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Talaulikar D, Joshua D, Ho PJ, Gibson J, Quach H, Gibbs S, Ling S, Ward C, Augustson B, Trotman J, Harrison SJ, Tam CS, Chair SHV, Vietoria HQ, Viewria MP, Vietria AS, Viewria AK, Vietoria SG, Joshua D, Ho J, Ward C, Ling S, Molle P, Weber N, Horvath N, Zannettino A, Jase W, Lee C, Augustson B, Radesk D, Talaulikar D, Murphy N, Johnston A, Szabo F, Romer K, Chan H. Treatment of Patients with Waldenström Macroglobulinaemia: Clinical practice update from the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2022; 53:599-609. [PMID: 36441109 DOI: 10.1111/imj.15980] [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] [Received: 06/10/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent B-cell malignancy characterised by the presence of IgM paraprotein, bone marrow infiltration by clonal small B lymphocytes with plasmacytic differentiation and the MYD88 L265P mutation in >90% of cases. Traditionally, WM has been treated with chemoimmunotherapy. Recent trials have demonstrated the efficacy and safety of Bruton tyrosine kinase inhibitors in WM, both as monotherapy and in combination with other drugs. There is emerging evidence on use of other agents including BCL2 inhibitors and on treatment of rare presentations of WM. In this update, the Medical and Scientific Advisory Group of Myeloma Australia review the available evidence on the treatment of WM since the last publication in 2017 and provide specific recommendations to assist Australian clinicians in the management of this disease.
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Affiliation(s)
- Dipti Talaulikar
- ACT Pathology, Canberra Hospital Canberra Australia
- Australian National University Canberra Australia
| | - D Joshua
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
| | - P J Ho
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - J. Gibson
- Institute of Haematology, Royal Prince Alfred Hospital Camperdown NSW
- University of Sydney Camperdown NSW
| | - H Quach
- St Vincent's Hospital, Fitzroy Victoria
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
| | - S Gibbs
- Department of Haematology Eastern Health Box Hill VIC
- Eastern Clinical Research Unit Monash University
| | - S Ling
- Liverpool Hospital Liverpool NSW
| | - C Ward
- Royal North Shore Hospital St Leonards NSW
| | - B Augustson
- Department of Haematology Sir Charles Gairdner Hospital Nedlands WA
| | - Judith Trotman
- University of Sydney Camperdown NSW
- Concord Repatriation General Hospital Concord NSW
| | - S J Harrison
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne Vic
- Sir Peter MacCallum Dept of Oncology University of Melbourne, Parkville Vic
| | - Constantine S. Tam
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Australia
- Alfred Hospital, Melbourne Victoria
- Central Clinical School, Monash University, Melbourne Victoria
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Seymour J, Opat S, Cull G, Trotman J, Gottlieb D, Simpson D, Marlton P, Anderson M, Ku M, Ritchie D, Ratnasingam S, Augustson B, Kim W, Wang L, Xue L, Hilger J, Huang J, Hedrick E, Roberts A, Tam C. HIGH OVERALL RESPONSE RATE WITH THE BTK INHIBITOR BGB-3111 IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA/SMALL LYMPHOCYTIC LYMPHOMA: AN UPDATE ON SAFETY AND ACTIVITY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J.F. Seymour
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Australia
| | - S. Opat
- Clinical Haematology; Monash Health; Clayton Australia
| | - G. Cull
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Australia
| | - J. Trotman
- Department of Haematology; Concord Hospital; Concord Australia
| | - D. Gottlieb
- Haematology Department; Westmead Hospital; Westmead Australia
| | - D. Simpson
- Aukland Haematology; North Shore Hospital; Aukland New Zealand
| | - P. Marlton
- University of Queensland School of Medicine; Princess Alexandra Hospital; Brisbane Australia
| | - M. Anderson
- Department of Clinical Haematology & BMT, The Royal Melbourne Hospital; University of Melbourne; Parkville Australia
| | - M. Ku
- Clinical Haematology, Austin Health; Heidelberg Australia
| | - D.S. Ritchie
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Australia
| | | | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Australia
| | - W. Kim
- Division of Hematology-Oncology; Samsung Medical Center; Seoul Korea, Republic of
| | - L. Wang
- Research and Development Center, BeiGene, Beijing and Emeryville; CA, US China
| | - L. Xue
- Research and Development Center, BeiGene, Beijing and Emeryville; CA, US China
| | - J. Hilger
- Research and Development Center, BeiGene, Beijing and Emeryville; CA, US China
| | - J. Huang
- Research and Development Center, BeiGene, Beijing and Emeryville; CA, US China
| | - E. Hedrick
- Research and Development Center, BeiGene, Beijing and Emeryville; CA, US China
| | - A.W. Roberts
- Department of Clinical Haematology & BMT, The Royal Melbourne Hospital; University of Melbourne; Parkville Australia
| | - C.S. Tam
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Australia
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Cull G, Hall D, Fabis-Pedrini MJ, Carroll WM, Forster L, Robins F, Ghassemifar R, Crosbie C, Walters S, James I, Augustson B, Kermode AK. Lymphocyte reconstitution following autologous stem cell transplantation for progressive MS. Mult Scler J Exp Transl Clin 2017; 3:2055217317700167. [PMID: 28607754 PMCID: PMC5415040 DOI: 10.1177/2055217317700167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/26/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) for progressive multiple sclerosis (MS) may reset the immune repertoire. OBJECTIVE The objective of this paper is to analyse lymphocyte recovery in patients with progressive MS treated with ASCT. METHODS Patients with progressive MS not responding to conventional treatment underwent ASCT following conditioning with high-dose cyclophosphamide and antithymocyte globulin. Lymphocyte subset analysis was performed before ASCT and for two years following ASCT. Neurological function was assessed by the EDSS before ASCT and for three years post-ASCT. RESULTS CD4+ T-cells fell significantly post-transplant and did not return to baseline levels. Recent thymic emigrants and naïve T-cells fell sharply post-transplant but returned to baseline by nine months and twelve months, respectively. T-regulatory cells declined post-transplant and did not return to baseline levels. Th1 and Th2 cells did not change significantly while Th17 cells fell post-transplant but recovered to baseline by six months. Neurological function remained stable in the majority of patients. Progression-free survival was 69% at three years. CONCLUSION This study demonstrates major changes in the composition of lymphocyte subsets following ASCT for progressive MS. In particular, ablation and subsequent recovery of thymic output is consistent with the concept that ASCT can reset the immune repertoire in MS patients.
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Affiliation(s)
- G Cull
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - D Hall
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - M J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - W M Carroll
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - L Forster
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - F Robins
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - R Ghassemifar
- Department of Haematology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Australia
| | - C Crosbie
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - S Walters
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - I James
- Institute for Immunology and Infectious Diseases, Murdoch University, Australia
| | - B Augustson
- Department of Haematology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
| | - A K Kermode
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Australia
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Weber N, Mollee P, Augustson B, Brown R, Catley L, Gibson J, Harrison S, Ho PJ, Horvath N, Jaksic W, Joshua D, Quach H, Roberts AW, Spencer A, Szer J, Talaulikar D, To B, Zannettino A, Prince HM. Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2016; 45:371-82. [PMID: 25169210 DOI: 10.1111/imj.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 06/06/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.
