Key clinical point: Outcomes remain poor for patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome who suffer relapse after allogeneic hematopoietic cell transplantation; factors associated with mortality included acute graft vs. host disease grade II-IV.

Major finding: The cumulative incidence of morphologic relapse in patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome after allogeneic hematopoietic cell transplantation was 19%, 24%, and 26%, respectively at 12 months; the estimated median survival after relapse across all diseases was 2.9 months.

Study details: The data come from 420 adults with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Hong S et al. Hematol Oncol Stem Cell Ther. 2020 Dec 5. doi: 10.1016/j.hemonc.2020.11.006.

Key clinical point: Outcomes remain poor for patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome who suffer relapse after allogeneic hematopoietic cell transplantation; factors associated with mortality included acute graft vs. host disease grade II-IV.

Major finding: The cumulative incidence of morphologic relapse in patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome after allogeneic hematopoietic cell transplantation was 19%, 24%, and 26%, respectively at 12 months; the estimated median survival after relapse across all diseases was 2.9 months.

Study details: The data come from 420 adults with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Hong S et al. Hematol Oncol Stem Cell Ther. 2020 Dec 5. doi: 10.1016/j.hemonc.2020.11.006.

Key clinical point: Outcomes remain poor for patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome who suffer relapse after allogeneic hematopoietic cell transplantation; factors associated with mortality included acute graft vs. host disease grade II-IV.

Major finding: The cumulative incidence of morphologic relapse in patients with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome after allogeneic hematopoietic cell transplantation was 19%, 24%, and 26%, respectively at 12 months; the estimated median survival after relapse across all diseases was 2.9 months.

Study details: The data come from 420 adults with acute lymphocytic leukemia, acute myeloid leukemia, and myelodysplastic syndrome.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Hong S et al. Hematol Oncol Stem Cell Ther. 2020 Dec 5. doi: 10.1016/j.hemonc.2020.11.006.

Key clinical point: Use of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) added to the International Prognostic Scoring System, revised (IPSS-R) could identify low, intermediate, and high-risk groups of patients with patients with higher-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia.

Major finding: Serum ferritin levels < 520 ng/mL, ECOG PS scores of 0 or 1, and IPSS-R independently predicted stronger response to 5-AZA in patients with myelodysplastic syndromes and oligoblastic acute myeloid leukemia. 

Study details: The data come from a retrospective study of 687 consecutive patients with myelodysplastic syndrome and oligoblastic acute myeloid leukemia who were treated with 5-azacytidine (5-AZA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Papageorgiou SG et al. Ther Adv Hematol. 2020 Dec 8. doi: 10.1177/2040620720966121.

Key clinical point: Use of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) added to the International Prognostic Scoring System, revised (IPSS-R) could identify low, intermediate, and high-risk groups of patients with patients with higher-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia.

Major finding: Serum ferritin levels < 520 ng/mL, ECOG PS scores of 0 or 1, and IPSS-R independently predicted stronger response to 5-AZA in patients with myelodysplastic syndromes and oligoblastic acute myeloid leukemia. 

Study details: The data come from a retrospective study of 687 consecutive patients with myelodysplastic syndrome and oligoblastic acute myeloid leukemia who were treated with 5-azacytidine (5-AZA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Papageorgiou SG et al. Ther Adv Hematol. 2020 Dec 8. doi: 10.1177/2040620720966121.

Key clinical point: Use of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) added to the International Prognostic Scoring System, revised (IPSS-R) could identify low, intermediate, and high-risk groups of patients with patients with higher-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia.

Major finding: Serum ferritin levels < 520 ng/mL, ECOG PS scores of 0 or 1, and IPSS-R independently predicted stronger response to 5-AZA in patients with myelodysplastic syndromes and oligoblastic acute myeloid leukemia. 

Study details: The data come from a retrospective study of 687 consecutive patients with myelodysplastic syndrome and oligoblastic acute myeloid leukemia who were treated with 5-azacytidine (5-AZA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Papageorgiou SG et al. Ther Adv Hematol. 2020 Dec 8. doi: 10.1177/2040620720966121.

Key clinical point: Myelodysplastic syndrome patients who responded to treatment with azacytidine showed significantly reduced peripheral blood levels of Wilms’ tumour 1 mRNA (WT-1) compared to nonresponders.

Major finding: A total of 20 patients (63%) showed a response to azacytidine; 7 patients (22%) achieved complete response and 19 patients (59%) achieved hematologic improvement. Responders had an average peripheral blood WT-A mRNA of 2,050 copies per micrograms of RNA vs. 7,550 copies per micrograms of RNA for nonresponders (P = 0.03).

Study details: The data come from 32 adult patients aged 31 to 85 years with myelodysplastic syndrome who were treated with azacytidine for an average of five cycles.

Disclosures: The study was supported in part by the Practical Research for Innovative Cancer Control Program from the Japan Agency for Medical Research and Development, AMED. Lead author Dr. Maeda disclosed relationships with Nippon Shinyaku and Janssen; several coauthors also disclosed relationships with multiple companies.

Source: Maeda T et al. Leukemia Res Rep. 2020 Dec 8. doi: 10.1016/j.lrr.2020.100231.

Key clinical point: Myelodysplastic syndrome patients who responded to treatment with azacytidine showed significantly reduced peripheral blood levels of Wilms’ tumour 1 mRNA (WT-1) compared to nonresponders.

