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The official podcast feed of MDedge Hematology-Oncology, part of the Medscape Professional Network. Our Tuesday show brings you the latest hem/onc news. On Thursdays, Dr. David Henry interviews key opinion leaders and rising stars in hematology and oncology. The information in this podcast is provided for informational and educational purposes only.

Blood & Cancer Medscape Professional Network

    • Medizin

The official podcast feed of MDedge Hematology-Oncology, part of the Medscape Professional Network. Our Tuesday show brings you the latest hem/onc news. On Thursdays, Dr. David Henry interviews key opinion leaders and rising stars in hematology and oncology. The information in this podcast is provided for informational and educational purposes only.

    Convalescent plasma for COVID-19, race linked to cancer-associated thrombosis risk, iron deficiency common in pregnancy, and more from ‘Best of ASH’

    Convalescent plasma for COVID-19, race linked to cancer-associated thrombosis risk, iron deficiency common in pregnancy, and more from ‘Best of ASH’

    New studies have shed additional light on how convalescent plasma may affect patients with COVID-19, how blood type impacts bleeding risk, the effects of race on cancer-associated thrombosis, and iron deficiency in pregnancy.
    These studies were presented as part of the “Best of ASH” session at the 2020 annual meeting of the American Society of Hematology.
    Alisa S. Wolberg, PhD, of the University of North Carolina at Chapel Hill, who cochaired the session, reviews these studies with host David H. Henry, MD, in this episode.
     
    Abstract #572: Association of ABO Blood Group with Bleeding Severity in Patients with Bleeding of Unknown Cause. https://bit.ly/2Mc0R2A.
    This study, which included 422 patients, indicated that blood group O is overrepresented in patients with bleeding of unknown cause. Blood group O was associated with a more severe bleeding phenotype, especially oral mucosal bleeding, independent of the levels of von Willebrand factor and factor VIII. Patients with blood group O had increased clot density, but blood group O didn’t influence thrombin generation or platelet function analysis. The researchers said these findings are important for better understanding the underlying mechanisms of bleeding in patients who have bleeding of unknown cause. Dr. Wolberg said this study reframed how people look at bleeding of unknown cause. Abstract #203: Racial/Ethnic Disparities in Cancer-Associated Thrombosis: A Population-Based Study. https://bit.ly/35Xi5HE.
    This study included more than 942,109 cancer patients. Results showed an independent association between race/ethnicity and the risk of cancer-associated thrombosis. Asians/Pacific Islanders had a significantly lower incidence of cancer-associated thrombosis, compared with non-Hispanic Whites. African Americans had a significantly higher incidence of cancer-associated thrombosis versus non-Hispanic Whites. Racial/ethnic differences were especially prominent when examining pulmonary embolism only. It’s hard to determine what causes these differences, Dr. Wolberg said. The differences could be explained by underlying biological traits, systemic racism, access to care, and/or the severity of underlying comorbidities, according to the researchers. Abstract #424: Suboptimal Iron Deficiency Screening in Pregnancy in a High Resource Setting. https://bit.ly/2XYedSA.
    The study included data on 47,590 pregnancies in 44,552 women from Ontario. About 40% of these patients (n = 25,880) had ferritin measurements taken during pregnancy. Iron deficiency was observed in 52.8% of evaluable pregnancies, and severe iron deficiency was seen in 23.8%. These findings suggest a ferritin test should be included as part of routine bloodwork at the first prenatal visit, the researchers said. They also noted that failing to evaluate iron stores in the second and/or third trimester misses the periods of highest iron-deficiency risk, when intravenous iron may be considered. The researchers said these gaps in care should be addressed by revising guidelines.
    Abstract #245: Efficacy of COVID-19 Pathogen-Inactivated Convalescent Plasma for Patients with Moderate-to-Severe Acute COVID-19: A Case-Matched Control Study. https://bit.ly/2XVlulU.
    For this study, researchers compared 15 cases and 30 controls, all of whom had COVID-19. Cases received two units of COVID-19 convalescent plasma (CCP) from different donors. CCP appeared to improve survival in hospitalized COVID patients, though the difference was not significant. The 28-day mortality rate was 6.7% among cases and 20.7% in controls (P = .233). The researchers also found that unselected CCPs have heterogeneous antivirus activity. Pathogen reduction treatment did not impact antivirus activity. ADAP, ACE2, RVPN, and COVAM could be used to define activity. A posttransfusion increase in activity could be detected in some, but not al

