Podcasts about haematological

Here we discuss the administration and logistical challenges faced by a Rural Emergency department in a question and answer table format for the same clinical scenario as Cast 24 - Haematological Malignancy.  For the Cast Notes go to artofemergency.com 

We discuss a question here on a patient presenting with a Haematological Malignancy delving into the differentials and their aetiologies (more possible questions and answers revealed in the SAQ document), clinical features, CXR and CT interpretation along with complications.   Please follow the link to the SAQ on  . 

Jonathan is joined by Elizabeth Macintyre, President-Elect and Board Member of the Biomedical Alliance, Europe; and Past President of the European Haematology Association (EHA). The pair delve into the world of haematology, focusing on Macintyre's research towards equal access, haematological diagnostics, and her presidency during the COVID-19 pandemic.  Use the following timestamps to navigate the content in this episode:  (00:00)-Introduction  (01:39)-Macintyre's route into medicine   (04:13)-Haematology in Europe, and leading the EHA   (08:30)-Diagnostics in haematological malignancies  (10:18)-Changes to congress following COVID-19  (14:12)-Coffee conversations   (15:36)-Madrid 2024  (18:42)-Jonathan speaks French   (24:07)-Medical politics and economics  (30:00)-Accessing new treatments   (35:43)-Three wishes for the future of healthcare  

Haematological management of major haemorrhage: A podcast recording of a conversation between Prof Simon Stanworth and Dr Heidi Doughty.

Effective management of B12 is important to prevent Haematological complications such as B12 deficiency and megaloblastic anaemia. Here, Dr Rachna Chowla, GP and joint Director of Clinical Strategy for King's Health Partners, interviews Dr Deepti Radia, Consultant Haematologist at Guy's and St Thomas' Hospital to gain in-depth advice on effective Vitamin B12 patient management in Primary Care. Visit our website at: https://www.kingshealthpartners.org/institutes/haematology Or tweet us @KHPHaematology

What are platelets, why are they important and why do you get packed off to the obstetrician if your count is low? Here I talk about thrombocytopenia or low platelets & th eimplications.Want to know more?https://mft.nhs.uk/app/uploads/sites/4/2018/04/Remifentanil-PCA-for-Women-in-Labour-October-2017.pdf https://elearning.rcog.org.uk/sites/default/files/Haematological disorders/Myers_TOG_2009.pdfhttps://yourhealth.leicestershospitals.nhs.uk/library/women-s-children-s/obstetrics/28-234-062018-low-platelets-in-pregnancy/fileThank you all for listening, if you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider. Do explore my back catalogue of episodes and feel free to get in touch to suggest topics, I love to hear your thoughts and ideas. If you have found my ideas helpful please recommend theobspod to others who may be interested in exploring all things pregnancy and birth. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and email me on TheObsPod@gmail.com please check out #MatExp matexp.org.uk for ideas about how to improve maternity experience.  My beautiful artwork is thank to Anna Geyer www.newpossibilities.co.uk

Welcome back to the tasty morsels of critical care podcast. Of the many things I poorly understand, I suspect that haematology holds a special place. Knowing the intricacies of the haematological malignancies was not exactly core knowledge for emergency medicine ... Read More »

Dr Raul Cordoba discusses the joint Series between The Lancet Healthy Longevity and The Lancet Haematology on haematological malignancies in older people.Read the full article:https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00241-6/fulltext