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Affiliation(s)
- N Weber
- Clinical Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Kastritis E, Leleu X, Arnulf B, Zamagni E, Cibeira M, Kwok F, Mollee P, Hájek R, Moreau P, Jaccard A, Schönland S, Filshie R, Nicolas-Virelizier E, Augustson B, Mateos MV, Wechalekar A, Hachulla E, Milani P, Dimopoulos M, Fermand JP, Foli A, Gavriatopoulou M, Palumbo A, Sonneveld P, Johnsen H, Merlini G, Palladini G. A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moore E, Bergin K, McQuilten Z, Wood E, Augustson B, Blacklock H, Ho P, Horvath N, King T, McNeil J, Mollee P, Quach H, Reid C, Rosengarten B, Walker P, Spencer A. Real world management of multiple myeloma: initial results from the Australia and New Zealand Myeloma and Related Diseases Registry. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:335-43. [DOI: 10.1111/imj.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Ho
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Harrison
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. Roberts
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talaulikar
- Department of Haematology; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison SJ, Mollee P, Roberts AW, Horvath N, Talulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are eligible for stem cell transplantation: position statement of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:94-105. [DOI: 10.1111/imj.12640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 09/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Ho
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. J. Harrison
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. W. Roberts
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talulikar
- Department of Haematology; Canberra Hospital; Canberra ACT Australia
- Australian National University; Canberra ACT Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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Chow A, Phillips M, Siew T, Cull G, Augustson B, Ward M, Joske D. Prognostic nomogram for diffuse large B-cell lymphoma incorporating the International Prognostic Index with interim-positron emission tomography findings. Intern Med J 2014; 43:932-9. [PMID: 23692386 DOI: 10.1111/imj.12194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 11/08/2012] [Accepted: 05/06/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND/AIMS Results from interim-positron emission tomography (PET) studies in diffuse large B-cell lymphoma (DLBCL) patients are varied. We evaluated the prognostic value of interim-PET in our centre. To improve concordance, interim-PET was combined with the International Prognostic Index (IPI). METHODS We retrospectively reviewed 100 new consecutive DLBCL patients treated with immunochemotherapy from 2005 to 2010. Twenty-four patients did not receive interim-PET and were excluded. Interim-PET images were re-examined using a qualitative assessment technique. Progression-free survival (PFS) and overall survival (OS) were analysed by the Cox proportional hazards model and prognostic accuracy was assessed using Harrell's C statistics (C). RESULTS Eleven patients were positive, and 65 were negative at interim-PET. The 2-year OS and PFS were 70.8% and 60.0%, respectively, in the PET-negative group, 36.4% and 36.4% for the PET-positive group (log-rank P-value 0.0008 for PFS, 0.0001 for OS). The IPI and interim-PET were minimally correlated. On Cox regression analysis, both were significant indicators of PFS (P < 0.001 and P = 0.002 respectively). The prognostic accuracy for PFS of a negative PET result was limited (C = 0.63), as it was for IPI (C = 0.75), but with the two indicators combined, the predictive accuracy was improved (C = 0.81). A nomogram, predictive for relapse-free survival at 2 years, was constructed. CONCLUSION In DLBCL patients treated with immunochemotherapy, the IPI and interim-PET provide independent prognostic information. In combination, a more powerful predictive model may be created as a nomogram. This can be refined in prospective trials and may help clinical decision making.
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Affiliation(s)
- A Chow
- Haematology Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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10
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Nwaba A, MacQuillan G, Adams LA, Garas G, Delriviere L, Augustson B, DeBoer B, Moody H, Jeffrey GP. Tacrolimus-induced thrombotic microangiopathy in orthotopic liver transplant patients: case series of four patients. Intern Med J 2013; 43:328-33. [PMID: 23441660 DOI: 10.1111/imj.12048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/26/2012] [Indexed: 12/23/2022]
Abstract
Thrombotic microangiopathy (TMA) is a potentially fatal complication in solid organ and bone marrow transplant patients, with reported incidence of 0.5-3% and mortality of about 75%. To emphasise the importance of early diagnosis and prompt commencement of therapy results in improved clinical outcomes. A retrospective study of all patients who underwent orthotopic liver transplantation (OLTX) at the Western Australian Liver Transplantation Service from May 1994 to December 2010 was conducted to identify patients who developed tacrolimus-induced TMA. We identified four patients with tacrolimus-induced TMA post-OLTX, derived from a cohort of 104 patients treated with tacrolimus in our institution. The mean age at diagnosis was 40 years, and the mean time of onset was 63 ± 7.5 weeks after OLTX. The indications for OLTX in the four patients were fulminant hepatic failure in three (Wilson disease, paracetamol overdose and post-partum thrombotic thrombocytopenic purpura) and hepatitis C virus-related cirrhosis. All patients had tacrolimus post-OLTX. At diagnosis, tacrolimus was discontinued in all patients, and three of the four patients underwent plasma exchange and all patients improved clinically. Mean duration of follow up was 15 ± 7.5 months. There was no mortality 6 months post-TMA. Early diagnosis with immediate discontinuation or conversion of calcineurin inhibitors and plasma exchange should be offered to OLTX patients with TMA as it results in good outcomes.
