Convalescent plasma for COVID-19, race linked to cancer-associated thrombosis risk, iron deficiency common in pregnancy, and more from ‘Best of ASH’
Release Date: 01/21/2021
Biosimilars with Dr. Gary Lyman
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Existing biosimilars are safe, effective alternatives to their reference biologics, and are increasingly being incorporated into oncology treatment guidelines. Technological advances that have emerged in the years since biologic agents entered the market allow for the careful assessment of “critical clinical attributes” of biosimilar agents. This helps ensure the safety and efficacy of biosimilars, as well as their structural, functional, and behavioral similarities to the original reference biologics, according to , professor and senior lead, health care quality and policy at the...
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Advanced bladder cancer: Dr. Arjun Balar talks treatment strategies in a changing field
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Systemic treatment for advanced urothelial cancer is quickly evolving. On this week’s podcast, , MD, director of the genitourinary medical oncology program at New York University discusses his approach amid changing times with guest host Alan Lyss, MD, a community-based medical oncologist and clinical researcher in the St. Louis area before his recent retirement. Chemotherapy or immunotherapy first line? With the negative phase 3 results for chemotherapy in combination with either pembrolizumab or atezolizumab, “if I use immunotherapy, I use it alone,” Dr. Balar said. Patients who...
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Gene therapies in hemophilia with Dr. Glenn Pierce
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Thrombosis and thrombocytopenia caused by COVID-19 vaccines: How to identify and treat VITT, VIPIT, or TTS
Blood & Cancer
At least 17 cases of thrombosis and thrombocytopenia have been reported in patients who received the Johnson & Johnson COVID-19 vaccine in the United States. Such events have been reported in patients who received the AstraZeneca vaccine as well. In this episode, , of the University of Pennsylvania, Philadelphia, tells host , how to identify and manage patients with these vaccine-induced events. What’s in a name? The phenomenon of vaccine-induced thrombosis and thrombocytopenia has been given different names, including: Vaccine-induced immune thrombotic thrombocytopenia (VITT)...
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Toward more personalized treatment in prostate cancer: The CCR score predicts metastasis and guides treatment decisions after radiation
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The combined clinical cell-cycle risk (CCR) score uses clinical and genetic factors to assess the risk of metastasis after radiation therapy in patients with prostate cancer. The CCR score has proven accurate in studies and can guide post-radiation treatment decisions in practice, according to , of the University of Utah, Salt Lake City. Dr. Tward discusses the CCR score with host , in this episode. About the score The CCR score combines the cell-cycle progression (CCP) score (available commercially as the Prolaris test) and the Cancer of the Prostate Risk Assessment (CAPRA) score to more...
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Changing perspectives: Dr. Michael Weiner recounts his experiences as an oncologist who became a cancer patient and then a caregiver
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Optimizing CAR T-cell therapies in lymphoma: Improving response, fighting cytokine release syndrome, and identifying mechanisms of resistance
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Studies have shown that chimeric antigen receptor (CAR) T-cell therapies produce responses in patients with relapsed/refractory B-cell lymphomas, but researchers continue to look for ways to improve efficacy, decrease toxicity, and overcome treatment resistance. , of Boston Children’s Hospital, discusses some of this research with host , in this episode. Dr. Kean outlines four recent studies of CAR T-cell therapies in lymphoma. The studies were selected as part of the “” session at the 2020 annual meeting of the American Society of Hematology. Primary Analysis of ZUMA-5: A Phase 2 Study...
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Trends in genetic testing for breast and ovarian cancer: Undertesting and racial/ethnic disparities persist
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Researchers have tracked the evolution of genetic germline testing in women with breast or ovarian cancer in recent years and reported the results in the Journal of Clinical Oncology. Study author , of Stanford (Calif.) University, describes the group’s findings () to guest host Alan Lyss, MD, subprincipal investigator emeritus for Heartland Cancer Research NCORP, in this episode. Study rationale and methods Dr. Kurian said that an inflection point for breast cancer genetics was in 2013 when the U.S. Supreme Court ruled that gene patenting was not allowed for the purposes of genetic...
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Improving cancer screening in the COVID era: Drive By Flu-FIT allows for socially distanced colorectal cancer screening
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A program called Drive By Flu-FIT has allowed for socially distanced colorectal cancer (CRC) screening during the COVID-19 pandemic. Armenta Washington, senior research coordinator at the University of Pennsylvania, describes the program to guest host Alan Lyss, MD, subprincipal investigator emeritus for Heartland Cancer Research NCORP, in this episode. What is Drive By Flu-FIT? Drive By Flu-FIT is a socially distanced version of the Flu-Fecal Immunochemical Test (Flu-FIT) program. Flu-FIT was designed to increase access to CRC screening by offering take-home FIT tests to patients at the time...