Major finding: A total of 20 patients (63%) showed a response to azacytidine; 7 patients (22%) achieved complete response and 19 patients (59%) achieved hematologic improvement. Responders had an average peripheral blood WT-A mRNA of 2,050 copies per micrograms of RNA vs. 7,550 copies per micrograms of RNA for nonresponders (P = 0.03).

Study details: The data come from 32 adult patients aged 31 to 85 years with myelodysplastic syndrome who were treated with azacytidine for an average of five cycles.

Disclosures: The study was supported in part by the Practical Research for Innovative Cancer Control Program from the Japan Agency for Medical Research and Development, AMED. Lead author Dr. Maeda disclosed relationships with Nippon Shinyaku and Janssen; several coauthors also disclosed relationships with multiple companies.

Source: Maeda T et al. Leukemia Res Rep. 2020 Dec 8. doi: 10.1016/j.lrr.2020.100231.

Key clinical point: Myelodysplastic syndrome patients who responded to treatment with azacytidine showed significantly reduced peripheral blood levels of Wilms’ tumour 1 mRNA (WT-1) compared to nonresponders.

Major finding: A total of 20 patients (63%) showed a response to azacytidine; 7 patients (22%) achieved complete response and 19 patients (59%) achieved hematologic improvement. Responders had an average peripheral blood WT-A mRNA of 2,050 copies per micrograms of RNA vs. 7,550 copies per micrograms of RNA for nonresponders (P = 0.03).

Study details: The data come from 32 adult patients aged 31 to 85 years with myelodysplastic syndrome who were treated with azacytidine for an average of five cycles.

Disclosures: The study was supported in part by the Practical Research for Innovative Cancer Control Program from the Japan Agency for Medical Research and Development, AMED. Lead author Dr. Maeda disclosed relationships with Nippon Shinyaku and Janssen; several coauthors also disclosed relationships with multiple companies.

Source: Maeda T et al. Leukemia Res Rep. 2020 Dec 8. doi: 10.1016/j.lrr.2020.100231.

Key clinical point: A simplified system based on four clinical parameters of the flow cytometric score (MFCM-Score) was positively correlated with the Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome.

Major finding: No significant difference appeared between the MFCM-score and FCM-score in diagnosing myelodysplastic syndrome (P > 0.05).

Study details: The data come from 118 adults with suspected myelodysplastic syndrome. Patients were compared using the FCM and MFCM. Four parameters were used in the standard FCM scoring: myeloblast-related cluster size (myeloblast-related cells/all nucleated cell), B-progenitor-related cluster size (B-progenitor-related cells/all CD34⁺ cells), CD45 mean fluorescence intensity (MFI) ratio (lymphocytes/myeloid blast cells), and SSC peak channel ratio (granulocyte/lymphocyte). The MFCM simplified the scoring further by using CD19 and CD33 to separate B lymphocyte progenitor cells and myeloblasts within the CD34⁺CD45^dimm population.

Disclosures: The study was funded by the National Natural Science Foundation of China and the Natural Science Research Project of Anhui Medical University. The researchers had no financial conflicts to disclose.

Source: Guo J et al. Am J Transl Res. 2020 Nov 15. 12(11):7449–7458.

Key clinical point: A simplified system based on four clinical parameters of the flow cytometric score (MFCM-Score) was positively correlated with the Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome.

Major finding: No significant difference appeared between the MFCM-score and FCM-score in diagnosing myelodysplastic syndrome (P > 0.05).

Study details: The data come from 118 adults with suspected myelodysplastic syndrome. Patients were compared using the FCM and MFCM. Four parameters were used in the standard FCM scoring: myeloblast-related cluster size (myeloblast-related cells/all nucleated cell), B-progenitor-related cluster size (B-progenitor-related cells/all CD34⁺ cells), CD45 mean fluorescence intensity (MFI) ratio (lymphocytes/myeloid blast cells), and SSC peak channel ratio (granulocyte/lymphocyte). The MFCM simplified the scoring further by using CD19 and CD33 to separate B lymphocyte progenitor cells and myeloblasts within the CD34⁺CD45^dimm population.

Disclosures: The study was funded by the National Natural Science Foundation of China and the Natural Science Research Project of Anhui Medical University. The researchers had no financial conflicts to disclose.

Source: Guo J et al. Am J Transl Res. 2020 Nov 15. 12(11):7449–7458.

Key clinical point: A simplified system based on four clinical parameters of the flow cytometric score (MFCM-Score) was positively correlated with the Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome.

Major finding: No significant difference appeared between the MFCM-score and FCM-score in diagnosing myelodysplastic syndrome (P > 0.05).

Study details: The data come from 118 adults with suspected myelodysplastic syndrome. Patients were compared using the FCM and MFCM. Four parameters were used in the standard FCM scoring: myeloblast-related cluster size (myeloblast-related cells/all nucleated cell), B-progenitor-related cluster size (B-progenitor-related cells/all CD34⁺ cells), CD45 mean fluorescence intensity (MFI) ratio (lymphocytes/myeloid blast cells), and SSC peak channel ratio (granulocyte/lymphocyte). The MFCM simplified the scoring further by using CD19 and CD33 to separate B lymphocyte progenitor cells and myeloblasts within the CD34⁺CD45^dimm population.

Disclosures: The study was funded by the National Natural Science Foundation of China and the Natural Science Research Project of Anhui Medical University. The researchers had no financial conflicts to disclose.

Source: Guo J et al. Am J Transl Res. 2020 Nov 15. 12(11):7449–7458.

Yet another study has linked the consumption of ultraprocessed, or “junk,” foods to bad health outcomes.

