Acquired aplastic anemia following SARS-CoV-2 vaccination.

COVID-19 is a potential life-threatening viral disease caused by SARS-CoV-2 and was declared a pandemic by the WHO in March 2020. mRNA-based SARS-CoV-2 vaccines are routinely recommended in immune-compromised patients, including patients with AA, as these patients are at increased risk of contracting COVID-19 and developing a more severe course of disease. Between March 2021 and November 2021 relapse of AA occurred in four (age [median]: 53 years, range 30-84 years) out of 135 patients currently registered at our department and two de novo cases of AA in temporal context to vaccination against SARS-CoV-2, were documented. Median time after first COVID-19 vaccination and relapse of AA was 77 days. All relapsed patients were vaccinated with the mRNA-based vaccine Comirnaty®. Relapse in two out of the four patients was refractory to CsA/eltrombopag, favoring IST with hATG/CsA or BMT, respectively. Our observations should prompt clinicians to take vaccine-induced relapse of AA or de novo AA after SARS-CoV-2 vaccination into account. Furthermore, careful clinical monitoring and vigilance for signs or symptoms that may indicate relapse of AA (e.g., bleeding complications) are indicated.

A perspective on value co-creation processes in eSports service ecosystems

PurposeElectronic Sports (eSports) is an emerging sector of the sports and entertainment industry experiencing an accelerated increase in consumer and sponsor demand. This paper aims to study selected cases of eSports service ecosystems, to identify similarities and differences and to understand the different roles, relationships and multiple interactions of actors involved in value co-creation processes.Design/methodology/approachThis empirical paper follows the service-dominant logic to highlight value creation. Based on the sport value framework, an organizing logic for the actors in sports-related ecosystems to exchange service and co-create value, the authors apply the conceptualization of an eSports service ecosystem framework in which actors create value through their interactions. A case study approach was applied to qualitatively describe two cases of value co-creation by multiple actors during three eSports events. Case study 1a is the 2019 League of Legends World Championship Finals in Paris. Case study 1b is the 2020 League of Legends World Championship Finals in Shanghai. Case study 2 is the BLAST Premier Counter-Strike: Global Offensive Global Final 2020, which was entirely virtual.FindingsThe outcome is an empirically investigated conceptual framework of multiple actors co-creating value within a service ecosystem in eSports. The insights of the cases explain how actors interact with each other and co-create value during events in eSports ecosystems. The cases illustrate interactions in the context of eSports where the actors are connected within ecosystems. This enables further development of a value co-creation concept and a better understanding of value co-creation in eSports.Originality/valueThis study contributes to research by explicating a theoretically grounded framework for eSports service ecosystems based on empirical evidence. This research extends the scope of value co-creation beyond the firm–customer dyad to a service ecosystem in eSports, demonstrating the dynamic interactions of multiple actors.

Efficacy and Safety at 48 Weeks of Pegcetacoplan in Adult Paroxysmal Nocturnal Hemoglobinuria Patients with Suboptimal Response to Prior Eculizumab Treatment

Context: Pegcetacoplan (PEG) is a C3 complement inhibitor recently approved by the FDA for the treatment of paroxysmal nocturnal hemoglobinuria (PNH). PEG was superior to eculizumab (ECU;C5-inhibitor) in improving hemoglobin levels at week 16 during the phase 3 PEGASUS trial (NCT03500549) in patients with suboptimal response to prior ECU treatment. Objective: We report on efficacy and safety of PEG and results from a post hoc time-aligned analysis based on start of PEG dosing. Design: Eighty PNH patients (≥18 years, hemoglobin levels <10.5 g/dL despite stable ECU treatment [≥3 months]) were enrolled. Following a 4-week run-in, patients were randomized (1:1) to PEG or ECU monotherapy for the randomized controlled period (RCP) through week 16, before initiating an open-label period (OLP) through week 48, where ECU patients completed a second run-in before switching to PEG monotherapy (ECU-to-PEG), and PEG patients continued PEG monotherapy (PEG-to-PEG). Key endpoints included change from baseline (CFB) in hemoglobin levels and incidence of adverse events (AEs). Timepoints were manually aligned based on start of PEG dosing (PEG-to-PEG: day 1;ECU-to-PEG: week 20) to compare changes in hemoglobin levels between groups. Results: PEG-to-PEG patients achieved sustained improvements in hemoglobin levels at week 16 through the OLP (week 48 mean hemoglobin level: 11.3 g/dL;CFB: 2.5 g/dL). ECU-to-PEG patients displayed improved hemoglobin levels during the OLP (week 48 mean hemoglobin level: 11.6 g/dL;CFB: 2.9 g/dL). Timepoint alignment demonstrated no significant difference (p=0.64) between improvements in hemoglobin levels at 28 and 48 weeks among PEG-to-PEG and ECU-to-PEG groups, respectively. Thirty percent of patients reported a serious AE, 6% possibly PEG-related. Common AEs for PEG-treated patients were injection site reactions (36%), hemolysis (24%), and diarrhea (21%). Twelve patients (15%) discontinued PEG due to AEs: 3 in RCP, 8 in OLP, 1 during follow-up, including one death due to COVID-19, unrelated to PEG. Conclusions: PEG-treated patients experienced sustained improvements in hemoglobin levels at week 48, and the safety profile of PEG was consistent with previously reported data. The treatment effect of PEG on hemoglobin levels over time was similar between PEG-to-PEG and ECU-to-PEG groups. Thus, PEG represents a new effective therapeutic option for PNH patients.