Haematology Podcast

Gehan Soosaipillai and Lina Pereira are members of the Transforming End of Life Care team, and have been embedded within the Lymphoma team at UCLH for the last 12 months. Will Townsend is a Lymphoma consultant and joins us for his third Bolus episode today. We focus on the topic of 'how can End of Life care be improved'? We discuss Advanced and Parallel care planning, Coordinate my Care, when to initiate Do Not Attempt Resuscitation discussions, tips for effective communication and whether Haematology remains a speciality where the recognition and planning for appropriate end of life care still happens at too late a stage. This is the final episode in season 5, and with luck we'll be able to bring out season 6 relatively soon in the new year!

Following on from his episode on Acute Graft Versus Host Disease (GVHD), Ronjon Chakraverty returns to tackle Chronic GVHD.

We are again joined by UCLH Consultant Microbiologist Vanya Gant, for a sobering discussion on the increasing difficulty antimicrobial resistance (AMR) is causing in healthcare. As the era of effective antibiotics fades, we discuss the causes and potential ways forward. We look at how phages and plasmids can spread AMR traits across the bacterial ecology of a hospital. How rapidly dividing pathogens such as E. coli gain evolutionary advantages in developing AMR due to selection pressures. And ultimately the devastating impact that AMR can have when it becomes prevalent in a Bone Marrow Transplant unit. The weapons within our grasp are now antibiotic stewardship and effective prevention of cross infection, through control of the air, water, equipment and people that work with the healthcare setting.

Haemophagocytic Lymphohistiocytosis is being diagnosed ever more as it becomes more widely known and better understood. We ask UCLH Consultant Rheumatologist Jessica Manson to give us some insight into Primary and Secondary HLH, including the various diseases that can precipitate a Secondary case, such as rheumatology conditions, lymphoproliferative disorders and infections (including COVID-19). If you've ever found yourself confused by HLH, this is the episode for you.

Jeremy Brown is a Respiratory Consultant at UCLH, with an interest in the lung complications patients experience following chemotherapy and stem cell transplantation. We discuss the issues caused by Bacterial Pneumonia, PCP, Fungal infections like Aspergillosis, CMV, Lung GVHD, Organising Pneumonia and TB.

Jon Lambert is a Haematologist at UCLH, and specialises in the treatment of Lymphoma and Myeloproliferative Neoplasms (MPNs). We ask him to give us insight into the presentation, diagnosis, treatment and long term impact of two common MPNs, Essential Thrombocythaemia and Polycythaemia Vera.

Deepak Suri is a Hepatologist and Gastroenterologist at UCLH and the Whittington. He joins us to discuss all things liver, including Hepatitis, VOD, GVHD and Haemochromatosis.

In this episode we look at how T-cell based therapies are being developed for use in solid cancers. Claire Roddie is a UCLH consultant specialising in CAR T-cell treatment and discusses tumour infiltrating lymphocytes, neo-antigen receptors, checkpoint inhibitors and the barriers that need to be overcome to develop effective immunotherapy treatments for solid cancers.

We invited back consultant virologist Gee Yen Shin and pharmacist Marian Salek to discuss the preparations being made for this winter. The conversation revolves mainly around the value of widespread uptake of the flu vaccine amongst healthcare professionals.

Dr Ashu Wechalekar joins in our first of ten episodes that will make up Series 5 of Bolus. Ashu is a renowned expert in Amyloidosis, and carries out his clinical and research work at the National Amyloidosis Centre at the Royal Free Hospital. Don't miss this comprehensive run through of this fascinating disorder.

