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Deirdra R. Terrell - One of the best experts on this subject based on the ideXlab platform.
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Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general Hematologist-Oncologists
Journal of Thrombosis and Thrombolysis, 2018Co-Authors: Allyson M. Pishko, James N. George, Sara K. Vesely, Mudi Misgav, Adam Cuker, Douglas B. Cines, Deirdra R. TerrellAbstract:While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both hematologists with an international reputation in treatment of ITP (n = 48) and also general hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
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Management of primary immune thrombocytopenia, 2012: a survey of oklahoma hematologists-oncologists.
The American journal of the medical sciences, 2014Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract Background Management options for patients with primary immune thrombocytopenia (ITP) have increased, and treatment of patients with ITP has changed during the past 10 years. Methods To document current practice and to determine how current practice is related to recommendations of 2 recent practice guidelines for ITP, an international Consensus report and an American society of Hematology (ASH) guideline, the authors surveyed practicing hematologistsoncologists in Oklahoma. Surveys were specific for children or adults. Each survey had 3 questions describing patients with a new diagnosis and patients who had not achieved remission with initial treatment. Questions were adapted from the clinical scenarios of the ASH guideline. Results Twelve (92%) Oklahoma pediatric hematologistsoncologists responded; 82 (81%) Oklahoma adult hematologistsoncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8000/μL and minor bleeding, 5 (42%) hematologistsoncologists selected observation without drug treatment (recommended by both guidelines). For an adult with a platelet count of 9000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by the ASH guideline); 30 (37%) selected rituximab and 13 (16%) selected thrombopoietin-receptor agonists (both recommended by the International Consensus report). Hematologists-oncologists who had more years in practice were more likely to select splenectomy ( P = 0.047). Conclusions In a time of changing management for patients with ITP, these data document reported current management in Oklahoma and provide a basis for serial comparisons across time and for comparisons with other regions and comparison of management with patient outcomes.
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Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists
Blood, 2012Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract 1094 Introduction With the availability of multiple new agents, management of patients with primary immune thrombocytopenia (ITP) has changed substantially since the initial practice guideline for ITP was developed by the American Society of Hematology (ASH). To document current practice and to determine how current practice is related to recommendations of 2 recent guidelines for ITP, an International Consensus report (ICR), 2010, and an updated ASH guideline, 2011, we surveyed practicing hematologists-oncologists in Oklahoma. Methods Separate surveys were developed for children and adults. Each survey had 3 clinical scenarios; each scenario had 5–7 management choices. Hematologists-oncologists were instructed to select 1 management choice. Questions were adapted from the clinical scenarios of the ASH guideline. Additionally, data were collected for [1] number of years in practice; [2] site of practice, (either University of Oklahoma Medical Center or community); and [3] the estimated number of patients with ITP seen each year. Oklahoma hematologists-oncologists were identified by searching the Oklahoma Board of Medical Licensure and the Oklahoma Osteopathic Association websites for all active physicians certified in adult/pediatric hematology/oncology as of 12/31/2011. Exclusion criteria were: physicians whose careers were devoted to full-time research/administration. Data was collected between 1/31/2012–3/15/2012. Only the stronger grades of recommendations by the ICR and ASH guidelines were used for comparison to the hematologists-oncologists9 responses. Comparison of treatment responses to the number of years in practice was selected a priori , because it was hypothesized that hematologists-oncologists with fewer years in practice may more readily accept newer treatments while hematologists-oncologists with more years in practice may prefer more traditional management. Chi-square or Fisher9s exact test were used to determine if treatment responses differed by number of years in practice. SAS version 9.2 was used; alpha was set at 0.05. Results All 13 (100%) Oklahoma pediatric hematologists-oncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8,000/μL, and minor bleeding, 5 (38%) pediatric hematologists-oncologists selected observation without drug treatment (recommended by both guidelines). Because of the small number of pediatric hematologists-oncologists, no comparison of their responses to years in practice was performed. Eighty-three (82%) adult