Now showing 1 - 10 of 10
  • Publication
    Journal Article
    How comparable are patient outcomes in the "real-world" with populations studied in pivotal AML trials?
    (2024-03-25)
    Tiong, Ing Soo
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    Wall, Meaghan
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    Bajel, Ashish
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    Kalro, Akash
    ;
    Fleming, Shaun
    ;
    Roberts, Andrew W
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    Thiagarajah, Nisha
    ;
    Chua, Chong Chyn
    ;
    Latimer, Maya
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    Yeung, David
    ;
    Marlton, Paula
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    Johnston, Amanda
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    Enjeti, Anoop
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    Fong, Chun Yew
    ;
    Cull, Gavin
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    Larsen, Stephen
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    Kennedy, Glen
    ;
    Schwarer, Anthony
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    Kipp, David
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    Ramanathan, Sundra
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    Verner, Emma
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    Tiley, Campbell
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    Morris, Edward
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    Hahn, Uwe
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    Moore, John
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    Taper, John
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    Purtill, Duncan
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    Warburton, Pauline
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    Stevenson, William
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    Murphy, Nicholas
    ;
    Tan, Peter
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    Beligaswatte, Ashanka
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    Mutsando, Howard
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    Hertzberg, Mark
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    Shortt, Jake
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    Dunne, Karin
    ;
    Wei, Andrew H
    Despite an increasing desire to use historical cohorts as "synthetic" controls for new drug evaluation, limited data exist regarding the comparability of real-world outcomes to those in clinical trials. Governmental cancer data often lacks details on treatment, response, and molecular characterization of disease sub-groups. The Australasian Leukaemia and Lymphoma Group National Blood Cancer Registry (ALLG NBCR) includes source information on morphology, cytogenetics, flow cytometry, and molecular features linked to treatment received (including transplantation), response to treatment, relapse, and survival outcome. Using data from 942 AML patients enrolled between 2012-2018, we assessed age and disease-matched control and interventional populations from published randomized trials that led to the registration of midostaurin, gemtuzumab ozogamicin, CPX-351, oral azacitidine, and venetoclax. Our analyses highlight important differences in real-world outcomes compared to clinical trial populations, including variations in anthracycline type, cytarabine intensity and scheduling during consolidation, and the frequency of allogeneic hematopoietic cell transplantation in first remission. Although real-world outcomes were comparable to some published studies, notable differences were apparent in others. If historical datasets were used to assess the impact of novel therapies, this work underscores the need to assess diverse datasets to enable geographic differences in treatment outcomes to be accounted for.
  • Publication
    Journal Article
    Dental extraction in a child with chronic idiopathic thrombocytopenia purpura: are preoperative platelet transfusions necessary?
    (2013-10)
    Tay, Stanley
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    ;
    Thresholds for platelet counts in patients at risk for bleeding are often used before surgery. We present a case report of a 13-year-old female with chronic idiopathic thrombocytopenia purpura for dental extraction with a platelet count of 4 × 10 L. Usually, therapies including platelet infusions, IV immunoglobulin, or corticosteroids would be used to increase platelet numbers. In this patient, rather than using any of these prophylactic therapies preoperatively, we used a "watchful waiting" strategy with a multidisciplinary team, the use of tranexamic acid and the aforementioned therapies available only as "rescue" agents.
      1036
  • Publication
    Case Reports
      1221
  • Publication
    Journal Article
    The incidence and outcome of clinically significant antibodies detected in Rhesus-D positive pregnant women of the Northern Territory.
    (2018-10)
    Andersson, Lauren
    ;
    Haemolytic disease of the fetus/newborn secondary to clinically significant non-Rhesus-D antibodies has risen in importance since the advent of immunoprophylactic anti-D administration to Rhesus-D negative women. Of interest is the incidence of these antibodies in Rhesus-D positive women, who receive less frequent antenatal alloantibody screening. This is of particular concern if the antibodies arise late in pregnancy and may go undetected. To assess the proportion of Rhesus-D positive pregnant women with late developing clinically significant antibodies for haemolytic disease of the fetus/newborn, and whether these resulted in adverse fetal outcomes. A retrospective analysis over a 12-month period at a tertiary hospital in the Northern Territory. Group and antibody screen results in addition to clinical data regarding pregnancy/newborn were collected. Sixty-four of 2612 women (2.5%) had red blood cell antibodies detected during their pregnancy. Of these, 21 clinically significant antibodies were detected in 19 women (0.7% of initial cohort). The most common antibody detected was anti-c (28.5%). In six of these women (0.23% of initial cohort), the antibodies were late developing. Mild jaundice was noted in three newborns with phototherapy required in one. Although clinically significant antibodies were detected during pregnancy, and in a small proportion of cases as a late developing antibody undetected in the first trimester screening, clinical outcomes for the newborn were mild. As such, the cost of retesting all Rhesus-D positive pregnant women in the third trimester would be considerable and unlikely to result in any meaningful clinical benefit.
      1062
  • Publication
    Journal Article
    Executive summary of consensus clinical practice guidelines for the prevention of infection in patients with multiple myeloma.