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Affiliation(s)
- A Nwaba
- West Australian Liver Transplant Service, University of Western Australia, Perth, Australia.
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Lobb EA, Joske D, Butow P, Kristjanson LJ, Cannell P, Cull G, Augustson B. When the safety net of treatment has been removed: patients' unmet needs at the completion of treatment for haematological malignancies. Patient Educ Couns 2009; 77:103-108. [PMID: 19272749 DOI: 10.1016/j.pec.2009.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/18/2008] [Accepted: 02/01/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine patients' information, emotional and support needs at the completion of treatment for a haematological malignancy. METHODS A self-report questionnaire was mailed to 113 adult patients. RESULTS Sixty-six questionnaires were returned. The most frequently endorsed patient needs related to care co-ordination and help to manage the fear of recurrence. The most frequently endorsed unmet needs included managing the fear of recurrence, the need for a case-manager and the need for communication between treating doctors. Predictors of unmet needs included younger patients (p=0.01), marital status (p=0.03) and employment (p=0.03). Almost two-thirds of patients (59%) reported they would have found it helpful to talk with a health care professional about their experience of diagnosis and treatment at the completion of treatment and endorsed significantly more need in the arenas of Quality of Life (p=0.03) and Emotional and Relationships (p=0.04). CONCLUSION This study provides valuable data on haematological cancer patients' needs in the first 12 months of finishing treatment. It appears that many needs emerge or remain unresolved at this time. PRACTICE IMPLICATIONS An opportunity for patients to talk with a health professional about making the transition from active treatment to extended survivorship may be helpful.
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Affiliation(s)
- E A Lobb
- Calvary Health Care Sydney, Australia.
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12
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So K, Macquillan G, Garas G, Delriviere L, Mitchell A, Speers D, Mews C, Augustson B, de Boer WB, Baker D, Jeffrey GP. Urgent liver transplantation for acute liver failure due to parvovirus B19 infection complicated by primary Epstein?Barr virus and cytomegalovirus infections and aplastic anaemia. Intern Med J 2007; 37:192-5. [PMID: 17316340 DOI: 10.1111/j.1445-5994.2006.01293.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 11-year-old boy presented with hepatic failure secondary to parvovirus B19 infection, requiring urgent liver transplantation. His recovery was complicated by primary Epstein-Barr virus and cytomegalovirus infections. He subsequently developed aplastic anaemia that has been refractory to antithymocyte globulin and cyclosporine therapy and may now require bone marrow transplantation. We present this case to emphasize parvovirus as a rare cause of hepatic failure and of aplastic anaemia as a complication of the virus.
