariable and multivariable linear and logistic regression analyses to calculate coefficients and odds ratios, considering relevant variables and addressing potential confounding factors. We studied 1437 deceased kidney cancer patients, with 53.9% receiving palliative care. Those receiving palliative care had lower total costs ($99,804 vs. $1,34,731) and a shorter LoS (7.19 days vs. 7.66 days), compared to those who didn’t. No significant difference was discovered in LoS. Private insurance, higher income, and female patients were more likely to receive palliative care. Race, hospital teaching status, and hospital size showed no significant differences. This study revealed insights into palliative care use among deceased kidney cancer patients, with cost-saving benefits evident. Disparities showed that individuals with private insurance and higher income more likely accessed palliative care, and females received it more often than males. Physicians and policymakers must consider these findings for equitable resource allocation and improved access.