hematologists-oncologists responded. For an adult with a platelet count of 9,000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by ASH guideline); 31 (37%) selected rituximab and 13 (16%) selected thrombopoietin (TPO)-receptor agonists (both recommended by ICR). There was not a statistically significant difference between the number of years in practice for those who selected splenectomy versus all other treatment options (p = 0.07). Discussion Although both recent guidelines recommended that children with no/mild bleeding may be managed with observation regardless of the platelet count, only 5 (38%) pediatric hematologists-oncologists selected observation in this scenario. The practice guidelines have different recommendations for second-line treatment in adults: the ICR recommends TPO-receptor agonists and rituximab but not splenectomy; the ASH guideline recommends splenectomy but not TPO-receptor agonists or rituximab. For this clinical scenario, 39% of hematologists-oncologists selected splenectomy, 37% selected rituximab and 16% selected TPO-agents. These different choices and recommendations reflect the changing clinical practice. Although not statistically significant, the hematologists-oncologists who had been in practice for >20 years appeared to be more likely to select splenectomy (p=0.07), consistent with greater acceptance of newer treatments by younger hematologists-oncologists. Although these data may not be generalizable, the high survey response rate provides confidence that these data accurately reflect the judgment, if not the actual practice, of Oklahoma hematologists-oncologists. Conclusion These observations provide an estimate of actual current clinical practice for management of patients with ITP. Disclosures: Off Label Use: Rituximab for primary immune thrombocytopenia (ITP). George: Alexion, Inc.: Consultancy; Baxter, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding. Terrell: Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy.
Denise M Adams - One of the best experts on this subject based on the ideXlab platform.
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Practice Considerations for the Hematologist/Oncologist in Vascular Anomaly Clinics
Vascular Anomalies, 2020Co-Authors: Michael Jeng, Denise M AdamsAbstract:With the increase in number of clinical centers focused on vascular anomalies, it is evident that a broad, interdisciplinary approach is optimal. Hematology/oncology (H/O) is an integral specialty for a vascular anomaly team, as many of the clinical sequelae that are encountered are within the scope of practice of H/O. Nonvascular oncologic diagnoses (such as certain solid cancers) are part of the differential diagnosis for vascular anomalies and malformations, experience with chemotherapy and developmental therapeutics, expertise with the management of coagulopathy and thromboses, and workup of anemia and thrombocytopenia are all expectations for H/O subspecialists. For some institutions, the incorporation of patients with vascular anomalies into the H/O program or a provider’s clinical workflow can be challenging. The thoughtful consideration of the hematologist/oncologist’s role in the context of the clinical infrastructure and available services at each center will promote optimal patient care and clinician well-being.
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Vascular Anomalies: Diagnosis of Complicated Anomalies and New Medical Treatment Options.
Hematology oncology clinics of North America, 2019Co-Authors: Denise M Adams, Kiersten W. RicciAbstract:Vascular anomalies consist of a diverse group of disorders that are broadly categorized as tumors and malformations. . Recently, there has been significant genomic discovery allowing phenotype/genotype correlation of disease. An increasing number of pediatric hematologists/oncologists are caring for individuals with vascular anomalies as these patients require chronic care and have high medical acuity needs. The advent of new medical therapy options, along with ongoing and upcoming clinical trials, makes the involvement of hematologists/oncologists essential. This article highlights diagnosis and management of complicated vascular anomalies as well as important new treatment options and discoveries.
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Vascular anomaly cases for the pediatric hematologist oncologists—An interdisciplinary review
Pediatric Blood & Cancer, 2017Co-Authors: Denise M Adams, Leonardo R. Brandão, Caitlin M. Peterman, Anita Gupta, Manish N. Patel, Steven J. Fishman, Cameron C. TrenorAbstract:Vascular anomalies (VAs) are classified as tumors or malformations depending on their clinical characteristics, pathological diagnosis, and genomic information. Diagnosis can be challenging because of the heterogeneity of clinical presentation; thus, the best diagnosis and care are provided by an interdisciplinary team of specialists. Over the past 10 years, an increasing number of pediatric hematologist/oncologists are caring for patients with VAs secondary to new medical therapy options and clinical trials. This paper focuses on complicated VA issues often seen by the pediatric hematologist/oncologist. The paper reviews clinical pearls on diagnosis, histology, radiology, and treatment options.