    (2023-04-24)
    Teh BW
    ;
    Reynolds G
    ;
    Slavin MA
    ;
    Cooley L
    ;
    Roberts M
    ;
    Liu E
    ;
    Thursky K
    ;
    Talaulikar D
    ;
    Mollee P
    ;
    ;
    Ward C
    ;
    Chan H
    ;
    Prince HM
    ;
    Harrison SJ
    Infection remains a significant contributor to morbidity and mortality in patients with myeloma. This guideline was developed by a multidisciplinary group of clinicians who specialise in the management of patients with myeloma and infection from the medical and scientific advisory group from Myeloma Australia and the National Centre for Infections in Cancer. In addition to summarising the current epidemiology and risk factors for infection in patients with myeloma, it provides recommendations that address three key areas in the prevention of infection: screening for latent infection, use of antimicrobial prophylaxis and immunoglobulin replacement and vaccination against leading respiratory infections (SARS-CoV-2, influenza, S. pneumoniae) and other preventable infections. This guideline provides sa practical approach to the prevention of infection in patients with myeloma and harmonises the clinical approach to screening for infection, use of prophylaxis and vaccination to prevention infectious complications. This article is protected by copyright. All rights reserved.
      3601
  • Publication
    Comparative Study
    Use of fresh-frozen plasma at Royal Darwin Hospital: a retrospective audit.
    (2008-09)
    Moylan, S
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    Scott, H
    ;
    Kwok, G
    The aim of the study was to assess the appropriateness of use of fresh-frozen plasma (FFP) at Royal Darwin Hospital against the National Health and Medical Research Council and Australian and New Zealand Society for Blood Transfusion guidelines. A retrospective review of blood product request forms, online pathology storage system data, pathology records and clinical notes between 1 January 2006 and 31 December 2006 was carried out. The appropriateness of requests was assessed against existing guidelines. The percentage of appropriate and inappropriate FFP transfusions was obtained. Six hundred and forty-eight of 950 units (68%) of FFP were used with an appropriate indication as per National Health and Medical Research Council/Australian and New Zealand Society for Blood Transfusion guidelines. Of the remaining units, 14% (137 units) was given without a clear indication and a decision of appropriateness could not be established for 17% (165 units) because of inadequate clinical or pathology information (e.g. coagulation results). Multiple issues around prescribing practice were identified. There is significant use of FFP at Royal Darwin Hospital without clear clinical indication. The employment of a transfusion nurse to monitor use of FFP (and other blood products) and provide education is aimed at improving transfusion efficiency and patient safety.
      1116
  • Publication
    Journal Article
    Venous thromboembolism in tropical Australia and in Indigenous Australians.
    (2014-10) ; ;
    Huynh, Dat Khuong
    There is a paucity of data on the incidence of venous thromboembolism (VTE) in Australia, particularly amongst Indigenous Australians. We have therefore conducted a retrospective review of all cases of deep vein thrombosis and pulmonary embolism over a 24 months' period in two major hospitals of the Northern Territory (NT). A total of 429 VTE diagnoses were recorded over a 2-year period and 71 of 429 (17%) patients were Indigenous Australians. The overall incidence rate was 0.9 per 1,000 person-year for the population of the NT with a rate of 0.5 per 1,000 person-year for Indigenous Australians versus 1 per 1,000 person-year for non-Indigenous Australians. Of the 71, 39 (55%) of the VTE cases in the Indigenous group occurred in patients younger than 50 years and almost half of these (n = 18) were younger than 29 years. Hospitalization was found to be a major risk factor for VTE in 20 (38%) of the 54 Indigenous Australians of whom 10 (26%) patients were younger than 50 years. Although the rate of VTE in Indigenous Australians was low, its onset was significantly earlier in life and it was often triggered by prolonged hospitalization. VTE therefore should be added to the list of adverse outcomes of poor health and chronic diseases, which cause disproportional high rates of hospitalization amongst Indigenous Australians. The low number of VTE observed in older Indigenous patients in our study possibly reflects on the lower life expectancy and ongoing wide gap in life expectancy between Indigenous and non-Indigenous Australians.
      1213
  • Publication
    Journal Article
    The Importance of Frailty Assessment in Multiple Myeloma: A Position Statement From The Myeloma Scientific Advisory Group (MSAG) To Myeloma Australia.
    (2023-03-07)
    Sim S
    ;
    Kalff A
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    Tuch G
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    Mollee P
    ;
    Ho J
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    Harrison S
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    Gibbs S
    ;
    Prince HM
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    Spencer A
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    Joshua D
    ;
    Lee C
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    Ling S
    ;
    Murphy N
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    Szer J
    ;
    Weber N
    ;
    Ward C
    ;
    Talaulikar D
    ;
    Zannettino A
    ;
    Quach H
    Multiple myeloma (MM) is a disease of older people, yet factors relating to comorbidity and frailty may threaten treatment tolerability for many of this heterogeneous group. There has been increasing interest in defining specific and clinically relevant frailty assessment tools within the MM population, with the goal of using these frailty scores not just as a prognostic instrument, but also as a predictive tool to allow for a frailty-adapted treatment approach. This paper reviews the various frailty assessment frameworks used in the evaluation of MM patients, including the International Myeloma Working Group Frailty Index (IMWG-FI), the Mayo Frailty Index and the simplified frailty scale. While the IMWG-FI remains the most widely accepted tool, the simplified frailty scale is the most user-friendly in busy day-to-day clinics based on its ease of use. This paper summarises the recommendations from the Myeloma Scientific Advisory group (MSAG) of Myeloma Australia, on the use of frailty assessment tools in clinical practice and propose a frailty-stratified treatment algorithm to aid clinicians in tailoring therapy for this highly heterogeneous patient population. This article is protected by copyright. All rights reserved.
