Category: 3. Business

  • Strategist warns of capital flight risk from Japan, drawing parallels with Liz Truss era

    Strategist warns of capital flight risk from Japan, drawing parallels with Liz Truss era

    By Steve Goldstein

    Deutsche Bank says simultaneous move in yen and JGBs is reminiscent of sterling and gilt fall in 2022

    The premierships of Sanae Takaichi, left, and Liz Truss, both have been bad for their domestic bonds and currency.

    Have we seen this movie before?

    The simultaneous decline in Japanese bond yields BX:TMBMKJP-30Y and its currency (USDJPY) is reminding Deutsche Bank’s head of currency research of Liz Truss’s ill-fated premiership, when sterling and U.K. gilts tumbled in value after the introduction of what’s called a mini-budget.

    New Japanese Prime Minister Sanae Takaichi differs from Truss in that she wants to spend rather than cut taxes, but both plans amount to aggressive fiscal stimulus.

    The U.S. dollar and U.S. Treasury bonds also fell simultaneously in April in reaction to President Donald Trump’s “Liberation Day” tariff plan, which subsequently has been reduced in scope.

    “While most commentators have been focused on the recent bout of volatility in U.S. equity markets, something far more worrying is happening elsewhere in our view: the Japanese yen and bond market are collapsing together, with the dynamic sharply accelerating in recent days. The yen and 30-yr government bond have dropped by more than 5% in recent weeks, all the more remarkable given that global fixed-income markets have been rallying elsewhere,” said Deutsche Bank’s George Saravelos.

    He says the issue in Japan is that inflation expectations have become unanchored.

    “If domestic confidence in the government’s and Bank of Japan’s commitment to low inflation is lost, the reasons to buy JGBs disappear, and more disruptive capital flight ensues,” he says.

    Saravelos said that he’ll be watching for signs of capital flight, and whether Japanese authorities give in to pressure from financial markets.

    -Steve Goldstein

    This content was created by MarketWatch, which is operated by Dow Jones & Co. MarketWatch is published independently from Dow Jones Newswires and The Wall Street Journal.

    (END) Dow Jones Newswires

    11-21-25 0523ET

    Copyright (c) 2025 Dow Jones & Company, Inc.

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  • Hydrogen Europe

    Hydrogen Europe

    Solvay and Sapio sign ten-year agreement for the production of renewable hydrogen in Rosignano, Italy

    Solvay and Sapio have entered a 10-year agreement to collaborate on renewable hydrogen production at Solvay’s Rosignano facility, part of the Hydrogen Valley Rosignano Project aimed at cutting CO2 emissions from Solvay’s peroxides operations.

    Under the agreement, Sapio will construct and manage a 5 MW electrolysis system, powered by a 10 MW photovoltaic installation built by Solvay. The project, expected to be operational by mid-2026, will produce up to 756 tons of renewable hydrogen annually, reducing the site CO2 emissions by up to 15%. It has received €16 million in funding from the Tuscan Region under Italy’s National Recovery and Resilience Plan (PNRR).

    Click here to read more

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  • New Dexcom G7 Feature Cleared as 15-day Sensor Set to Launch – Medscape

    1. New Dexcom G7 Feature Cleared as 15-day Sensor Set to Launch  Medscape
    2. Dexcom Smart Basal Receives FDA Clearance Becoming the First and Only CGM-integrated Basal Insulin Dosing Optimizer for Type 2 Diabetes  DexCom Investor Relations
    3. FDA clears Dexcom’s Type 2 diabetes software for optimizing basal insulin doses  Fierce Biotech
    4. FDA clearances: Dexcom, GE HealthCare, Zimmer Biomet, BrainsWay  Modern Healthcare News
    5. Dexcom wins FDA nod for smart CGM-integrated basal dosing for type 2 diabetes  MassDevice

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  • Norwegian Saleform 2012 – Court of Appeal Rules Buyers Can Recover Loss of Bargain Damages under Cla : Clyde & Co

    Norwegian Saleform 2012 – Court of Appeal Rules Buyers Can Recover Loss of Bargain Damages under Cla : Clyde & Co

    Does a seller’s failure to deliver a ship by the agreed Cancelling Date under a ship sale Memorandum of Agreement (MOA) on the Norwegian Saleform 2012 (NSF 2012) – resulting in the cancellation of the MOA – entitle the buyer to recover “loss of bargain” damages under Clause 14 of the NSF 2012 where said failure did not amount to a repudiatory breach by the seller?

