Catching Up With Alan Tseng
CLINICAL NEWS
Patients were monitored for six days post-transfusion for adverse events ( AEs ) and clotting efficacy ( measured by prothrombin time , partial thromboplastin time , D-dimer , and fibrinogen testing ).
The authors observed no thrombotic events after transfusion of CPP units , in any of the cohorts . Thirty-eight AEs were reported , five of which were deemed “ possibly related to a CPP transfusion .” These included DMSO skin odor , mild fever , chills , and moderate headache . The authors deemed these to be related to “ worsening of the patients ’ underlying medical conditions .”
While no patient developed a post-transfusion hypercoagulable state , all experienced stabilization ( 60 % had improvement ) of their bleeding following a CPP transfusion . One patient with grade 4 central nervous system bleeding had resolution of neurologic symptoms with no further platelet transfusions , and four patients ( 17 %) had a downgrading of their bleeding severity ( per World Health Organization criteria ).
Because the CPP units are highly activated from the freeze-thaw process , the authors reasoned , their ability to control bleeding might be superior to standard platelets . “ Frozen platelets are ‘ crumbly ’; some of them will become mircoparticles ,” Dr . Slichter said . While this raises concern about clotting for patients without
Large Registry Analysis Confirms Autologous Hematopoietic Cell Transplantation Is Feasible in Older Patients
Older patients ( ≥65 years ) with hematologic malignancies are often considered unsuitable for autologous hematopoietic cell transplantation ( AHCT ) because of the potential for higher risks of complications . As a result , they are often excluded from or under-represented in clinical trials studying transplantation . A large cohort study presented at the 2016 ASH Annual Meeting specifically examined overall survival ( OS ) rates for older patients undergoing AHCT , and provides some assurance that it is safe .
“ Our data convincingly suggest that age , per se , should not be an exclusion criterion to consider AHCT in this [ older ] population ,” the authors , led by Isabel Sánchez-Ortega , MD , PhD , from the Institut Català d ’ Oncologia , Hospital Durán i Reynals in Barcelona , Spain , wrote . The results also call into question whether the age limit on AHCT is valid ( a topic ASH Clinical News covered in November 2016 , “ For Transplants , Is Age Just a Number ?”), and highlight the need “ to assess comorbidity and frailty beyond age in older AHCT candidates .”
Dr . Sánchez-Ortega and authors collected information on consecutive patients ≥65 years of age undergoing AHCT who had data reported to the European Society for Blood and Marrow Transplantation ( EBMT ) registry between 2000 and 2014 . A total of 21,390 patients undergoing AHCTs were analyzed , including 3,514 with second or subsequent procedures , from 515 EBMT centers in 45 countries . thrombocytopenia , she added , “ we want to induce clotting in thrombocytopenic patients who are actively bleeding .”
She also commented that preparing the CPP units for infusion is less cumbersome than many other methods . “ In the past , [ clinicians ] would centrifuge the platelets post-freezing to remove the DMSO ; however , there aren ’ t many centrifuges in Afghanistan ,” Dr . Slichter said . “ So , now we centrifuge the platelets to remove the DMSO [ and ] then freeze them . These products take up a small amount of space , and the only thing [ clinicians ] have to do to get the CPP unit ready for transfusion is thaw it in a 37-degree water bath and add a little saline .”
The study is limited by its small size . Dr . Slichter also cautioned that CPP units are “ designed to be used when standard platelets are not available or have not been effective in controlling bleeding ,” and the study did not evaluate CPP transfusion as a firstline option for actively bleeding patients .
REFERENCE
Slichter SJ , Dumont LJ , Cancelas JA , et al . Treatment of bleeding in severely thrombocytopenic patients with transfusion of dimethyl sulfoxide ( DMSO ) cryopreserved platelets ( CPP ) is safe – report of a phase 1 dose escalation safety trial . Abstract # 1030 . Presented at the 2016 ASH Annual Meeting , December 5 , 2016 ; San Diego , CA .
The median patient age was 67 years ( range = 65-89 years ); 17,531 patients were ages 65 to 69 years old ( group 1 ) and 3,859 were ≥70 years old ( group 2 ). Most patients ( 61 %) were male , and patients had the following diagnoses :
• multiple myeloma ( 62 %)
• lymphoproliferative disorders ( 30.5 %)
• acute leukemia ( 3.4 %)
• other ( 3.3 %)
Nearly all patients ( 99 %) received peripheral blood stem cells , and 10.3 percent had reduced-dose preparative regimens for advanced age . The median time from diagnosis to AHCT was 8.9 months ( range = 5.9-18.7 months ), and this was significantly longer for those in group 2 ( 9.4 vs . 8.8 months ; p < 0.001 ).
Neutrophil and platelet engraftment were achieved after a median of 12 days ( range = 10-13 days ) and 17 days ( range = 14-22 days ), respectively , and 1.4 percent of patients experienced primary or secondary graft failure . The most common post- AHCT complication was mucositis ( occurring in 67.5 % of patients ), and veno-occlusive disease occurred in 0.8 percent of patients . The incidence of complications did not differ between age groups .
OS was 87 percent ( 95 % CI 86.5-87.5 ) at one year post-AHCT , and 66.7 percent ( 95 % CI 66.8- 68.5 ) at three years post-AHCT . OS was significantly lower for patients in group 2 compared with group 1 , both at one year ( 87.7 % [ 95 % CI 87.2-88.3 ] vs .
Catching Up With Alan Tseng
In our December 2016 issue , we introduced you to Alan Tseng , first-time attendee . We checked in with Alan to find out how his first annual meeting went and what he learned in San Diego , California . Alan is part of the MD / PhD program at the University of Illinois at Chicago College of Medicine , and is in his third year of PhD training .
What were your overall thoughts and impressions of the meeting ? I had a tremendously positive experience at the 2016 ASH Annual Meeting . As an MD / PhD student who will hopefully be able to do both as a future career , it was inspirational to hear presenters from different backgrounds talk openly about their research . My impression was that the oral presentations featured mostly complete stories whereas the posters mostly gave a glimpse at works in progress : The common factor was that the research was all very exciting .
Were you surprised by anything ? I went to the meeting with the expectation to learn a lot about the current state of research in the field of hematology and to be exposed to the year ’ s most significant scientific discoveries . I was surprised , however , at the quality of the trainee events . The diverse group of mentors who led the small-group discussions and largegroup seminars were passionate about educating and being a resource for the next generation of scientists and clinicians . I wasn ’ t able to make it in time for the dedicated Trainee Day , but I will plan for it in the future .
What did you learn that will be most useful to you in the future ? I think a lot of the clinical Education Sessions will be beneficial . However , I am somewhat removed from the clinical aspects of my training right now , so I didn ’ t participate in those events .
What are your three takeaways from the meeting ? It ’ s hard for me to list three takeaways since I was able to attend only sessions related to my own research scope ( broadly falls under non-malignant hematology ), which easily filled out my schedule . If I had to list one takeaway , it would be that there is a huge surge in sickle cell disease ( SCD ) research , especially at the clinical level , and the future for SCD treatment looks very promising .
Will you attend the 2018 meeting ? Definitely . I believe the ASH annual meeting has a lot to offer for everyone at all levels of training . ●
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