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Special Considerations in Vascular Anomalies: Hematologic
2011Co-Authors: Denise M AdamsAbstract:Proper care of the patient with a vascular anomaly requires the expertise of multiple specialists. Because of the need for an interdisciplinary approach, several vascular anomalies centers have now been developed across the world. A hematologist/oncologist provides clinical acumen in establishing a correct diagnosis and guiding the medical management of these patients. These patients can have complicated coagulopathies and need medical therapy. The hematologist/ oncologist provides insights into the availability and suitability of enrollment into clinical trials or the use of novel experimental treatments for these complicated conditions. This article emphasizes the hematologic complications and management of these patients.
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Special considerations in vascular anomalies: hematologic management
Clinics in plastic surgery, 2011Co-Authors: Denise M AdamsAbstract:Proper care of the patient with a vascular anomaly requires the expertise of multiple specialists. Because of the need for an interdisciplinary approach, several vascular anomalies centers have now been developed across the world. A hematologist/oncologist provides clinical acumen in establishing a correct diagnosis and guiding the medical management of these patients. These patients can have complicated coagulopathies and need medical therapy. This article emphasizes the hematologic complications and management of these patients.
James N. George - One of the best experts on this subject based on the ideXlab platform.
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Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general Hematologist-Oncologists
Journal of Thrombosis and Thrombolysis, 2018Co-Authors: Allyson M. Pishko, James N. George, Sara K. Vesely, Mudi Misgav, Adam Cuker, Douglas B. Cines, Deirdra R. TerrellAbstract:While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both hematologists with an international reputation in treatment of ITP (n = 48) and also general hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
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Management of primary immune thrombocytopenia, 2012: a survey of oklahoma hematologists-oncologists.
The American journal of the medical sciences, 2014Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract Background Management options for patients with primary immune thrombocytopenia (ITP) have increased, and treatment of patients with ITP has changed during the past 10 years. Methods To document current practice and to determine how current practice is related to recommendations of 2 recent practice guidelines for ITP, an international Consensus report and an American society of Hematology (ASH) guideline, the authors surveyed practicing hematologistsoncologists in Oklahoma. Surveys were specific for children or adults. Each survey had 3 questions describing patients with a new diagnosis and patients who had not achieved remission with initial treatment. Questions were adapted from the clinical scenarios of the ASH guideline. Results Twelve (92%) Oklahoma pediatric hematologistsoncologists responded; 82 (81%) Oklahoma adult hematologistsoncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8000/μL and minor bleeding, 5 (42%) hematologistsoncologists selected observation without drug treatment (recommended by both guidelines). For an adult with a platelet count of 9000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by the ASH guideline); 30 (37%) selected rituximab and 13 (16%) selected thrombopoietin-receptor agonists (both recommended by the International Consensus report). Hematologists-oncologists who had more years in practice were more likely to select splenectomy ( P = 0.047). Conclusions In a time of changing management for patients with ITP, these data document reported current management in Oklahoma and provide a basis for serial comparisons across time and for comparisons with other regions and comparison of management with patient outcomes.