    The Court of Appeal answered this in the affirmative in Orion Shipping & Trading LLC v Great Asia Maritime Ltd (The “LILA LISBON”) [2025] EWCA Civ 1210, overturning the earlier High Court decision.

    Background

    In this case, the sellers (Orion Shipping and Trading LLC) had agreed to sell the “LILA LISBON”, a Capesize bulk carrier, to the buyers (Great Asia Maritime Ltd) for US$15 million under a Memorandum of Agreement made on the Norwegian Saleform 2012, dated 4 June 2021.

    Following the sellers’ failure to serve the Notice of Readiness by the (extended) Cancelling Date, the buyers proceeded to cancel the sale contract in accordance with its terms and commence arbitration proceedings. The buyers sought to recover from the sellers US$1.85 million, this amount representing the difference between the market price of the vessel at the date of cancellation (US$16.85 million) and the sale contract price (US$15 million).

    Clause 14 NSF 2012

    Under the terms of the MOA, Clause 14 of the NSF 2012 provided that, “should the Sellers fail to give Notice of Readiness … or fail to be ready to complete a legal transfer by the Cancelling Date the Buyers shall have the option of cancelling this Agreement…In the event that the Buyers elect to cancel this Agreement, the Deposit together with interest earned, if any, shall be released to them immediately.

    In addition, Clause 14 provided that in the event the sellers failed to provide Notice of Readiness by the Cancelling Date or failed to be ready to validly complete a legal transfer, “…they shall make due compensation to the Buyers for their loss and for all expenses together with interest if their failure is due to proven negligence and whether or not the Buyers cancel this Agreement.”

    Arbitration Tribunal

    The Arbitration Tribunal found in favour of the buyers and awarded them US$1.85 million by way of damages for “loss of bargain” together with compound interest at 5% per annum. The Tribunal found that the sellers’ failure to deliver by the Cancelling Date was due to proven negligence on their part and concluded that the buyers were entitled to loss of bargain damages under Clause 14.

    High Court

    Following an appeal by the sellers to the High Court, the judge reversed the Tribunal’s award holding that the buyers were not entitled to damages for “loss of bargain” under Clause 14 and that, furthermore, the sellers were under no obligation to provide Notice of Readiness by the Cancelling Date.

    Court of Appeal

    The buyers proceeded to appeal to the Court of Appeal which held that a buyer was entitled to “loss of bargain” damages where the seller’s failure to deliver the vessel by the Cancelling Date was caused by “proven negligence” as contemplated by Clause 14 of the NSF 2012.

    Reasonable Diligence

    Furthermore, the Court found that, under the NSF 2012, a seller is under an obligation to use reasonable diligence to deliver the vessel by the Cancelling Date. It held that the Judge was wrong to conclude that there was no obligation on sellers to tender Notice of Readiness, nor to be ready to validly complete a legal transfer, by the Cancelling Date.

    Loss of Bargain Damages

    Importantly, the Court did not find the sellers’ conduct to be a repudiatory breach. Typically, under English law, “loss of bargain” damages are only recoverable where a contract is terminated following such a breach. However, Clause 14 of the NSF 2012 creates a distinct contractual mechanism: if the seller fails to deliver due to proven negligence, the buyer may cancel and claim compensation for losses and expenses, including the “loss of bargain”.

    Proven Negligence

    So, what was the “proven negligence” in The ”LILA LISBON”? The sellers’ failure to deliver by the original Cancelling Date of 20 August 2021 derived from regulations at Qingdao which required the departing crew to leave mainland China on the day of disembarkation. The sellers’ failure to arrange the necessary flights in time, resulting in the loss of the berthing slot, constituted “proven negligence” on the part of the sellers.