In a longitudinal analysis of more than 22,000 men and women from southern Italy, those who consumed the most ultraprocessed food (UPF) had the highest risk for cardiovascular disease (CVD) and all-cause mortality, likely mediated through a diet high in sugar, researchers said.

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The findings “should serve as an incentive for limiting consumption of UPF and encouraging natural or minimally processed foods, as several national nutritional policies recommend,” Marialaura Bonaccio, PhD, department of epidemiology and prevention, IRCCS Neuromed, Pozzilli, Italy, and colleagues wrote. The results were published online Dec. 18 in the American Journal of Clinical Nutrition.

Earlier this year, as reported by this news organization, researchers found mounting evidence that the obesity epidemic and the increase in incidence of related chronic conditions corresponded with an increase in the intake of UPF.

A study that was conducted in a European cohort found that adults whose diet included more UPF and beverages, such as ice cream, soda, and hamburgers, were more likely to develop CVD or die sooner than others who had a more wholesome diet.

As reported previously by this news organization, among adults in France who had a 10% higher intake of UPF and beverages, the rate of CVD, coronary heart disease, and cerebrovascular disease was 11% to 13% higher over a period of about 5 years.

Similarly, university graduates in Spain who consumed more than four servings of UPF and beverages a day were 62% more likely to die of any cause over about a decade than those who consumed less than two servings per day.
 

Where’s the food?

There is very little actual food in UPF. “The NOVA classification provides 4 main classes of food and beverages, the last of which is represented by the ultraprocessed food group. This comprises products (e.g., snacks, drinks, and ready meals, ‘created mostly or entirely from substances extracted from foods or derived from food constituents with little, if any intact food, which often contain flavors, colors, and other additives that imitate or intensify the sensory qualities of foods or culinary preparations made from foods,’ ” Dr. Bonaccio and colleagues wrote.

Such foods are very convenient, tasty, inexpensive, and have a long shelf life. They are highly competitive with foods that are naturally ready to consume and freshly prepared dishes and meals, the authors add.

The researchers conducted a longitudinal analysis on 22,475 men and women (mean age, 55 years; range, 43-67 years) who were recruited from the Moli-sani Study, a population-based cohort of men and women aged 35 years and older in the Molise region of southern Italy, between 2005 and 2010. Participants were followed for 8.2 years.

Food intake was assessed with the Food Frequency Questionnaire; UPF was defined using the NOVA classification according to degree of processing.

UPF intakes were categorized as quartiles of the ratio of UPF to total food consumed.

Overall, study participants reported a median of 10% (interquartile range, 6.6%-14.6%) of dietary intake as UPF and a total of 181.5 g/d of UPF intake.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

High consumers of UPF, defined as those for whom UPF constituted more than 14.6% of their total diet, were more likely to be women, to be younger, and to have a higher educational level. They also reported fewer risk factors and fewer baseline chronic diseases and health conditions than persons who consumed UPF less frequently.

In addition, high consumption of UPF was associated with lower adherence to the Mediterranean diet; higher intake of fat, sugar, dietary cholesterol, and sodium; and lower intake of fiber.

During a median follow-up of 8.2 years, 1,216 all-cause deaths occurred. Of these, 439 were attributed to CVD, 255 to IHD/cerebrovascular disease, 477 to cancer, and 300 to other causes.
 

The more UPF, the higher the risk for CVD, death

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Individuals who reported the highest intake of UPF (fourth quartile, 14.6% of total food) as opposed to the lowest (first quartile, UPF <6.6%) experienced increased risks for CVD mortality (hazard ratio, 1.58; 95% CI, 1.23-2.03), death from IHD/cerebrovascular disease (HR, 1.52, 95% CI, 1.10-2.09), and all-cause mortality (HR, 1.26; 95% CI, 1.09-1.46).

High sugar content accounted for 36.3% of the relation of UPF with IHD/cerebrovascular mortality. Other nutritional factors, such as saturated fats, were unlikely to play a role, the researchers wrote.

Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality and 12.0% for that of UPF with CVD mortality.

Subgroup analyses indicated that the magnitude of the association between UPF and all-cause mortality risk was greater among high-risk individuals, such as those with a history of CVD or diabetes. UPF was also likely to be more strongly associated with CVD mortality among those high-risk groups.

The interesting finding that the association between UPF and CVD mortality was greater among individuals with good adherence to the Mediterranean diet, which is known to have health benefits, could be explained by the fact that people who may benefit from a Mediterranean diet are more susceptible to losing health advantages when they also include “detrimental dietary behavior,” whereas those who consume a poor-quality diet are less likely to be harmed by an additional unhealthy behavior such as eating UPF regularly, wrote Dr. Bonaccio and colleagues.

“This is an interesting study confirming that consumption of highly processed foods such as pizza, processed meats, and soda are associated with greater risks of cardiovascular disease,” Walter Willett, MD, professor of epidemiology and nutrition, Harvard School of Public Health, Boston, said in an interview.

“These higher risks appear to be mediated in part by high intakes of saturated fat and sugar, but lower intakes of health-promoting aspects of diet also likely contribute to the findings,” Dr. Willett said.

“Some processing of food can be useful for preservation and control of infectious agents, but in general, a diet emphasizing minimally processed fruits and vegetables, whole grains, nuts, legumes, and plant sources of fat will be best for long-term well-being,” he said.

The study was supported in part by the Italian Ministry of Health and the HYPERCAN Study Italian Association for Cancer Research. Dr. Bonaccio and Dr. Willett reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Yet another study has linked the consumption of ultraprocessed, or “junk,” foods to bad health outcomes.