Venetoclax in combination with FLAG-IDA chemotherapy shows safety and promising efficacy in both untreated and relapsed/refractory AML in this phase 1b/2 study, providing a strong rationale for phase 3 trials incorporating this agent in patients fit for intensive therapy.   TRANSCRIPT This JCO Podcast provides observations and commentary on the JCO article “Venetoclax Combined with FLAG-IDA Induction and Consolidation in Newly Diagnosed and Relapsed/Refractory Acute Myeloid Leukemia” by DiNardo et al. My name is Richard Dillon, and I am a Clinical Senior Lecturer in Cancer Genetics at King's College London and Consultant Hematologist at Guy's Hospital, London, UK. My oncologic specialty is Adult Acute Myeloid Leukaemia. I'd like to note that my institution receives research funding support from Abbvie.   The recently published VIALE-A and VIALE-C trials demonstrated significant efficacy of venetoclax when added to low dose chemotherapy in patients with newly diagnosed AML who cannot receive intensive chemotherapy due to their age or comorbidities. Venetoclax has now become the standard of care for these patients, and there is growing interest in investigating how the potent anti-leukemic efficacy of this agent can be exploited in younger patients, who are fit to receive intensive treatment with curative intent. To date, only a small number of studies have addressed this important question.   In the front-line setting, a phase 1b study performed in Australia by Chua and colleagues tested the addition of 14 days of venetoclax to a regimen consisting of 7 days of infusional cytarabine and two doses of idarubicin for patients aged over 65 with previously untreated AML. This was well tolerated, and the overall response rate was 72%: 97% in patients with de-novo and 43% in patients with secondary AML.   Karol and colleagues from St. Jude's Children's Hospital performed a phase 1 study testing the combination of 28 days of venetoclax with varying doses of cytarabine and idarubicin in children with relapsed or refractory AML. At the recommended phase 2 dose, which was 600mg of venetoclax and eight doses of 1000mg per square meter cytarabine, with or without idarubicin, the overall response rate was 70%. Importantly, for children who received a lower dose of cytarabine (20 doses of 100mg per meter square), the response rate was markedly lower at 33%.   In the study referred to in this podcast, DiNardo and colleagues combined venetoclax with the FLAG-IDA regimen. FLAG-IDA is an intensive chemotherapy schedule incorporating high-dose cytarabine, typically used for patients with refractory or relapsed AML. And in this setting, overall response rates between 50 and 60% have been reported. FLAG-IDA has also been used in patients with newly diagnosed AML—for example, in the UK NCRI AML15 study, where the overall response rate was 86% and 5-year overall survival was 44%.   The current study comprised a phase 1b dose escalation in patients with relapsed or refractory disease, followed by a phase 2 dose expansion in both newly diagnosed and relapsed or refractory patient cohorts. In total, 68 patients were treated with the venetoclax FLAG-IDA combination. As expected, this combination was severely myelosuppressive, and during the dose-escalation phase, a number of alterations were made to the schedule to mitigate this toxicity, including reductions in the cytarabine dose to 1.5g per meter square and the length of venetoclax treatment to two weeks in induction and one week in consolidation. With these modifications, hematological toxicity at the recommended phase 2 dose was manageable. The time to count recovery was 31 days for previously untreated patients and 37 days for patients with relapsed or refractory disease and was not prolonged in patients who had undergone previous allogeneic stem cell transplantation. Haematological toxicity was more severe in the second cycle of treatment with 59% of patients experiencing delayed count recovery beyond day 45. Nevertheless, day 60 mortality was low at 4.4%.   The response rates observed in this study were impressive. At the recommended phase 2 dose, 97% of newly diagnosed and 70% of relapsed or refractory patients had achieved a composite complete remission, which included CR, CRi and CR with partial hematological recovery, CRh. CR or CRi was achieved in 72% and 48%, and MRD negativity by flow cytometry was achieved in 89% and 48% of patients with newly diagnosed and relapsed or refractory disease, respectively.   Although the number of patients was too small to reliably identify molecular and cytogenetic groups with a differential response, patients with relapsed or refractory AML with genotypes previously reported to be particularly sensitive to venetoclax containing regimens, which are NPM1, IDH1 and IDH2, appeared to have a particularly high rate of response with a composite CR rate of 100% and 12-month overall survival rate of 83%. In addition, the 7 patients with MLL rearrangements appeared to do particularly well, with a composite CR rate of 100% and 80% of patients testing negative for MLL fusion transcripts by PCR. One-year overall survival in this group was 80%, possibly highlighting MLL-rearranged leukemias as an additional group with particular sensitivity to BCL2 inhibition. This signal was not apparent in earlier trials using low doses of chemotherapy, perhaps because MLL rearrangements are much less frequent in older adults, or alternatively perhaps because this lesion requires higher doses of chemotherapy to synergise with BCL2 inhibition to overcome the apoptotic threshold.   On the other hand, there appeared to be some groups with less favorable responses. Patients with core-binding factor leukemias appeared to do less well than expected, with a median overall survival time of 7.6 months. Patients with these leukemias were excluded from the earlier phase 2 and 3 studies of venetoclax, so there is no prior clinical data regarding their sensitivity to BCL2 inhibition; however, this finding does concur with in vitro data suggesting a lack of sensitivity.   The outcomes for patients with TP53 mutations were disappointing with a median overall survival time of 9 months for newly diagnosed and 7 months for relapsed patients. Interestingly, even in the four TP53-mutated patients who tested MRD negative by flow cytometry, the TP53 mutation was still detectable by next-generation sequencing after treatment. The number of patients in these groups were small and will require confirmation in larger studies; however, alternative treatment strategies might be required for these patients.   Overall, these results appear extremely promising and suggest that venetoclax may have significant activity when used with intensive induction or salvage chemotherapy schedules in younger adults. This now needs to be confirmed in randomized trials comparing intensive chemotherapy with and without venetoclax in both the front-line and salvage settings. If these trials are positive, further comparative studies will be needed to define the best chemotherapy schedule to combine with venetoclax. While limited data indicate that standard doses of cytarabine are likely inadequate, the optimal dose of cytarabine, and the additional value of fludarabine and anthracyclines remains to be defined. Nevertheless, the study by DiNardo and colleagues represents a significant step forward in the deployment of venetoclax in young fit adults, with the hope that this will increase the rate of long-term cures from this aggressive and frequently fatal hematological malignancy.   This concludes this JCO Podcast. Thank you for listening.