In our final (planned) COVID-19 episode, we are joined by intensivist Mervyn Singer, to discuss the treatments that were used in ICU for patients with severe COVID-19. In the first third we discuss the preparations that took place to get a London critical care unit ready for a pandemic. Then in the middle section, we delve into what treatments proved the most valuable, from invasive and non-invasive ventilation, proning, sedation and paralysis strategies, anti-coagulation and steroids. Finally, out attention shifts to what comes next, and the preparations being made for another wave or for a future pandemic. Do the UK's ICU bed numbers need to increase or should the emphasis be on High Dependency beds? The importance of training more staff in ICU level skills, that may be used outside of the ICU and lastly the UK's preparedness and the issues that arise with stockpiling.

Elaine Thorpe is the UCH matron for Critical Care, one of the largest intensive care departments in the UK. We ask her to give us some insight into how her unit was prepared and reconfigured to cope with the eye of the COVID-19 storm. As increasing numbers of very unwell patients were admitted due to COVID-19, pressure on staff continued to mount. We discuss with Elaine how they were able to cope during this period, as well as the after effects that wouldn't become known until weeks later.

Haematology consultant Kwee Yong joins us to discuss the immunomodulatory drugs (such as Dexamethasone, Anakinra, Tocilizumab and Ibrutinib) being evaluated as possible options to treat severe COVID-19.

UCLH Haematology consultant Marie Scully gives a concise summary of the effects COVID-19 has on coagulation and risks presented by thrombosis.

In this latest fascinating podcast on COVID-19, divisional clinical director and infectious diseases consultant Mike Brown talks about what UCLH has discovered so far about the novel coronavirus – identifying unusual symptoms, discovering which tests are proving to be the most useful and other important lessons learnt along the way. Mike was talking to Sarah Jordan, a ward sister on T16 South Haematology and her colleague Gavin Cooper, a haematology clinical practice facilitator.

In this series of podcasts on COVID-19 with UCLH leaders, chief executive Marcel Levi reflects on the challenges we've faced over the last three months, and changes to come in the future. Marcel was interviewed by Gavin Cooper, a haematology senior clinical practice facilitator and Sarah Jordan, the ward sister of T16 South Haematology.

Consultant virologist Gee Yen Shin joins us to discuss why this coronavirus continues to pose particular challenges, now and in the future.

In the latest of a series of podcasts on COVID-19, Gavin Cooper, a haematology clinical practice facilitator and his colleague Sarah Jordan, a ward sister on T16 South, talk to UCLH director of strategy Laura Churchward about the importance of testing NHS staff for COVID-19. “If you have symptoms, please, please, please, get a test,” says Laura who is leading on staff testing in North Central London. Under a self-referral programme, thousands of staff or their family members have already been tested after experiencing potential symptoms. Other staff – without symptoms - are also undergoing tests in ward areas as part of a national pilot. For details on how to self-refer for a test please click here: https://my.uclh.nhs.uk/interact/Pages/Section/ContentListing.aspx?subsection=7383

In the latest of a series of podcasts on COVID-19, Gavin Cooper, a haematology clinical practice facilitator and his colleague Sarah Jordan, a ward sister on T16 South, talk to Dr Lisa Monaghan, head of the staff psychological and welfare service, and Jane Keep, head of staff engagement and experience.

In the first of a series of podcasts on COVID-19 with UCLH leaders, chief executive Marcel Levi reflects on the challenges we all face in the coming weeks and how we can prepare. “(those colleagues who) work in security to those in our telephone centres – they are as important as our intensive care nurses. That is the spirit at UCLH.” Marcel was interviewed by Gavin Cooper, a haematology senior clinical practice facilitator and Sarah Jordan, the ward sister of T16 South Haematology.

This will be our last episode for awhile due to the COVID-19 outbreak. Mallika Sekhar joins us to discuss all things blood transfusion related. Our conversation covers the history of transfusion, antibodies, matching, infectious complications, thresholds, special requirements and more. Mallika is a Haematology Consultant specialising in Leukaemia and MPNs, and leads the UCLH Blood Transfusion Service.

