Hematology (all articles)
Podcast | Antiplatelets, anticoagulation for coronary artery disease and atrial fibrillation
28 Jun, 2023 | 13:11h | UTC#400 Antiplatelets, Anticoagulation for Coronary Artery Disease and Afib – The Curbsiders
RCT | Cyclophosphamide-based regimen enhances GVHD-free survival after hematopoietic stem-cell transplantation
27 Jun, 2023 | 13:54h | UTCSummary: The article details a phase 3 trial comparing the efficacy of two graft-versus-host disease (GVHD) prophylactic regimens in hematologic cancer patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT). The experimental group received cyclophosphamide–tacrolimus–mycophenolate mofetil, and the standard group received tacrolimus–methotrexate. The patients, a total of 431, underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched unrelated donor.
The primary end point was GVHD-free, relapse-free survival at 1 year. Results indicated a significantly higher incidence of this outcome in the experimental group (hazard ratio, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P=0.001). At 1 year, adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) in the experimental group, compared to 34.9% (95% CI, 28.6 to 41.3) in the standard group.
Notably, patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall survival, disease-free survival, relapse, transplantation-related death, and engraftment did not show a substantial difference between the groups. These results suggest that cyclophosphamide–tacrolimus–mycophenolate mofetil may offer a more effective prophylaxis against GVHD in HSCT patients.
Article: Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Study Sets New Standard for Graft-Versus-Host Disease Prevention After Stem Cell Transplant – Johns Hopkins Medicine
Commentary on Twitter
In this trial, 1-year GVHD-free, relapse-free survival after stem-cell transplantation was 52.7% in the cyclophosphamide–tacrolimus–mycophenolate mofetil group and 34.9% in the tacrolimus–methotrexate group. https://t.co/wCdvP1LChu
— NEJM (@NEJM) June 21, 2023
Review | Renal thrombotic microangiopathy
27 Jun, 2023 | 13:34h | UTCRenal Thrombotic Microangiopathy: A Review – American Journal of Kidney Diseases
Commentary on Twitter
Renal Thrombotic Microangiopathy: A Review https://t.co/YabUm18t4q (FREE)@CPQMD @ReichHeather @UofTNephrology pic.twitter.com/Y9rSnuTFBo
— AJKD (@AJKDonline) June 24, 2023
Report | Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021
23 Jun, 2023 | 13:40h | UTCNews Release: Sickle cell disease is 11 times more deadly than previously recorded – Institute for Health Metrics and Evaluation
Commentary on Twitter (thread – click for more)
Ahead of #WorldSickleCellDay #WSCD23 we are publishing the first detailed global estimates on the burden of #sicklecell disease
Read it #openaccess https://t.co/pVlWZ6s1G4
The authors show that mortality linked to #sicklecell disease is higher than previously described🧵 pic.twitter.com/WplWr0gXqJ
— The Lancet Haematology (@TheLancetHaem) June 16, 2023
Consensus Paper | Primary prophylaxis of invasive fungal diseases in patients with hematological malignancies
23 Jun, 2023 | 13:23h | UTC
Review | Nonsurgical management of major hemorrhage
22 Jun, 2023 | 15:16h | UTCNonsurgical management of major hemorrhage – Canadian Medical Association Journal
M-A | Anticoagulation options for continuous renal replacement therapy in critically ill patients
22 Jun, 2023 | 14:54h | UTC
RCT | LMWH does not increase live birth rates in women with thrombophilia and recurrent miscarriage
21 Jun, 2023 | 13:39h | UTCHeparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2): an international open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter (thread – click for more)
New study: Many women with recurrent miscarriage are tested for inherited thrombophilia. If confirmed positive, daily subcutaneous low-molecular-weight heparin (LMWH) is given.
This is despite an absence of evidence that such treatment is beneficial 🧵 https://t.co/0IuFhvjlZr
— The Lancet (@TheLancet) June 2, 2023
Position statement | Gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy
21 Jun, 2023 | 13:22h | UTCPosition statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy – Indian Journal of Gastroenterology (if the link is paywalled, try this one)
Review | Traumatic hemorrhage and chain of survival
21 Jun, 2023 | 13:17h | UTC
RCT | Thrice-weekly oral iron shows non-inferiority and fewer gastrointestinal effects in treating iron-deficiency anemia
20 Jun, 2023 | 12:48h | UTCA randomized controlled trial of thrice-weekly versus thrice-daily oral ferrous fumarate treatment in adult patients with iron-deficiency anemia – Ann Hematol (if the link is paywalled, try this one)
Consensus Paper | Management of febrile neutropenia in pediatric hematology and oncology patients
20 Jun, 2023 | 12:38h | UTC
Review | Updates in immunohistochemistry for hematopoietic and lymphoid neoplasms
20 Jun, 2023 | 12:36h | UTC
RCT | Avapritinib superior to placebo in reducing symptoms, mast-cell burden in indolent systemic mastocytosis patients
20 Jun, 2023 | 12:34h | UTCAvapritinib versus Placebo in Indolent Systemic Mastocytosis – NEJM Evidence
Commentary on Twitter
“…in this 24-week blinded phase of the PIONEER trial, avapritinib demonstrated superiority to placebo in improving symptoms in patients with moderate to severe symptomatic ISM [indolent systemic mastocytosis]….”#Oncology #ClinicalTrials @StanfordDeptMed @ProfMaurer
— NEJM Evidence (@NEJMEvidence) June 15, 2023