    Following this, the sellers proposed a revised Cancelling Date of 15 October 2021, which Buyers accepted, however, without prejudice to their rights under Clause 14 to claim damages for all loss and expense suffered. The sellers, once more, failed to deliver the vessel by the revised Cancellation Date, not having taken reasonable steps to arrange this, and this failure was again attributable to their proven negligence.

    Loss of Use Damages

    It should be noted that the sellers’ failure to deliver by the original Cancelling Date due to proven negligence also entitled the buyers to damages under Clause 14 for loss of use of the ship for 56 days – from 20 August to 15 October 2021 – and this was assessed by the Arbitration Tribunal at US$1,650,992. This aspect of the award was not challenged before the Court of Appeal.

    Comment

    It is well known that in volatile markets, the difference between the contract price of an asset and its market value on or around the time of sale can vary significantly.

    In a seller/owner-friendly market, this may tempt sellers to delay delivery of the vessel under the relevant MOA (potentially agreed when the market was less seller-friendly) either to simply delay delivery and continue benefiting from flows of charter income or, should they eventually wish not to deliver the vessel at all, to purposefully extend the Cancelling Date in the hope that buyers will at some point cancel the MOA and only seek compensation of mere-out of pocket expenses (estimated to be lower than the forecasted sellers’ gains from a future sale of the vessel or even from its continuous employment in the charter market) without buyers engaging in expensive litigation and arrest proceedings.

    Also, in a seller/owner-friendly market, the buyers would not normally opt to cancel an MOA (entered into on the NSF 2012 form) if the sellers simply missed the contractually agreed Cancelling Date unless, in the meantime, the market price of the same type of vessel had been, or was forecasted to be soon, significantly reduced and the vessel had, consequently, become or would soon become “overpriced”.

    The “LILA LISBON” Court of Appeal ruling now provides valuable clarity as to the required performance standards for sellers and the remedies available to buyers under the widely used NSF 2012 in commercial shipping.

    For sellers, this judgement emphasizes the importance of operational diligence and underlines the fact that it is now clear that:

    1. sellers have to be reasonably diligent in meeting the Cancelling Date under the NSF 2012 (and any extension would be “entirely without prejudice to any [buyers’] claim for damages” under the standard NSF 2012), and
    2. loss of bargain damages are recoverable under Clause 14 of the NSF 2012 following a contractual cancellation, and
    3. the lack of a repudiatory breach does not prevent buyers from claiming “loss of bargain” damages. This also signifies the importance of sellers considering their potential exposure to the aforementioned damages if they fail to meet the relevant deadline variations in the Cancelling Date under the MOA.

    For buyers, this decision brings comfort knowing that their financial interests in the transaction are, in principle, safeguarded under the NSF 2012 form. It might be expected that, if sellers missed the deadline for delivery of the vessel due to their own negligence (especially more than once as in this case), buyers would wish to cancel the NSF 2012 under Clause 14 of the MOA.

    The decision, therefore, strengthens the buyers’ position by ensuring that the right to cancel under Clause 14 is backed by a sensible financial remedy, assuming that sellers do not negotiate wording that restricts buyers from the right to claim such remedies unless a proven repudiatory breach has taken place on the sellers’ side. However, in practice, buyers may not be in a position to prove the sellers’ negligence and lack of reasonable diligence at the time they cancel the MOA.

    One point that also remains open is that the Court of Appeal decision does not elaborate on the standard for assessing what equates to “reasonable due diligence” in the context of an NSF 2012 MOA, although there is substantial case law material that addresses the interpretation of these two terms (albeit not necessarily in a conclusive way).

     

     

     

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  • What to serve at your drinks party? An expert guide

    What to serve at your drinks party? An expert guide

    It’s around this time of year that I start getting messages from friends: “What cocktails shall I serve at my party?” “Can you recommend a good champagne for Christmas Day?” “How do I make an Espresso Martini?” So here are some festive drinks tips from some of the best hosts in the business.