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Affiliation(s)
- K So
- Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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Willson A, Cannell P, Joske D, Augustson B. Imatinib-induced cytogenetic remission in chronic eosinophilic leukaemia. Intern Med J 2006; 36:537-8. [PMID: 16866664 DOI: 10.1111/j.1445-5994.2006.01122.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND AND OBJECTIVES Transfusion laboratories with transfusion committees have a responsibility to monitor transfusion practice and generate improvements in clinical decision-making and red cell usage. However, this can be problematic and expensive because data cannot be readily extracted from most laboratory information systems. To overcome this problem, we developed and introduced a system to electronically extract and collate extensive amounts of data from two laboratory information systems and to link it with ICD10 clinical codes in a new database using standard information technology. MATERIALS AND METHODS Three data files were generated from two laboratory information systems, ULTRA (version 3.2) and TM, using standard information technology scripts. These were patient pre- and post-transfusion haemoglobin, blood group and antibody screen, and cross match and transfusion data. These data together with ICD10 codes for surgical cases were imported into an MS ACCESS database and linked by means of a unique laboratory number. Queries were then run to extract the relevant information and processed in Microsoft Excel for graphical presentation. We assessed the utility of this data extraction system to audit transfusion practice in a 600-bed adult tertiary hospital over an 18-month period. RESULTS A total of 52 MB of data were extracted from the two laboratory information systems for the 18-month period and together with 2.0 MB theatre ICD10 data enabled case-specific transfusion information to be generated. The audit evaluated 15,992 blood group and antibody screens, 25,344 cross-matched red cell units and 15,455 transfused red cell units. Data evaluated included cross-matched to transfusion ratios and pre- and post-transfusion haemoglobin levels for a range of clinical diagnoses. Data showed significant differences between clinical units and by ICD10 code. CONCLUSION This method to electronically extract large amounts of data and linkage with clinical databases has provided a powerful and sustainable tool for monitoring transfusion practice. It has been successfully used to identify areas requiring education, training and clinical guidance and allows for comparison with national haemoglobin-based transfusion guidelines.
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Affiliation(s)
- D E Grey
- Transfusion Medicine Unit, PathWest, QEII Medical Centre, Perth, Australia.
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15
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Raj K, Narayanan S, Augustson B, Ho A, Mehta P, Duncan N, Tauro S, Mahendra P, Craddock C, Mufti G. Rituximab is effective in the management of refractory autoimmune cytopenias occurring after allogeneic stem cell transplantation. Bone Marrow Transplant 2004; 35:299-301. [PMID: 15568036 DOI: 10.1038/sj.bmt.1704705] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and autoimmune neutropenia (AIN) are well-recognised complications of allogeneic stem cell transplantation (SCT), but have previously only been reported in the context of myeloablative conditioning regimens. Management of AIHA, ITP or AIN occurring after allogeneic SCT is unsatisfactory since they frequently prove refractory to conventional therapies including splenectomy. As a consequence, autoimmune cytopenias occurring after allogeneic SCT are associated with substantial morbidity and mortality. We report four patients who developed AIHA or ITP after allogeneic transplantation -- three of which occurred after a reduced-intensity conditioning (RIC) regimen. All patients demonstrated a complete response to Rituximab, having failed to respond to conventional treatment including high-dose prednisolone and intravenous immunoglobulin (IVIg). We conclude that Rituximab can be a valuable agent in the management of autoimmune cytopenias occurring after allogeneic SCT and that autoimmune cytopenias may be a hitherto unrecognised complication of RIC regimens.
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MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Disease Management
- Female
- Hematologic Neoplasms/complications
- Hematologic Neoplasms/therapy
- Hematopoietic Stem Cell Transplantation/adverse effects
- Humans
- Male
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Rituximab
- Salvage Therapy/methods
- Transplantation Conditioning/adverse effects
- Transplantation, Homologous
- Treatment Outcome
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Affiliation(s)
- K Raj
- Department of Haematology, Guy's, King's and St Thomas' School of Medicine, London, UK
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16
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Mehta P, Augustson B, Krishnamurthy S, Jacob A, Roy D, Olliff J, Cook M, Craddock C, Mahendra P. Successful allogeneic haematopoietic stem cell transplantation in patients with poor-risk leukaemia and prior invasive fungal infection. Bone Marrow Transplant 2004; 34:825-6. [PMID: 15361904 DOI: 10.1038/sj.bmt.1704685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Craddock C, Augustson B, Basu S. Imatinib or transplant for chronic myeloid leukaemia? Lancet 2003; 362:173. [PMID: 12867130 DOI: 10.1016/s0140-6736(03)13880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Affiliation(s)
- P V Van Heerden
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia
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