1. Cheung MC, Hay AE, Crump M, Imrie KR, Song Y, Hassan S, Risebrough N, Sussman J, Couban S, MacDonald D, Kukreti V, Kouroukis CT, Baetz T, Szwajcer D, Desjardins P, Shepherd L, Meyer RM, Le A, Chen BE, Mittmann N; Committee on Economic Analysis and the Hematology Disease Site Committee, NCIC Clinical Trials Group. Gemcitabine/dexamethasone/cisplatin (GDP) vs. Cytarabine/dexamethasone/cisplatin (DHAP) for relapsed or refractory aggressive-histology lymphoma: Cost-utility Analysis of NCIC CTG LY.12. JNCI 2015 107(7). http://www.ncbi.nlm.nih.gov/pubmed/25868579
This study compared two second-line treatment options for relapsed aggressive histology lymphoma. The main clinical trial results had previously documented that there was no meaningful difference in response rates and survival with the two therapies, GDP and DHAP. Our study was a cost-effectiveness analysis based on trial-level data and clearly established the superiority of one treatment arm, GDP, based on quality-adjusted outcomes and cost savings. From an economic evaluation standpoint, we were able to establish that GDP was the dominant therapy available. GDP is now considered the national standard of care in Canada, and we anticipate with the full trial and cost-effectiveness publications that international practice will change.
2. Shanavas M, Popat U, Michaelis LC, Fauble V, McLornan D, Klisovic R, Mascarenhas J, Tamari R, Arcasoy MO, Davies J, Gergis U, Ukaegbu OC, Kamble RT, Storring JM, Majhail NS, Romee R, Verstovsek S, Pagliuca A, Vasu S, Ernst B, Atenafu EG, Hanif A, Champlin R, Hari P, Gupta V. Outcomes of allogeneic hematopoietic cell transplantation in patients with myelofibrosis with prior exposure to JAK 1/2 inhibitors. Biology of Blood and Marrow Transplantation. 2015 Oct 19 (in press) http://www.bbmt.org/article/S1083-8791(15)00675-8/abstract
Janus activated kinase 1/2 (JAK1/2) inhibitors are used in the treatment of myelofibrosis (MF) symptoms, though hematopoietic cell transplant (HCT) is currently the only curative therapy. This retrospective study of 100 patients, the largest multicentre experience to date on JAK inhibitor use in myelofibrosis (MF) prior to HCT, demonstrated that JAK inhibitor exposure prior to HCT did not adversely affect HCT outcomes. Favourable outcomes were observed in patients who experienced clinical improvement with JAK inhibitor therapy prior to HCT and the authors recommend that JAK inhibitor therapy be continued until close to the start of conditioning therapy.
3. Compliance with a massive transfusion protocol (MTP) impacts patient outcome. Bawazeer M, Ahmed N, Izadi H, McFarlan A, Nathens A, Pavenski K. Injury. 2015 Jan;46(1):21-8. doi: 10.1016/j.injury.2014.09.020. Epub 2014 Oct 5. PMID:25452004
The medical literature indicates that complex or critically ill patients treated as per protocol have better outcomes. In this retrospective single centre study, we examined the association between compliance with an institutional massive transfusion protocol (MTP) and mortality in severely injured, massively bleeding patients. We reviewed consecutive MTP activations in trauma over 20 months and found that the patient group that experienced the highest compliance with the protocol had the lowest mortality rate. To improve compliance, barriers to achieving high compliance should be explored and measures directed at provider and system factors should be trialed.
4. Houston B, Yan M, Tinckam K, Kamel-Reid S, Chang H, Kuo KHM, Tsien C, Seftel M, Avitzur Y, Grant D, Cserti-Gazdewich C. Extra-Corporeal Photopheresis (ECP) in Solid Organ Transplant – Associated Acute Graft-Versus-Host Disease (SOT-GVHD) Transfusion 2015, in press
We were confronted with a young male newlywed whose life was saved by an extensive cluster transplant (stomach, small bowel, pancreas, liver, and colon) after catastrophic evisceration. However, between the 5th and 8th week after allografting, there was evidence that the passenger immune system from the donor was expanding to the point of vastly injuring the patient. We confirmed that this was the rare entity known as solid-organ transplant-associated graft versus host disease (SOT-GVHD), which has only been seen in 0.06% of our Multi-Organ Transplant Program patients to date. With the high case fatality rate of this complication (as surmised from a review of the case report literature), and the constraints on safe immune suppression posed by his simultaneous struggles with septic marrow failure, we elected to try extracorporeal photopheresis (ECP). ECP is a limited-resource technology locally used in the treatment of chronic graft versus host disease complications of bone marrow transplantation, and it is not as immune suppressive as other strategies. After various other drug treatments, ECP was the first intervention to alter the pace of graft lymphocyte proliferation, as we witnessed a doubling time of 6 days fall to a decay rate with a half-life of 23 days. Two treatments were offered, but the patient succumbed as the effects of pre-existing, antimicrobial-refractory sepsis supervened. This was the 3rd published case describing ECP in SOT-GVHD, and it raises questions of when and how to deploy ECP (or other treatments) more effectively to achieve recovery before irreversible damages occur in SOT-GVHD.
