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Djebbari F, Rampotas A, Vallance G, Panitsas F, Basker N, Sangha G, Salhan B, Karim F, Al-Kaisi F, Gudger A, Ngu L, Poynton M, Lam HPJ, Morgan L, Yang L, Young J, Walker M, Tsagkaraki I, Anderson L, Chauhan SR, Maddams R, Soutar R, Triantafillou M, Prideaux S, Obeidalla A, Eyre TA, Bygrave C, Kothari J, Basu S, Ramasamy K. Frailty subgroup analysis of isatuximab with pomalidomide and dexamethasone in a UK-wide real-world cohort of relapsed myeloma patients. Br J Haematol 2023; 201:162-167. [PMID: 36720464 DOI: 10.1111/bjh.18672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Faouzi Djebbari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexandros Rampotas
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Grant Vallance
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fotios Panitsas
- Department of Haematology, Laiko General Hospital, Athens, Greece
| | - Nanda Basker
- University Hospital Southampton, Southampton, UK
| | | | - Beena Salhan
- Birmingham Heartlands Hospital, Birmingham, UK.,Good Hope Hospital, Birmingham, UK.,Solihull Hospital, Birmingham, UK.,West Midlands Research Consortium (WMRC), West Midlands, UK
| | - Farheen Karim
- West Midlands Research Consortium (WMRC), West Midlands, UK.,The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Amy Gudger
- West Midlands Research Consortium (WMRC), West Midlands, UK.,Queen Elizabeth Hospital, Birmingham, UK
| | - Loretta Ngu
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Laura Yang
- University Hospitals Sussex NHS Foundation Trust, Chichester, UK
| | - Jennifer Young
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Saleena Rani Chauhan
- West Midlands Research Consortium (WMRC), West Midlands, UK.,Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | | | | | | | | | | | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Jaimal Kothari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Supratik Basu
- West Midlands Research Consortium (WMRC), West Midlands, UK.,The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,University of Wolverhampton, Wolverhampton, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Djebbari F, Rampotas A, Vallance G, Panitsas F, Basker N, Sangha G, Salhan B, Karim F, Firas AK, Gudger A, Ngu L, Poynton M, Lam HPJ, Morgan L, Yang L, Young J, Walker M, Tsagkaraki I, Anderson L, Chauhan SR, Maddams R, Soutar R, Triantafillou M, Prideaux S, Obeidalla A, Eyre TA, Bygrave C, Basu S, Ramasamy K. Infections in relapsed myeloma patients treated with isatuximab plus pomalidomide and dexamethasone during the COVID-19 pandemic: Initial results of a UK-wide real-world study. Hematology 2022; 27:691-699. [PMID: 35666686 DOI: 10.1080/16078454.2022.2082725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES There are no real-world data describing infection morbidity in relapsed/refractory myeloma (RRMM) patients treated with anti-CD38 isatuximab in combination with pomalidomide and dexamethasone (IsaPomDex). In this UK-wide retrospective study, we set out to evaluate infections experienced by routine care patients who received this novel therapy across 24 cancer centres during the COVID-19 pandemic. METHODS The primary endpoint was infection morbidity (incidence, grading, hospitalization) as well as infection-related deaths. Secondary outcomes were clinical predictors of increased incidence of any grade (G2-5) and high grade (≥G3) infections. RESULTS In a total cohort of 107 patients who received a median (IQR) of 4 cycles (2-8), 23.4% of patients experienced ≥1 any grade (G2-5) infections (total of 31 episodes) and 18.7% of patients experienced ≥1 high grade (≥G3) infections (total of 22 episodes). Median time (IQR) from start of therapy to first episode was 29 days (16-75). Six patients experienced COVID-19 infection, of whom 5 were not vaccinated and 1 was fully vaccinated. The cumulative duration of infection-related hospitalizations was 159 days. The multivariate (MVA) Poisson Regression analysis demonstrated that a higher co-morbidity burden with Charlson Co-morbidity Index (CCI) score ≥4 (incidence rate ratio (IRR) = 3, p = 0.012) and sub-optimal myeloma response less than a partial response (<PR) (p = 0.048) are independent predictors of ≥ G3 infections. CONCLUSION Our study described initial results of infection burden during IsaPomDex treatment. We recommend close monitoring particularly in elderly patients with co-morbidities, the effective use of an-infective prophylaxis, as well as optimal vaccination strategies, to limit infections.