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Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists
Blood, 2012Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract 1094 Introduction With the availability of multiple new agents, management of patients with primary immune thrombocytopenia (ITP) has changed substantially since the initial practice guideline for ITP was developed by the American Society of Hematology (ASH). To document current practice and to determine how current practice is related to recommendations of 2 recent guidelines for ITP, an International Consensus report (ICR), 2010, and an updated ASH guideline, 2011, we surveyed practicing hematologists-oncologists in Oklahoma. Methods Separate surveys were developed for children and adults. Each survey had 3 clinical scenarios; each scenario had 5–7 management choices. Hematologists-oncologists were instructed to select 1 management choice. Questions were adapted from the clinical scenarios of the ASH guideline. Additionally, data were collected for [1] number of years in practice; [2] site of practice, (either University of Oklahoma Medical Center or community); and [3] the estimated number of patients with ITP seen each year. Oklahoma hematologists-oncologists were identified by searching the Oklahoma Board of Medical Licensure and the Oklahoma Osteopathic Association websites for all active physicians certified in adult/pediatric hematology/oncology as of 12/31/2011. Exclusion criteria were: physicians whose careers were devoted to full-time research/administration. Data was collected between 1/31/2012–3/15/2012. Only the stronger grades of recommendations by the ICR and ASH guidelines were used for comparison to the hematologists-oncologists9 responses. Comparison of treatment responses to the number of years in practice was selected a priori , because it was hypothesized that hematologists-oncologists with fewer years in practice may more readily accept newer treatments while hematologists-oncologists with more years in practice may prefer more traditional management. Chi-square or Fisher9s exact test were used to determine if treatment responses differed by number of years in practice. SAS version 9.2 was used; alpha was set at 0.05. Results All 13 (100%) Oklahoma pediatric hematologists-oncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8,000/μL, and minor bleeding, 5 (38%) pediatric hematologists-oncologists selected observation without drug treatment (recommended by both guidelines). Because of the small number of pediatric hematologists-oncologists, no comparison of their responses to years in practice was performed. Eighty-three (82%) adult hematologists-oncologists responded. For an adult with a platelet count of 9,000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by ASH guideline); 31 (37%) selected rituximab and 13 (16%) selected thrombopoietin (TPO)-receptor agonists (both recommended by ICR). There was not a statistically significant difference between the number of years in practice for those who selected splenectomy versus all other treatment options (p = 0.07). Discussion Although both recent guidelines recommended that children with no/mild bleeding may be managed with observation regardless of the platelet count, only 5 (38%) pediatric hematologists-oncologists selected observation in this scenario. The practice guidelines have different recommendations for second-line treatment in adults: the ICR recommends TPO-receptor agonists and rituximab but not splenectomy; the ASH guideline recommends splenectomy but not TPO-receptor agonists or rituximab. For this clinical scenario, 39% of hematologists-oncologists selected splenectomy, 37% selected rituximab and 16% selected TPO-agents. These different choices and recommendations reflect the changing clinical practice. Although not statistically significant, the hematologists-oncologists who had been in practice for >20 years appeared to be more likely to select splenectomy (p=0.07), consistent with greater acceptance of newer treatments by younger hematologists-oncologists. Although these data may not be generalizable, the high survey response rate provides confidence that these data accurately reflect the judgment, if not the actual practice, of Oklahoma hematologists-oncologists. Conclusion These observations provide an estimate of actual current clinical practice for management of patients with ITP. Disclosures: Off Label Use: Rituximab for primary immune thrombocytopenia (ITP). George: Alexion, Inc.: Consultancy; Baxter, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding. Terrell: Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy.
Sara K. Vesely - One of the best experts on this subject based on the ideXlab platform.
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Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general Hematologist-Oncologists
Journal of Thrombosis and Thrombolysis, 2018Co-Authors: Allyson M. Pishko, James N. George, Sara K. Vesely, Mudi Misgav, Adam Cuker, Douglas B. Cines, Deirdra R. TerrellAbstract:While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both hematologists with an international reputation in treatment of ITP (n = 48) and also general hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
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Management of primary immune thrombocytopenia, 2012: a survey of oklahoma hematologists-oncologists.
