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“We know that in CLL, of course,
ibrutinib has recently received full approval for the randomized trial comparing ibrutinib to ofatumumab,” Dr.
Brown noted, “and the progression-free
survival curve for that study looks fairly
similar to the survival curves we saw
with idelalisib and rituximab.”
Given the toxicity profiles of each regimen, she suggested the following:
• For patients requiring
anticoagulation and those with
histories of hepatitis or atrial
fibrillation, use idelalisib.
• In patients with a history of hepatitis
or inflammatory bowel disease, use
ibrutinib.
“Another issue concerning how we might
think about sequencing these drugs to
maximize overall patient benefit is that
we don’t know anything yet about the
mechanisms of resistance to idealisib,”
Dr. Brown added. This is an area of active
investigation, and as these mechanisms
become clearer, ideas about optimal sequencing with idelalisib may change.
In the case of indolent lymphoma,
there are fewer therapeutic choices than
with CLL – mainly because there is no
equivalent to ibrutinib in this setting.
“The data suggest impressive activity in a
very difficult patient population (patients
with rituximab-refractory, chemotherapyrefractory disease),” Dr. Brown explained,
“so it is likely that idelalisib may be used
earlier in treatment, especially in patients
who have comorbidities or who cannot
tolerate chemotherapy.”
*ASH, in collaboration with the FDA,
offers webinars that feature an unbiased
discussion of newly approved hematology therapies. Access recordings of these
programs at ashondemand.org.
Order Now!
Slippery Coating on
Medical Devices Helps
Get a Handle on Blood
Clots
American Society
of Hematology
Self-Assessment
Program (ASH -SAP)
A new bio-inspired coating for medical
devices repels blood and bacteria, according to results from a large animal efficacy
study conducted by scientists at Harvard’s
Wyss Institute for Biologically Inspired
Engineering.
The coating is derived from the carnivorous plant, nepenthes, which produce
a super-slippery surface that causes insects
to climb into the plant and slide into the
trap. Scientists tested whether this idea
could be applied to the medical problem
of blood clots that can occur when medical devices are implanted into the body.
Using FDA-approved materials, engineers and scientists developed a coating
that repelled blood from more than 20
medically relevant substrates the team
tested – from plastic to glass to metal –
and also suppressed biofilm formation.
Results were reported in the journal Nature
Biotechnology.
When the team implanted medicalgrade tubing and catheters coated with
the material in large blood vessels in pigs,
the coating prevented blood from clotting
for at least eight hours without the use of
blood thinners such as heparin and warfarin – medicines that can cause their own
bleeding problems.
“Devising a way to prevent blood clotting without using anticoagulants is one
of the holy grails in medicine,” said Don
Ingber, MD, PhD, founding director of
Harvard’s Wyss Institute. ●
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Source: Leslie DC, et al. A bioinspired omniphobic surface coating on
medical devices prevents thrombosis and biofouling. Nat Biotech. 2014
October 12. [Epub ahead of print]
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Blood sticks to the untreated glass slide (left), but not to the coated slide (right).
38
ASH Clinical News
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December 2014