    • 18 Min.
    Thrombosis research from ASH 2020: Khorana score falls short in cancer study, factors predict VTE in cancer patients with COVID-19, and antithrombotics don’t affect severe COVID outcomes

    Thrombosis research from ASH 2020: Khorana score falls short in cancer study, factors predict VTE in cancer patients with COVID-19, and antithrombotics don’t affect severe COVID outcomes

    Three studies revealed new findings on thrombosis in patients with cancer and/or COVID-19. These studies were presented at the 2020 annual meeting of the American Society of Hematology.
    One study suggested the Khorana score may be ineffective for predicting venous thromboembolism (VTE) in cancer patients. Another study revealed factors that can predict VTE in patients with cancer and COVID-19. And a third study indicated that antithrombotic agents don’t improve outcomes in patients with severe COVID-19. 
    Kristen M. Sanfilippo, MD, of Washington University, St. Louis, reviews these studies with host David H. Henry, MD, in this episode.
    Abstract 202: Performance of Khorana Score to Predict One-Year Risk of Venous Thromboembolism in Over Two Million Patients With Cancer. https://bit.ly/3oCHOfQ.
    The study included 2,112,260 patients with cancer. At 1 year after diagnosis, 227,170 (10.8%) patients had developed VTE. The Khorana score was a weak to modest predictor of the 1-year risk of VTE (area under the curve, 0.565; 95% confidence interval, 0.564-0.566). Abstract 204: Incidence of and Risk Factors for Venous Thromboembolism Among Hospitalized Patients With Cancer and COVID-19: Report From the COVID-19 and Cancer Consortium (CCC19) Registry. https://bit.ly/38waPnX.
    The study included 1,813 hospitalized patients with COVID-19 and cancer who were enrolled in the CCC19 registry. Patients had an increased risk of VTE if they had received anticancer therapy in the last 3 months (odds ratio, 1.63), had active disease (OR, 1.25 for stable/responding disease and 1.67 for progressing disease), had a cancer subtype with a high VTE risk (OR, 1.57 for high risk and 3.42 for very high risk), or were admitted to the ICU within 48 hours of hospitalization (OR, 2.38). Patients had a reduced risk of VTE if they received preadmission anticoagulant (OR, 0.80) or antiplatelet therapy (OR, 0.71). The researchers said this information will aid the development of a risk prediction tool for VTE in hospitalized patients with cancer and COVID-19. For more information on the CCC19 registry, listen to the Blood & Cancer episode, “Studying cancer patients with COVID-19: NCCAPS and CCC19.” https://bit.ly/39lB0x0. Abstract 206: Anticoagulant and Antiplatelet Use not Associated With Improvement in Severe Outcomes in COVID-19 Patients. https://bit.ly/3bvHqvV.
    This retrospective study included 28,076 patients with confirmed COVID-19 – 1,024 of whom were on antiplatelet agents, anticoagulants, or both. Chronic anticoagulant or antiplatelet use was not associated with a significantly lower risk of VTE (OR, 1.44), emergency department visit (OR, 0.94), ICU stay (OR, 0.87), or death (OR, 0.91). However, anticoagulant or antiplatelet use was associated with a decreased risk of ventilator use (OR, 0.72). Overall, these findings suggest chronic anticoagulant or antiplatelet use don't mitigate disease severity in COVID-19 patients, the researchers concluded. The session in which these abstracts were presented is entitled, “904. Outcomes Research – Non-Malignant Conditions: Venous Thromboembolism Associated With Cancer and/or COVID-19,” and details can be found here: https://bit.ly/39olwIl.
    Data in some of the abstracts differ from data presented at the meeting.
    Disclosures
    Dr. Sanfilippo disclosed relationships with Covington & Burling, Luther & Associates, Bayer, Health Services Advisory Group, and Amgen. Dr. Henry has no relevant disclosures.
    *  *  *
    For more MDedge Podcasts, go to mdedge.com/podcasts
    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgehemonc
    David Henry on Twitter: @davidhenrymd

    • 24 Min.
    Highlights from SABCS 2020: New data on CDK4/6 inhibitors, omitting chemotherapy and radiotherapy, underreporting toxicity, and predicting outcomes in breast cancer