The American journal of the medical sciences, 2014Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract Background Management options for patients with primary immune thrombocytopenia (ITP) have increased, and treatment of patients with ITP has changed during the past 10 years. Methods To document current practice and to determine how current practice is related to recommendations of 2 recent practice guidelines for ITP, an international Consensus report and an American society of Hematology (ASH) guideline, the authors surveyed practicing hematologistsoncologists in Oklahoma. Surveys were specific for children or adults. Each survey had 3 questions describing patients with a new diagnosis and patients who had not achieved remission with initial treatment. Questions were adapted from the clinical scenarios of the ASH guideline. Results Twelve (92%) Oklahoma pediatric hematologistsoncologists responded; 82 (81%) Oklahoma adult hematologistsoncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8000/μL and minor bleeding, 5 (42%) hematologistsoncologists selected observation without drug treatment (recommended by both guidelines). For an adult with a platelet count of 9000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by the ASH guideline); 30 (37%) selected rituximab and 13 (16%) selected thrombopoietin-receptor agonists (both recommended by the International Consensus report). Hematologists-oncologists who had more years in practice were more likely to select splenectomy ( P = 0.047). Conclusions In a time of changing management for patients with ITP, these data document reported current management in Oklahoma and provide a basis for serial comparisons across time and for comparisons with other regions and comparison of management with patient outcomes.
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Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists
Blood, 2012Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract 1094 Introduction With the availability of multiple new agents, management of patients with primary immune thrombocytopenia (ITP) has changed substantially since the initial practice guideline for ITP was developed by the American Society of Hematology (ASH). To document current practice and to determine how current practice is related to recommendations of 2 recent guidelines for ITP, an International Consensus report (ICR), 2010, and an updated ASH guideline, 2011, we surveyed practicing hematologists-oncologists in Oklahoma. Methods Separate surveys were developed for children and adults. Each survey had 3 clinical scenarios; each scenario had 5–7 management choices. Hematologists-oncologists were instructed to select 1 management choice. Questions were adapted from the clinical scenarios of the ASH guideline. Additionally, data were collected for [1] number of years in practice; [2] site of practice, (either University of Oklahoma Medical Center or community); and [3] the estimated number of patients with ITP seen each year. Oklahoma hematologists-oncologists were identified by searching the Oklahoma Board of Medical Licensure and the Oklahoma Osteopathic Association websites for all active physicians certified in adult/pediatric hematology/oncology as of 12/31/2011. Exclusion criteria were: physicians whose careers were devoted to full-time research/administration. Data was collected between 1/31/2012–3/15/2012. Only the stronger grades of recommendations by the ICR and ASH guidelines were used for comparison to the hematologists-oncologists9 responses. Comparison of treatment responses to the number of years in practice was selected a priori , because it was hypothesized that hematologists-oncologists with fewer years in practice may more readily accept newer treatments while hematologists-oncologists with more years in practice may prefer more traditional management. Chi-square or Fisher9s exact test were used to determine if treatment responses differed by number of years in practice. SAS version 9.2 was used; alpha was set at 0.05. Results All 13 (100%) Oklahoma pediatric hematologists-oncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8,000/μL, and minor bleeding, 5 (38%) pediatric hematologists-oncologists selected observation without drug treatment (recommended by both guidelines). Because of the small number of pediatric hematologists-oncologists, no comparison of their responses to years in practice was performed. Eighty-three (82%) adult hematologists-oncologists responded. For an adult with a platelet count of 9,000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by ASH guideline); 31 (37%) selected rituximab and 13 (16%) selected thrombopoietin (TPO)-receptor agonists (both recommended by ICR). There was not a statistically significant difference between the number of years in practice for those who selected splenectomy versus all other treatment options (p = 0.07). Discussion Although both recent guidelines recommended that children with no/mild bleeding may be managed with observation regardless of the platelet count, only 5 (38%) pediatric hematologists-oncologists selected observation in this scenario. The practice guidelines have different recommendations for second-line treatment in adults: the ICR recommends TPO-receptor agonists and rituximab but not splenectomy; the ASH guideline recommends splenectomy but not TPO-receptor agonists or rituximab. For this clinical scenario, 39% of hematologists-oncologists selected splenectomy, 37% selected rituximab and 16% selected TPO-agents. These different choices and recommendations reflect the changing clinical practice. Although not statistically significant, the hematologists-oncologists who had been in practice for >20 years appeared to be more likely to select splenectomy (p=0.07), consistent with greater acceptance of newer treatments by younger hematologists-oncologists. Although these data may not be generalizable, the high survey response rate provides confidence that these data accurately reflect the judgment, if not the actual practice, of Oklahoma hematologists-oncologists. Conclusion These observations provide an estimate of actual current clinical practice for management of patients with ITP. Disclosures: Off Label Use: Rituximab for primary immune thrombocytopenia (ITP). George: Alexion, Inc.: Consultancy; Baxter, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding. Terrell: Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy.
