Pub Date : 2016-07-26DOI: 10.33590/emjhematol/10310457
C. Gisselbrecht, E. Van Den Neste
Non-Hodgkin lymphoma (NHL) is the eighth most common malignancy worldwide. Diffuse large B cell lymphoma (DLBCL) is the most frequent subtype, accounting for >30% of NHL cases. Advances in novel approaches in the last two decades, such as immunotherapy with rituximab, have achieved improvements in terms of overall and long-term survival rates. The current standard of care for the first-line treatment of DLBCL is chemotherapy with rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone; this regimen achieves complete and sustained remission in approximately 60% of patients. Nevertheless, DLBCL relapses in 30–40% of patients, of which 10% develop refractory disease. Recent findings have demonstrated that substantial responses could be achieved after second or third-line treatments with combined chemotherapy. Since 2012, the aza-anthracenedione, pixantrone, has been approved as a single agent for relapsed or refractory DLBCL. The drug could be a new option as a bridging therapy to consolidate autologous or allogeneic stem cell transplantation, which in turn, can deliver prolonged durations of remission. Numerous clinical studies are ongoing that aim to improve salvage rates, outcomes, and access to stem cell transplantations for relapsed or refractory DLBCL. The development of novel targeted therapies or chemotherapeutics, such as pixantrone, will help to salvage more patients and achieve further sustained and complete responses without compromising their quality of life.
{"title":"Bridging to Transplant in Diffuse Large B Cell Lymphoma","authors":"C. Gisselbrecht, E. Van Den Neste","doi":"10.33590/emjhematol/10310457","DOIUrl":"https://doi.org/10.33590/emjhematol/10310457","url":null,"abstract":"Non-Hodgkin lymphoma (NHL) is the eighth most common malignancy worldwide. Diffuse large B cell lymphoma (DLBCL) is the most frequent subtype, accounting for >30% of NHL cases. Advances in novel approaches in the last two decades, such as immunotherapy with rituximab, have achieved improvements in terms of overall and long-term survival rates. The current standard of care for the first-line treatment of DLBCL is chemotherapy with rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone; this regimen achieves complete and sustained remission in approximately 60% of patients. Nevertheless, DLBCL relapses in 30–40% of patients, of which 10% develop refractory disease. Recent findings have demonstrated that substantial responses could be achieved after second or third-line treatments with combined chemotherapy. Since 2012, the aza-anthracenedione, pixantrone, has been approved as a single agent for relapsed or refractory DLBCL. The drug could be a new option as a bridging therapy to consolidate autologous or allogeneic stem cell transplantation, which in turn, can deliver prolonged durations of remission. Numerous clinical studies are ongoing that aim to improve salvage rates, outcomes, and access to stem cell transplantations for relapsed or refractory DLBCL. The development of novel targeted therapies or chemotherapeutics, such as pixantrone, will help to salvage more patients and achieve further sustained and complete responses without compromising their quality of life.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124122943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-28DOI: 10.33590/emjhematol/10312028
Joan Thomas
Several rare haematological diseases are linked to bone marrow failure (BMF). This symposium provided the latest scientific insights into the different pathophysiological mechanisms and clinical advances in the management of these conditions, with a specific focus on the clinical management of patients with paroxysmal nocturnal haemoglobinuria (PNH) in the context of aplastic anaemia (AA), and the pathophysiology, consequences, and identification of PNH in the context of BMF. Prof Gérard Socié chaired the symposium and overviewed BMF. Dr Austin Kulasekararaj gave a presentation on new paradigms in BMF, followed by Prof Gérard Socié, who reviewed the diagnosis and management of AA. Dr Alexander Röth then discussed the diagnosis and management of PNH in the context of BMF. The symposium was concluded by a short question and answer session.