In a longitudinal analysis of more than 22,000 men and women from southern Italy, those who consumed the most ultraprocessed food (UPF) had the highest risk for cardiovascular disease (CVD) and all-cause mortality, likely mediated through a diet high in sugar, researchers said.

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The findings “should serve as an incentive for limiting consumption of UPF and encouraging natural or minimally processed foods, as several national nutritional policies recommend,” Marialaura Bonaccio, PhD, department of epidemiology and prevention, IRCCS Neuromed, Pozzilli, Italy, and colleagues wrote. The results were published online Dec. 18 in the American Journal of Clinical Nutrition.

Earlier this year, as reported by this news organization, researchers found mounting evidence that the obesity epidemic and the increase in incidence of related chronic conditions corresponded with an increase in the intake of UPF.

A study that was conducted in a European cohort found that adults whose diet included more UPF and beverages, such as ice cream, soda, and hamburgers, were more likely to develop CVD or die sooner than others who had a more wholesome diet.

As reported previously by this news organization, among adults in France who had a 10% higher intake of UPF and beverages, the rate of CVD, coronary heart disease, and cerebrovascular disease was 11% to 13% higher over a period of about 5 years.

Similarly, university graduates in Spain who consumed more than four servings of UPF and beverages a day were 62% more likely to die of any cause over about a decade than those who consumed less than two servings per day.
 

Where’s the food?

There is very little actual food in UPF. “The NOVA classification provides 4 main classes of food and beverages, the last of which is represented by the ultraprocessed food group. This comprises products (e.g., snacks, drinks, and ready meals, ‘created mostly or entirely from substances extracted from foods or derived from food constituents with little, if any intact food, which often contain flavors, colors, and other additives that imitate or intensify the sensory qualities of foods or culinary preparations made from foods,’ ” Dr. Bonaccio and colleagues wrote.

Such foods are very convenient, tasty, inexpensive, and have a long shelf life. They are highly competitive with foods that are naturally ready to consume and freshly prepared dishes and meals, the authors add.

The researchers conducted a longitudinal analysis on 22,475 men and women (mean age, 55 years; range, 43-67 years) who were recruited from the Moli-sani Study, a population-based cohort of men and women aged 35 years and older in the Molise region of southern Italy, between 2005 and 2010. Participants were followed for 8.2 years.

Food intake was assessed with the Food Frequency Questionnaire; UPF was defined using the NOVA classification according to degree of processing.

UPF intakes were categorized as quartiles of the ratio of UPF to total food consumed.

Overall, study participants reported a median of 10% (interquartile range, 6.6%-14.6%) of dietary intake as UPF and a total of 181.5 g/d of UPF intake.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

High consumers of UPF, defined as those for whom UPF constituted more than 14.6% of their total diet, were more likely to be women, to be younger, and to have a higher educational level. They also reported fewer risk factors and fewer baseline chronic diseases and health conditions than persons who consumed UPF less frequently.

In addition, high consumption of UPF was associated with lower adherence to the Mediterranean diet; higher intake of fat, sugar, dietary cholesterol, and sodium; and lower intake of fiber.

During a median follow-up of 8.2 years, 1,216 all-cause deaths occurred. Of these, 439 were attributed to CVD, 255 to IHD/cerebrovascular disease, 477 to cancer, and 300 to other causes.
 

The more UPF, the higher the risk for CVD, death

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Individuals who reported the highest intake of UPF (fourth quartile, 14.6% of total food) as opposed to the lowest (first quartile, UPF <6.6%) experienced increased risks for CVD mortality (hazard ratio, 1.58; 95% CI, 1.23-2.03), death from IHD/cerebrovascular disease (HR, 1.52, 95% CI, 1.10-2.09), and all-cause mortality (HR, 1.26; 95% CI, 1.09-1.46).

High sugar content accounted for 36.3% of the relation of UPF with IHD/cerebrovascular mortality. Other nutritional factors, such as saturated fats, were unlikely to play a role, the researchers wrote.

Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality and 12.0% for that of UPF with CVD mortality.

Subgroup analyses indicated that the magnitude of the association between UPF and all-cause mortality risk was greater among high-risk individuals, such as those with a history of CVD or diabetes. UPF was also likely to be more strongly associated with CVD mortality among those high-risk groups.

The interesting finding that the association between UPF and CVD mortality was greater among individuals with good adherence to the Mediterranean diet, which is known to have health benefits, could be explained by the fact that people who may benefit from a Mediterranean diet are more susceptible to losing health advantages when they also include “detrimental dietary behavior,” whereas those who consume a poor-quality diet are less likely to be harmed by an additional unhealthy behavior such as eating UPF regularly, wrote Dr. Bonaccio and colleagues.

“This is an interesting study confirming that consumption of highly processed foods such as pizza, processed meats, and soda are associated with greater risks of cardiovascular disease,” Walter Willett, MD, professor of epidemiology and nutrition, Harvard School of Public Health, Boston, said in an interview.

“These higher risks appear to be mediated in part by high intakes of saturated fat and sugar, but lower intakes of health-promoting aspects of diet also likely contribute to the findings,” Dr. Willett said.

“Some processing of food can be useful for preservation and control of infectious agents, but in general, a diet emphasizing minimally processed fruits and vegetables, whole grains, nuts, legumes, and plant sources of fat will be best for long-term well-being,” he said.

The study was supported in part by the Italian Ministry of Health and the HYPERCAN Study Italian Association for Cancer Research. Dr. Bonaccio and Dr. Willett reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Yet another study has linked the consumption of ultraprocessed, or “junk,” foods to bad health outcomes.