    Keep it refreshing

    “Partying is a thirsty business – so go with wines that will leave you refreshed,” says Dye. “A fun crowd-pleaser like a zippy Grüner Veltliner or juicy Beaujolais.” Even in the depths of winter I also always serve lashings of rosé. Chilled wines on the rosé/red cusp also always go down well.

    Christian Tschida Birdscape Pink, £39. BUY

    Clos de Grillons Esprit Libre, £38.25

    Clos de Grillons Esprit Libre, £38.25. BUY

    “A deep, dark rosé – Christian Tschida Birdscape Pink – or very light chilled red – Clos des Grillons Esprit Libre – that can be consumed on its own or with food, and doesn’t have to be treated with the utmost care,” says McMillan. 


    Use drinks as a focal point

    A beautiful fruit-strewn punch that allows guests to serve each other can really break the ice (see recipe below). Serve with a little handwritten card alongside detailing the ingredients so you don’t have to explain it a hundred times. People tend to congregate in the kitchen, so use drinks to create focal points elsewhere; lay on mezcal shots in the sitting room or a pastis in the garden. Or create a spectacle, à la One Club Row, and construct a Martini tower.

    Iced Peach Tea Punch by Juliette Larrouy

    Serves approx 30

    2 litres cold black peach tea

    1.5 litres white rum

    1 litre simple syrup (1kg sugar dissolved in 1 litre of water over a low heat and left to cool)

    500ml fresh lemon juice

     

    Mix all the ingredients in a bowl or jugs and chill in the fridge. Serve over ice with lots of citrus wheels.


    Champagne is a no-brainer

    Free-flowing champagne is marvellous – but it doesn’t need to last all night. I think it’s rather chic to serve a little coupe of champagne before moving on to cocktails. “Make sure it’s perfectly chilled to 8°C or 9°C prior to opening,” says Xavier Padovani. “Then allow it to go up to 10°C once it’s out of the refrigerator. Serve it in wine glasses – no one uses champagne glasses any more.”

    Legrand-Latour Yprésien 2018, £110

    Legrand-Latour Yprésien 2018, £110. BUY

    Langham Culver Classic Cuvee, £33.95

    Langham Culver Classic Cuvee, £33.95. BUY

    A niche grower champagne should get people talking – especially if it has an interesting story attached. I love Legrand-Latour’s floral Yprésien 2018 – a Meunier-forward, subtly floral organic champagne, from a cave that’s studded with fossils. Or, if it’s an oenophile crowd, then consider English fizz. Sessions Arts Club’s head of wine Sophie Liverman suggests Langham’s classy Culver Classic Cuvée, which recently won Best Non-Vintage Sparkling at the WineGB awards. 


    Quantity is quality

    Get drinks into your guests’ hands as soon as they arrive, says Tadas Alisauskas. “The first moments of a party are crucial.” “And plan to serve two to three drinks per guest for the first two hours, then one drink per hour after,” says Svajune Janeliunaite 


    Lean in to alcohol-free

    Saicho Sparkling Tea in Hojicha, Jasmine and Darjeeling, £17.99 each
    Saicho Sparkling Tea in Hojicha, Jasmine and Darjeeling, £17.99 each

    Don’t neglect the non-alc options – even the biggest boozers need a break sometimes. “I’ll always offer a great selection of non-alcoholic beers, spirit alternatives such as Pentire Coastal Spritz, and a variety of sodas so guests can experiment,” says Nathan McCarley-O’Neill of Carbone. Good de-alcoholised wines are hard to come by, but the rosé fizz Beau Viva – which is made by the same people as Provençal rosé Maison Saint AIX – is great.

    Vichy Catalan Naturally Sparkling Water, £2.9

    Vichy Catalan Naturally Sparkling Water, £2.95. BUY

    Beau Viva, £27.50

    Beau Viva, £27.50. BUY

    Sparkling teas such as Saicho or Real offer a sophisticated substitute for champagne. A little gaggle of Crodinos on ice is hard to resist. And a smart sparkling water – Vichy Catalan or Chateldon 1650 – will also show you’ve put some thought into it.  


