Communication breakdown when pregnancy meets lymphoma
Women diagnosed with lymphoma during pregnancy or within 12 months postpartum would benefit from improved communication with their health practitioners including more sensitivity around issues such as embryotoxicity, pregnancy termination and adverse outcomes.
An Australian and New Zealand study, comprising semi-structured phone interviews with 29 women, is the first to report the lived experiences of survivors of lymphoma during pregnancy.
The study, presented as a poster at ASH 2021, found over half of the women (55%) reported a perceived communication breakdown between them and their health practitioners at a time when the welfare of their unborn child (41%) and a fear of dying (27%) were of high concern.
The women reported that practical support such as financial/logistic assistance from charity organisations (48%), a personal support network (45%), clinical psychology referral (31%) and emergency childcare (10%) was highly valued at this time.
Many women (41%) also reported a diagnostic delay with symptoms such as fatigue, breathlessness, weight change and musculoskeletal pain, difficult to interpret in the context of pregnancy/postpartum period.
The study was led by Dr Georgia Mills, Lymphoma fellow at St Vincents’ Hospital, Sydney.
Sutimlimab quickly controls cold agglutinin disease
The monoclonal antibody sutimlimab which inhibits complement C1s results in a rapid and sustained increase in haemoglobin levels and control of haemolysis in patients with cold agglutinin disease (CAD).
Nominated as one of the top ASH 2021 abstracts, the phase 3 CADENZA trial randomised 42 patients with CAD and without a recent history of transfusion to either sutimlimab or placebo for 26 weeks.
The composite primary endpoint of Hb increase ≥1.5 g/dL and avoidance of transfusion and study-prohibited CAD therapy was met by 73% of treated patients compared to 15% of controls.
Dr Alexander Roeth, from the University Hospital Essen in Germany, said treatment with sutimlimab also led to improved quality of life with clinically meaningful improvements in fatigue and other anaemia symptoms of weakness and shortness of breath.
Clinical improvements in anaemia, haemolysis and fatigue coincided with reductions in classical complement pathway activity and normalisation of C4 levels.
Treatment-emergent adverse events including hypertension, headache, rhinitis, Raynaud’s phenomenon and acrocyanosis were more common with sutimlimab.
The international study recruited from 13 countries including Australia.
Lymphoma still an AIDS-defining event
Despite high levels of health education and healthcare availability in Australia, people are still presenting with aggressive lymphoma as an AIDS-defining event prior to HIV diagnosis.
In an Australasian Lymphoma Alliance study of 44 people living with HIV and either DLBCL or Burkitt lymphoma, 27% were diagnosed with HIV at the time of their lymphoma diagnosis.
The majority of patients (82%), from across five states, presented with advanced stage (III-IV) disease and most (84%) were given concurrent antiretroviral therapy and chemoimmunotherapy.
The CD4 count dropped initially on treatment, but appeared to recover within 6 months post-therapy.
The study, led by Dr Kenneth Lim of St Vincent’s Hospital Melbourne, showed that CR rates after first-line curative intent therapy were 75% in Burkitt lymphoma and 83% DLBCL.
The 2-year OS was 77% overall; 67% for Burkitt lymphoma and 81% for DLBCL.
“The OS of this cohort appears similar to the HIV negative population and published cohort studies,” the study authors concluded.