      3572
  • Publication
    Journal Article
    Carfilzomib, thalidomide, and dexamethasone is safe and effective in relapsed and/or refractory multiple myeloma: final report of the single arm, multicenter phase II ALLG MM018/AMN002 study.
    (2024-01-18)
    Ninkovic, Slavisa
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    Harrison, Simon J
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    Lee, Je-Jung
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    Murphy, Nick
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    Lee, Jae Hoon
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    Estell, Jane
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    Chen, Vivien M
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    Horvath, Noemi
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    Kim, Kihuyn
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    Eek, Richard
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    Augustson, Bradley
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    Bang, Soo-Mee
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    Huang, Shang-Yi
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    Rajagopal, Rajeev
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    Engeler, Daniel
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    Butcher, Belinda E
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    Mollee, Peter
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    Durie, Brian
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    Chng, Wee Joo
    ;
    Quach, Hang
    This multicentre, phase II study of the Australian Lymphoma and Leukaemia Group (ALLG) and the Asian Myeloma Network (AMN) investigated fixed-duration (18-month) treatment with carfilzomib (K), thalidomide (T), and dexamethasone (d; KTd) in patients with relapsed and/or refractory multiple myeloma and 1-3 prior lines of therapy. Patients received induction with up to twelve 28-day cycles of K [20mg/m2 IV cycle 1 day 1 and 2, 56mg/m2 (36mg/m2 for patients ≥75 years) from day 8 onwards), T 100mg PO nocte and weekly dexamethasone 40mg (20mg for patients ≥75 years). During maintenance T was omitted, while K continued on days 1,2,15,16 with fortnightly dexamethasone. The primary endpoint was progression free survival (PFS). Secondary endpoints were overall response rate, overall survival (OS), duration of response, safety, and tolerability. Ninety-three patients (median age 66.3 years (41.9 - 84.5)) were enrolled with a median follow-up of 26.4 (1.6 - 54.6) months. The median PFS was 22.3 months (95% CI 15.7 - 25.6) with a 46.3% (95% CI 35.1 - 52.8) 2-year PFS. Median OS was not reached and was 73.8% (95% CI 62.9 - 81.9) at 2 years. The overall response rate was 88% (≥ VGPR 73%). There was no difference in the depth of response, PFS or OS comparing Asian and Non-Asian cohorts (p=0.61). The safety profile for KTd was consistent with each individual drug. KTd is well tolerated and effective in patients with RRMM irrespective of Asian or non-Asian ethnicity and provides an alternative option particularly where use of KRd is limited by access, cost, or renal impairment.
      1504
  • Publication
    Journal Article
    ABO and Rhesus D blood groups in the Northern Territory of Australia.
    (2021-01-18)
    McLean, Antonia
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    ;
    Wang, Zhiqiang
    BACKGROUND: There is no contemporary published data on the frequency of the ABO and Rhesus D (RhD) blood groups in the Northern Territory of Australia (NT), particularly for the large Aboriginal population. AIMS: To establish the frequencies of ABO and RhD blood groups in the NT Aboriginal and non-Aboriginal populations in order to aid transfusion inventory management and clinical practice. METHODS: Retrospective data was collected from 01/01/2012 to 31/12/2012. All patients with a blood group sample processed by the NT public hospital laboratories and a recorded ABO and RhD report were included. Results were analysed using Stata 14. RESULTS: The Aboriginal and non-Aboriginal populations had significantly different ABO and RhD distributions (p <0.001). For Aboriginal individuals 955/1686 (56.6%) were group O and 669/1686 (39.7%) were group A. In non-Aboriginal individuals 1201/2657 (45.2%) were group O and 986/2657 (37.1%) were group A. We found that 1646/1686 (97.6%) of Aboriginal individuals were RhD positive, compared with 2225/2657 (83.7%) of non-Aboriginal individuals. Only 62/1686 (3.7%) of Aboriginal individuals were group B or AB, compared with 470/2657 (17.7%) of non-Aboriginal individuals. In Aboriginal individuals we found that group O was more common than A in the 'Northern' NT, whereas there was similar distribution of the groups in 'Central Australia'. CONCLUSIONS: We found a significant difference in ABO and RhD blood groups between Aboriginal and non-Aboriginal individuals in the NT (p<0.001). These findings will aid transfusion inventory management, allowing us to plan supply of blood products and reduce waste. This article is protected by copyright. All rights reserved.
      2211