VenR long term responses for relapsed CLL

The combination of venetoclax plus rituximab (VenR) induced both a ‘deep and highly durable’ response in patients with relapsed CLL, long term follow up of a phase 1 trial reveals

Five-year rates for overall survival, progression-free survival, and duration of response were 86% (95% CI, 72–94), 56% (40–70), and 58% (40–73), respectively among the 49 patients involved in the study.

However, researchers involved in the international trial, including from sites in Australia, say deep responders who chose to stay on venetoclax appeared to show no incremental benefit from continuous monotherapy over those deep responders who chose to discontinue treatment followed by re-treatment with VenR on disease progression.

At five-years estimates of ongoing response among the 33 deep responders were similar between continuous (71% [95% CI, 39–88]) or limited-duration therapy (79% [49–93]).

Investigators report that six of 19 patients in the latter group had subsequent disease progression, all more than two years off venetoclax (range, 2.1–6.4).

Four patients have been retreated with VenR, with partial responses observed in the three evaluable to date, they add.

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High dose IVIG responses in older VITT patients

Haematologists in Canada have reported the response to IVIG therapy in three of the first patients who experienced vaccine-induced immune thrombotic thrombocytopenia (VITT) following COVID-19 vaccination.

All three patients, two men aged 63 and 69 and a woman aged 72 years, had one or more arterial thrombotic events while two patients had additional venous thrombosis. 

Writing in NEJM, the specialists say use of high-dose IVIG to treat thrombosis is unusual, especially considering that thrombotic events have been well documented after IVIG administration in patients with immune thrombocytopenic purpura. But, in the case of patients with autoimmune HIT, and in the three reported VITT cases, the inhibition of serum-induced platelet-activating properties by IVIG was associated with increased platelet counts.

The team suspects the finding, which was shown by an increase in fibrinogen levels and a decrease in d-dimer levels in two of the patients, reflect in vivo inhibition of antibody-induced platelet activation and reduced hypercoagulability.”

They say early administration of IVIG may be an important adjunct therapy to anticoagulation for the management of VITT since patients can have severe thrombocytopenia that potentially lasts for several weeks.

The woman reported having an onset of left limb pain and claudication 7 days after vaccination and presented to ED the following day.

Meanwhile patient two, who reported no cardiovascular risk factors or history of thrombosis presented to ED some 24 days after vaccination. He reported cramping in his left leg beginning 18 days after vaccination. Acute dyspnea developed four days later with his left leg reportedly becoming painful and cold.

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Specialists in top 10 for Australian incomes

Doctors led by surgeons and anaesthetists hold five of the 10 top places for high-income earners in Australia, according to ATO statistics for the 2018-19 financial year.

Internal medicine specialists were in third spot, with average taxable income of $304,752, although earnings varied by jurisdiction, from $343,353 in Western Australia to $287,437 in NSW and $269,158 in the Northern Territory.

Surgeons were Australia’s most highly remunerated occupation, with an average taxable income of $394,303, followed by anaesthetists on $386,065. Psychiatrists were in 5th place on $235,558, while ‘other medical practitioners’, in 6th place, recorded average earnings of $222,933.

By way of comparison, the average taxable income for Australians was $62,549 overall, ($73,218 for males, $51,382 for females). Besides doctors other high income occupations included financial dealers in 4th place with $275,984, judges and lawyers (7th) with $188,798 and mining engineers (8th) with $184,507.

Australian CEOs and managing directors recorded average incomes of $164,896, (9th) and engineering managers rounded out the list with $159,940.