To mark International Nurses Day, Eugenia Trigoso Arjona, nurse coordinator at Hospital La Fe (Valencia, Spain) and chair of the European Society for Blood and Marrow Transplantation Nurses Global Education Committee, joins acting Editor-in-Chief Yaiza del Pozo Martin to discuss how nurses can reshape the future of haematological care. 

Para el Día International de la Enfermera, Eugenia Trigoso Arjona, enfermera coordinadora en el Hospital La Fe (Valencia, España) y presidenta del comité de educación de la European Society for Blood and Marrow Transplantation Nurses hablo con la Editora Yaiza del Pozo Martin sobre como las enfermeras pueden remodelar el futuro de la hematología. 

Dr Philip Smith, Associate and Social Media Editor of Frontline Gastroenterology and Consultant Gastroenterologist at the Royal Liverpool Hospital, UK, interviews Dr Nick Thompson, who is a Consultant Gastroenterologist in the Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust. Dr Thompson has helped develop Newcastle as a regional centre for parenteral nutrition support and the hospital was recently designated as one of the Integrated Intestinal Failure Centres in England. Dr Thompson is the senior author on the guidance document "British Intestinal Failure Alliance (BIFA) guidance - haematological and biochemical monitoring of adult patients receiving home parenteral nutrition". Read the paper: https://fg.bmj.com/content/early/2021/02/16/flgastro-2020-101758

Dr. Laura Garvican-Lewis is Director of Science at the US Anti-Doping Agency. Previously, she was a Research Fellow at the Australian Catholic University. She was awarded a PCC Research Grant in 2015 and a PCC Fellowship in 2018. We discuss her work on haematological responses to altitude training and iron supplementation, how these impact the Athlete Biological Passport (ABP), her recent work validating a model that addresses blood plasma volume variance in the ABP, and her experiences as a PCC Fellow.

Focused examination of a person with possible anaemia.

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.

Lead author Gita Thanarajasingam joins The Lancet Haematology to discuss the new Commission on assessment and adverse event reporting in haematological malignancies.

Dr Corradini talks to ecancertv at ICMM 2016 about the new drugs emerging for treating various haematological cancers. He discusses both three and four-drug combinations as well as new antibodies such as daratumumab and elotuzumab. The complete remission rate is of high importance, he stresses, and has seen much improvement in recent years, especially in younger patients.

Dr Townsley talks to ecancertv at ASH 2015 about adding eltrombopag to standard immunosuppressive therapy for aplastic anaemia in previously untreated patients. Eltrombopag was originally developed to increase platelet counts in patients with chronic immune thrombocytopenia (ITP) but it was found to also increase white and red cell counts. This was logical in hindsight, Dr Townsley observes in the interview. Although it is licensed for the treatment of refractory aplastic anaemia in Europe, eltrombopag is only approved for use in ITP in the USA and further study data were needed. The study presented by Dr Townsley aimed to provide evidence that eltrombopag could be used in aplastic anaemia setting and included 92 patients with the rare disease. Results showed a clear benefit of adding eltrombopag to standard immunosuppressive therapy of horse antithymocyte globulin (hATG) and cyclosporine versus the immunosuppressive therapy alone. Haematological overall response rates were 80% and 85% at 3 and 6 months, respectively, and highest if eltrombopag was given on the first day of immunosuppressive therapy as opposed to 2 weeks after and continued for either 3 or 6 months. Overall survival is 99%, Dr Townsley highlights, as only one patient has died while in the study to date but follow up is short.

