News in brief: Mobilising regimen quirk in myeloma patients; GP in trouble for LMWH slip; Hairy cell leukaemia guidance for COVID-19

Thursday, 6 May 2021

Post-transplant mobilising regimen impact survival in myeloma patients

Patients with multiple myeloma have better overall survival (OS) after autologous transplant with a G-CSF only mobilising regimen compared with G-CSF and cyclophosphamide, an Australian study shows.

The findings comes from a retrospective review of outcomes for 601 patients treated at 12 transplant centres with bortezomib, cyclophosphamide and dexamethasone induction followed by melphalan autograft.

Compared to patients who received G-CSF and cyclophosphamide mobilisation, G-CSF only mobilisation was associated with significantly improved OS (adjusted Hazard Ration = 0.60) and time to next treatment (aHR = 0.77).

Investigators led by Dr Matthew Reece of Austin Health, Melbourne said the survival benefit may reflect selection bias in excluding patients with unsuccessful G-CSF only mobilisation, or may be due to enhanced autograft immune cell content and improved early immune reconstitution.

Bone Marrow Transplantation

$120k payout for anticoagulant negligence

A $120,000 settlement has been agreed for a woman who had a cerebral haemorrhage after being prescribed enoxaparin by her GP for a longer duration than recommended for venous thromboprophylaxis.

The 44-year old female was prescribed Clexane for 15 days following hospital discharge after sustaining severe injuries in a car accident.

However her GP decided to continue to prescribe daily injections for several more weeks, during which time the patient became unwell and a brain CT scan revealed that she had developed subdural haemorrhages that required neurosurgery.

A medicolegal firm representing the NSW woman said it had reached a pre-trial settlement based on expert reports from a pathologist and neurologist that her brain bleed had been due to negligent excessive prescribing of anticoagulant.


COVID-modified advice for hairy cell leukaemia

International experts, including Australians Professor John Seymour and Professor Con Tam, have provided guidance on the prevention and management of hairy cell leukaemia during the COVID-19 pandemic.

Recommendations are based on the 2017 consensus for the diagnosis and management with classic HCL, but modified due to the increasing evidence of the adverse course of COVID-19 in patients with haematological malignancies.

They include advice that initiation of effective therapy in patients with newly diagnosed cHCL should not be delayed in the absence of ongoing infection.

“Since many patients with newly diagnosed cHCL have pancytopenia, it may be prudent to initiate therapy before the haematologic parameters decline to critical levels,” they said.

They also recommended less myelosuppressive and immunosuppressive treatment regimens. For example, “The “off-label” use of a BRAF inhibitor (e.g., vemurafenib) in cHCL patients harbouring this mutation has resulted in disease responses including early granulocyte recovery enabling control of infection.”

In relapsed cHCL, active surveillance in patients with low but stable blood counts may be more appropriate than active treatment.


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