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Unpacking von Willebrand disease guidelines: Dr. Paula James talks diagnosis and pre-procedure prophylaxis
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Earlier this year, clinical practice guidelines for the diagnosis and management of von Willebrand disease (VWD) were published in Blood Advances. The guidelines () are a collaborative effort from the American Society of Hematology, the International Society on Thrombosis and Haemostasis, the National Hemophilia Foundation, and the World Federation of Hemophilia. Guideline author , of Queens University, Kingston, Ont., reviews some of the recommendations in these guidelines with host , in this episode. Case discussion A patient presents with the complaint of heavy menstrual bleeding, which...
info_outlineNew studies have shed additional light on how convalescent plasma may affect patients with COVID-19, how blood type impacts bleeding risk, the effects of race on cancer-associated thrombosis, and iron deficiency in pregnancy.
These studies were presented as part of the “Best of ASH” session at the 2020 annual meeting of the American Society of Hematology.
Alisa S. Wolberg, PhD, of the University of North Carolina at Chapel Hill, who cochaired the session, reviews these studies with host David H. Henry, MD, in this episode.
Abstract #572: Association of ABO Blood Group with Bleeding Severity in Patients with Bleeding of Unknown Cause. https://bit.ly/2Mc0R2A.
- This study, which included 422 patients, indicated that blood group O is overrepresented in patients with bleeding of unknown cause.
- Blood group O was associated with a more severe bleeding phenotype, especially oral mucosal bleeding, independent of the levels of von Willebrand factor and factor VIII.
- Patients with blood group O had increased clot density, but blood group O didn’t influence thrombin generation or platelet function analysis.
- The researchers said these findings are important for better understanding the underlying mechanisms of bleeding in patients who have bleeding of unknown cause.
- Dr. Wolberg said this study reframed how people look at bleeding of unknown cause.
Abstract #203: Racial/Ethnic Disparities in Cancer-Associated Thrombosis: A Population-Based Study. https://bit.ly/35Xi5HE.
- This study included more than 942,109 cancer patients.
- Results showed an independent association between race/ethnicity and the risk of cancer-associated thrombosis.
- Asians/Pacific Islanders had a significantly lower incidence of cancer-associated thrombosis, compared with non-Hispanic Whites.
- African Americans had a significantly higher incidence of cancer-associated thrombosis versus non-Hispanic Whites.
- Racial/ethnic differences were especially prominent when examining pulmonary embolism only.
- It’s hard to determine what causes these differences, Dr. Wolberg said. The differences could be explained by underlying biological traits, systemic racism, access to care, and/or the severity of underlying comorbidities, according to the researchers.
Abstract #424: Suboptimal Iron Deficiency Screening in Pregnancy in a High Resource Setting. https://bit.ly/2XYedSA.
- The study included data on 47,590 pregnancies in 44,552 women from Ontario.
- About 40% of these patients (n = 25,880) had ferritin measurements taken during pregnancy.
- Iron deficiency was observed in 52.8% of evaluable pregnancies, and severe iron deficiency was seen in 23.8%.
- These findings suggest a ferritin test should be included as part of routine bloodwork at the first prenatal visit, the researchers said.
- They also noted that failing to evaluate iron stores in the second and/or third trimester misses the periods of highest iron-deficiency risk, when intravenous iron may be considered.
- The researchers said these gaps in care should be addressed by revising guidelines.
Abstract #245: Efficacy of COVID-19 Pathogen-Inactivated Convalescent Plasma for Patients with Moderate-to-Severe Acute COVID-19: A Case-Matched Control Study. https://bit.ly/2XVlulU.
- For this study, researchers compared 15 cases and 30 controls, all of whom had COVID-19.
- Cases received two units of COVID-19 convalescent plasma (CCP) from different donors.
- CCP appeared to improve survival in hospitalized COVID patients, though the difference was not significant.
- The 28-day mortality rate was 6.7% among cases and 20.7% in controls (P = .233).
- The researchers also found that unselected CCPs have heterogeneous antivirus activity.
- Pathogen reduction treatment did not impact antivirus activity.
- ADAP, ACE2, RVPN, and COVAM could be used to define activity.
- A posttransfusion increase in activity could be detected in some, but not all, patients.
- The researchers said more definitive studies are needed.
*Some of the data presented at the meeting differ from data included in the abstracts.
Disclosures:
Dr. Wolberg disclosed relationships with Bristol-Myers Squibb, GlaxoSmithKline, and Takeda. Dr. Henry has no financial disclosures relevant to this episode.
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