CLL patients have poor melanoma outcomes

People with chronic lymphocytic leukaemia (CLL) who develop melanoma have significantly poorer outcomes compared to people without a history of blood cancer, a first study of its kind shows.

The retrospective case-controlled trial from the Peter MacCallum Cancer Centre involving 56 patients with CLL and melanoma found CLL was associated with significantly worse melanoma-specific mortality (hazard ratio 2.46; p = 0.007) and recurrence (hazard ratio 3.44; p < 0.001) compared to patients with melanoma alone.

Furthermore, adverse events requiring cessation of immunotherapy occurred in 43% of patients with CLL compared to 7% of patients without CLL.

“With new and effective treatments, patients with CLL are living longer and the impact of second malignancies on their survival is becoming increasingly important. We found that the patients with CLL who developed melanoma had poorer MSS, RFS and potentially poorer immunotherapy intolerance,” the authors led by Professor Michael Henderson said.

“Patients with CLL with newly diagnosed melanoma should be counselled about this recurrence risk and possible immunotherapy complications. Future studies should investigate the most appropriate management in this vulnerable population,” they concluded in the study published in the British Journal of Haematology.

The authors noted that the study was limited by its small, low event number and its long observational period.

Benefits and harms of DOACs and LMWHs in VTE prophylaxis

Direct oral anticoagulants (DOACs) and low molecular weight heparin (LMWH) both reduce venous thromboembolism (VTE) in patients undergoing non-cardiac surgery, and also likely increased major bleeding to a similar extent, suggest findings of an international meta-analysis published in the BMJ.

However, according to the research team, the analysis indicated that oral anticoagulants probably prevent symptomatic VTE “to a greater extent” than prophylactic low molecular weight heparin, when given at standard prophylactic doses.

For the analysis, researchers looked at 68 randomised controlled trials (RCTs) – involving 45,445 patients undergoing non-cardiac surgery – included in the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases up to August 2021.

They found that low dose (odds ratio 0.33) and high dose (OR 0.19) LMWH, and DOAC (OR 0.17) reduced symptomatic VTE compared with no active treatment, with absolute risk differences of 1-100 per 1,000 patients, depending on baseline risks.

Both DOACs and LMWH were linked with a 2-3-fold rise in the odds of major bleeding compared with no active treatment, with absolute risk differences as high as 50 per 1,000 in patients at high risk, according to the paper.

Compared with low dose LMWH, high dose LMWH did not reduce symptomatic VTE (OR 0.57) but did increase rates of major bleeding (OR 1.87), while DOACs significantly reduced symptomatic VTE (0.53) but did not raise the risk of major bleeding (OR 1.23), the researchers said.

Covid curbs pharma sponsorship of doctor meetings

Pharmaceutical industry spending on hospitality for doctors attending medical education events fell by 40% during the pandemic, according to new figures released by industry lobby group Medicines Australia.

In its transparency report for the period 1 November 2020 to 30 April 2021 the total expenditure reported by companies on hospitality was $364,332, down from $594,474.

There were 721 medical education events sponsored during the six month period at a total costs of $5.96 million covered by the report, compared to spending of $5.63 million on 804 events in the same period a year previously.

The total hours of education supported by industry sponsorship declined from 6253 hours to 4934 hours.

The number of healthcare professional attendances at industry sponsored events fell from 165,455 to 148,810.

The pandemic forced most medical meetings to be transformed into virtual meetings and a recent pharmaceutical industry survey showed that most companies expected a significant level of virtual engagement with healthcare professionals to be maintained in future.