{"title":"New Insights in Bone Marrow Failure","authors":"Joan Thomas","doi":"10.33590/emjhematol/10312028","DOIUrl":"https://doi.org/10.33590/emjhematol/10312028","url":null,"abstract":"Several rare haematological diseases are linked to bone marrow failure (BMF). This symposium provided the latest scientific insights into the different pathophysiological mechanisms and clinical advances in the management of these conditions, with a specific focus on the clinical management of patients with paroxysmal nocturnal haemoglobinuria (PNH) in the context of aplastic anaemia (AA), and the pathophysiology, consequences, and identification of PNH in the context of BMF.\u0000\u0000Prof Gérard Socié chaired the symposium and overviewed BMF. Dr Austin Kulasekararaj gave a presentation on new paradigms in BMF, followed by Prof Gérard Socié, who reviewed the diagnosis and management of AA. Dr Alexander Röth then discussed the diagnosis and management of PNH in the context of BMF. The symposium was concluded by a short question and answer session.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133940815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-06-16DOI: 10.33590/emjhematol/10311643
Shire
The 11th New Horizons in Haematology (NHH11) conference was moderated by Dr Sarah Jarvis, healthcare reporter and television presenter, and was delivered in the format of a live, interactive, online meeting. Prof Gunnar Birgegård opened the conference with a presentation on the evolution of essential thrombocythaemia (ET) disease, Prof Sélim Aractingi described the incidence of skin lesions in myeloproliferative neoplasms (MPN), Prof Claire Harrison discussed key aspects in women’s health when managing ET including pregnancy, Prof Jean‑Jacques Kiladjian covered the management of elderly patients with ET, and Dr Manuel Martínez‑Sellés concluded the meeting by emphasising the importance of identifying and managing cardiovascular (CV) risk factors in ET. Dr Tamara Lado Cives, Prof Chiaki Nakaseko, Dr Melania Moreno Vega, and Dr Samah Alimam each shared a case study after the main presentations.
第十一届血液学新视野(NHH11)会议由卫生保健记者和电视节目主持人Sarah Jarvis博士主持，并以现场互动在线会议的形式举行。Gunnar birgegamatrd教授以原发性血小板增多症(ET)的演变为开场，ssamlim Aractingi教授介绍了骨髓增生性肿瘤(MPN)中皮肤损伤的发生率，Claire Harrison教授讨论了管理ET时妇女健康的关键方面，包括怀孕，Jean - Jacques Kiladjian教授介绍了老年ET患者的管理。和Manuel Martínez‑sellsams博士在会议结束时强调了识别和管理ET中心血管(CV)风险因素的重要性。Tamara Lado Cives博士、Chiaki Nakaseko教授、Melania Moreno Vega博士和Samah Alimam博士在主要发言后分别分享了一个案例研究。
{"title":"Advancing Our Clinical Perspectives in Haematology: What Is Your Approach?","authors":"Shire","doi":"10.33590/emjhematol/10311643","DOIUrl":"https://doi.org/10.33590/emjhematol/10311643","url":null,"abstract":"The 11th New Horizons in Haematology (NHH11) conference was moderated by Dr Sarah Jarvis, healthcare reporter and television presenter, and was delivered in the format of a live, interactive, online meeting. Prof Gunnar Birgegård opened the conference with a presentation on the evolution of essential thrombocythaemia (ET) disease, Prof Sélim Aractingi described the incidence of skin lesions in myeloproliferative neoplasms (MPN), Prof Claire Harrison discussed key aspects in women’s health when managing ET including pregnancy, Prof Jean‑Jacques Kiladjian covered the management of elderly patients with ET, and Dr Manuel Martínez‑Sellés concluded the meeting by emphasising the importance of identifying and managing cardiovascular (CV) risk factors in ET. Dr Tamara Lado Cives, Prof Chiaki Nakaseko, Dr Melania Moreno Vega, and Dr Samah Alimam each shared a case study after the main presentations.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131156219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-30DOI: 10.33590/emjhematol/10312591
Juliette B. Bell
Prof Martin Dreyling opened the symposium by providing an overview of the current status of mantle cell lymphoma (MCL) and the current guidelines for treatment. Prof Steven Le Gouill discussed emerging tools to improve the diagnosis and monitoring of patients such as the assessment of minimal residual disease and the optimal incorporation of new technologies into the treatment pathway. Prof Marek Trněný then spoke about new treatment options for MCL and the improved survival that has been reported from certain combination therapies. Prof Martin Dreyling closed the MCL session. Prof Gilles Salles introduced the follicular lymphoma (FL) session by explaining how the treatment landscape of FL has recently changed with the advent of anti-CD20 therapies. Prof Paulo Corradini then described the current treatment landscape in FL and Dr Jehan Dupuis spoke about the use of positron emission tomography (PET) at the start, interim, and end of treatment for FL. Prof Gilles Salles described the challenges of incorporating new treatment recommendations and tools for FL within current treatment options, and then summarised and closed the event.
