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Lew TE, Bennett R, Lin VS, Whitechurch A, Handunnetti SM, Marlton P, Shen Y, Mulligan SP, Casan J, Blombery P, Tam CS, Roberts AW, Seymour JF, Thompson PA, Anderson MA. Venetoclax-rituximab is active in patients with BTKi-exposed CLL, but durable treatment-free remissions are uncommon. Blood Adv 2024; 8:1439-1443. [PMID: 38231032 PMCID: PMC10955641 DOI: 10.1182/bloodadvances.2023011327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Thomas E. Lew
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Rory Bennett
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Victor S. Lin
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Ashley Whitechurch
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Paula Marlton
- Department of Hematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yandong Shen
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Stephen P. Mulligan
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, NSW, Australia
| | - Joshua Casan
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Andrew W. Roberts
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - John F. Seymour
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Philip A. Thompson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Mary A. Anderson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
- Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
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Ratnasingam S, Casan J, Shortt J, Hawkes E, Gilbertson M, McQuilten Z, Grigoriadis G, Htun KT, Htet SM, Campbell P, Chai KL, Quach H, Patil S, Opat S. Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma. Sci Rep 2019; 9:13544. [PMID: 31537857 PMCID: PMC6753133 DOI: 10.1038/s41598-019-49776-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/30/2019] [Indexed: 11/09/2022] Open
Abstract
The role of cytarabine-based induction and autologous stem cell transplantation (ASCT) in front-line treatment of younger patients with mantle cell lymphoma (MCL) is well established, however the utility of intensive approaches in older patients remains unclear. This retrospective study compared first line treatment outcomes in patients aged 60 years or more, treated at six tertiary centres between 2000-2015. 70 patients included had a median age of 69 (60-91) and most (94%) demonstrated advanced stage disease. Treatment regimens included: R-CHOP-like (n = 39), alternating R-CHOP/R-DHAC (n = 10), R-HyperCVAD/R-MA (n = 7), R-CHOP/Cytarabine (Nordic Protocol) (n = 10) and other (n = 4). 16 patients underwent an ASCT. The median follow-up for surviving patients was 37 months. Compared to R-CHOP-like therapies, cytarabine-based regimens were associated with an improved overall response rate (ORR) of 70% vs 33% (p < 0.001) and overall survival (OS) (HR 0.541, [0.292-1.001], p = 0.05). No difference in efficacy between different cytarabine-based regimens was detected, but R-HyperCVAD/R-MA was associated with increased hospitalisation and transfusion requirements. Patients undergoing ASCT demonstrated an improved median OS (HR 0.108 [0.015-0.796], p = 0.029) but were significantly younger. These results reaffirm the use of cytarabine in MCL for selected patients aged over 60. Such regimens should be strongly considered for this population in frontline therapy.
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Affiliation(s)
- Sumita Ratnasingam
- Department of Haematology, Monash Health, Melbourne, Australia.,Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia
| | - Joshua Casan
- Department of Haematology, Monash Health, Melbourne, Australia. .,School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
| | - Jake Shortt
- Department of Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Eliza Hawkes
- Department of Medical Oncology and Clinical Haematology, Olivia Newton John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.,Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | | | - Zoe McQuilten
- Department of Haematology, Monash Health, Melbourne, Australia
| | - George Grigoriadis
- Department of Haematology, Monash Health, Melbourne, Australia.,Department of Haematology, Alfred Health, Melbourne, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Kay Thwe Htun
- Department of Haematology, Alfred Health, Melbourne, Australia
| | - Swe Myo Htet
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia
| | - Philip Campbell
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia
| | - Khai Li Chai
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
| | - Hang Quach
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
| | - Sushrut Patil
- Department of Haematology, Alfred Health, Melbourne, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
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Casan J, Wolyncewicz G, Alam W, Opat S, Gregory G, Shortt J, Patil S, Gilbertson M. R-IVAC SALVAGE THERAPY IN RELAPSED AND REFRACTORY DLBCL. Hematol Oncol 2019. [DOI: 10.1002/hon.110_2631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J. Casan
- Haematology; Monash Health; Clayton Australia
| | | | - W. Alam
- Haematology; Monash Health; Clayton Australia
| | - S. Opat
- School of Clinical Sciences at Monash Health; Monash University; Clayton Australia
| | - G. Gregory
- School of Clinical Sciences at Monash Health; Monash University; Clayton Australia
| | - J. Shortt
- School of Clinical Sciences at Monash Health; Monash University; Clayton Australia
| | - S. Patil
- Haematology; The Alfred Hospital; Melbourne Australia
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Casan J, Ansell E, Davies A, Gilbertson M, Opat S. SHORT DIAGNOSIS-TO-TREATMENT INTERVAL IS ASSOCIATED WITH HIGH RISK AND POOR OUTCOMES IN DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.84_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J. Casan
- Haematology; Monash Health; Clayton Australia
| | - E. Ansell
- Haematology; Monash Health; Clayton Australia
| | - A. Davies
- Haematology; Monash Health; Clayton Australia
| | | | - S. Opat
- School of Clinical Sciences at Monash Health; Monash University; Clayton Australia
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Tiong M, Casan J, McLean C. Atraumatic splenic rupture following IVIg for parvovirus B19 pure red cell aplasia post renal transplant. Transpl Infect Dis 2018; 21:e13045. [PMID: 30586222 DOI: 10.1111/tid.13045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/17/2018] [Revised: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 12/01/2022]
Abstract
Parvovirus B19 (PB19) associated pure red cell aplasia (PRCA) is an uncommon but well described complication of immunosuppression post solid organ transplantation. We report a unique case of a renal transplant patient with PB19 associated PRCA who developed a spontaneous splenic rupture after receiving IVIg for persistent anemia. He subsequently required splenectomy. Within the spleen we subsequently identified PB19 affected cells.
