ABSTRACT
Introduction: Corona Virus Disease 2019 (COVID-19) Infection is associated with acute cardiac injury. We examined the risk of in-hospital mortality in patients with concomitant COVID-19 infection and acute myocardial infarction (AMI) as compared to patients with AMI without COVID-19 infection. Hypothesis: COVID-19 is associated with increased in-hospital mortality in patients hospitalized for AMI. Methods: We conducted a systematic review and meta-analysis of published articles from January 2019 to May 2021. Literature search was performed on PubMed, Cochrane database, Embase, and Web of Science. We included studies done in patients with index hospitalization for AMI. Patients with positive COVID-19 Polymerase Chain Reaction were considered to have COVID-19 infection. We used random-effects model using the risk ratio (RR) and 95% confidence interval (CI). We used I squared test to assess for heterogeneity Results: After assessing 20 articles for full text screen for eligibility, four cohort studies met our inclusion criteria. There were a total of 1918 participants in both COVID and non-COVID groups, who were hospitalized for AMI between February 1, 2020 to June 30, 2020. 168 participants (8.76%) had concomitant COVID-19. Confounders were adjusted in only one article. Most of the confounders like age, sex, race and BMI were similar in both groups but co-morbidities were higher in COVID group in all four studies. 42 patients (61%) with COVID-19 and 69 patients (0.96%) with no COVID-19 died in hospital. Pooled data from the four studies showed patients with AMI and COVID-19 infection had more than six times increased risk of in-hospital mortality compared with patients who had AMI but no COVID-19 infection (RR 6.17, 95% CI: 4.11-9.26;I2=9%, P<0.00001). Conclusions: Our study shows that COVID-19 infection is associated with increased in-hospital mortality in patients hospitalized for AMI. Our limitations include higher comorbidities in COVID group, unable to capture all COVID patients, and high risk of bias with cohort studies. Whether patients with concomitant COVID-19 infection and AMI will benefit from unique management approaches should be further examined.
ABSTRACT
Background: Chimeric antigen receptor T cells (CART) have shown promising results in the treatment of relapsed and refractory multiple myeloma (RRMM). Recently, bispecific-CART cells targeting 2 antigens are being evaluated in various clinical trials. Methods: A comprehensive literature search was done of Pubmed, Embase, and Cochrane. Data presented at annual hematology and oncology conferences were also included. Results: We included 4 phase I clinical trials with a total of 77 RRMM patients between the ages of 18 to 71 years. The median follow-up duration ranged from 1 month to 27.5 months. All were lymphodepleted with Cyclophosphamide and Fludarabine before receiving CAR-T cell therapy. The CAR-T cell targets include BCMA and CD38 (dose range 0.5 x 10∧6 - 4 x 10∧6 cells/kg), BCMA and TACI (dose range 15 - 900 x 10e6 CAR-T cells), BCMA and CD19 (1 x 10e5/kg - 3 x 10e5 CAR-T cells/kg), and BCMA and CD19 (dose 1 x 10e6 cells/kg). Overall response rate (ORR) was reported by 4 trials (87.5%, 43%, 93.8%, 95%). Complete response (CR) was also reported in 4 trials as 50%, 64%, 56.3% and 14% and partial response (PR) reported as 25%, 28%, 16.6%, 14%, 18% in 5 trials (table). The most common grade 3-4 adverse effects that were reported include cytokine release syndrome, neurotoxicity, neutropenia, lymphopenia, anemia, thrombocytopenia, diarrhea, increased LDH, lower respiratory tract infections (LRTI), dehydration, renal failure (table). Yan et al. reported one death due to cerebral hemorrhage which was considered unrelated to treatment. Jiang et al. reported one death from unknown cause of a patient who presented with fever during the COVID- 19 pandemic.Conclusions: Bispecific CART cells have shown promising results in the treatment of RRMM. However, the clinical trials are ongoing, and a longer follow-up is needed.