Martin Dreyling教授首先概述了套细胞淋巴瘤(MCL)的现状和目前的治疗指南。Steven Le Gouill教授讨论了用于改善患者诊断和监测的新兴工具，例如评估最小残留疾病和将新技术最佳地纳入治疗途径。Marek教授Trněný随后谈到了MCL的新治疗方案，以及某些联合疗法所提高的生存率。Martin Dreyling教授结束了MCL会议。Gilles Salles教授介绍了滤泡性淋巴瘤(FL)会议，他解释了最近随着抗cd20疗法的出现，滤泡性淋巴瘤的治疗前景是如何发生变化的。paul Corradini教授随后描述了目前FL的治疗前景，Jehan Dupuis博士谈到了在FL治疗的开始、中期和结束时使用正电子发射断层扫描(PET)。Gilles Salles教授描述了在当前治疗方案中纳入新的治疗建议和FL工具的挑战，然后总结并结束了这次活动。
{"title":"Perspectives on the Treatment of Mantle Cell Lymphoma and Follicular Lymphoma in 2015 and Beyond","authors":"Juliette B. Bell","doi":"10.33590/emjhematol/10312591","DOIUrl":"https://doi.org/10.33590/emjhematol/10312591","url":null,"abstract":"Prof Martin Dreyling opened the symposium by providing an overview of the current status of mantle cell lymphoma (MCL) and the current guidelines for treatment. Prof Steven Le Gouill discussed emerging tools to improve the diagnosis and monitoring of patients such as the assessment of minimal residual disease and the optimal incorporation of new technologies into the treatment pathway. Prof Marek Trněný then spoke about new treatment options for MCL and the improved survival that has been reported from certain combination therapies. Prof Martin Dreyling closed the MCL session.\u0000\u0000Prof Gilles Salles introduced the follicular lymphoma (FL) session by explaining how the treatment landscape of FL has recently changed with the advent of anti-CD20 therapies. Prof Paulo Corradini then described the current treatment landscape in FL and Dr Jehan Dupuis spoke about the use of positron emission tomography (PET) at the start, interim, and end of treatment for FL. Prof Gilles Salles described the challenges of incorporating new treatment recommendations and tools for FL within current treatment options, and then summarised and closed the event.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131233596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-30DOI: 10.33590/emjhematol/10311696
Lynda M. McEvoy
The meeting was introduced by Prof Robin Foà who spoke about the difficulties for patients accessing therapies in the context of rising healthcare costs and reduced budgets. Dr Mark McCamish then explained the biosimilar development process and the analytical techniques involved. Prof Felix Keil discussed the role of biosimilar medicines in haematology using the example of GP2013/rituximab (RTX), and Ms Karen Van Rassel of the Lymphoma Coalition presented the role a patient organisation can play when working with the physician to support a patient’s questions and concerns regarding lymphoma.