Episode Two is an exploration into the issues Cytomegalovirus cause in Allogeneic Stem Cell Transplant patients. Kirsty Thomson is the Clinical Lead for UCLH Haematology and a Transplant Consultant. She guides us through the biology, screening, prophylaxis and treatment of CMV. We also discuss the issues caused by respiratory viruses in transplant patients, including coronavirus. We recorded this podcast in December 2019, prior to COVID-19, so this is just referring to common coronavirus. Kirsty also takes some time to discuss the strengths of the Haematology Nursing service as well as how she balances her variety of roles

We're back with the first episode of Series 4. We're lucky to be joined by Beth Payne for a third time, as we delve into haematopoiesis and the role of the stem cell in blood production.

The final episode of Series 3 is an interesting and wide ranging conversation on the overlap between two specialities, Haematology and Intensive Care. David Brealey is an Intensivist at UCLH and we are also rejoined by Lymphoma Consultant Will Townsend. We delve into the topics ICU staff might want to know more about in Haematology; prognosis, post ICU outcomes, TTP, Sickle Cell Disease, CAR T-cells and Transplantation. We discuss the importance of early detection of deterioration on the wards and the role performance scores play on patient's treatment options. Finally we look towards the future, thinking about the potential impact of telemetry wearables and bedside testing for pathogens. See you in 4 weeks for Season 4!

Sarah Grace is a Transplant Clinical Nurse Specialist at UCLH. She joins us to discuss all things transplant, but with a particular focus on organising transplants, searching for and matching donors and the difficulties inherent in the consenting process.

Joining us this week to discuss all things Acute Kidney Injury (AKI) is Chris Laing. Chris is a Consultant Nephrologist, Divisional Clinical Director for Emergency Medicine at UCLH and founder of the London AKI network. We discuss how to spot AKI in patients, both at the bedside and laboratory models that can quickly flag at risk patients. STOP criteria is a quick tool to help clinicians consider the possible causes of AKI: Sepsis, Toxicity, Obstruction and Primary (renal diesease). We delve into questions such as: Is creatinine the best blood value to determine AKI? What are the indications for hourly urine measure? When is renal replacement therapy beneficial? How do you manage Tumour Lysis Syndrome? When can you trust an eGFR, and when can't you? How are renal complications of Multiple Myeloma best managed? And most importantly, why do humans have two kidneys?

In episode seven we discuss Acute Graft versus Host disease with Prof Ronjon Chakraverty, a transplant consultant at UCLH. Our conversation on aGvHD covers grading, locations, treatment and strategies to prevent it, including HLA matching, post transplant cyclophosphomide, donor lymphocyte infusions and use of steroids. We will be releasing the second part of our conversation focusing on Chronic GvHD soon

For our discussion on CNS Lymphoma, we are joined by an expert in her field, Kate Cwynarski. We go through the differences between primary and secondary CNS Lymphoma, how it's diagnosed and how treatments are being improved with new clinical trial data.

We are joined once again by Magdalena Dziadzio and John Dempster to discuss Secondary Immunodeficiencies. The immunology team supports patients following treatments such as Rituximab, CAR T-cells, Ibrutinib and autologous stem cell transplantation, due to the long term effects on their antibody production. John talks about how patients can self administer immunoglobulin therapy at home due to recent advances in subcutaneous routing. Our discussion also touches on XLA, HIV and Hepititis C.

Welcome to Episode four of this series! We recorded a fantastic episode on MDS with Beth Payne a few months ago, and have been looking for an opportunity to release this additional part of our conversation. We had a wide ranging conversation, but initially had asked Beth to explain Diamond-Blackfan Anaemia (DBFA) to us. Our subsequent conversation then touches on her research with Zebrafish, how genes can be 'knocked in' and 'knocked out' in lab work, how CRISPR-Cas9 works and finally how viruses can infect bacteria.

