News in brief: Blood intervention to reduce toxic PFAS in firefighters; Fifth dose of COVID-19 vax recommended for immunocompromised patients; Research backs FLAG-Ida as a standard of care for R/R AML

Wednesday, 13 Apr 2022

Blood intervention to reduce toxic PFAS in firefighters

Regular blood or plasma donation can be used to reduce elevated levels of blood perfluoroalkyl and polyfluoroalkyl substances (PFASs) in firefighters exposed to the toxic chemicals through the use of firefighting foams.

In a Victorian study, 285 firefighters with baseline perfluorooctane sulfonate (PFOS) levels of 5 ng/mL or more were randomised to donate plasma every six weeks for 12 months, donate blood every 12 weeks for 12 months, or be observed only.

The study found mean PFOS levels were significantly reduced one year from baseline by both plasma (-2.9 ng/mL, 95% CI: -3.6 to -2.3 ng/mL, P < 0.001) and blood donation (1.1 ng/mL, 95% CI: -1.5 to -0.7 ng/mL, P < 0.001).

Mean serum perfluorohexane sulfonate (PFHxS) levels were also significantly reduced by plasma donation (-1.1 ng/mL, 95% CI: -1.6 to -0.7 ng/mL, P < 0.001) but not by blood donation.

“Plasma donations resulted in a more substantial decrease in serum PFAS levels than blood donations, and both treatments were more effective than observation alone,” the study said.

Read more in JAMA Network Open

Fifth dose of COVID-19 vax recommended for immunocompromised patients

A fifth-dose winter booster of COVID-19 vaccine is now recommended for severely immunocompromised people, including people with cancer.

The latest advice from the Australian Technical Advisory Group on Immunisation (ATAGI)  is that people who are at high risk of COVID-19 should receive an additional booster dose known as the “winter booster dose” four months after the 1st booster dose.

The advice applies to people aged 16 years or older who are severely immunocompromised, such as people with cancer receiving chemotherapy, and also to adults aged 65 years or older, residents of aged care or disability care facilities; and Aboriginal and Torres Strait Islander people aged 50 years or older.

This means that three primary doses are now recommended for people aged five years or older, and two booster doses (five doses total) are recommended for those aged 16 years or older.

“These recommendations for an additional booster dose focus on protecting vulnerable cancer patients among others, against severe disease and reducing the potential burden on the healthcare system over the coming months,” said Professor Dorothy Keefe, CEO Cancer Australia.

The rollout of the additional booster dose starts from April 2022, coinciding with the rollout of the 2022 influenza vaccination program.

“An influenza vaccine can be co-administered with the additional booster dose of COVID-19 vaccine. However, if the patient with cancer is not yet eligible for their additional booster dose, the influenza vaccine can be given ahead of the additional booster dose,” said Professor Keefe.

Read more in Cancer Australia’s Frequently Asked Questions

Research backs FLAG-Ida as a standard of care for R/R AML

A study pitting a novel salvage regimen of daunorubicin/clofarabine (DClo) against a recommended regimen of fludarabine, cytarabine, granulocyte colony-stimulating factor with idarubicin (FLAG-Ida) has shown no difference in outcomes in patients with relapsed or refractory acute myeloid leukaemia (R/R AML), but the authors said the latter should remain the standard of care in this setting.

As part of the UK NCRI AML17 trial, a total of 94 R/R AML patients (median age 47 years) with mainly favourable or intermediate-risk cytogenetics were randomised to receive up to three courses of DClo or FLAG-Ida.

The findings, published in the British Journal of Haematology, showed a high overall response rate of 74%, but no difference between DClo and FLAG-Ida, and that 57% of patients received a transplant, again with no difference between the arms. Similarly, there was no difference in overall survival at five years (21% for DClo vs 22% for FLAG-Ida).

However, the team, led by Professor Nigel Russel, a Consultant Haematologist at Guy’s Hospital, concluded that while the FLAG-Ida schedule was not superior in this setting, it should still be considered the standard of care for relapsed patients when taking into account prior findings from the UK NCRI AML17 trial, which demonstrated its superiority in patients with high-risk disease following one course of induction therapy.

Also, “a stratified analysis of all patients entering the high-risk randomisation showed overall benefit making it the standard of care for relapsed disease, certainly for patients with favourable or intermediate-risk cytogenetics without a FLT3 mutation”, they noted.

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