In a longitudinal analysis of more than 22,000 men and women from southern Italy, those who consumed the most ultraprocessed food (UPF) had the highest risk for cardiovascular disease (CVD) and all-cause mortality, likely mediated through a diet high in sugar, researchers said.

High consumption of UPF in this Mediterranean cohort was associated with a 58% increased risk for CVD mortality and 52% higher risk of dying from ischemic heart disease (IHD) and cerebrovascular causes, independently of known risk factors for CVD, even among individuals who otherwise adhered to the Mediterranean diet.

The findings “should serve as an incentive for limiting consumption of UPF and encouraging natural or minimally processed foods, as several national nutritional policies recommend,” Marialaura Bonaccio, PhD, department of epidemiology and prevention, IRCCS Neuromed, Pozzilli, Italy, and colleagues wrote. The results were published online Dec. 18 in the American Journal of Clinical Nutrition.

Earlier this year, as reported by this news organization, researchers found mounting evidence that the obesity epidemic and the increase in incidence of related chronic conditions corresponded with an increase in the intake of UPF.

A study that was conducted in a European cohort found that adults whose diet included more UPF and beverages, such as ice cream, soda, and hamburgers, were more likely to develop CVD or die sooner than others who had a more wholesome diet.

As reported previously by this news organization, among adults in France who had a 10% higher intake of UPF and beverages, the rate of CVD, coronary heart disease, and cerebrovascular disease was 11% to 13% higher over a period of about 5 years.

Similarly, university graduates in Spain who consumed more than four servings of UPF and beverages a day were 62% more likely to die of any cause over about a decade than those who consumed less than two servings per day.
 

Where’s the food?

There is very little actual food in UPF. “The NOVA classification provides 4 main classes of food and beverages, the last of which is represented by the ultraprocessed food group. This comprises products (e.g., snacks, drinks, and ready meals, ‘created mostly or entirely from substances extracted from foods or derived from food constituents with little, if any intact food, which often contain flavors, colors, and other additives that imitate or intensify the sensory qualities of foods or culinary preparations made from foods,’ ” Dr. Bonaccio and colleagues wrote.

Such foods are very convenient, tasty, inexpensive, and have a long shelf life. They are highly competitive with foods that are naturally ready to consume and freshly prepared dishes and meals, the authors add.

The researchers conducted a longitudinal analysis on 22,475 men and women (mean age, 55 years; range, 43-67 years) who were recruited from the Moli-sani Study, a population-based cohort of men and women aged 35 years and older in the Molise region of southern Italy, between 2005 and 2010. Participants were followed for 8.2 years.

Food intake was assessed with the Food Frequency Questionnaire; UPF was defined using the NOVA classification according to degree of processing.

UPF intakes were categorized as quartiles of the ratio of UPF to total food consumed.

Overall, study participants reported a median of 10% (interquartile range, 6.6%-14.6%) of dietary intake as UPF and a total of 181.5 g/d of UPF intake.

The foods that contributed most to total UPF consumed were processed meat, which accounted for 19.8% of UPF intake; pizza (16.8%); and cakes and pies (13.4%).

High consumers of UPF, defined as those for whom UPF constituted more than 14.6% of their total diet, were more likely to be women, to be younger, and to have a higher educational level. They also reported fewer risk factors and fewer baseline chronic diseases and health conditions than persons who consumed UPF less frequently.

In addition, high consumption of UPF was associated with lower adherence to the Mediterranean diet; higher intake of fat, sugar, dietary cholesterol, and sodium; and lower intake of fiber.

During a median follow-up of 8.2 years, 1,216 all-cause deaths occurred. Of these, 439 were attributed to CVD, 255 to IHD/cerebrovascular disease, 477 to cancer, and 300 to other causes.
 

The more UPF, the higher the risk for CVD, death

The researchers found a direct linear dose-response relation between a 5% increase in the proportion of UPF in the diet and risk for all-cause and CVD mortality.

Individuals who reported the highest intake of UPF (fourth quartile, 14.6% of total food) as opposed to the lowest (first quartile, UPF <6.6%) experienced increased risks for CVD mortality (hazard ratio, 1.58; 95% CI, 1.23-2.03), death from IHD/cerebrovascular disease (HR, 1.52, 95% CI, 1.10-2.09), and all-cause mortality (HR, 1.26; 95% CI, 1.09-1.46).

High sugar content accounted for 36.3% of the relation of UPF with IHD/cerebrovascular mortality. Other nutritional factors, such as saturated fats, were unlikely to play a role, the researchers wrote.

Biomarkers of renal function accounted for 20.1% of the association of UPF with all-cause mortality and 12.0% for that of UPF with CVD mortality.

Subgroup analyses indicated that the magnitude of the association between UPF and all-cause mortality risk was greater among high-risk individuals, such as those with a history of CVD or diabetes. UPF was also likely to be more strongly associated with CVD mortality among those high-risk groups.

The interesting finding that the association between UPF and CVD mortality was greater among individuals with good adherence to the Mediterranean diet, which is known to have health benefits, could be explained by the fact that people who may benefit from a Mediterranean diet are more susceptible to losing health advantages when they also include “detrimental dietary behavior,” whereas those who consume a poor-quality diet are less likely to be harmed by an additional unhealthy behavior such as eating UPF regularly, wrote Dr. Bonaccio and colleagues.