Lauren Willis - One of the best experts on this subject based on the ideXlab platform.
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Rare Lymphoma Cases: Online Education Significantly Improves Hematologist/Oncologist Ability to Personalize Treatment
Blood, 2020Co-Authors: Lauren Willis, Tristin Abair, Sara R. FagerlieAbstract:Background: Mantle cell lymphoma (MCL) and marginal zone lymphoma (MZL) are rare types of non-Hodgkin lymphoma (NHL). While MZL is generally indolent, MCL often has a more aggressive clinical course and many patients progress after initial treatment. This study was conducted to determine if an online, case-based continuing medical education (CME) intervention could improve skills of hematologists/oncologists (hem/oncs) to personalize treatment for patients with relapsed/refractory (R/R) MCL or R/R MZL. Methods: The format was an online CME-certified text-based activity composed of 2 patient cases with interactive questions on the diagnosis and treatment of rare types of NHL. Evidence-based educational feedback was provided following each response. Three case-based questions were repeated immediately after activity participation and learners had to select treatment for patients based on prior treatment history, imaging results, and lab values. Question 1, 2, and 3 tested hem/oncs ability to select treatment for a patient with R/R MZL, R/R MCL, and R/R MCL, respectively. Additionally, 1 self-efficacy question was also repeated immediately after activity participation. These questions assessed the impact of the education in the form of a repeated pairs pre-assessment/post-assessment study design in which each participant served as his/her own control. Using data from the assessment completers, percentages of correct responses to pre- and post-assessment questions were compared. A chi-square test was used to assess statistical significance of the educational impact, where P < .05 was considered statistically significant. Cramer's V was used to estimate the magnitude of change in the total number of correct responses between the compared test scores, where V >0.26 indicates an extensive educational impact. The activity launched online on January 9, 2020 and data reported were collected through July 9, 2020. Results: At the time of data collection 203 hem/oncs had completed the activity. Of these 104 (57%) were community-based practitioners. Education had an extensive impact (V =.424) and significantly improved hem/oncs competence to select personalized treatment for patients with these rare types of NHL (Figure 1). Table 1 shows the case summary, questions, and answer choices. Conclusions: This online, interactive, case-based CME-certified educational activity led to statistically significant improvements in the clinical competence of hematologists/oncologists regarding personalizing treatment selection for patients with R/R mantle cell or marginal zone lymphoma. The results indicate that unique educational methodologies and platforms, which are available on-demand, can be effective tools for advancing clinical decision making. Additional studies are needed to assess whether improved aptitude translates to improved performance during clinical practice. Acknowledgements: This CME activity was supported by an independent educational grant from Celgene Corporation and Pharmacyclics, Inc. Reference: https://www.medscape.org/viewarticle/923424 Figure 1 Disclosures No relevant conflicts of interest to declare.