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Affiliation(s)
- Faouzi Djebbari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexandros Rampotas
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Grant Vallance
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fotios Panitsas
- Department of Haematology, Laiko General Hospital, Athens, Greece
| | - Nanda Basker
- University Hospital Southampton, Southampton, UK
| | | | - Beena Salhan
- Birmingham Heartlands Hospital, Birmingham, UK.,Good Hope Hospital, Birmingham, UK.,Solihull Hospital, Solihull, UK.,West Midlands Research Consortium (WMRC), West Midlands, UK
| | - Farheen Karim
- West Midlands Research Consortium (WMRC), West Midlands, UK.,The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Al-Kaisi Firas
- Royal Derby Hospital, Derby, UK.,Wexham Park Hospital, Slough, UK
| | - Amy Gudger
- West Midlands Research Consortium (WMRC), West Midlands, UK.,Queen Elizabeth Hospital, Birmingham, UK.,University of Wolverhampton, Wolverhampton, UK
| | - Loretta Ngu
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Laura Yang
- University Hospitals Sussex NHS Foundation Trust, Sussex, UK
| | - Jennifer Young
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | - Saleena Rani Chauhan
- West Midlands Research Consortium (WMRC), West Midlands, UK.,Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | | | | | | | | | | | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Supratik Basu
- West Midlands Research Consortium (WMRC), West Midlands, UK.,The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,University of Wolverhampton, Wolverhampton, UK
| | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Bull TP, McCulloch R, Nicolson PL, Doyle AJ, Shaw RJ, Langridge A, Sayar Z, Tucker DL, Pettit M, Perry R, Thomas W, Page C, Whalley I, Dutt T, Garth L, Lester W, Buka RJ, Subhan M, Ware V, Rayment R, Castle D, Etherington A, Carter‐Brzezinski L, Peters J, Corrigan C, Sharma N, Benson G, Challenor S, Skinner TS, Zhao R, McLeod‐Kennedy LA, Douglas K, Knott A, Smith S, Wolf J, Todd SA, McDonald V, Rampotas A, Dean C, Sangha G, Pavord S, Denny N, Jaafar S, McLaughlin DP, Ross JE, Karanth M, Beverstock SL, Mansonso L, Burrows SH, McLaughlin DP, Tauro S, Shenouda A, Bailiff BM, Kajita D, Hermans J, Goradia H, Finan EM, Alford S, Pickard K, Greystoke B, Fail T, Abdussalam A, Roberts LN, Clark JB, Heeney N, Young J, Maddox J, Srinath S, Khawaja J, Parkes J, Babiker S, Hunt BJ, Wheeldon SL, Kerr P, Tahhan M, Vickers M, Pike AC, Hill Q, Mustafa N, Almaremi A, Hughes E, McGoldrick SJ, Loizou E, James I, Boyce SR, Farmer I, Thanigaikumar M, Wheeldon SL, Kerr P, Wickenden K, Gooding R, Thornton K, Kane C, Cole A, Griffin J, Docherty S, Dixon KI, Crowe J, Sheridan M, De Lord C, Sud A, Austin A, Coooper N, Bailey C, Attwell L, Hall R, Gray B, Chauhan SR, Lokare A, Gudger A, Horgan C, Venkatadasari I, Kaddam I, Mapplebeck CL, Van Veen J, Raj M, De Abrew K, Belsham E, Gyansah C, Sadullah S, Salhan B, Murrin R, Williams RL, Stewart A, Cornish N, Otton S, Khan Z, Ackroyd S, Chen LY, Lafferty NP, Leonforte F, Pemberton N, Rawi E, Triantafyllopoulou D, Adiyodi J, Yong J, Jones E, Davies D, Peck RC, Philip R, Seddon T, Cahalin P, Prodger C, Dutton DA, Sternberg AJ, Chengal R, Polzella P, Scully M. Diagnostic uncertainty presented barriers to the timely management of acute thrombotic thrombocytopenic purpura in the United Kingdom between 2014 and 2019. J Thromb Haemost 2022; 20:1428-1436. [PMID: 35189012 PMCID: PMC9314944 DOI: 10.1111/jth.