2 Minute Medicine ® - Hematology/Oncology (Hematology Focus)

1. Mitoxantrone enhances five-year event-free survival over liposomal daunorubicin in MRD-guided pediatric AML treatment. 2. High-risk patients identified by MRD guidance benefited from hematopoietic stem-cell transplantation. Evidence Rating Level: 1(Excellent) Study Rundown: The study was a phase 3 trial investigating the efficacy of mitoxantrone versus liposomal daunorubicin as induction therapy for pediatric acute myeloid leukemia (AML). Treatment allocation was determined by overall disease risk, assessed through MRD analysis using flow cytometry...

1. The 3-month symptomatic venous thromboembolism rate was 0.7% in patients with TRiP(cast) score < 7 and not receiving anticoagulation. 2. There was no significant difference between the control and intervention phases regarding secondary outcomes. Evidence Rating Level: 1 (Excellent) Study Rundown : Venous thromboembolism (VTE) is a well-recognized potential complication resulting from orthopedic trauma and periods of prolonged immobilization. However, there exists a lack of consensus around prophylactic anticoagulation among patients with lower limb trauma requiring immobilization...

1. This case-control study found that in patients with atrial fibrillation concomitant Serotonin Reuptake Inhibitor (SSRI) and Oral Anticoagulants (OAC) was associated with an increased risk of major bleeding compared with OAC use alone. 2. This increased risk was highest in the first 30 days of continuous, concomitant use. Evidence Rating Level :  2 (Good) Antidepressants, especially SSRIs, are widely prescribed, raising concerns about their interaction with OACs and the risk of major bleeding. Utilizing the UK Clinical Practice Research Datalink, this case-control study investigated whether concomitant SSRIs and OACs use was associated with the risk of major bleeding compared with OAC use alone among patients with AF...

1. Significantly more patients in the imetelstat group achieved RBC transfusion independence at 8 weeks after treatment compared to placebo. 2. Grade 3-4 treatment-related adverse events were greater in the imetelstat group. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients with red blood cell transfusion-dependent lower-risk myelodysplastic syndromes (LR-MDS) face unmet medical needs when unresponsive to erythropoiesis-stimulating agents (ESAs). Imetelstat, a telomerase inhibitor, showed promise in a phase 2 trial; however, limited evidence exists surrounding its therapeutic efficacy...

1. In this randomized controlled trial, tenecteplase administered at 4.5 to 24 hours after stroke onset to patients with an occluded middle cerebral artery (MCA) or internal carotid artery (ICA) was not superior to placebo. 2. Tenecteplase did not differ from placebo with regards to rates of death and symptomatic intracranial hemorrhage. Evidence Rating Level: 1 (Excellent) Study Rundown: Intravenous thrombolysis with tissue plasminogen activators, such as tenecteplase, is the standard of care for ischemic stroke within 4...

1. In geriatric patients with hip fractures on direct oral anticoagulants (DOACs), surgical treatment within 48 hours of their last preoperative DOAC dose had comparable complication rates and 1-year mortality compared with patients with surgery delayed past 48 hours. 2. Patients who underwent surgical management within 48 hours required fewer transfusions and had decreased length of stay, compared with those who underwent surgery beyond 48 hours.  Evidence Rating Level : 2 (Good) Geriatric hip fractures are associated with 1-year mortality rates as high as 33%...

Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study : https://read.qxmd.com/read/38395963 1. In patients with traumatic rib fractures, the number of rib fractures was an independent risk factor for venous thromboembolism (VTE). 2. Surgical fixation of isolated rib fractures involving ≥3 ribs reduced the incidence of VTE compared with conservative treatment. Evidence Rating Level :1 (Excellent) Traumatic rib fractures increase VTE risk due to reduced mobility, trauma impact, and treatment interventions...

1. Tabelecleucel provided clinical improvement in patients with EBV-related post-transplant lymphoproliferative disease. 2. There were no fatal treatment related adverse events in those treated with tabelecleucel. Evidence Rating Level: 1 (Excellent) Study Rundown: The present study was a phase 3 multicenter trial that assessed the impact of tabelecleucel (a T-cell based immunotherapy directed against EBV) on patients with EBV-related post-transplant lymphoproliferative disease.  Patients included in the trial had EBV-positive post-transplant disease...

1. In this serial cross-sectional analysis, discharge rates for acute pulmonary embolism (PE) in emergency departments (EDs) in the United States (US) remained constant between 2012 and 2020. 2. No baseline characteristics in patients with acute PE were associated with an increased likelihood of discharge from the ED. Evidence Rating Level: 2 (Good) Study Rundown: Acute PE occurs when there is a disruption of blood flow in the pulmonary artery or its branches due to a thrombus, which often originates in the deep veins...

1. Median progression-free survival was greater in the SBRT group than in the standard-of-care group. 2. Patients with NSCLC displayed a significant survival benefit with SBRT in comparison to patients with breast cancer. Evidence Rating Level: 1 (Excellent) Study Rundown: Most patients with metastatic breast cancer develop resistance to systemic therapy. Stereotactic body radiotherapy (SBRT) is a relatively novel technique that may limit disease progression, although its evidence in non-small-cell lung cancer and metastatic breast cancer patients has been limited...