    Keep it simple

    People often mistakenly offer too many choices. “People will try to offer something like 10 drinks, and then get overwhelmed. It’s much better to have two or three that you execute really well,” says Strangeway. “You want something you can make ahead of time, like a bottled cocktail or a punch. I would never shake a cocktail at a party – it just creates chaos and mess.” (Which means Espresso Martinis are out.)

    Bottled Pomegranate Negroni by Nick Strangeway

    Serves approx 30

    750ml gin

    750ml red vermouth

    750ml Campari or other Italian bitter

    750ml Pom Wonderful pomegranate juice (other brands may need filtering to remove sediment)

    Mix all ingredients together, bottle and put in the fridge overnight to chill. Serve 100ml over a block of ice, in a rocks glass, garnished with a few pomegranate seeds. 

    Strangeway suggests serving a pre-bottled Pomegranate Negroni with a scattering of ruby pomegranate seeds (see his recipe, below). “Set the bottles out on the table in big tin baths full of ice and let people help themselves.”

    Town’s Bottled Dill Boy Martini

    Makes approx 700ml or 8 servings

    340ml Luksosowa vodka (or other potato vodka)

    140ml Aalborg Dill Akvavit

    70ml Noilly Prat dry vermouth

    170ml chilled mineral water

    0.7g sea salt

     

    Mix ingredients together, bottle and store in the fridge. Place in freezer for 2-3 hours before serving (but no longer or it will freeze solid). Garnish with a sprig of fresh dill or a few drops of dill oil.

    “I’ll always make sure there are some freezer Martinis ready too, just in case we need to get things kick-started,” says Kevin Armstrong. (See his akvavit-spiked twist on a classic Martini, currently on the menu at Town restaurant.) Sparkling wine with a slosh of liqueur is another easy win – I love 25ml of yuzu sake topped up with chilled champagne.


    Don’t stint on the ice

    The number-one party fail, according to everyone, is not getting in enough ice. “Too many people treat ice like an optional extra rather than the lifeblood of the party,” says James Dye. “Warm drinks are unforgivable. You need tonnes more ice than you think.” If you’re serving cocktails, budget four to five cubes per drink; if you’re using ice to chill drinks as well, allow 1kg per person. If you don’t have room in the freezer, stack the bags tightly together in the bath or sink, to slow the rate at which they melt.

    For really show-stopping cocktails, order in some crystal‑clear ice blocks and spheres from a specialist supplier such as Ice Studio. For a more DIY flourish, Nick Strangeway suggests serving festive G&Ts over rectangular ice cubes with pine sprigs frozen inside.

    Chill wine, beer and mixers well in advance. “Put them in the refrigerator at least the night before,” says Juliette Larrouy. If possible, freeze your cocktail glasses as well – it will give your drinks the edge.


    Go large…

    “Magnums only! It screams celebration and is just fun to pour,” says Alisauskas. “Magnums are always fun,” agrees Amanda McMillan. “A delicious magnum of a light, chilled red equals party time.” “The theatricality of opening a big bottle of champagne is super-friendly,” says Padovani. “Relatively speaking, large formats can be cheaper, too. At the Farm Club nightclub in Verbier, we usually open a mag or two of Ruinart to kick off the season.”

    Ruinart Blanc de Blancs NV, £218 (Magnum)

    Ruinart Blanc de Blancs NV, £218 (Magnum). BUY

    Koehler-Ruprecht, £56, in store only at Shrine to the Vine

    Koehler-Ruprecht, £56, in store only at Shrine to the Vine

    Turning up at a party with a (ready-chilled) magnum of Riesling is also a good way to make a splash, says Liverman: “If you can find them, magnums of Koehler-Ruprecht (£56, in store only, shrinetothevine.co.uk) are very well-priced.”