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Evaluating Hematologist/Oncologist Knowledge of Current and Emerging Treatments for Myeloproliferative Neoplasms
Blood, 2020Co-Authors: Lauren Willis, Tristin Abair, Davecia Ragoonath CameronAbstract:Background: Myeloproliferative neoplasms (MPNs) are rare malignancies that include myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia. The objective of this study is to assess current clinical practices of hematologist/oncologists (hem/oncs) related to current and emerging therapies for MPNs, in order to identify knowledge, competency, and practice gaps. Methods: A continuing medical education (CME)-certified clinical practice assessment consisting of 25 multiple-choice questions was developed to measure knowledge, skills, attitudes, and competence of hem/oncs regarding current and emerging MPN therapies. The self-assessment was available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained, and responses were de-identified and aggregated for reporting. The activity launched on November 21, 2019 and responses collected through July 12, 2020 were analyzed and reported. Results: A total of 2,035 learners participated in the activity and 218 hem/oncs answered all questions in the assessment. Hem/onc demographics and patient load distributions are reported in Table 1. A majority (77%) of hem/oncs lack confidence treating adverse events of MPN therapies (Table 2). Baseline knowledge and competence of hem/oncs were grouped into themes: Knowledge/Competence with Risk Stratification, Prognostic Scoring, and Symptom Assessment: While 87% and 63%, demonstrated knowledge about variables included on the MPN Symptom Assessment Form Total Symptom Score and the Dynamic International Prognostic Scoring System (DIPSS), respectively, only 50% demonstrated knowledge about variables included in the mutation-enhanced International Prognostic Scoring System (MIPSS70). Additionally, only 27% demonstrated competence risk stratifying a patient with high-risk MF according to DIPSS. Knowledge of Available Therapies: While 62% demonstrated knowledge that the 5-year data from the COMFORT-1 trial found ruxolitinib demonstrated an overall survival benefit in patients with intermediate-2 (INT-2) and high-risk MF, only 57% demonstrated knowledge that in addition to reduction in spleen volume, ruxolitinib improved symptoms of patients with MF in the COMFORT trials. Additionally, only 56% demonstrated knowledge that in the RESPONSE trial ruxolitinib increased hematocrit control in patients with PV. A majority (77%) did not demonstrate knowledge that both ruxolitinib and fedratinib are approved for the first-line treatment of patients with high-risk MF. Knowledge of Emerging Therapies: Momelotinib: 72% did not demonstrate knowledge that in the SIMPLIFY-2 trial momelotinib increased symptom improvement compared to best available therapy (BAT) in patients with MF who were pretreated with ruxolitinib. Pacritinib: 47% did not demonstrate knowledge that in the PERSIST trial pacritinib did not demonstrate improved overall survival compared to BAT. Ropeginterferon: 80% did not demonstrate knowledge of the efficacy outcomes in patients with PV who received ropeginterferon in the PROUD-PV study. Knowledge and Competence Managing Adverse Events (AE): A majority (75%) demonstrated competence treating ruxolitinib-associated thrombocytopenia in a patient with INT-2 MF, however only 35% and 44%, respectively, demonstrated knowledge of the need to address thiamine deficiency before starting a patient on fedratinib (encephalopathy risk) and knowledge that diarrhea was the most common nonhematologic AE seen with ruxolitinib in patients on the COMFORT-II trial. Conclusions: This research identified several knowledge, competence, and confidence deficits for hem/oncs related to current and emerging MPN therapies in the areas of: (1) Risk stratification and use of prognostic scoring tools, (2) Clinical trial safety and efficacy data for currently available and emerging therapies, (3) Personalizing treatment selection for patients with MPNs, (4) Preventing and managing treatment-related AEs. Additional education is needed to address these gaps for hem/oncs who care for patients with MPNs, which is expected to translate into improved clinical performance and better patient outcomes. Acknowledgements: This CME activity was supported by an independent educational grant from Incyte Corporation. Reference: www.medscape.org/viewarticle/921334 Disclosures No relevant conflicts of interest to declare.