“This is an interesting study confirming that consumption of highly processed foods such as pizza, processed meats, and soda are associated with greater risks of cardiovascular disease,” Walter Willett, MD, professor of epidemiology and nutrition, Harvard School of Public Health, Boston, said in an interview.

“These higher risks appear to be mediated in part by high intakes of saturated fat and sugar, but lower intakes of health-promoting aspects of diet also likely contribute to the findings,” Dr. Willett said.

“Some processing of food can be useful for preservation and control of infectious agents, but in general, a diet emphasizing minimally processed fruits and vegetables, whole grains, nuts, legumes, and plant sources of fat will be best for long-term well-being,” he said.

The study was supported in part by the Italian Ministry of Health and the HYPERCAN Study Italian Association for Cancer Research. Dr. Bonaccio and Dr. Willett reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Overall survival improved by more than 20% in older adults with myelodysplastic syndrome who received allogeneic stem cell transplantation.

Major finding: Overall survival at 3 years was 47.9% for patients who received allogeneic hematopoietic cell transplantation compared to those who did not.

Study details: The data come from myelodysplastic syndrome patients with a median age of 66 years who were part of the prospective Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Study 1102 (NCT02016781) presented at the American Society of Hematology (ASH) 2020 virtual meeting.

Disclosures: Lead author Dr. Cutler disclosed serving as a consultant for Mesoblast, Generon, Medsenic, Jazz, Kadmon, and Incyte.

Source: Cutler C et al. ASH 2020.

Key clinical point: Overall survival improved by more than 20% in older adults with myelodysplastic syndrome who received allogeneic stem cell transplantation.

Major finding: Overall survival at 3 years was 47.9% for patients who received allogeneic hematopoietic cell transplantation compared to those who did not.

Study details: The data come from myelodysplastic syndrome patients with a median age of 66 years who were part of the prospective Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Study 1102 (NCT02016781) presented at the American Society of Hematology (ASH) 2020 virtual meeting.

Disclosures: Lead author Dr. Cutler disclosed serving as a consultant for Mesoblast, Generon, Medsenic, Jazz, Kadmon, and Incyte.

Source: Cutler C et al. ASH 2020.

Key clinical point: Overall survival improved by more than 20% in older adults with myelodysplastic syndrome who received allogeneic stem cell transplantation.

Major finding: Overall survival at 3 years was 47.9% for patients who received allogeneic hematopoietic cell transplantation compared to those who did not.

Study details: The data come from myelodysplastic syndrome patients with a median age of 66 years who were part of the prospective Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Study 1102 (NCT02016781) presented at the American Society of Hematology (ASH) 2020 virtual meeting.

Disclosures: Lead author Dr. Cutler disclosed serving as a consultant for Mesoblast, Generon, Medsenic, Jazz, Kadmon, and Incyte.

Source: Cutler C et al. ASH 2020.

Key clinical point: Incidence of graft vs. host disease was significantly lower in patients undergoing matched sibling donor stem cell transplants who received low-dose rabbit antitymoctye globulin (rATG).

Major finding: The 2-year cumulative incidences of chronic GVHD (cGVHD) were 35.4% and 60.4%, respectively, for patients in the rATG and non-rATG groups (P=0.039).

Study details: The data come from a retrospective study of 79 patients aged 16 years and older with hematologic malignancies who were treated with matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT); all received standard prophylaxis and 38 received 5 mg/kg of rATG in addition.

Disclosures: The study was supported in part by the Scientific Research Seed Fund of Peking University First Hospital. The researchers had no financial conflicts to disclose.

Source: Song ZY et al. Cancer Manag Res. 2020 Nov 30. doi: 10.2147/CMAR.S283855.

Key clinical point: Incidence of graft vs. host disease was significantly lower in patients undergoing matched sibling donor stem cell transplants who received low-dose rabbit antitymoctye globulin (rATG).

Major finding: The 2-year cumulative incidences of chronic GVHD (cGVHD) were 35.4% and 60.4%, respectively, for patients in the rATG and non-rATG groups (P=0.039).

Study details: The data come from a retrospective study of 79 patients aged 16 years and older with hematologic malignancies who were treated with matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT); all received standard prophylaxis and 38 received 5 mg/kg of rATG in addition.

Disclosures: The study was supported in part by the Scientific Research Seed Fund of Peking University First Hospital. The researchers had no financial conflicts to disclose.

Source: Song ZY et al. Cancer Manag Res. 2020 Nov 30. doi: 10.2147/CMAR.S283855.

Key clinical point: Incidence of graft vs. host disease was significantly lower in patients undergoing matched sibling donor stem cell transplants who received low-dose rabbit antitymoctye globulin (rATG).

Major finding: The 2-year cumulative incidences of chronic GVHD (cGVHD) were 35.4% and 60.4%, respectively, for patients in the rATG and non-rATG groups (P=0.039).

Study details: The data come from a retrospective study of 79 patients aged 16 years and older with hematologic malignancies who were treated with matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT); all received standard prophylaxis and 38 received 5 mg/kg of rATG in addition.

Disclosures: The study was supported in part by the Scientific Research Seed Fund of Peking University First Hospital. The researchers had no financial conflicts to disclose.

Source: Song ZY et al. Cancer Manag Res. 2020 Nov 30. doi: 10.2147/CMAR.S283855.

Key clinical point: The compound APR‐246 (PRIMA‐1Met/Eprenetapopt) caused synergistic tumor death in myelodysplastic syndrome with combined with inhibitors of efflux pump MRP1/ABCC1.