    Something to snack on

    Cocktails at The Black Duke, Brunswick House, London
    Cocktails at The Black Duke, Brunswick House, London © Brennan Bucannan

    And last but not least, don’t forget the food. “A baller move,” says McMillan, “is to serve some potato chips – the Spanish ones Bonilla a la Vista that come in a tin can are the very best – some oscietra caviar (don’t forget the caviar spoon, it’s essential), and crème fraîche. I also like to do a beautiful rustic grand aïoli plate with the prettiest vegetables I can find – lettuces, snap peas, green beans, radishes, sungold tomatoes – served with aïoli. A hot dog party also always crushes.” Alex Young prefers his party drinks with “a platter of cigarettes”. 

    @alicelascelles


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  • Understand Markets With Trusted Global Data

    Understand Markets With Trusted Global Data

    Analyze market sizes and trends with expert-verified data

    Access data across 1,000+ markets in 190+ countries to understand market size, segmentation, and economic performance.

    • Compare the size and segmentation of markets across countries and regions
    • Track current volume and economic performance in key markets
    • Understand the factors driving growth or decline in the market

    Learn how

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  • Thailand Monthly Economic Monitor (English) – World Bank Group

    Thailand Monthly Economic Monitor (English) – World Bank Group

    1. Thailand Monthly Economic Monitor (English)  World Bank Group
    2. Analysts forecast rate cut in December  bangkokpost.com
    3. Thailand Risks Sliding to Fifth-Largest ASEAN Economy Within Five Years, Warns Industry Federation  Nation Thailand
    4. Thai Q3 GDP grows 1.2% y/y, slowest pace in four years  The Star | Malaysia
    5. Thai FinMin Confident in Fourth-Quarter Growth on Strong Fiscal Foundation and Stimulus  kaohoon international

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  • Chinese cruise ships look to steer clear of Japan amid diplomatic dispute – Reuters

    1. Chinese cruise ships look to steer clear of Japan amid diplomatic dispute  Reuters
    2. Korean travel stocks rally as China imposes Japan travel ban  The Korea Times
    3. Japan’s Tourism Industry Reels As Chinese Cruise Liner Cancels Miyakojima Stop Due To Escalating Tensions, Underlining The Broader Impact Of Political Conflicts On Global Travel  Travel And Tour World
    4. While foreign tourists have recovered to pre-corona levels, there is an analysis that Korea’s touris..  매일경제
    5. Cosmetics stocks climb on expected spillover from China Hanil-ryeong – CHOSUNBIZ  Chosun Biz

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  • Error Page

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    newsroom.st.com | RBZ Access denied (403)

    Current session has been terminated.

    ALERT! You are entering into a secured area! Your IP, Login Time, Username has been noted and has been sent to the server administrator! This service is restricted to authorized users only. All activities on this system are logged. Unauthorized access will be fully investigated and reported to the appropriate law enforcement agencies.

    Ref: 87.118.116.236 1763716598

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  • Patient with High-Risk Mantle Cell Lymphoma

    Patient with High-Risk Mantle Cell Lymphoma

    A previously health women in her 60s was diagnosed with high-risk mantle cell lymphoma. A year after enrolling in a clinical trial for a combination of monoclonal antibody, BTK inhibitor and BCL-2 inhibitor, she experienced complete remission with minimal side effects.

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    Case presentation

    A retired middle school teacher sought medical attention for enlarged lymph nodes in her neck. This led to a biopsy, which led to a diagnosis of mantle cell lymphoma. Her spleen was also quite enlarged at 27 centimeters, which is roughly double the normal size. In addition, she had pancytopenia from bone marrow involvement with mantle cell lymphoma.

    Her community oncologist recommended initiating bendamustine and rituximab. However, after reading that some mantle cell lymphoma doesn’t respond to chemotherapy, she reached out to Cleveland Clinic Cancer Institute for a second opinion.

    With a team of seven lymphoma specialists, Cleveland Clinic Cancer Institute has a depth of experience treating patients with this somewhat rare condition, which represents less than 10% of non-Hodgkin’s lymphoma.

