Hematology Link
Continued from page 16
What are unique issues of palliative care for
patients with hematologic disorders?
Obviously, the need for transfusions in
this patient population can be profound,
but what was once a lifeline for patients
for so long can become ineffective and
burdensome. This can raise difficult issues
for patients where collaboration between
our providers can be rich and effective.
For example, in a patient requiring
transfusions for a hematologic condition, we
can review the patient’s overall trajectory
to predict his or her likely outcome. That
includes asking each other:
implications on the patient’s life. In this
case, one component of the “total pain”
management plan, then, is reducing that
physical pain, but also thinking about
alternative ways the patient can access his
or her faith. This would involve asking
questions like, “Can your pastor come to
your home? Is there a television program
that would equate to going to Mass?”
Similarly, there are critical questions that
can provide us with more insight beyond a
numerical rating of pain: “How would your
life be different without the pain? What
do you think is causing the pain? To what
degree can your pain be relieved? What does
that pain mean to you?” These questions
can help us better understand the individual
patient’s pain experience.
Relative to the hematologist’s practice
and clinic workflow, pain assessments
may be initiated as part of an intake
questionnaire conducted by a medical
assistant or a nurse colleague at the
beginning the patient’s visit – asking
about the intensity, severity, duration,
location, and what makes the pain better
• Are transfusions being required
more often?
or worse. Gathering those data can help
guide the hematologist, when necessary,
toward conducting a more thorough pain
assessment during a clinical visit.
When does a patient transition from cancer
treatment plus palliative care to only palliative care? What makes determining that
point difficult?
It is different for every patient. One
important thing I find helpful is to explore
and identify the patient’s values and goals.
We need that individualized, personalized
N O W AVA I L A B L E
• Is the efficacy of the transfusions
lessening? Is the patient
responding as robustly to the
transfusions?
F O R T H E T R E A T M E N T O F P h - N E G A T I V E R E L A P S E D / R E F R A C T O RY
B - C E L L A C U T E LY M P H O B L A S T I C L E U K E M I A ( A L L )
• What is the patient’s functionality or
performance status? Are transfusions
helping the patient’s energy level
now as they previously did?
• How does the patient’s overall
status compare to month ago?
Three months ago? Six and 12
months ago?
• Would we be surprised if the patient
would be alive in six months? In
one year? Why or why not?
Together we can look at global
indices of a patient’s well-being.
As hematologists know, with many
hematologic disorders – unlike
solid tumor oncology – you can’t
always measure the size of a tumor
or the impingement upon an organ
and come to conclusions about the
trajectory of the illness. You have to
rely on longitudinal information. A
dual approach can take the aggregate
care and interpretation of the illness
to the next level - examining where
the patient’s been, where the patient
is now, and where we would forecast
the patient to be in the future.
What kinds of questions should hematologists be asking their patients to
assess pain?
Pain can be thought of as “the fifth
vital sign.” For anyone providing
pain management, it is important to
assess how all the different domains
– physical, psychosocial, quality-oflife, spiritual – are being impacted.
For example, a patient’s physical
pain may prevent him or her from
attending church, which may then
contribute to feelings of spiritual pain
from losing that connection with his
or her congregation and God. So,
that physical pain is having broader
48
ASH Clinical News
Discover the first and only FDA-approved Bispecific CD19-directed CD3 T-cell Engager
In a phase 2, open-label, multicenter,
single-arm clinical trial:
• The primary endpoint was the complete
remission/complete remission with partial
hematological recovery (CR/CRh*) rate
within 2 cycles of treatment with BLINCYTO™.
• Eligible patients were ≥ 18 years of age with
Philadelphia chromosome-negative relapsed
or refractory B-precursor ALL.
• Relapsed or refractory was defined as relapsed
with first remission duration of ≤ 12 months
in first salvage or relapsed or refractory after
first salvage therapy or relapsed within
12 months of allogeneic hematopoietic stem
cell transplantation (HSCT), and had ≥ 10%
blasts in bone marrow.
75.3%
41.6%
(95% CI: 34.4-49.1)
of R/R ALL evaluable
patients achieved a
CR/CRh* (n=77/185)1
(95% CI: 64.2-84.4)
with CR/CRh* also had an
MRD response (defined
as MRD by PCR < 1 x 10-4)
(n=58/77)1
39%
of patients who achieved
CR/CRh* went on to receive
allogeneic transplant
(n=30/77)1
INDICATION
BLINCYTO™ is indicated for the treatment of Philadelphia chromosome-negative relapsed or refractory B-cell precursor
acute lymphoblastic leukemia (ALL).
This indication is approved under accelerated approval. Continued approval for this indication may be contingent upon
verification of clinical benefit in subsequent trials.
IMPORTANT SAFETY INFORMATION
WARNING: CYTOKINE RELEASE SYNDROME and NEUROLOGICAL TOXICITIES
• Cytokine Release Syndrome (CRS), which may be life-threatening or fatal, occurred in patients receiving
BLINCYTO™. Interrupt or discontinue BLINCYTO™ as recommended.
• Neurological toxicities, which may be severe, life-threatening or fatal, occurred in patients receiving BLINCYTO™.
Interrupt or discontinue BLINCYTO™ as recommended.
Contraindications
BLINCYTO™ is contraindicated in patients with a known hypersensitivity to blinatumomab or to any component of the
product formulation.
Warnings and Precautions
• Cytokine Release Syndrome (CRS): Life-threatening or fatal CRS occurred in patients receiving BLINCYTO™. Infusion
reactions have occurred and may be clinically indistinguishable from manifestations of CRS. Closely monitor patients
for signs and symptoms of serious events such as pyrexia, headache, nausea, asthenia, hypotension, increased alanine
aminotransferase (ALT), increased aspartate aminotransferase (AST), increased total bilirubin (TBILI), disseminated
intravascular coagulation (DIC), capillary leak syndrome (CLS), and hemophagocytic lymphohistiocytosis/macrophage
activation syndrome (HLH/MAS). Interrupt or discontinue BLINCYTO™ as outlined in the Prescribing Information (PI).