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute thrombotic thrombocytopenic purpura (TTP) is a life-threatening emergency and plasma exchange (PEX) is the initial treatment shown to reduce acute mortality. OBJECTIVES To compare current practice in the United Kingdom (UK) against the standards set out in the 2012 British Society of Haematology guideline, and to better understand the issues affecting prompt initiation of PEX. PATIENTS/METHODS The trainee research network HaemSTAR conducted a retrospective nationwide review of adults presenting to UK hospitals with a first episode of acute TTP. RESULTS Data on 148 patients treated at 80 UK hospitals between 2014 and 2019 demonstrated that 64.8% of patients received PEX within 24 h. Diagnostic uncertainty was the most commonly cited reason for delayed treatment. Conversely, a shorter time to PEX occurred in patients who had red cell fragments or severe thrombocytopenia identified on their first complete blood count. Availability of on-site PEX was associated with a greater proportion of patients receiving PEX within 8 h compared to patients transferred, but by 24 h there was no difference between the two groups and two-thirds of all patients had received their first PEX. The mortality rate for patients that received PEX was 9.2%, with 27.8% of deaths linked to delayed treatment initiation. CONCLUSIONS This is the first multi-center evaluation of treatment delays in acute TTP and it will inform targeted pathways to improve prompt access to life-saving intervention.
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Kinsella FAM, Inman CF, Gudger A, Chan YT, Murray DJ, Zuo J, McIlroy G, Nagra S, Nunnick J, Holder K, Wall K, Griffiths M, Craddock C, Nikolousis E, Moss P, Malladi R. Very early lineage-specific chimerism after reduced intensity stem cell transplantation is highly predictive of clinical outcome for patients with myeloid disease. Leuk Res 2019; 83:106173. [PMID: 31276965 DOI: 10.1016/j.leukres.2019.106173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/27/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The importance of chimerism status in the very early period after hematopoietic stem cell transplantation is unclear. We determined PBMC and T-cell donor chimerism 50 days after transplantation and related this to disease relapse and overall survival. METHODS 144 sequential patients underwent transplantation of which 90 had AML/MDS and 54 had lymphoma. 'Full donor chimerism' was defined as ≥99% donor cells and three patient groups were defined: 40% with full donor chimerism (FC) in both PBMC and T-cells; 25% with mixed chimerism (MC) within both compartments and 35% with 'split' chimerism (SC) characterised by full donor chimerism within PBMC and mixed chimerism within T-cells. RESULTS In patients with myeloid disease a pattern of mixed chimerism (MC) was associated with a one year relapse rate of 45% and a five year overall survival of 40% compared to values of 8% and 75%, and 17% and 60%, for those with SC or FC respectively. The pattern of chimerism had no impact on clinical outcome for lymphoma. CONCLUSION The pattern of lineage-specific chimerism at 50 days after transplantation is highly predictive of clinical outcome for patients with myeloid malignancy and may help to guide subsequent clinical management.
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Affiliation(s)
- Francesca A M Kinsella
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | | | - Amy Gudger
- Heartlands Hospital, Heart of England NHS Foundation trust, Birmingham, UK
| | - Yuen T Chan
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Duncan J Murray
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Jianmin Zuo
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Graham McIlroy
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Jane Nunnick
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - Kathy Holder
- Heartlands Hospital, Heart of England NHS Foundation trust, Birmingham, UK
| | - Kerry Wall
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Mike Griffiths
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | | | - Paul Moss
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK.
| | - Ram Malladi
- School of Cancer Sciences, University of Birmingham, Birmingham, UK; Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
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