Guideline | Screening and diagnosis of significant hemoglobinopathies
20 Jun, 2023 | 12:32h | UTC
M-A | Anticoagulation options for continuous renal replacement therapy in critically ill patients
19 Jun, 2023 | 13:51h | UTC
Systematic Review | Tranexamic acid likely decreases red blood cell transfusion need in hip fracture surgery
16 Jun, 2023 | 14:09h | UTC
Review | Antifungal stewardship interventions in patients with hematologic malignancies
16 Jun, 2023 | 13:47h | UTCAntifungal Stewardship Interventions in Patients with Hematologic Malignancies
RCT | Prehospital use of tranexamic acid in severe trauma cases shows no superiority over placebo
15 Jun, 2023 | 15:16h | UTCPrehospital Tranexamic Acid for Severe Trauma – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Shining a new light on tranexamic acid for trauma care – Monash University
Commentary on Twitter
Late breaking at #CCR23: In the PATCH-Trauma trial involving adults with major trauma, treatment with tranexamic acid did not result in a greater number of patients surviving with a favorable functional outcome at 6 months than placebo. https://t.co/i8fu34ReCB pic.twitter.com/GEOtRphOBb
— NEJM (@NEJM) June 14, 2023
RCT | Second-line treatment with Axi-cel results in increased overall survival in large B-cell lymphoma
14 Jun, 2023 | 14:25h | UTCSurvival with Axicabtagene Ciloleucel in Large B-Cell Lymphoma – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Late breaking at #ASCO23: In the phase 3 ZUMA-7 trial, patients with relapsed or refractory large B-cell lymphoma who received axi-cel (CD19-specific CAR T cells) had a 27.4% lower risk of death than patients who received standard therapy. Full trial results:
— NEJM (@NEJM) June 5, 2023
RCT | Cilta-cel shows superior progression-free survival over standard care in lenalidomide-refractory multiple myeloma
14 Jun, 2023 | 14:22h | UTCCilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Original Article: Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma (CARTITUDE-4) https://t.co/Wag2UTKOfH#ASCO23
— NEJM (@NEJM) June 6, 2023
Review | Acute graft-versus-host disease
14 Jun, 2023 | 14:20h | UTCAcute graft-versus-host disease – Nature Reviews Disease Primers (if the link is paywalled, try this one)
Commentary on Twitter
Tissue damage resulting from allogenic hematopoietic cell transplantation conditioning regimens triggers cellular interactions and #inflammatory cascades that lead to acute #GraftVersusHost disease symptoms https://t.co/iHyUVoV75J pic.twitter.com/ob9X7zQWB8
— Nature Reviews Disease Primers (@DiseasePrimers) June 11, 2023
Brief Review | Resistance to unfractionated heparin in the ICU: evaluation and management options
12 Jun, 2023 | 13:32h | UTCResistance to unfractionated heparin in the ICU: evaluation and management options – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
🩸 Resistance to unfractionated heparin in #ICU, evaluation & management options
💉 monitoring UFH
💉 mechanisms of resistance
💉 how to manage UFH resistance
PS check supplement table on IV anticoagulants in ICU#FOAMcc @JerroldLevy @Dr_Cit @foamecmo
🖇️ https://t.co/ojQw5On5ZL pic.twitter.com/0uPQuwUmOr— Intensive Care Medicine (@yourICM) June 7, 2023
RCT | Noninferiority shown between DOACs and LMWH for recurrent VTE prevention in cancer patients
5 Jun, 2023 | 13:50h | UTCSummary: This unblinded, pragmatic, noninferiority randomized clinical trial aimed to assess the efficacy of direct oral anticoagulants (DOACs) against low-molecular-weight heparin (LMWH) in preventing recurrent venous thromboembolism (VTE) in patients with cancer. The study included 671 patients from 67 oncology centers, with a new clinical or radiological diagnosis of VTE.
Participants were randomly assigned to receive either a DOAC or LMWH for 6 months, and treating physicians selected and prescribed the drugs based on considerations like availability and drug-drug interactions. The primary outcome was the rate of recurrent VTE at 6 months. Findings revealed that the DOAC group had a recurrent VTE rate of 6.1% as compared to 8.8% in the LMWH group, showing noninferiority. Both groups had statistically similar rates of major bleeding and severe adverse events.
This pragmatic study included patients with advanced cancer and brain metastases, impaired performance status, and reduced liver or kidney function, making it more representative of routine oncology practice. Moreover, patient adherence to DOAC treatment was significantly higher than to LMWH. Nevertheless, the study had limitations, including the lack of blinding and underrepresentation of certain racial and ethnic groups.
In conclusion, this trial suggests that DOACs were noninferior to LMWH for preventing recurrent VTE in patients with cancer over a 6-month follow-up period, supporting the use of DOACs in this population for VTE prevention. Further research is needed to confirm these results and investigate long-term outcomes.
Article: Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer: A Randomized Clinical Trial – JAMA (free for a limited period)
See also: Visual abstract
Commentary on Twitter
Among adults with cancer and VTE, direct oral anticoagulants were noninferior to low-molecular-weight heparin for preventing recurrent VTE over 6-month follow-up. #ASCO23 https://t.co/DP5RvlSYxe pic.twitter.com/rBJ99plopK
— JAMA (@JAMA_current) June 2, 2023
Review | Prevention of venous thromboembolism in patients with cancer
5 Jun, 2023 | 13:48h | UTCPrevention of venous thromboembolism in patients with cancer – The BMJ