1. In patients diagnosed with stage III or IV non-small cell lung cancer (NSCLC), immune checkpoint inhibitors were associated with a greater risk of atherosclerotic cardiovascular disease. Evidence Rating Level: 2 (Good) Tumor treatment has become significantly better, specifically with the start of immune checkpoint inhibitors (ICIs). ICIs can be used to target programmed cell death 1 (PD-1), programmed cell death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). An important biomarker is coronary artery calcium (CAC) as it can show direct proof of coronary atherosclerosis which has a high association with atherosclerotic cardiovascular disease (ASCVD)...

1. In this cost analysis, compared to standard care, it was found that gene therapy for sickle cell disease (SCD) is cost-effective at a societal level based on two simulation models. 2. Acceptable value-based prices (VPBs) for SCD gene therapy ranged from $1 million to $2.5 million.  Evidence Rating Level: 2 (Good) Study Rundown: SCD is a genetic condition characterized by sickling red cells leading to recurrent vaso-occlusion and hemolysis and precipitating acute pain crises, ischemia, and progressive organ damage...

1. The Atezolizumab group demonstrated significantly greater progression-free and overall survival among patients with metastatic, persistent, or recurrent cervical cancer. 2. Grade 3 or worse adverse events were comparable in both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: A previous large-scale trial has shown improved overall survival among patients with cervical cancer treated with bevacizumab and chemotherapy. Other studies have shown similar results using chemotherapy and PD-L1 monoclonal antibodies, such as pembrolizumab...

1. Patients in the pembrolizumab plus chemotherapy group reported a significantly greater overall survival compared to those in the chemotherapy alone group (17.3 months vs. 16.1 months). 2. Grade 5 adverse events were comparable in both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Pleural mesothelioma often presents at an advanced stage, and platinum–pemetrexed chemotherapy is a standard treatment. Pembrolizumab, a programmed cell death protein-1 (PD-1) inhibitor, has been used to treat non-small-cell lung cancer; however, little is known about its use in patients with mesothelioma...

1. In patients with low tumor burden follicular lymphoma (LTBFL): Rituximab maintenance therapy does not improve overall survival in comparison to retreatment at 10 year follow-up. 2. Rituximab maintenance therapy is superior to retreatment therapy for freedom of cytotoxic therapy and response duration at 7-year follow-up. Evidence Rating Level: 1 Study Rundown : The RESORT study was a phase III clinical trial that initially compared the impact of maintenance rituximab (MR) dosing versus retreatment therapy (RR) on patients with LTBFL...

1. Patients in the primaquine group reported a significant reduction in parasitemia risk at day 63 compared to those in the standard care group. 2. The majority of adverse events were mild-to-moderate with no treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown: In areas where Plasmodium vivax and Plasmodium falciparum coexist, there exists an elevated risk of P. vivax parasitemia following P. falciparum malaria. This randomized controlled trial aimed to assess the efficacy of expanding radical cure indications to P...

1. In this case-control study, the use of statins in menopausal women concurrently with hormone therapy (HT) significantly reduced the risk of VTE.  2. The response was dose-dependent, with high-intensity statins providing a higher reduction in VTE risk compared with low- to -medium intensity statins.  Evidence Rating Level: 3 (Average) Menopausal symptoms can have debilitating impacts on women’s quality of life, and although hormone therapy (HT) can be effective, concerns surrounding increased risk for complications (such as the doubled risk for VTE) are a barrier to the initiation of HT...

1. In this randomized controlled trial, thalidomide resulted in a dose-dependent reduction in bleeding among patients with recurrent bleeding from small-intestinal angiodysplasia (SIA).  2. Thalidomide was associated with a higher rate of adverse events than the placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: SIA is a vascular abnormality within the walls of the small intestine that results in vessels prone to occult bleeding and resultant iron-deficiency anemia, especially in older patients...

1. This phase 3 randomised trial demonstrated that compared with placebo in combination with trastuzumab and docetaxal, pyrotinib in the same combination conferred significantly improved progression-free survival in patients with human epidermal growth factor receptor 2 (HER2) positive metastatic breast cancer. Evidence Rating Level :1 (Excellent) HER-2 breast cancer makes up approximately 20% of all breast cancers. Pyrotinib is a small molecule, irreversible, pan-HER receptor tyrosine kinase inhibitor that targets epidermal growth factor receptor and HER2, as well as HER4...

1. Median overall survival increased by 3.2 months in the sacituzumab govitecan group compared to chemotherapy. 2. One fatal treatment-related adverse event was reported in the sacituzumab group. Evidence Rating Level: 1 (Excellent) Study Rundown: In phase 3 of the TROPiCS-02 trial, sacituzumab govitecan demonstrated significant survival benefit versus chemotherapy among patients with hormone-receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. However, protocol-specified analysis of overall survival and endpoints was unexplored...