Robin focom教授介绍了这次会议，他谈到了在医疗成本上升和预算减少的背景下，患者获得治疗的困难。马克·麦卡米什博士随后解释了生物仿制药的开发过程和所涉及的分析技术。Felix Keil教授以GP2013/rituximab (RTX)为例讨论了生物仿制药在血液学中的作用，淋巴瘤联盟的Karen Van Rassel女士介绍了患者组织在与医生合作支持患者关于淋巴瘤的问题和担忧时可以发挥的作用。
{"title":"Why Biosimilars Matter: An Innovative Solution to Improve Patient Access","authors":"Lynda M. McEvoy","doi":"10.33590/emjhematol/10311696","DOIUrl":"https://doi.org/10.33590/emjhematol/10311696","url":null,"abstract":"The meeting was introduced by Prof Robin Foà who spoke about the difficulties for patients accessing therapies in the context of rising healthcare costs and reduced budgets. Dr Mark McCamish then explained the biosimilar development process and the analytical techniques involved. Prof Felix Keil discussed the role of biosimilar medicines in haematology using the example of GP2013/rituximab (RTX), and Ms Karen Van Rassel of the Lymphoma Coalition presented the role a patient organisation can play when working with the physician to support a patient’s questions and concerns regarding lymphoma.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132655190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-30DOI: 10.33590/emjhematol/10314714
M. Mateos, E. Ocio, V. Gonzalez, J. Dávila
Multiple myeloma (MM) usually responds to treatment but is incurable. The clinical course is characterised, in most patients, by a series of remissions and relapses. For younger patients, the initial treatment currently usually involves induction with the proteasome inhibitor bortezomib (BOR), alone or in combination, followed by an autologous stem cell transplant (ASCT). Usually only clinical relapses require treatment; the treatment plan should be individualised to take into account factors such as response to previous treatment, duration of the remission, adverse effects experienced, and available treatment options. Evidence suggests that many patients who have responded to BOR will respond to it again. Patients at first relapse should also be considered for a further ASCT or an allotransplant. Clinical studies have led to other drugs being approved for treatment of relapsed MM. These include lenalidomide (an immunomodulatory drug), carfilzomib (another proteasome inhibitor), pomalidomide (an immunomodulatory drug), and most recently panobinostat (a deacetylase inhibitor). The availability of these drugs greatly enhances the therapeutic options available to treat further relapses. Moreover, a bewildering array of other novel agents are at various stages in testing. They include other drugs from the classes already mentioned, as well as monoclonal antibodies, drugs acting on the cell cycle, kinase inhibitors, and signal transduction pathway inhibitors. It seems probable that the introduction of these agents in the coming years will further improve the survival of patients with MM, and may even lead to a cure.
{"title":"Relapsed/Refractory Multiple Myeloma: The Current State of Play","authors":"M. Mateos, E. Ocio, V. Gonzalez, J. Dávila","doi":"10.33590/emjhematol/10314714","DOIUrl":"https://doi.org/10.33590/emjhematol/10314714","url":null,"abstract":"Multiple myeloma (MM) usually responds to treatment but is incurable. The clinical course is characterised, in most patients, by a series of remissions and relapses. For younger patients, the initial treatment currently usually involves induction with the proteasome inhibitor bortezomib (BOR), alone or in combination, followed by an autologous stem cell transplant (ASCT). Usually only clinical relapses require treatment; the treatment plan should be individualised to take into account factors such as response to previous treatment, duration of the remission, adverse effects experienced, and available treatment options. Evidence suggests that many patients who have responded to BOR will respond to it again. Patients at first relapse should also be considered for a further ASCT or an allotransplant. Clinical studies have led to other drugs being approved for treatment of relapsed MM. These include lenalidomide (an immunomodulatory drug), carfilzomib (another proteasome inhibitor), pomalidomide (an immunomodulatory drug), and most recently panobinostat (a deacetylase inhibitor). The availability of these drugs greatly enhances the therapeutic options available to treat further relapses. Moreover, a bewildering array of other novel agents are at various stages in testing. They include other drugs from the classes already mentioned, as well as monoclonal antibodies, drugs acting on the cell cycle, kinase inhibitors, and signal transduction pathway inhibitors. It seems probable that the introduction of these agents in the coming years will further improve the survival of patients with MM, and may even lead to a cure.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131353083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-30DOI: 10.33590/emjhematol/10312317
Saroshi Amirthalingam
The meeting commenced with a talk from Prof Anna Falanga on the management of thrombosis in both onco-haematological and non-oncological diseases. Adjunct Prof Sakari Jokiranta gave an overview of the complement system and the interplay between the complement and coagulation systems. Dysregulation of complement and resulting disease states were also discussed. The session was concluded with a presentation from Dr Anita Hill on the management of thrombosis in paroxysmal nocturnal haemoglobinuria (PNH).