Panos Kottaridis is a Leukaemia and Transplant consultant at UCLH, and he joins us to discuss the implications for patient's fertility that receiving treatment for a haematological condition can cause. We delve into the relative dangers posed by different chemotherapy, SACT (systemic anti-cancer therapies) and radiation to fertility, and the strategies available for female and male patients to best mitigate these risks.

In Episode 2 we explore the most rare of the myeloproliferative neoplasms, Myelofibrosis. Donal McLornan joins us to discuss diagnosis, patient experience and options available to treat this bone marrow scarring disease, including JAK2 inhibitors and stem cell transplantation.

To kick off Series 3, we have invited pre-eminent microbiologist and clinical director for Infection at UCLH, Vanya Gant, to give us a fascinating introduction to bacteria, and it's delicate relationship with humans. Whilst bacteria is an important ally to us in health, this is always at risk of breaking down in certain circumstances. We discuss the normal role of bacteria, the gut's role as an immune organ, how translocation occurs, appropriate responses to Febrile Neutropenia, how Pipericillin and Tazobactam combine to work more effectively and what the difference is between C. diff antigen and toxin.

Welcome to the final episode of Series 2 of Bolus. We are joined by Prof Mervyn Singer, a UCLH intensivist, researcher and teacher. He famously lead the international task force to redefine sepsis in 2016, known as Sepsis-3. Our wide ranging conversation covers a number of interesting and thought provoking questions: Is sepsis over diagnosed? Can you predict who will develop sepsis following an infection? Is a rapid, broad spectrum approach to antibiotics causing more problems than it solves? What's best for spotting sepsis at the bedside qSOFA or NEWS? Hyperlactataemia, is it always bad? How to assess for intravascular depletion and how should fluid resuscitation be administered? See you in 4 weeks for Series 3.

In episode 9 we are very pleased to be joined by Jillian Hartin, lead nurse for the Patient Emergency Response and Resuscitation Team (PERRT), and known to everyone as Titch. Our conversation revolves around the principles of preventing and appropriately responding to patient deterioration, which we consider on an organisational, ward and personal level. We discuss the benefits (and limits) of using of NEWS (National Early Warning Scores), ISBARD handovers, Treatment Escalation Plans, Do Not Resuscitate orders, Nurse to Patient ratios and the importance of trusting you clinical instincts.

Dr Magdalena Dziadzio kindly joins us to discuss all things immunity. She discusses the organs, tissues, proteins and cells that when combined, protect us from infection and cancer. We gain insight into how B-cell and T-cell lymphocytes work together in the thymus to develop antibodies that give our immune system memory. We then proceed onto different types of primary immunodeficiencies, where one element of protection (i.e. compliment or T-cells) has not developed as intended, and how they can be treated.

In this episode we explore the slightly less common acute leukaemia sub-type, Acute Lymphoblastic Leukaemia (ALL). Prof Adele Fielding takes us through many technical questions, why is ALL a disease seen predominantly in the young, why does it require years of maintenance therapy unlike AML, how is it diagnosed and graded, can ALL be considered a lymphoma in some patients, the role of the Philadelphia chromosome in an era of TKIs, and many more. This discussion is kept very grounded in the experience of the patient and their family throughout, and we delve into the communication challenges that must be negotiated by healthcare professionals when caring for patients with acute haematological conditions.

In Episode 6 we are joined by Stephen Rowley, the senior nurse for Haematology at UCLH and the originator of Aseptic Non-Touch Technique (ANTT). Our conversation covers the role of standardisation in improving standards, the importance of having a common language when discussing asepsis, and ultimately how he has helped develop and spread the idea internationally, into what is now the de facto standard for aseptic practice.

In episode 5 we welcome UCLH Red Cell Consultant Perla Eleftheriou to discuss Sickle Cell Disease. She takes us through the pathophysiology of sickle cell disease (SCD) and the mainstays of current treatment including hydroxyurea and blood transfusion/red cell exchange. We look into the role allogeneic transplant can play in curing SCD, as well as newer drugs and gene therapies that will be shaping treatment options in the future. Appropriate and timely treatment is essential in the management of a veno-oclusive crisis (VOC), and we go through the monitoring of patients, analgesia, red cell exchange, and the dangers of patients going into chest crisis.

