Haematology

24/05/2022

Updated myeloma risk stratification. 35% of data derived from a UK clinical trial

PURPOSE Patients with newly diagnosed multiple myeloma (NDMM) show heterogeneous outcomes, and approximately 60% of them are at intermediate-risk according to the Revised International Staging system (R-ISS), the standard-of-care risk stratification model. Moreover, chromosome 1q gain/amplification....

23/05/2022

Older patients with DLBCL can be equally well transplanted

Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma (NHL), has a poor prognosis in the relapsed or refractory (R/R) setting. The risk of developing NHL increases throughout life, with more than half of patients ≥65 years at the time of diagnosis (1). Following th...

13/12/2020

Quick reminder
Cefepime = ceftriaxone + pseudomonas coverage
Tazocin (pip/tazo) = cefepime + anaerobic coverage
Meropenem = Tazocin + ESBL coverage
Ertapenem = Meropenem - pseudomonas coverage

07/12/2020

Dara-VCD new standard of care for AL AMYLOID

24/11/2020

Nice work from the Spanish group on smoldering multiple myeloma (SMM). Recently, MM was redefined to include biomarkers predicting a high risk of progression from SMM, thus necessitating a redefinition of SMM and its risk stratification. They assembled a large cohort of SMM patients meeting the revised IMWG criteria to develop a new risk stratification system. 1996 patients, based on stepwise selection and multivariable analysis, they identified three independent factors predicting progression risk at 2 years: serum M-protein >2 g/dL (HR: 2.1), involved to uninvolved free light-chain ratio >20 (HR: 2.7), and marrow plasma cell infiltration >20% (HR: 2.4). This translates into 3 categories with increasing 2-year progression risk: 6% for low risk (38%; no risk factors, HR: 1); 18% for intermediate risk (33%; 1 factor; HR: 3.0), and 44% for high risk (29%; 2–3 factors). Addition of cytogenetic abnormalities (t(4;14), t(14;16), +1q, and/or del13q) allowed separation into 4 groups (low risk with 0, low intermediate risk with 1, intermediate risk with 2, and high risk with ≥3 risk factors) with 6, 23, 46, and 63% risk of progression in 2 years, respectively.

09/11/2020

Same issue over and over again. Thrombophilias and adverse pregnancy outcome. Evidence‐based evaluation and treatment of patients with adverse pregnancy outcomes is often impeded by two factors: understandably emotionally charged parents who would ‘do anything’ to have a successful pregnancy outcome, and are thus accepting of unproven and unnecessary invasive treatments, and clinicians’ uncertainty and the willingness to ‘try anything’ in this context. At present, within a heterogeneous set of underlying causes, inherited thrombophilias appear to be, at best, a weak contributor to adverse pregnancy outcomes. As always, association does not prove causation, and even if causation is established, effective therapies need to be available before routine testing can be justified. This is not the case for heritable thrombophilias, and as a result, testing for them in women who have sustained adverse pregnancy outcomes cannot currently be recommended. Their increased prevalence in the population does not justify testing with a view to improving long‐term maternal health outcomes either, as this approach has not been shown to confer a net benefit, and has potential harms associated with insurance risk profiles, unecessary anxiety and familial consequences of this genetic information.

14/10/2020

Simple scoring system to help predict outcomes (PFS & OS) in in pts. Really useful and easily applicable:
1 point for each at initiation
- TP53 abn
- prior Rx
- B2M>5 mg/L
- LDH>250 U/L

3y PFS:
3-4: high 47%
2: intermediate 74%
1-0 low: 87%

06/06/2020

High prognostic significance of PET in early Hodgkin Lymphoma. A positive PET did not carry uniform prognostic weight; only a PET score of 5 was associated with inferior outcomes.

In RAPID, a positive PET scan did not carry uniform prognostic weight; only a PET score of 5 was associated with inferior outcomes. This suggests that in future trials involving patients without B symptoms or mediastinal bulk, a score of 5 rather than a positive PET result should be used to guide tr...

03/06/2020

Faster and better responses with the combination. 5 months improvement in survival as well. Secondary AML still does poorly. Aza+Ven vs Aza + PBO

EHA Library; DiNardo C. Jun 14 2020; 303390;

10/04/2020

Take a new CLL. Assign 1 point for each one of the following: unmutated IGHV genes, absolute lymphocyte count >15 x10 (9)/l, and presence of palpable lymph nodes. Risk classify your patient to either low-risk (score 0), intermediate-risk (score 1) or high-risk (score 2-3). Estimate the 5-year cumulative risk of treatment start to be around 8.4%, 28.4%, and 61.2% if low-risk, intermediate-risk, or high-risk

10/04/2020

Phase II trial, Acalabrutinib in R/R CLL. Median No of previous treatments 2.ORR including PR with lymphocytosis, with acalabrutinib was 94%; responses similar regardless of presence of del(11)(q22.3), del(17)(p13.1), complex karyotype, or immunoglobulin variable region heavy chain mutation status. Median DoR and PFS not reached. Estimated 45-month PFS 62% (95% confidence interval, 51% to 71%). BTK mutation was detected in 6 of 9 patients (67%) at relapse.