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Medical Simulation in Relapsed Follicular Lymphoma Improves Clinical Decision Making of Hematologists/Oncologists
Blood, 2020Co-Authors: Lauren Willis, Donna Topping, Sarah Atwood, Jonathon B. CohenAbstract:Background: Frontline treatment of follicular lymphoma (FL) yields high response rates, but most patients relapse. In addition, response rates and duration of response have historically declined with subsequent treatments. These factors make management of this disease challenging. Therefore, this study was conducted to determine if an online, simulation-based continuing medical education (CME) intervention could improve clinical decision making of hematologists/oncologists (hem/oncs) regarding treatment selection for relapsed/refractory (R/R) FL. Description of Intervention: A CME certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases of R/R FL presented in a platform that allows hem/oncs to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities, matching the scope and depth of actual practice. Case 1: Patient with FL who failed 2 prior lines of therapy (R-CHOP, bendamustine/obinutuzumab), past medical history (PMH) well controlled hypertension and poorly controlled type 2 diabetes, presenting with constitutional symptoms and needs 3rd line treatment. Case 2: Patient with FL who failed 2 prior lines of therapy (bendamustine/rituximab, lenalidomide/rituximab), PMH well controlled atrial fibrillation and ulcerative colitis, patient requests intravenous therapy because he has trouble remembering to take oral medications. Methods: Clinical decisions were analyzed using a sophisticated decision engine, and tailored clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Decisions were collected post-CG and compared with each user's baseline (pre-CG) decisions using McNemar's test to determine p-values (P < .05 indicates significance). Data were collected between 11/20/19 and 2/19/20. Results: At the time of assessment, 154 hem/oncs who made clinical decisions were included in the analysis. From pre- to post-CG in the VPS, hem/oncs were more likely to make evidence-based practice decisions in: -Diagnosing patients with relapsed FL: 55% pre-CG and 73% post-CG (P < 0.001) -Starting an appropriate treatment for a patient with R/R FL ----Case 1: Ordering idelalisib: 7% pre-CG and 33% post-CG (P < 0.001) ----Case 1: Ordering lenalidomide + rituximab: 6% pre-CG and 28% post-CG (P < 0.001) ----Case 1: Ordering duvelisib: 2% pre-CG and 9% post-CG (P < 0.001) ----Case 2: Ordering copanlisib: 32% pre-CG and 73% post-CG (P < 0.001) The top rationales for selecting an appropriate treatment option were: recommended by guidelines, convenience of administration route, better efficacy compared to other agents, and best option based on patient comorbidities. Other relevant concomitant therapies ordered were consult for chimeric antigen receptor (CAR) T-cell therapy, consult for stem cell transplant, radiation therapy, refer to a clinical trial, and Pneumocystis jirovecii pneumonia (PJP) prophylaxis (Figure 1). Conclusion: This study demonstrates that VPS that immerses and engages hem/oncs in an authentic and practical learning experience improved evidence-based clinical decisions related to the management of R/R FL. This VPS increased the percentage of heme/oncs who correctly diagnosed R/R FL and selected an appropriate treatment option. This study indicates that unique educational methodologies and platforms, which are available on-demand, can be effective tools for promoting guideline-based therapy selection and clinical decision making. Acknowledgement: This CME activity was supported by an independent educational grant from Bayer, Celgene Corporation, and Verastem Oncology. Jake Cohen contributed to data analysis for this research. Reference: https://www.medscape.org/viewarticle/915986 Figure Disclosures Cohen: Janssen, Adicet, Astra Zeneca, Genentech, Aptitude Health, Cellectar, Kite/Gilead, Loxo: Consultancy; Genentech, BMS, Novartis, LAM, BioInvent, LRF, ASH, Astra Zeneca, Seattle Genetics: Research Funding.
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Targeting B-cell malignancies: Impact of an educational curriculum on BTK inhibitors.
Journal of Clinical Oncology, 2019Co-Authors: Lauren Willis, Mindy Tanzola, Richard Caracio, Katie S. Lucero, Bijal D. Shah, Jennifer A. Woyach, Richard R. Furman, Michael Wang, Jennifer R. BrownAbstract:10531Background: We sought to determine if a curriculum of online continuing medical education (CME) activities could improve hematologists/oncologists (hem/onc) knowledge and competence related to...