Major finding: A combination of combination of APR‐246 with the MRP1 inhibitor MK‐571 significantly reduced IC₅₀ values in 21 cell lines (P < 0.0001).

Study details: The data come from a combination of in vitro, ex vivo, and in vivo models, using combined treatment of APR‐246 and inhibitors of efflux pump MRP1/ABCC1. 

Disclosures: The study was funded by multiple organizations including Vetenskapsrådet, Cancerfonden (Swedish Cancer Society), Barncancerfonden (Swedish Childhood Cancer Foundation), Radiumhemmets Forskningsfonder (Cancer Research Foundations of Radiumhemmet, Knut och Alice Wallenbergs Stiftelse (Knut and Alice Wallenberg Foundation), Aprea Therapeutics, Karolinska Institutet (KI), Department of Health, Australian Government/National Health and Medical Research Council (NHMRC), Department of Health and Human Services, State Government of Victoria (DHHS), Tour de Cure Foundation, UKRI/Medical Research Council (MRC), Australian Cancer Research Foundation (ACRF), Australian Government’s National Collaborative Research Infrastructure Strategy (NCRIS) program, Peter MacCallum Cancer Centre Foundation, University of Melbourne Research Collaborative Infrastructure Program (MCRIP), and Cancer Research UK.

Source: Ceder S et al. EMBO Mol Med. 2020 Dec 14. doi: 10.15252/emmm.201910852.

Key clinical point: The compound APR‐246 (PRIMA‐1Met/Eprenetapopt) caused synergistic tumor death in myelodysplastic syndrome with combined with inhibitors of efflux pump MRP1/ABCC1.

Major finding: A combination of combination of APR‐246 with the MRP1 inhibitor MK‐571 significantly reduced IC₅₀ values in 21 cell lines (P < 0.0001).

Study details: The data come from a combination of in vitro, ex vivo, and in vivo models, using combined treatment of APR‐246 and inhibitors of efflux pump MRP1/ABCC1. 

Disclosures: The study was funded by multiple organizations including Vetenskapsrådet, Cancerfonden (Swedish Cancer Society), Barncancerfonden (Swedish Childhood Cancer Foundation), Radiumhemmets Forskningsfonder (Cancer Research Foundations of Radiumhemmet, Knut och Alice Wallenbergs Stiftelse (Knut and Alice Wallenberg Foundation), Aprea Therapeutics, Karolinska Institutet (KI), Department of Health, Australian Government/National Health and Medical Research Council (NHMRC), Department of Health and Human Services, State Government of Victoria (DHHS), Tour de Cure Foundation, UKRI/Medical Research Council (MRC), Australian Cancer Research Foundation (ACRF), Australian Government’s National Collaborative Research Infrastructure Strategy (NCRIS) program, Peter MacCallum Cancer Centre Foundation, University of Melbourne Research Collaborative Infrastructure Program (MCRIP), and Cancer Research UK.

Source: Ceder S et al. EMBO Mol Med. 2020 Dec 14. doi: 10.15252/emmm.201910852.

Key clinical point: The compound APR‐246 (PRIMA‐1Met/Eprenetapopt) caused synergistic tumor death in myelodysplastic syndrome with combined with inhibitors of efflux pump MRP1/ABCC1.

Major finding: A combination of combination of APR‐246 with the MRP1 inhibitor MK‐571 significantly reduced IC₅₀ values in 21 cell lines (P < 0.0001).

Study details: The data come from a combination of in vitro, ex vivo, and in vivo models, using combined treatment of APR‐246 and inhibitors of efflux pump MRP1/ABCC1. 

Disclosures: The study was funded by multiple organizations including Vetenskapsrådet, Cancerfonden (Swedish Cancer Society), Barncancerfonden (Swedish Childhood Cancer Foundation), Radiumhemmets Forskningsfonder (Cancer Research Foundations of Radiumhemmet, Knut och Alice Wallenbergs Stiftelse (Knut and Alice Wallenberg Foundation), Aprea Therapeutics, Karolinska Institutet (KI), Department of Health, Australian Government/National Health and Medical Research Council (NHMRC), Department of Health and Human Services, State Government of Victoria (DHHS), Tour de Cure Foundation, UKRI/Medical Research Council (MRC), Australian Cancer Research Foundation (ACRF), Australian Government’s National Collaborative Research Infrastructure Strategy (NCRIS) program, Peter MacCallum Cancer Centre Foundation, University of Melbourne Research Collaborative Infrastructure Program (MCRIP), and Cancer Research UK.

Source: Ceder S et al. EMBO Mol Med. 2020 Dec 14. doi: 10.15252/emmm.201910852.

Key clinical point: Researchers developed a flow score based on three variables: developed a “flow score” with the three variables percentage of myeloid CD34⁺ cells > 2%; percentage of B-cell progenitors < 0.05%; and CD16⁺ monocytes/TNCs > 1.0%.

Major finding: Of the 95 patients in the study, 23 remained alive after the end of the study period. A high percentage of CD16⁺ monocytes/TNCs > 1.0% (in the highest quartile) was associated with significantly worse survival.

Study details: The data come from 95 adult patients with newly diagnosed myelodysplastic syndrome seen at a single center and followed for an average of 42 months.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Vido-Marques JR et al. Sci Rep. 2020 Nov 20. doi: 10.1038/s41598-020-77158-z.

Key clinical point: Researchers developed a flow score based on three variables: developed a “flow score” with the three variables percentage of myeloid CD34⁺ cells > 2%; percentage of B-cell progenitors < 0.05%; and CD16⁺ monocytes/TNCs > 1.0%.