    Highlights from SABCS 2020: New data on CDK4/6 inhibitors, omitting chemotherapy and radiotherapy, underreporting toxicity, and predicting outcomes in breast cancer

    A number of groundbreaking and practice-changing studies were presented at the San Antonio Breast Cancer Symposium 2020.
    The RxPONDER, ADAPT, and PRIME-2 trials revealed patients who can forgo chemotherapy or radiotherapy, monarchE and PENELOPE-B showed conflicting results with CDK4/6 inhibitors, one study indicated that a new tool can guide adjuvant chemotherapy, and another study suggested that circulating tumor cells (CTCs) can predict overall survival (OS).
    Alan P. Lyss, MD, subprincipal investigator for Heartland Cancer Research NCORP, joined host David H. Henry, MD, to discuss these and other studies — their top 10 presentations from SABCS 2020 — in this episode.


    1. Abstract GS3-07. Identifying patients whose symptoms are under-recognized during breast radiotherapy: Comparison of patient and physician reports of toxicity in a multicenter cohort. https://bit.ly/2MGCVEH
    This presentation could be one of the most important stories to emerge from SABCS 2020, according to Dr. Lyss. The trial included 9,868 breast cancer patients who received radiotherapy over an 8-year period. Investigators compared patient and physician reports of toxicity during radiotherapy, assessing four symptoms: pain, pruritus, edema, and fatigue. Physicians under-recognized moderate to severe pain 30.9% of the time, pruritus 36.7% of the time, edema 51.4% of the time, and fatigue 18.8% of the time. “The bottom line is: We’ve got to do better at this, and the first step in correcting it is to acknowledge that there is a problem. This abstract established that,” Dr. Lyss said.  
    2. Abstract GS2-03. Prime 2 randomised trial (postoperative radiotherapy in minimum-risk elderly): Wide local excision and adjuvant hormonal therapy +/- whole breast irradiation in women =/> 65 years with early invasive breast cancer: 10-year results. https://bit.ly/3omINAL
    The trial enrolled 1,326 women with histologically confirmed, unilateral invasive, hormone receptor-positive (HR+) breast cancer who were all 65 or older, had a tumor measuring 3 cm or less, had no nodal involvement, and were about to undergo breast-conserving surgery. The women were randomized 1:1 to receive adjuvant whole-breast irradiation or no radiotherapy in addition to adjuvant endocrine therapy. At 10 years, the rate of ipsilateral recurrence was significantly lower with radiotherapy than without it (0.9% vs 9.8%, P = .00008). The 10-year rate of regional recurrence was significantly lower with radiotherapy as well (0.5% vs. 2.3%, P = .014). There was no significant difference in the radiotherapy and no-radiotherapy arms when it came to distant recurrence (3.6% vs. 1.9%, P = .07), contralateral recurrence (2.2% vs. 1.2%, P = .20), non–breast cancer (8.7% vs. 10.2%, P = .41), metastasis-free survival (96.4% vs. 98.1%, P = .28), or OS (81.0% vs. 80.4%, P = .68). These results suggest radiotherapy could be omitted in this patient population, but the decision should be discussed and tailored to the individual patient, according to Dr. Henry.  
    3. Abstract GS1-01. Primary outcome analysis of invasive disease-free survival for monarchE: abemaciclib combined with adjuvant endocrine therapy for high-risk early breast cancer. https://bit.ly/38oSHwt
    The monarchE trial enrolled 5,637 women with HR+, HER2- early breast cancer. Cohort 1 included patients with four or more positive nodes, up to three positive nodes and a tumor size ≥ 5 cm, or grade 3 disease. Cohort 2 included women with up to three positive nodes and a Ki-67 index ≥ 20%. Patients in both cohorts were randomized to standard endocrine therapy alone or standard endocrine therapy with abemaciclib. The 2-year rate of invasive disease-free survival (IDFS) was 92.3% in the abemaciclib arm and 89.3% in the control arm (P = .0009). The 2-year distant relapse-free survival rate was 93.8% and 90.8%, respectively (P = .00

    • 52 Min.
    Best of Blood & Cancer 2020

    Best of Blood & Cancer 2020

    In this episode, we bring you clips from the best Blood & Cancer shows of 2020. Blood & Cancer will be back with new episodes in 2021. 