{"title":"Thrombosis in Haematological Disorders: Tailored Management Approaches","authors":"Saroshi Amirthalingam","doi":"10.33590/emjhematol/10312317","DOIUrl":"https://doi.org/10.33590/emjhematol/10312317","url":null,"abstract":"The meeting commenced with a talk from Prof Anna Falanga on the management of thrombosis in both onco-haematological and non-oncological diseases. Adjunct Prof Sakari Jokiranta gave an overview of the complement system and the interplay between the complement and coagulation systems. Dysregulation of complement and resulting disease states were also discussed. The session was concluded with a presentation from Dr Anita Hill on the management of thrombosis in paroxysmal nocturnal haemoglobinuria (PNH).","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116430347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-31DOI: 10.33590/emjhematol/10310005
Tom Priddle
Biologicals have revolutionised modern medicine by offering vital therapeutic options to treat or prevent complex, disabling, and life-threatening diseases. Between 2013 and 2018, seven of the top ten pharmaceuticals worldwide will be biologicals; however, growing demand, combined with historically-limited competition, will continue to strain healthcare budgets and limit patient access to these treatments. Since 2006, when the first biosimilar Omnitrope® was approved in Europe, 18 other biosimilars, including the first biosimilar monoclonal antibody (mAb), infliximab (approved in 2013), have received marketing authorisation with many others currently in development. There is now extensive clinical experience with biosimilar epoetin (EPO) and filgrastim in patients with cancer, and many studies have reported comparable efficacy with the originator products, no unexpected safety concerns, and significant economic savings. Nevertheless, misconceptions concerning biosimilars remain. This educational session discussed these issues and gave an overview of biosimilar use in hematology. Dr Joerg Windisch highlighted the particular challenges and considerations associated with the development of biosimilars while Prof Steffen Thirstrup covered the approval of biosimilars from the regulatory perspective. Dr Wojciech Jurczak gave a presentation on the development of biosimilars in hematology, with a particular focus on rituximab from a clinical perspective. Dr Paul Cornes concluded with the opportunities that the introduction of biosimilars offer in terms of health economics and improved patient access to care.
{"title":"Biosimilars in Hematology: Increasing Choice, Expanding Access","authors":"Tom Priddle","doi":"10.33590/emjhematol/10310005","DOIUrl":"https://doi.org/10.33590/emjhematol/10310005","url":null,"abstract":"Biologicals have revolutionised modern medicine by offering vital therapeutic options to treat or prevent complex, disabling, and life-threatening diseases. Between 2013 and 2018, seven of the top ten pharmaceuticals worldwide will be biologicals; however, growing demand, combined with historically-limited competition, will continue to strain healthcare budgets and limit patient access to these treatments. Since 2006, when the first biosimilar Omnitrope® was approved in Europe, 18 other biosimilars, including the first biosimilar monoclonal antibody (mAb), infliximab (approved in 2013), have received marketing authorisation with many others currently in development. There is now extensive clinical experience with biosimilar epoetin (EPO) and filgrastim in patients with cancer, and many studies have reported comparable efficacy with the originator products, no unexpected safety concerns, and significant economic savings. Nevertheless, misconceptions concerning biosimilars remain. This educational session discussed these issues and gave an overview of biosimilar use in hematology. Dr Joerg Windisch highlighted the particular challenges and considerations associated with the development of biosimilars while Prof Steffen Thirstrup covered the approval of biosimilars from the regulatory perspective. Dr Wojciech Jurczak gave a presentation on the development of biosimilars in hematology, with a particular focus on rituximab from a clinical perspective. Dr Paul Cornes concluded with the opportunities that the introduction of biosimilars offer in terms of health economics and improved patient access to care.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123996040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-31DOI: 10.33590/emjhematol/10312664
M. Muñoz, S. Gómez‐Ramírez, A. Campos
In patients undergoing major surgical procedures, preoperative anaemia and perioperative allogeneic blood transfusion (ABT) have been linked to increased postoperative morbidity and mortality, as well as longer hospital stays. A multidisciplinary, multimodal, individualised strategy – collectively termed patient blood management – used to minimise or eliminate ABT is indicated to improve outcomes. This new standard of care relies on detection and treatment of perioperative anaemia (Pillar 1) and reduction of surgical blood loss and perioperative coagulopathy (Pillar 2) to harness and optimise physiological tolerance of anaemia (Pillar 3), thus allowing the use of restrictive transfusion criteria. Normalisation of preoperative hemoglobin levels is a World Heath Organization recommendation. Iron repletion should be routinely ordered when indicated. Preoperative oral iron is time-consuming and poorly tolerated with low adherence in published trials. Postoperative oral iron has been proven to be inefficacious and is no longer recommended. Preoperative and perioperative intravenous iron, with or without erythropoiesis stimulating agents, is safe and effective at reducing ABT rate and hastening the recovery from postoperative anaemia. Intravenous iron does not seem to increase the risk for postoperative thromboembolism, infection, or mortality. Newer intravenous iron formulations demonstrate potentially much lower immunogenic activity, allow complete replacement dosing in 15 to 60 minutes, markedly facilitating care, and may be cost-effective in many clinical settings.