    Further evaluation and testing showed that the patient’s tumor harbored a TP53 mutation, which is typically associated with poor outcomes.

    “In recent years, the hematology community has increasingly recognized that patients with mantle cell lymphoma who have TP53 mutations in their biopsy specimens at the time of diagnosis are at increased risk of failure with chemotherapy,” explains Director of the Lymphoid Malignancies Program and Staff Physician Brian T. Hill, MD, PhD. “Patients with these mutations tend to respond better to BTK inhibitors and BCL-2 inhibitors.”

    Treatment plan

    The patient contacted the Institute’s Cancer Answer Line, whose goal is to arrange an appointment within seven days of the referral. “We really prioritize swift access to care because time is of the essence both in getting the disease under control and because patients are appropriately anxious,” says Dr. Hill. “Referring physicians also appreciate that if they need guidance with a challenging case, their patients can be seen quickly by one of our disease specialists.”

    Based on the patient’s high-risk disease status and mutation status, Dr. Hill spoke with the patient and her husband about participating in a clinical trial where she would receive the monoclonal antibody rituximab in combination with the BTK inhibitor acalabrutinib and the BLC-2 inhibitor venetoclax. The goal was to provide her with treatment targeted for this mutation and spare her the side effects of traditional cytotoxic chemotherapy. The patient and her husband were eager to hear about alternatives to nonspecific chemotherapy, and she decided to participate in the trial.

    “People often think of clinical trials as a last resort option and that’s not the case, especially in lymphoma,” says Dr. Hill. “We have so many good treatments and increasingly they’re being used in the frontline setting instead of chemotherapy. There are many clinical trial opportunities in the frontline setting as well as for patients who have relapsed. If your patient is at a fork in the road and you’re unsure of the right approach, I’d recommend speaking with a disease team specialist.”

    After enrolling in the trial, the patient received IV rituximab monthly and the oral agents daily for roughly a year. All treatment was administered on an outpatient basis.

    Outcome

    The patient tolerated the treatment remarkably well. Aside from minor bruising on her arms, which is common with BTK inhibitors, she had few side effects. There were mild changes to her platelet count but there were no neutropenia, infections or other cytopenias.

    PET scans were performed at baseline and at the end of treatment. The scans showed that the patient entered a complete metabolic response. Minimal residual disease (MRD) testing showed no detected lymphoma. The plan is for her to continue acalabrutinib as a single agent maintenance therapy as part of the study.

    This “chemo free” approach is likely to be a standard of care for mantle cell lymphoma in the future, particularly for patients with TP53 mutation

    Case highlights

    Dr. Hill shared several takeaways from this case:

    Consult with disease specialists for rare diseases. “Especially for less common diseases, it’s prudent to discuss cases like this with disease specialists,” says Dr. Hill. “The standard of care changes rapidly, and it’s difficult to stay up to date with all the changes in a community setting where you’re managing multiple diseases.”

    Having a deep roster of specialists improves care. Dr. Hill specifically highlighted his outstanding colleagues at main campus, Drs. Caimi, Brooks, Winter, Jagadeesh, Dean and Bezerra, who all focus specifically on lymphoma. In addition to seeing patients and leading research studies, they run a weekly Lymphoma Tumor Board for complex cases. These insights are essential in a fast-moving field like lymphoma where the treatment landscape is shifting rapidly.

    MRD testing is increasingly used clinically and in research studies to attain a more sensitive assessment of the depth of remission. MRD negativity correlates with a longer duration of response. “The patient achieved a deep remission, which we typically wouldn’t expect in this situation if she had received chemotherapy, explains Dr. Hill.”

    The Institute’s hematopathologists keep up to date with the latest molecular testing and all indications. “TP53 testing for mantle cell lymphoma is now standard for Cleveland Clinic patients,” says Dr. Hill.

    A strong research team makes a difference for patients. Dr. Winter, the principal investigator of the clinical trial, and the research nurses were instrumental in the patient’s care. Specifically, Sarah Billy, RN, made a big impression on the patient and her family for her attention to detail and close follow-up.

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