Major finding: Of the 95 patients in the study, 23 remained alive after the end of the study period. A high percentage of CD16⁺ monocytes/TNCs > 1.0% (in the highest quartile) was associated with significantly worse survival.

Study details: The data come from 95 adult patients with newly diagnosed myelodysplastic syndrome seen at a single center and followed for an average of 42 months.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Vido-Marques JR et al. Sci Rep. 2020 Nov 20. doi: 10.1038/s41598-020-77158-z.

Key clinical point: Researchers developed a flow score based on three variables: developed a “flow score” with the three variables percentage of myeloid CD34⁺ cells > 2%; percentage of B-cell progenitors < 0.05%; and CD16⁺ monocytes/TNCs > 1.0%.

Major finding: Of the 95 patients in the study, 23 remained alive after the end of the study period. A high percentage of CD16⁺ monocytes/TNCs > 1.0% (in the highest quartile) was associated with significantly worse survival.

Study details: The data come from 95 adult patients with newly diagnosed myelodysplastic syndrome seen at a single center and followed for an average of 42 months.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Vido-Marques JR et al. Sci Rep. 2020 Nov 20. doi: 10.1038/s41598-020-77158-z.

Higher expression of Wilms’ tumor 1 (WT-1) has been associated with poor survival in MDS. To further characterize the prognostic value of WT-1 expression level, peripheral WT-1 mRNA expression level at baseline was measured in MDS patients undergoing treatment with azacitidine. Lower WT-1 mRNA level was associated with higher overall response, as defined by CR, marrow CR, partial response, or HI (p=0.03), although WT-1 mRNA level did not show difference in overall survival. This was a small retrospective, single center study; role of WT-1 mRNA level as a biomarker for response to azacitidine should be further investigated.

Results of a multi-center trial comparing reduced intensity allogeneic stem cell transplant (SCT) to hypomethylating agents or best supportive care in higher risk MDS patients aged 50-75 was reported in the annual meeting of the American Society of Hematology in 2020. Patients with intermediate-2 or higher risk by IPSS were assigned based on SCT or no SCT arm based on donor status, and patients who had donor proceeded to reduced intensity SCT within 6 months of enrolment. In an intent-to-treat analysis, the study showed different in 3-year overall survival, which was the primary endpoint between SCT vs non-SCT arms (47.9% vs 26.6%, p=0.0001). Leukemia-free survival at 3 years was also greater for the SCT arm (35.8% vs 20.6%, p=0.003). Allogenic stem cell transplant is currently offered to patients with higher risk MDS given this is the only potential curable approach for MDS patients. This study further supports allogeneic stem cell transplant for older patients with higher risk MDS.

Higher expression of Wilms’ tumor 1 (WT-1) has been associated with poor survival in MDS. To further characterize the prognostic value of WT-1 expression level, peripheral WT-1 mRNA expression level at baseline was measured in MDS patients undergoing treatment with azacitidine. Lower WT-1 mRNA level was associated with higher overall response, as defined by CR, marrow CR, partial response, or HI (p=0.03), although WT-1 mRNA level did not show difference in overall survival. This was a small retrospective, single center study; role of WT-1 mRNA level as a biomarker for response to azacitidine should be further investigated.

Results of a multi-center trial comparing reduced intensity allogeneic stem cell transplant (SCT) to hypomethylating agents or best supportive care in higher risk MDS patients aged 50-75 was reported in the annual meeting of the American Society of Hematology in 2020. Patients with intermediate-2 or higher risk by IPSS were assigned based on SCT or no SCT arm based on donor status, and patients who had donor proceeded to reduced intensity SCT within 6 months of enrolment. In an intent-to-treat analysis, the study showed different in 3-year overall survival, which was the primary endpoint between SCT vs non-SCT arms (47.9% vs 26.6%, p=0.0001). Leukemia-free survival at 3 years was also greater for the SCT arm (35.8% vs 20.6%, p=0.003). Allogenic stem cell transplant is currently offered to patients with higher risk MDS given this is the only potential curable approach for MDS patients. This study further supports allogeneic stem cell transplant for older patients with higher risk MDS.

Higher expression of Wilms’ tumor 1 (WT-1) has been associated with poor survival in MDS. To further characterize the prognostic value of WT-1 expression level, peripheral WT-1 mRNA expression level at baseline was measured in MDS patients undergoing treatment with azacitidine. Lower WT-1 mRNA level was associated with higher overall response, as defined by CR, marrow CR, partial response, or HI (p=0.03), although WT-1 mRNA level did not show difference in overall survival. This was a small retrospective, single center study; role of WT-1 mRNA level as a biomarker for response to azacitidine should be further investigated.

Results of a multi-center trial comparing reduced intensity allogeneic stem cell transplant (SCT) to hypomethylating agents or best supportive care in higher risk MDS patients aged 50-75 was reported in the annual meeting of the American Society of Hematology in 2020. Patients with intermediate-2 or higher risk by IPSS were assigned based on SCT or no SCT arm based on donor status, and patients who had donor proceeded to reduced intensity SCT within 6 months of enrolment. In an intent-to-treat analysis, the study showed different in 3-year overall survival, which was the primary endpoint between SCT vs non-SCT arms (47.9% vs 26.6%, p=0.0001). Leukemia-free survival at 3 years was also greater for the SCT arm (35.8% vs 20.6%, p=0.003). Allogenic stem cell transplant is currently offered to patients with higher risk MDS given this is the only potential curable approach for MDS patients. This study further supports allogeneic stem cell transplant for older patients with higher risk MDS.