News in brief: Shingrix now available for over 18s; Bortezomib improves survival in T-LL; ANZSBT urges use blood wisely

Shingrix now available for over 18s

The non-live recombinant Varicella Zoster Virus vaccine Shingrix is now available on the private market for the prevention of shingles (herpes zoster) and post-herpetic neuralgia (PHN) in people aged 18 years who are at increased risk of shingles.

In June 2021 Shingrix was made available to people over the age of 50. According to GSK, the new approval of Shingrix was supported by a range of clinical trials in highly immunocompromised populations aged 18 years and older, including patients with solid tumours, haematological malignancies, HIV infection, autologous hematopoietic stem cell transplant recipients, and renal transplant patients on chronic immunosuppressive treatment.

The TGA has previously warned of the risks of live zoster vaccines in immunocompromised people after receiving reports of two deaths, The most recent case involved a man with arthritis who at the time of vaccination was taking hydroxychloroquine and a low dose of prednisolone, who died 3 weeks after receiving Zostavax.

Shingrix is given intramuscularly in two doses, six months apart.

Bortezomib improves survival in T-LL.

Adding the proteasome inhibitor bortezomib to chemotherapy significantly improves overall survival in children and young adults with newly diagnosed T-cell lymphoblastic lymphoma (T-LL), according to a new study.

A phase 3 clinical trial conducted at 212 sites around the world and led by the US-based Children’s Oncology Group (COG) also found that systemic therapy intensification allowed elimination of cranial radiotherapy  in more than 90% of patients with T-ALL without excess relapse.

In the trial involving 824 patients with T-LL, dexamethasone was used instead of prednisone during chemotherapy and two extra doses of pegaspargase were added with a goal of eliminating cranial radiotherapy.

For patients with T-LL, both the 4-year event-free survival and overall survival were significantly improved for patients on bortezomib plus chemotherapy versus chemotherapy alone (86.4% and 89.5% vs. 76.5% and 78.3%, respectively).

“The data show that most patients with T-ALL no longer need cranial radiation for cure and also suggest bortezomib should be considered as part of the new standard of care for newly diagnosed patients with T-cell lymphoblastic lymphoma,” said the study investigators, led by Dr David Teachey, Director of Clinical Research at the Center for Childhood Cancer Research at Children’s Hospital of Philadelphia.

The findings are published in the Journal of Clinical Oncology.

ANZSBT: use blood wisely

Clinicians are urged to use blood ‘wisely’ as recent guidelines suggest transfusions are still being prescribed inappropriately in Australia and New Zealand.

Among the top 5 recommendations listed by Evolve and Choosing Wisely Australia are instructions to “not use peri-operative transfusion for otherwise reversible anaemia prior to elective surgery” and “not transfuse red blood cells for iron deficiency where there is no haemodynamic instability”.

Instead, clinicians should “identify and manage anaemia prior to [elective] surgery”, or give oral or intravenous iron to deficient, but haemodynamically-stable patients, respectively. Iron supplements may be administered to patients with low haemoglobin levels, the guidelines read, though they may not be suitable for those with poor compliance or gastrointestinal issues.

The recommendations emphasise blood should not be used unnecessarily and that “each unit of blood must have a clear [and evidence-based] indication”.

The “lifesaving” resource is scarce and recipients may be at risk of febrile and allergic reactions, transfusion-associated circulatory overload, transfusion-transmitted infections, transfusion-associated lung injury and anaphylaxis, Dr Anastazia Keegan, Royal Australasian College of Physicians Lead Fellow, and Vice President of the Australian and New Zealand Society of Blood Transfusion, said in a statement.

Given blood is limited and, can, in some cases, confer more risk than benefit, the “precious resource” must be used wisely,  she concluded.

The full recommendations are available via Evolve’s website.


Already a member?

Login to keep reading.

Email me a login link

© 2022 the limbic