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

1. Patients with HIV treated with antiretroviral : https://read.qxmd.com/read/39242159 therapy (ART) have a 31.5% chance of being anemic with many significantly positively associated risk factors that can be easily screened for and monitored Evidence Rating Level: 3 (Average) Anemia is a significant cause of morbidity and mortality in individuals undergoing highly active antiretroviral therapy (HAART). An estimate showed 46.60% of all individuals living with HIV on HAART experience anemia with 1/3 North American patients having anemia...

1. BrECADD resulted in significantly lower treatment-related morbidity than eBEACOPP. 2. Progression-free survival at 48 months was significantly greater in the BrECADD group compared to the eBEACOPP group. Evidence Rating Level: 1 (Excellent) Study Rundown : Intensified systemic chemotherapy provides high cure rates, albeit with severe and long-lasting toxicities, in patients with advanced-stage classical Hodgkin lymphoma. The BrECADD regimen (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone) aims to reduce these toxicities while maintaining treatment effectiveness compared to current treatment regimens...

1. In patients with an established history of atherosclerotic cardiovascular disease (ASCVD) randomized to either take a daily high (325mg) or low (81mg) dose aspirin, there was no interaction between race and the primary endpoint consisting of death, hospitalization for myocardial infarction, or stroke.  Evidence Rating Level: 1 (Excellent)  In the USA, there are disparities in the outcome of atherosclerotic cardiovascular disease (ASCVD) between Black and non-Black patients. This disparity is due to many factors, one of which may be the different reactions of platelets in self-reported Black patients to aspirin...

1. In a cohort of patients with mechanical heart valves and a prior history of intracranial hemorrhage (ICH), the risk of thromboembolism, ischemic stroke, and valve thrombosis was low following anticoagulation reversal therapy (PCC or FFP)  2. The timing of anticoagulation reinitiation was not associated with the risk of ICH expansion however bridging with IV heparin increased the risk of ICH Evidence Rating Level: 2 (Good)  In patients with intracranial hemorrhage (ICH) and mechanical heart valves, the optimal time for reinitiation of oral anticoagulation is unknown...

1. Patients in the sintilimab group reported a significantly greater event-free survival at 36 months compared to the standard therapy group. 2. Grade 3-4 adverse events were slightly more common in the sintilimab group. Evidence Rating Level: 1 (Excellent) Study Rundown: Anti-PD-1 therapy is used to treat metastatic and refractory nasopharyngeal carcinoma, yet its role in locoregionally advanced disease remains unclear. Sintilimab, a novel PD-1 inhibitor, has shown some promise when added to the standard chemoradiotherapy regimen, although further evidence is needed...

1. In this randomized controlled trial, a prophylactic weekly dose of efanesoctocog alfa (ALTUVIIIO) resulted in sustained factor VIII activity in children with severe hemophilia A. 2. Having sustained elevated factor VIII activity prevented bleeding episodes in these children.  Evidence Rating Level: 1 (Excellent) Study Rundown: Hemophilia A is a life-threatening disease with inadequate treatment options to prevent major bleeding episodes. Maintaining high levels of coagulation factors protects against bleeding...

1. In this randomized controlled trial, CM313, an anti-CD38 monoclonal antibody therapy, was associated with rapid recovery of platelet counts among patients diagnosed with immune thrombocytopenia (ITP). 2. CM313 was associated with grade one to two adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown: ITP is a rare autoimmune disease resulting in the destruction of platelets, thrombocytopenia, and increased risk of bleeding, often potentially fatal. The mainstay of therapy for ITP is glucocorticoid, but long-term use involves many adverse effects, and ITP relapse is common following discontinuation...

1. Dual antiplatelet therapy with ticagrelor and asprin led to a significantly lower risk of major adverse cardiovascular events over 5 years compared to ticagrelor or asprin monotherapy 2. Bleeding and other adverse events were similar between dual antiplatelet, ticagrelor monotherapy, and asprin monotherapy  Evidence Rating Level: 1 (Excellent) Typically, asprin monotherapy is recommended after a coronary artery bypass graft surgery to reduce the risk of adverse cardiovascular events and improve graft patency...

