ABSTRACT
INTRODUCTION: Myeloid malignancies are a heterogenous group of clonal bone marrow disorders that are complex to manage in the community and therefore often referred to sub-specialists at tertiary oncology referral centers. A large group of patients do not live in close proximity to tertiary referral centers and are unable to commute large distances due to age, co-morbidities and frailty. We describe a cancer care delivery model for patients with myeloid malignancies that is built around tele-health and enables this vulnerable population access to care at an NCI designated cancer center without having to travel long distances. METHODS AND MATERIALS: We report on a cohort of patients with myeloid malignancies who were co-managed by a general community oncologist and an academic leukemia sub-specialist at Montefiore Einstein Cancer Center in New York. Patients were initially referred to our institute for a second opinion by community practices that are in partnership with Montefiore Health System, and initial visits were in-person or via tele-health, treatment plan was made after discussion with patient's local community oncologist. Patients then continued to receive majority of their treatment and supportive care including transfusion support with their local oncologist and follow-up visits were mainly via tele-health with the academic leukemia sub specialist. RESULTS: Our cohort of 12 patients had a median age of 81 years (range, 59-88 years). Patients remained on active treatment for a median time of 357 days (range, 154 - 557 days). Most of our patients had a performance status of ECOG 2 or higher. Three patients had MDS, seven patients had AML and two patients had myelofibrosis. Median number of hospitalizations over the total treatment time period was one. CONCLUSION: We demonstrate a shared academic and community care co-management model for the treatment of myeloid malignancies in elderly frail patients using tele-health as a backbone with a low hospitalization rate.
ABSTRACT
Immune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy caused by antibodies against ADAMTS13. We report a young, healthy female who developed hematuria, vomiting, and hematemesis 3 weeks after her first dose of Pfizer Bio-NTech COVID-19 vaccine. Investigations confirmed iTTP with undetectable ADAMTS13 activity and a positive antibody assay. Despite initial response to standard treatment with plasma exchange and corticosteroids, she had an acute deterioration of her TTP with neurological and cardiac involvement. Fortunately, she then had prompt response to rituximab and emergently obtained caplacizumab and is now in remission. Although most cases of iTTP are of unknown etiology, we cannot exclude that her almost fatal iTTP episode was triggered by the Pfizer-BioNTech COVID-19 vaccine. This case also highlights the ability of caplacizumab to quickly halt disseminated thrombus formation in refractory TTP.