PURPOSEUlnar superficialis slip resection (USSR) has been described to address persistent postoperative triggering following trigger finger release (TFR). The primary purpose of our study was to evaluate the results of simultaneous TFR and USSR under wide-awake local anesthesia no tourniquet (WALANT). The secondary purpose was to identify patient characteristics and risk factors associated with persistent triggering following A1 pulley release requiring USSR.METHODWe retrospectively identified 1,005 patients who underwent TFR at one institution by a single fellowship-trained, hand surgeon under WALANT from 2015 to 2023. Nine hundred ninety-two patients were treated with TFR alone. Twelve patients (1.2%) underwent USSR because of persistent triggering that was identified in the operating room after release of the A1 pulley. An age-, sex-, and body mass index-matched cohort of 28 patients who underwent TFR alone was created. Medical records were reviewed for demographics and complications.RESULTSA total of 12 patients (14 digits) underwent TFR with USSR. The long finger was the most commonly affected finger (6, 42%). Patients in the USSR group had more average lifetime trigger fingers compared with the control group (4 vs 1). Additionally, the percentage of patients who had previously undergone TFRs for other fingers was higher in the USSR group (100%) compared with the control group (36%). After surgery, 6 patients (4 USSR and 2 control) underwent formal hand therapy for postoperative stiffness with USSR patients receiving therapy more often than controls.CONCLUSIONSAlthough uncommon, some patients (1.2%) who undergo TFR require USSR for persistent triggering following A1 pulley release. Patients who have had more lifetime trigger fingers and/or who have previously undergone TFR for other fingers are more likely to need USSR. No serious complications were incurred by patients who underwent USSR, but these patients may benefit from hand therapy compared to those undergoing isolated TFR.TYPE OF STUDY/LEVEL OF EVIDENCETherapeutic III.

01 Oct 2024·Indian Journal of Hematology and Blood Transfusion

Real World Outcomes with Treatment Free Remission in Chronic Myeloid Leukemia-Experience from a Tertiary Care Cancer Centre

Article

Author: Bonda, Avinash ; Nair, Reena ; Mondal, Tanmoy ; Sarma, Rup Jyoti ; Tembhare, Prashant ; Srikanth, Anne ; Sengar, Manju ; Menon, Hari ; Nayak, Lingaraj ; Chatterjee, Gaurav ; Kashyap, Lakhan ; Jain, Hashmukh ; Subramanian, Papagudi ; Kashyap, Yashwant ; Gujral, Sumeet ; Patkar, Nikhil Vijay ; Bondili, Suresh Kumar ; Bagal, Bhausaheb ; Nandhana, Ravindra

Chronic myeloid leukaemia (CML) is caused by balanced translocation t(9::22)(q34;q11) resulting in formation of pathogenic BCR-ABL fusion gene. Tyrosine kinase inhibitors (TKI) have revolutionised the treatment of CML. Ongoing treatment with TKI leads to side effects and has financial impact. Teratogenic potential of TKI and growth disturbance also represent an important challenge. Thus, TKI discontinuation in form of treatment free remission (TFR) has emerged as a new and important therapeutic goal. In this retrospective study, we reviewed CML patients who were kept on TFR. Inclusion criteria was patient age ≥ 18 years diagnosed with CML in chronic phase who met the criteria for TFR and opted for same and who were in DMR but stopped TKI for any reason. We analysed the data for baseline characteristics, molecular relapse (MR), survival without molecular relapse (SWMR), TFR duration and factors affecting MR. We included 38 patients in this analysis. Thirty five (92%) patients were treated with imatinib at diagnosis. Median duration of TKI treatment was 135 months. 37 patients (97.5%) achieved DMR on TKI and median time from TKI initiation to DMR was 96 months. Median duration of DMR prior to TKI discontinuation was 41 months. TKI was discontinued after counselling for TFR in 26 patients (68%) while it was discontinued due to intolerance in 10 patients (29%). At median molecular follow up of 25 months, nine patients (23.7%) had molecular relapse. Median SWMR was not reached and 2 year estimated SWMR was 65.2% (95%CI,47.2- 83.2). Of all relapses, 5/9 (55.5%) occurred in the first six months of TFR. On univariate analysis, duration of TKI and duration of DMR were predictive of molecular relapse. On multivariate analysis, none of these factors were found to be significant. This retrospective study suggests that for CML CP patients achieving deep molecular response, discontinuing TKI therapy in real-world settings may be feasible while potentially achieving comparable outcomes.

01 Sep 2024·Hematological Oncology

Treatment‐free remission as a new goal in the management of chronic myeloid leukemia: Clinical and biological aspects

Review

Author: Mora, Barbara ; Bucelli, Cristina ; Bellani, Valentina ; Cattaneo, Daniele ; Iurlo, Alessandra

AbstractThe therapeutic armamentarium of chronic myeloid leukemia (CML) has dramatically improved after small molecule tyrosine kinase inhibitors (TKIs) targeting BCR::ABL1 became available, with a life expectancy now close to that of the general population. Although highly effective, these drugs also have a toxicity profile that is often mild to moderate, but sometimes severe. Indeed, long‐term treatment with TKIs can lead to chronic adverse events that can negatively affect patients' quality of life and can promote significant morbidity and mortality, particularly in the case of second‐ or third‐generation TKIs. Treatment discontinuation has therefore become an emerging goal for CML patients and numerous studies have evaluated in off‐TKI subjects what requirements are appropriate for an attempt at treatment‐free remission (TFR). TFR eligibility is currently limited to a small population of subjects with both deep and sustained molecular responses to TKIs. For those attempting TFR, average success rates are promising, with 25%–30% of patients experiencing prolonged TFR. In case of failure to maintain sustained TFR, safety results to date are reassuring, with almost all patients responding successfully to resumption of TKIs, and advanced‐phase disease progression representing a very rare event. The purpose of this review is to discuss guidelines for TKI discontinuation, clinical advances from clinical trials and real‐life experiences, and describe areas of research, particularly regarding the biological factors capable of predicting the success of TFR.

100 Deals associated with TfR conjugate (Eli Lilly)

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Indication	Highest Phase	Country/Location	Organization	Date
Central Nervous System Diseases	Preclinical	US	Eli Lilly & Co.	22 Feb 2024

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