Welcome to Episode 4, our first ever episode not directly discussing Haematology! We are joined by Dr Wai Keong Wong, who as well as being a clinical Haematologist, is also UCLH's Chief Research Information Officer. Following the introduction of an Electronic Health Record System (EHRS) at UCLH, data is no longer technically difficult to collect, and the research potential of an organisation can rise dramatically. This throws up new challenges for clinicians consenting patients, ethics committees and information governance. We discuss the lessons learnt from the controversial collaboration between the Royal Free Hospital and Google's Deep Mind in 2016, and how to stay patient focused when meeting a patient and using EHRS at the same time. Will EHRS help in the earlier detection of patient deterioration , and what other interesting directions will clinical research take now that randomised trials can be designed and run within a completely electronic system?

This week we delve into the plasma cell disorder Multiple Myeloma, with UCLH Myeloma consultant, Dr Rakesh Popat. With incredible clarity and efficiency he covers the basics of diagnosing and treating myeloma, including the role of newer targeted therapies, allogeneic transplantation and immunotherapies. He clarifies the pathophysiology of the side effects myeloma patients can commonly present with, including lytic lesions, spinal degeneration and renal damage. Some how we manage to cover all of this in 25 minutes flat!

We are joined in this episode by Prof Marcel Levi, the CEO of University College London Hospitals and a practicing Haematology consultant that specialises in coagulopathies, thrombosis and angioedema. This wide ranging discussion initially covers the skill of balancing clinical and managerial work, and how a medical approach to problem solving can be applied to board meetings. We discuss the clotting cascade, and why coagulation is far simpler than medical text books convey, the treatment of DIC and Vitamin K deficiency and how to understand a clotting screen. Finally we move onto Haemophilia, Angioedema and why Haematology is the best speciality to work in.

Claire Roddie leads the ever growing UCLH Immunotherapy team, caring for patients undergoing NHS funded CAR T-Cell therapy, as well as those that could be on one of the dozen different clinical trials involving CAR T-Cells. Her work has recently been featured on the BBC2 documentary 'War in the Blood' which followed two patients undergoing CAR T-Cell clinical trials at UCLH. We sat down with Claire in the most echo-y room we could find, to discuss the main side effects the ward teams have to face during the first four weeks of treatment. Namely Cytokine Release Syndrome and Neurotoxicity, why they occur, how to recognise each, and the main treatments options when they arise.

In our final podcast of the series we discuss with Dr Shirley D'Sa plasma cell function and disorders including POEMS and Waldenström’s macroglobulinaemia. Dr D'sa is a haematologist with a specialist interest in Waldenström’s macroglobulinaemia and associated disorders, myeloma and POEMS syndrome at UCLH. UCLH currently manages one of the largest reported group of POEMS patients in Europe, with approximately 75 people attending the clinic. POEMS syndrome is a rare condition caused by the body producing abnormal plasma cells. This blood disorder affects multiple organs in the body. We will discuss the 5 common features of the syndrome of which it is named, treatments and research.

For our penultimate podcast of the series, we are joined by Ben Carpenter, a Transplant Consultant at UCLH. We start by discussing the history of Allogeneic transplantation through the 20th Century, and how transplants are matched. We the move into the rationale for the use of different types of conditioning and sources of haematopoietic progenitor cells. Potential areas of refinement, and new directions of travel for immunotherapies are explored at the end. Transplantation is a large area, so we will be investigating the complications arising from infection, and GVHD in the next series.