1. In this randomized controlled trial, among patients presenting with acute intracerebral hemorrhage (ICH) who had taken factor Xa inhibitors, andexanet resulted in less hematoma expansion compared to usual care. 2. Andexanet was associated with higher risks of thrombotic events, including ischemic stroke, and no difference in modified Rankin scale or death at 30 days. Evidence Rating Level: 1 (Excellent) Study Rundown: Factor Xa inhibitors are anticoagulants that prevent thrombotic events. Nevertheless, these medications increase the risk of hemorrhage, with acute ICH resulting in significant disability and mortality, where hematoma expansion is a predictor of poor outcomes...

1. In this randomized controlled trial, a mong individuals with congenital thrombotic thrombocytopenic purpura (TTP), no patients in a prophylactic group that received recombinant ADAMTS13 had an acute TTP event, whereas one adverse event occurred in a patient who received prophylactic standard therapy.  2. The most common TTP manifestation was thrombocytopenia. Evidence Rating Level: 1 (Excellent) Study Rundown: TTP is a rare thrombotic microangiopathy that results from a deficiency in the ADAMTS13. A phase three randomized control trial was initiated to assess the efficacy and safety of recombinant ADAMTS13 in patients with TTP...

1. A multivariate predictive model was developed to help determine when a bone marrow sample would help distinguish between patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) . 2. The model aimed to minimize unnecessary b one marrow sampling in this population.  Evidence Rating Level: 2 (Good) Study Rundown: MGUS may be a precursor to MM and other lymphoproliferative disorders. The way to distinguish between SMM and MGUS is by looking at the bone marrow plasma cells (BMPC)...

1. Among patients on anticancer treatment with malignancy who were 75 years of age or older, the use of remote electronic patient-reported outcomes for monitoring had limited feasibility. 2. Feasibility was increased when considering only the subgroup of patients who agreed to test the web application, and not including the patients who declined. Evidence Rating Level: 2 (Good) In recent years, the use of telemedicine has expanded dramatically. Along with this has come many questions inquiring as to the efficacy of telemedicine and its feasibility...

1. The use of recombinant L-IFN adenovirus in patients with recurrent or refractory advanced solid tumours was well tolerated with few adverse events greater than Grade 3. 2. Recombinant L-IFN adenovirus injections showed preliminary efficacy against advanced solid tumours. Evidence Rating Level: 2 (Good) Oncolytic viruses are viruses that selectively induce cell lysis in tumour cells while preserving the health of normal cells. Prior studies have shown that the use of adenoviruses as a viral vector alone has limited efficacy in the management of tumours...

1. Progression-free survival at 24 months was higher in the pembrolizumab versus placebo-controlled group. 2. The pembrolizumab-chemoradiotherapy group reported slightly higher rates of grade 3 or higher adverse events compared to the placebo-chemoradiotherapy group. Evidence Rating Level: 1 (Excellent) Study Rundown: Pembrolizumab has demonstrated efficacy in advanced cervical cancer, prompting an investigation into its potential synergy with chemoradiotherapy. This randomized controlled trial aimed to assess the safety and efficacy of adding pembrolizumab to chemoradiotherapy for the treatment of locally advanced cervical cancer...

1. The median overall survival was 17.6 months in the gefitinib group vs 27.5 months in the gefitinib plus chemotherapy group, with HR 0.58 (significant). 2. The 5-year progression-free survival was 1.71% in the gefitinib group vs 6.67% in the gefitinib plus chemotherapy group, with HR 0.53 (significant). Evidence Rating Level : 1 (Excellent) Study Rundown: The standard initial treatment for EGFR-mutant advanced non–small-cell lung cancer (NSCLC) involves an oral tyrosine kinase inhibitor targeting the epidermal growth factor receptor (EGFR), however, there is some evidence of potential improvement in outcomes by combining it with pemetrexed and carboplatin chemotherapy...

Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial : https://read.qxmd.com/read/38649992 1. A randomized control trial found low-molecular weight heparin (LMWH) bridging therapy did not increase the frequency of perioperative acute myocardial infarction (MI), cardiac death, stroke, or major bleeding in elderly individuals that underwent surgery > 12 months after percutaneous coronary intervention (PCI) compared to the non-bridging group...

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...