Blood 2023 posters: CLL, VTE and SCIg

Blood cancers

By Siobhan Calafiore

13 Nov 2023

Poster presentations at Blood 2023 covered topics such as venous thromboembolism guidelines not being met, a new therapy for salvage prior to stem cell transplantation and the benefits of immunoglobulin self-administration.

Here, the limbic presents a selection of posters presented at the conference.

CLL mortality rates in Australia

Prevalence of chronic lymphocytic leukaemia (CLL) is on the rise nationally, however mortality rates are declining, according to Australian researchers.

They conducted a review of all CLL cases from January 2009 to December 2018 in Victoria, Tasmania, the ACT and Queensland using four cancer registries.

Data came from 9002 cases, with most patients male (62.9%) and aged 60-89.

Mortality data were available for 2277 patients with cause of death non-cancer related in more than a third of the cohort (38.8%), the researchers said.

Incidence was relatively stable between 2009 to 2014, before peaking in 2017.

Linear regression analyses suggested that by 2038, the total incidence rate of CLL could exceed 1600 cases per 10‌7 person-years, although the researchers conceded that current and future treatment options might affect this prediction.

They also found patient survival from 2009 to 2018 was significantly poorer in patients aged 60 and older compared to those under 50. Survival did not significantly differ by sex or year of diagnosis except for in 2015 and 2016, which showed a significant survival improvement compared with in 2009, they noted.

“Our findings underscore that management of CLL/SLL in Australia will continue to be an important consideration in assessing the national healthcare system’s readiness to serve an aging population in the decades to come,” the authors said.

The analysis was sponsored by BeiGene.

Venous thromboembolism prevention practices

One quarter of patients with hospital-acquired venous thromboembolism (VTE) are prescribed suboptimal prophylaxis and develop potentially avoidable complications, highlighting the need to comply with guidelines, researchers say.

Researchers from Eastern Health and the Royal Melbourne Hospital analysed the medical records of 52 adult patients (median age 70, 58% female) admitted to a metropolitan health services in 2022 with a diagnosis of hospital-acquired VTE.

The median time to VTE diagnosis from admission was 15.5 days.

The researchers said that VTE risk assessments were not performed on 23% of patients, while 12.5% of the performed VTE risk assessments were incorrect.

VTE prophylaxis was prescribed for 85% of patients, although 11% of these patients received an inappropriate dose. The remaining eight patients were not prescribed any VTE prophylaxis despite only two having a contraindication listed.

The median time to initiation of VTE prophylaxis was 28.2 hours.

Overall VTE prophylaxis management was assessed as suboptimal in 25% of cases, while the appropriateness of 11.5% of cases was deemed to be unclear.

Absent or incorrect VTE risk assessment was associated with a higher proportion of suboptimal management compared to correct assessment (41% versus 17%).

“This highlights that strategies to optimise compliance with current VTE guidelines are needed to improve patient outcomes,” the authors concluded.

Venetoclax-based therapies as a bridge for alloSCT

Low intensity venetoclax (VEN)-based salvage combinations are an effective bridge to allogenic stem cell transplantation (alloSCT) in refractory or relapsing acute myeloid leukaemia (AML) and high-risk myelodysplastic syndrome (MDS).

Melbourne researchers from the Alfred and Monash University conducted a retrospective review of patients who received a VEN-based regimen after failing conventional frontline intensive chemotherapy with intent to proceed to alloSCT.

Of the 14 patients (median age 60) included in the study, 10 patients were treated with low dose cytarabine (LDAC) and four with azacitidine (AZA) combinations.

AlloSCT realisation occurred in 64% of cases with a median 84 days to transplant.

There were no treatment-related deaths. Febrile neutropenia occurred in 21% of patients – all in the morphological disease group. The morphological disease and MRD median overall survival was four months and 21 months, respectively.

The authors concluded that low intensity VEN-based regimens were effective.

“The comparable success rates, fewer toxicities and resource use compared with intensive therapies make these treatments an attractive area for future investigation.”

Self-administration of immunoglobulin therapy

Self-administered subcutaneous immunoglobulin therapy in the home is an effective alternative to hospital-based intravenous therapy with advantages for patients, hospitals and clinicians, according to a WA-based pilot study.

The researchers said subcutaneous immunoglobulin (SCIg) therapy had demonstrated benefits over the intravenous (IVIg) approach, including ease of administration, more stable dosing and reduced demand on health services.

But use of SCIg products in WA remained below national levels.

They conducted a pilot program where 15 eligible haematology and neurology patients at Royal Perth Hospital receiving hospital-based IVIg therapy were transitioned to self-administered SCIg therapy at home and completed surveys.

Results showed 88% of patients had a self-reported improvement in general health since the new approach. Patients reported various benefits such as greater control of their treatment, reduced impact on lifestyle and reduced financial burden.

All but one of the participants continued to receive SCIg therapy at home at the conclusion of the pilot study, with no significant adverse reactions reported.

One patient withdrew from the study due to minor skin reactions,  the authors said.

Patient reviews demonstrated no deterioration of the patient’s condition during the course of treatment and no increase in acute hospital admissions, while most staff supported the program, agreeing that it reduced demand for hospital beds.

The researchers said the model was well coordinated and collaborative, while providing a convenient and acceptable model of care.

“Findings from this pilot program have been used to develop a framework of SCIg programs in WA with clearly defined roles for clinical and administrative support, facilitating hospitals to develop individual SCIg programs that are sustainable and effective,” the researchers concluded.

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