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Affiliation(s)
- Mark Tiong
- Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Joshua Casan
- Department of Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia.,Victorian Neuromuscular Laboratory Service, Alfred Health, Melbourne, Victoria, Australia.,Victorian Brain Bank, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
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Gardiner EE, Casan J, Montague SJ, Lukito P, Andrews RK, Davis AK. Abstract 532: Shear-induced Release of Platelet Receptors Contributes to Bleeding Outcomes in Patients With Lvads or Exposed to Ecmo. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite advances in design and materials, as well as pharmacological prophylaxis, hemostatic complications continue to plague device recipients. Ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are associated with bleeding that is not fully explained by anticoagulant or antiplatelet use. Exposure of platelets to elevated shear in vitro leads to increased shedding. We examined blood samples from patients with heart failure or in receipt of high fluid shear mechanocirculatory support to assess whether loss of platelet receptors occurs
in vivo
, and the relationship with acquired von Willebrand syndrome (AVWS) and changes in inflammatory cytokines. Platelet counts, levels of inflammatory cytokines IL-1β, IL-6, TNFα, MCP-1, IL-17A and IFNγ, coagulation tests and von Willebrand factor (VWF) analyses were performed on samples from 13 continuous flow VAD (CF-VAD), 14 ECMO, and 24 heart failure patients. Levels of platelet receptors were measured by flow cytometry or ELISA. The loss of high molecular weight VWF multimers was observed in 12 of 13 CF-VAD and 7 of 14 ECMO patients, consistent with AVWS. Platelet receptor shedding was demonstrated by elevated soluble glycoprotein (GP) VI levels in plasma and significantly reduced surface GPIbα and GPVI levels in CF-VAD and ECMO patients as compared with healthy donors. Platelet receptor levels were also significantly reduced in heart failure patients. Significant differences in levels of inflammatory cytokines monocyte-chemoattractant protein and tissue necrosis factor-a in a subset of patients with decompensated HF. These data link AVWS and increased platelet receptor shedding in patients with CFVADs or ECMO. Loss of the platelet surface receptors GPIbα and GPVI in heart failure, CFVAD and ECMO patients may be linked with extent of inflammation and may contribute to ablated platelet adhesion/activation, and limit thrombus formation under high/pathologic shear conditions.
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Abstract
As treatment options in modern medicine continue to expand, physicians globally have witnessed a veritable explosion in the utility of therapeutic devices. Particularly within the spheres of cardiology and critical care medicine, a plethora of devices are now available with an ever-increasing range of clinical indications. Additionally, the advent of transcatheter-mounted devices has enabled patients unsuitable for more invasive procedures to benefit from intervention, thereby greatly expanding the cohort of device-eligible patients. However, despite advances in design and materials, as well as pharmacological prophylaxis, hemostatic complications continue to plague device recipients, contributing to morbidity and mortality. Elucidating the complex interplay between components of the hemostatic system and cardiac devices has been the subject of much recent research, with greater focus on the coagulation cascade and device-induced perturbations. However, less is known about impact of mechanical surfaces on platelets and the resultant clinical complications, both hemorrhagic and thrombotic. This review will focus on exploring the pathobiology of platelet-surface interactions, contextualized within the wider hemostatic system, with a focus on the increasingly utilized technologies of transcatheter aortic-valve implantation, ventricular assist devices, and extracorporeal membrane oxygenation.
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Affiliation(s)
- Joshua Casan
- Hematology Unit, Alfred Hospital, Melbourne, Australia
| | - Robert K Andrews
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
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Narayan O, Casan J, Szarski M, Dart A, Cameron J. PT231 Impact of device and measurement technique on central systolic blood pressure estimation - A meta-analysis of. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Prabhu S, Stokes M, Kras A, Arunothayaraj S, Yi H, Kong L, Peck K, Casan J, Blusztein D, Jackson D, Toogood G. Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring In-patient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Satasivam P, Reeves F, Lin M, Daruwalla J, Casan J, Lim C, Royce PL. The effect of oral anticoagulation on the prevalence and management of haematuria in a contemporary Australian patient cohort. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11622.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Fairleigh Reeves
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
| | - Matthew Lin
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
| | - Jurstine Daruwalla
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
| | - Joshua Casan
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
| | - Chan Lim
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
| | - Peter L. Royce
- Department of Urology; The Alfred Hospital; Prahran; Victoria; Australia
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Casan J, Cameron J, Ramachandran P, Baldi M, Meredith I, Hope S. The Utility of Functional 320 Slice Cardiac CT for Assessing Aortic Stiffness: Relationships with Carotid-Femoral Pulse Wave Velocity. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Austin MA, Casan J, Baldi M, Meredith I, Hope S. Factors that Influence Patients’ Adherence to Medical Therapy Following Percutaneous Coronary Intervention. Heart Lung Circ 2008. [DOI: 10.1016/j.hlc.2008.05.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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