Beth Payne is a Senior Clinical Researcher at the UCL Cancer Institute, where she is Research Group leader in bone marrow failure and myelodysplastic syndromes. Beth is also a Leukaemia Consultant at UCLH. The title, Myelodysplastic Syndromes (MDS), covers a diverse group of diseases, with far more genetic mutations than many Haematological disorders. Ward staff are familiar with treating patients with MDS when it transforms to Acute Myeloid Leukaemia (AML), so we asked Beth to give us an overview of the disease, discussing what is happening in the bone marrow prior to it's potential development into AML.

Welcome to the formal launch episode of the 'Bolus' podcast! In this episode we are joined by Marc Mansour, a consultant haematologist specialising in the treatment of patients with Acute Leukaemias and Myelodyspastic Syndromes at UCLH. He is the research group leader of the Leukaemia Biology group at the UCL Cancer Institute, focusing on T-cell acute lymphoblastic leukaemia (T-ALL) and acute myeloid leukaemia (AML), and in particular on oncogenic transcription factor complexes, mechanisms of oncogenic enhancer formation, and novel drug targets. We start by discussing the seminal paper 'The Hallmarks of Cancer', and explore what processes begin to go wrong, in order for cancer to develop. DNA damage is a key driver in many cancers, but carcinogens are typically not the cause in many Haematological cancers, we discuss the reasons behind this. 'Bolus' explores the Haematology speciality, and has been created for nurses, junior doctors and allied healthcare professionals. It is made by three UCLH Haematology nurses, Sonia Thomas and Sarah Jordan, both ward sisters, and Gavin Cooper, a nurse educator. We will be releasing a new episode every Monday.

Thrombotic Thrombocytopenic Purpura (TTP) is a rare type of Microangiopathic Haemolytic Anaemia (MAHA). UCLH Haematology has long been a leading centre in the treatment of TTP, so we met up with a renowned authority on the subject, Professor Marie Scully, to discuss the disease. We run through the development of this specialism at UCLH, the disease pathophysiology and current treatment options. Much of the discussion is grounded in the importance of appropriate nursing care and monitoring of the patient, at the bedside. Finally we look at how Caplacizumab is dramatically reducing hospital length of stays, and the exciting development of a recombinant ADAMTS-13 drug.

Our discussion covers the background, pathophysiology and historic treatment options for patients with Thalassaemia. A new drug, LentiGlobin, has been used recently in clinical trials at UCLH. It involves genetically modifying autologous stem cells to produce sufficient Red blood cells, and takes away the need for blood transfusions. Prof John Porter is a well-recognised consultant haematologist and expert on red cell haematology. He is Professor of Haematology at UCL and Head of the Red Cell Unit for UCLH and Whittington Hospitals, and has received a British Society of Haematology Gold Medal award.

Dr Will Townsend is a UCLH Lymphoma Consultant and conducts Phase 1 clinical trials at the UCLH Clinical Research Facility. Our discussion covers the basics of Lymphoma, unpicking the different types, grades, classifications and treatments. At the end we touch upon a current clinical trial involving the use of T-cell Bispecific Antibodies, an off-the-shelf drug that can recruit the patient’s immune system to attack malignant B-cells.

UCLH NHS Foundation Trust and University College London have a close academic and clincal partnership. In the field of immunotherapy, this partnership has led to UCL being ranked second in the world and top in Europe for the number of inventions and patent applications made in relation to CAR T-cells. In 2018, more CAR T-cells were administered at UCLH than in the rest of Europe combined. To help explore these developments we asked Leigh Wood, the Cell Therapy Team Lead from the Cancer Clinical Trials Unit at UCLH to join us. The discussion covers practical considerations about caring for patients on clinical trials, and explanations of research concepts like Phase I, II and III. Randomised control trials, blinding and placebos; when they are appropriate to use in research, and when they are not. https://www.ncbi.nlm.nih.gov/pubmed/30940940 https://www.nih.gov/health-information/nih-clinical-research-trials-you/basics https://www.uclh.nhs.uk/OurServices/ServiceA-Z/Cancer/CCTrials/Pages/Home.aspx