    ESMO 2020: Late-breaking and practice-changing studies on COVID-19 and breast, lung, gastrointestinal, and other cancers
    https://bit.ly/3h7aWZM

    Beyond the lungs: How COVID-19 affects the blood, brain, gastrointestinal system, and other organ systems
    https://bit.ly/37GhV8Q

    EHA25: AML, myeloma, polycythemia vera, and COVID-19 with EHA President John Gribben
    https://bit.ly/3nS4592

    VTE rate, 'COVID toes,' and Virchow's triad: What you need to know about COVID and coagulation
    https://bit.ly/3rizmnM

    ASCO 2020: Practice-changing studies in breast, lung, colorectal, and other cancers
    https://bit.ly/37EIbkg
    * * *
    For more MDedge Podcasts, go to mdedge.com/podcasts

    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgehemonc
    David Henry on Twitter: @davidhenrymd

    • 40 Min.
    Oncology News from SABCS 2020 | More women may forgo chemo for breast cancer, surgery's role in opioid use

    Oncology News from SABCS 2020 | More women may forgo chemo for breast cancer, surgery's role in opioid use

    News from SABCS 2020:
    RxPONDER: Even more women may forgo chemo for breast cancer: https://bit.ly/2LIYjZt Breast surgery may be a gateway to addictive medication use: https://bit.ly/3gSWfJF Pregnancy after breast cancer is rockier but doesn’t increase recurrence risk: https://bit.ly/2KwlhCx Email Blood & Cancer at podcasts@mdedge.com. 

    • 7 Min.
    How does COVID-19 affect patients with hematologic malignancies? The ASH registry provides some answers

    How does COVID-19 affect patients with hematologic malignancies? The ASH registry provides some answers

    The ASH Research Collaborative COVID-19 Registry for Hematology was established earlier this year to study patients with hematologic malignancies diagnosed with COVID-19. Now, the registry also includes patients with nonmalignant hematologic disorders and hematologic manifestations of COVID-19.
    William Wood, MD, of the University of North Carolina at Chapel Hill, recently presented data from the registry at the ASH Annual Meeting. In this episode, Dr. Wood tells host David H. Henry, MD, how the registry came to be and reviews some of its findings.


    About the registry

    The registry is part of the ASH Research Collaborative, an organization established in 2018 to foster collaboration to accelerate progress in hematology. The registry houses data on patients with a COVID-19 diagnosis and hematologic disorders/malignancies or hematologic manifestations of COVID-19. Health care providers around the world can contribute data to the registry. Anyone can view summaries of the deidentified data on the registry website. The website data are updated every day or every few days. The information compiled in the registry includes: The nature of patients’ underlying disease Treatments received until COVID-19 diagnosis Sociodemographic information COVID-19 symptoms and time to resolution or death COVID-19–directed treatments Expected prognosis Whether patients opted for intensive care.
    Registry findings
    The registry data presented at ASH 2020 included 656 patients with hematologic malignancies and COVID-19. Dr. Wood said the first conclusion drawn from these data is that patients with underlying hematologic malignancies are a “medically vulnerable population” when it comes to COVID-19. The mortality rate was 20% overall and 33% in patients with hospitalization-level severity. The other major finding, Dr. Wood said, is that the risk of severe COVID-19 and death is differentially distributed. Risk factors for adverse COVID-19 outcomes include: Increasing age Advanced underlying disease or limited prognosis Forgoing intensive management.

    Relevant links

    ASH Research Collaborative: https://bit.ly/37pczyV. COVID-19 Registry for Hematology: https://bit.ly/3r1U9vO. Blood Adv. 2020. 4(23):5966-75. https://bit.ly/34jWVTt. Wood W et al. ASH 2020, Abstract 215. https://bit.ly/3gRzw0A.
    Disclosures
    Dr. Wood disclosed research funding from Pfizer, consultancy for Teladoc/Best Doctors, and honoraria from the ASH Research Collaborative. Dr. Henry has no relevant disclosures.
    *  *  *
    For more MDedge Podcasts, go to mdedge.com/podcasts
    Email the show: podcasts@mdedge.com
    Interact with us on Twitter: @MDedgehemonc
    David Henry on Twitter: @davidhenrymd
     

    • 26 Min.

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