{"title":"Iron Supplementation for Perioperative Anaemia in Patient Blood Management","authors":"M. Muñoz, S. Gómez‐Ramírez, A. Campos","doi":"10.33590/emjhematol/10312664","DOIUrl":"https://doi.org/10.33590/emjhematol/10312664","url":null,"abstract":"In patients undergoing major surgical procedures, preoperative anaemia and perioperative allogeneic blood transfusion (ABT) have been linked to increased postoperative morbidity and mortality, as well as longer hospital stays. A multidisciplinary, multimodal, individualised strategy – collectively termed patient blood management – used to minimise or eliminate ABT is indicated to improve outcomes. This new standard of care relies on detection and treatment of perioperative anaemia (Pillar 1) and reduction of surgical blood loss and perioperative coagulopathy (Pillar 2) to harness and optimise physiological tolerance of anaemia (Pillar 3), thus allowing the use of restrictive transfusion criteria. Normalisation of preoperative hemoglobin levels is a World Heath Organization recommendation. Iron repletion should be routinely ordered when indicated. Preoperative oral iron is time-consuming and poorly tolerated with low adherence in published trials. Postoperative oral iron has been proven to be inefficacious and is no longer recommended. Preoperative and perioperative intravenous iron, with or without erythropoiesis stimulating agents, is safe and effective at reducing ABT rate and hastening the recovery from postoperative anaemia. Intravenous iron does not seem to increase the risk for postoperative thromboembolism, infection, or mortality. Newer intravenous iron formulations demonstrate potentially much lower immunogenic activity, allow complete replacement dosing in 15 to 60 minutes, markedly facilitating care, and may be cost-effective in many clinical settings.","PeriodicalId":326555,"journal":{"name":"EMJ Hematology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127238408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-07-31DOI: 10.33590/emjhematol/10310807
E. Urrechaga, S. Izquierdo, J. Escanero
This year (2014) we are celebrating the 80th anniversary of Dr Maxwell Myer Wintrobe’s pioneer works, one of the most important contributions in clinical laboratory and medicine. Red cell indices continue to provide an essential support to the diagnosis and classification of anaemia. The erythrocyte indices, such as mean cell volume, mean cell hemoglobin concentration, and mean cell hemoglobin, are called the Wintrobe’s indices. Automation in hematology has progressed steadily since Wallace Coulter first applied electrical impedance technology to counting red cells and white cells. Technological advances being incorporated into hematology analysers since then are now allowing access to more cellular information than was ever available before through a ‘simple routine complete blood count’. Current research is beginning to demonstrate that this information also has great potential to identify cellular changes that typically occur in several important medical conditions-bringing us all one step closer to using hematology analysers as more than just simple cell counters, but instead as powerful tools for the management of any medical condition that impacts the biology of blood cells. There are increasing amounts of data provided, which require specialist knowledge to interpret as well as to understand the limitations in the measurement of the parameter. Both laboratory scientists and clinicians need to keep up-to-date with new parameters and methods in hematology, implying a stronger collaboration between them to improve clinical decision-making.
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