Dr Hromas talks to ecancertv at ASH 2015 about highlights from the targeted blood cancer therapies press conference that he chaired. The research presented at the press conference not only illustrated that immense progress has been made in the treatment of haematological malignancies, but also that the future lies in a more genetically driven and increasingly personalised approach. Dr Hromas comments that this is an exciting time for haematology-oncology practice.Dr Hromas comments that this is an exciting time for haematology-oncology practice.

Prof Bullinger speaks with ecancer about Work Package II, a project within HARMONY focused on the focused and interlinked research into haematological malignancies. He describes the uniqueness of the project in uniting many disciplines and stakeholders, and considers how the data generated from the project can be analysed with deeper dimensions of disease subtype, evolution, and progression. Prof Bullinger notes the HARMONY project is only at its inception, and looks forward to pilot studies producing results within the next few years.

Dr Nimer meets with ecancertv at ASCO 2016 to discuss haematological malignancies.

Dr Schlegerberger talks to ecancertv at EHA 2016 about inherited risks for haematological malignancies such as leukaemia and the screening practices surrounding them. She describes the current landscape of genetic screening and counselling available to patients in Europe with particular attention to known causative mutations and how these can influence patient involvement and therapy over the course of their treatment. She advocates for widespread testing and patient engagement, urging more awareness raising among clinicians and patients.

Dr Brentjens (Memorial Sloan Kettering Cancer Center, New York, USA) talks to ecancertv at TAT 2015 about chimeric antigen receptor (CAR) T cell therapy, outlining how it has been used with great success to treat patients with B-cell cancers. He also discusses some of the practicalities and challenges of using this approach in clinical practice.

Dr Brentjens (Memorial Sloan Kettering Cancer Center, New York, USA) talks to ecancertv at TAT 2015 about chimeric antigen receptor (CAR) T cell therapy, outlining how it has been used with great success to treat patients with B-cell cancers. He also discusses some of the practicalities and challenges of using this approach in clinical practice.

Prof Sonneveld provides ecancertv with an overview of the important issues being discussed at EHA 2014 in haematological cancer, with particular reference to novel agents such as the use of ibrutinib in CLL.

Dr Galetto talks to ecancertv at EHA 2014 about the genetic modification of T cells for fighting haematological cancers.

Paul Lane is an intensivist from Townsville, in the tropical north of Queensland, Australia. He gave this talk at last year's bedside critical care conference straight after Ed Morris' talk on the same subject. In this talk, Paul brings the intensivist's perspective. Not too late to join the 550 others coming to SMACC - see the website for details and see ICN for Paul's slides that go with this talk.

Ed Morris is an Englshman currently hailing from Townsville, Australia who is a superb haematologist. He gave this talk on haem malignancies with specific regards to the critical care aspects at last years bedside critical care conference. The slides are available for free on Intensive Care Network.

Background: Immunodeficiency, centromeric instability and facial dysmorphism (ICF syndrome) is a rare autosomal recessive disease characterised by facial dysmorphism, immunoglobulin deficiency and branching of chromosomes 1, 9 and 16 after PHA stimulation of lymphocytes. Hypomethylation of DNA of a small fraction of the genome is an unusual feature of ICF patients which is explained by mutations in the DNA methyltransferase gene DNMT3B in some, but not all, ICF patients. Objective: To obtain a comprehensive description of the clinical features of this syndrome as well as genotype– phenotype correlations in ICF patients. Methods: Data on ICF patients were obtained by literature search and additional information by means of questionnaires to corresponding authors. Results and conclusions: 45 patients all with proven centromeric instability were included in this study. Facial dysmorphism was found to be a common characteristic (n=41/42), especially epicanthic folds, hypertelorism, flat nasal bridge and low set ears. Hypo- or agammaglobulinaemia was demonstrated in nearly all patients (n=39/44). Opportunistic infections were seen in several patients, pointing to a T cell dysfunction. Haematological malignancy was documented in two patients. Life expectancy of ICF patients is poor, especially those with severe infections in infancy or chronic gastrointestinal problems and failure to thrive. Early diagnosis of ICF is important since early introduction of immunoglobulin supplementation can improve the course of the disease. Allogeneic stem cell transplantation should be considered as a therapeutic option in patients with severe infections or failure to thrive. Only 19 of 34 patients showed mutations in DNMT3B, suggesting genetic heterogeneity. No genotype–phenotype correlation was found between patients with and without DNMT3B mutations.