News in brief: Promising chemo sparing option in MCL; Lower INR targets for Asian patients; Hospital-acquired complications may not be so preventable

Promising chemo sparing option in MCL

Induction with ibrutinib–rituximab followed by shortened chemotherapy in the frontline treatment of mantle cell lymphoma patients <65 years is active and safe.

The single-centre, single-arm, phase 2 trial in 131 previously untreated patients with mantle cell lymphoma found 98% of patients had an overall response after ibrutinib–rituximab and four cycles of R-HCVAD alternating with methotrexate–cytarabine.

Patients without an initial complete response had up to a total of eight cycles of chemo.

The most common grade 3–4 adverse events were lymphocytopenia (14%), skin rash (12%), thrombocytopenia (9%), infections (8%), and fatigue (8%) with the shortened chemo and lymphocytopenia (73%), leukocytopenia (32%), thrombocytopenia (30%), and neutropenia (20%) with more cycles.

“This approach allowed minimisation of the number of chemotherapy cycles, thereby reducing the adverse events associated with chemotherapy,” the study said.

Read more in The Lancet Oncology

Lower INR targets for Asian patients

Asian patients may have improved outcomes with INR targets lower than those recommended in current evidence-based guidelines, a study has found.

With warfarin still the preferred anticoagulant for mechanical heart valve procedures, clinicians in Taiwan noted that the rate of thromboembolic events at INRs between 2.0 and 2.5 was not significantly higher than at INRs between 2.5 and 3.0 for mitral valve replacement procedures. In patients having aortic valve replacement, the incidence of thromboembolic events among patients with INRs in 1.5 to 2.0 range was not significantly higher than that among those with INRs in the 2.0 to 2.5 range, the results published in JAMA Network Open showed.

The study authors said these data and other studies suggested that a lower INR target for Asian patients compared with current Western guidelines could decrease bleeding events without increasing thromboembolism risk.

Hospital-acquired complications may not be so preventable

Complications are common in hospitalised patients but rates are driven more by patient factors rather than hospital care quality factors that can be modified, new Australian research shows.

A review of 1.5 million admissions at 38 major public hospitals in South Australia and Victoria between 2015–2018 found that almost one in ten patients (9.7%) had a complication episode.

However the variations between hospitals were determined mostly by patient factors (overall correlation coefficient 0.55) whereas hospital factors accounted for only 5% of the variation.

The findings have important implications for the interpretation of hospital‐acquired complication reports and implementation of mitigation programs, the study authors said.

“Failure to differentiate between the two groups of factors may lead to practice changes that are clinically sound but ineffective in reducing complication rates. Increasing the funding of health care, improved clinical guidelines, and training and education may reduce rates of complications attributable to hospital factors and health care errors, but are unlikely to reduce those linked with patient‐related factors,” they wrote in the MJA.

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