Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
1.
British Journal of Haematology ; 197(SUPPL 1):177, 2022.
Article in English | EMBASE | ID: covidwho-1861248

ABSTRACT

Background and objectives: The Haematology Department in Cork University Hospital (CUH) provides a consult service to other in-house medical and surgical teams, as well as the adjacent affiliated Cork University Maternity Hospital. With the COVID-19 pandemic creating additional pressure for the service, we analysed the consult requests logged from July to December 2021 to identify common consult queries and design a pro forma that could provide guidance on appropriateness before a consult is sought. This will be assessed by the proportion of consult patients who end up attending the Haematology outpatient service before and after the introduction of the pro forma. Methods: Consults received from July 2021 to December 2021 were logged. The main clinical questions were assessed and categorised under one of three divisions which best described the logged query;general/malignant haematology, coagulation and transfusion. Common investigations suggested after the initial consult were also noted. The proportion of consult patients who were given outpatient appointments was calculated. Results: From July 2021 to December 2021, a total of 153 consults were logged. One hundred and eight (70.6%) of these were coagulation consults, 28 (18.3%) were general haematology consults, 14 (9.2%) were malignant haematology consults and 3 (1.9%) were transfusion-related consults. Sixty-four (41.8%) consult patients reviewed were offered an outpatient follow-up. The stated categories will be used as the main themes on the pro forma to assist referring doctors improve clinical care and focus on haematological questions. The back page of this pro forma lists the usual non-haematological causes of possible consults which should be ruled out in advance. Commonly suggested investigations under these different categories are also listed to guide the requesting teams on the most appropriate investigations and reduce the time needed for consultation. Conclusion: This study categorised the most common consults received by the Haematology service in CUH. It provided a basis for designing a pro forma to guide primary teams on the appropriateness of their consults. The use of this pro forma will be evaluated in a future audit to compare the change in the percentage of patients who were given a Haematology outpatient appointment after they were seen as a consult..

2.
Journal of the American College of Cardiology ; 79(9):2375-2375, 2022.
Article in English | Web of Science | ID: covidwho-1848542
3.
Blood ; 138:2756, 2021.
Article in English | EMBASE | ID: covidwho-1582429

ABSTRACT

The anti-CD38 monoclonal antibody Daratumumab has shown impressive activity in combination with other agents for the treatment of multiple myeloma (MM), improving progression free survival and overall survival in several phase 3 studies. We conducted a phase 1b study of intravenous Daratumumab (16 mg/kg) with weekly subcutaneous bortezomib (1.3-1.5 mg/m 2 ), cyclophosphamide (150-300 mg/m 2), and dexamethasone (40 mg) (CyBorD-DARA) as induction before autologous stem cell transplantation (ASCT), followed by CyBorD-DARA consolidation (2 cycles) and monthly DARA +/- bortezomib (in high-risk disease) maintenance for 24 months. We hypothesized that the addition of cyclophosphamide could lead to enhanced antibody dependent cellular phagocytosis (ADCP). This trial was registered at www.clinicaltrials.gov as NCT02955810. We previously reported the initial results of this study. 1. In addition to a favourable safety profile we observed promising anti-MM activity with 10 of 13 patients (77%) in whom assessment was possible achieving measurable residual disease (MRD) negativity at a sensitivity of 10 -5 by next generation sequencing (NGS) after ASCT. We now report the results at EOT, with a focus on MRD. Eligible patients were ≤70 years of age with untreated transplant-eligible MM. 18 patients were enrolled. Median age was 56.5 years (range, 32-66 years), 61% were male and 94% of patients had Eastern Cooperative Oncology Group performance status ≤1. The International Staging System stages were I, II, and III in 78%, 17%, and 6% of patients, respectively. 29% of patients had high-risk genetic features by fluorescent in situ hybridisation (FISH) or gene expression profiling, including 17p deletion in 12% and t(4;14) and t(14;16) in 6% each. On an ITT basis, the rates of very good partial remission or better (≥VGPR) after ASCT, consolidation and at end of treatment (EOT) (after completion of 24 months of DARA) were 94%, 94% and 81% respectively, and rates of complete response or better (≥CR) were 50%, 63% and 63% respectively. Measurable residual disease (MRD) assessment was possible in 13 patients after induction, ASCT and consolidation, and 10 at EOT. Sustained MRD negativity (ie. MRD negativity after ASCT, consolidation and at EOT) to a level of 10 -5 by NGS was achieved in 33% (ITT). Of 13 patients who remained on study at EOT in VGPR or better, 54% were MRD negative (MRD was unavailable in 23%). 7 patients were MRD negative after both ASCT and consolidation. Of these patients, all evaluable at EOT(6/7) remained MRD negative, with 1 patient unable to undergo MRD assessment due to the COVID-19 pandemic, but remaining in CR. Nausea and diarrhoea occurred in 89% of patients, but were mostly grade 1-2 (Grade ≥3 nausea 17%;diarrhoea 6%). Neutropenia occurred in 44% (Grade ≥3 17%), anaemia in 39% (Grade ≥3 22%), and thrombocytopenia in 33% (Grade ≥3 22%). The rate of neutropenic sepsis was 11%. Infusion-related reactions occurred in 50% (Grade ≥3 6%) and peripheral neuropathy occurred in 33% (Grade ≥3 0%) The most commonly reported serious adverse event (SAE) was sepsis in 22%. One patient developed abnormal liver function tests leading to discontinuation from the trial. CyBorD-DARA induction, consolidation and DARA-maintenance is an effective and well-tolerated IMiD free regimen in transplant-eligible patients with MM. MRD negativity at a level of > 10 -5 after ASCT and consolidation may be predictive of sustained MRD negativity at EOT. References: 1. Naicker SD, et al. Cyclophosphamide alters the tumor cell secretome to potentiate the anti-myeloma activity of daratumumab through augmentation of macrophage-mediated antibody dependent cellular phagocytosis. Oncoimmunology. 2021 Jan 25;10(1):1859263. doi: 10.1080/2162402X.2020.1859263. PMID: 33552684;PMCID: PMC7849715. 2. O'Dwyer M, et al. CyBorD-DARA is potent initial induction for MM and enhances ADCP: initial results of the 16-BCNI-001/CTRIAL-IE 16-02 study. Blood Adv. 2019 Jun 25;3(12):1815-1825. doi: 10.1182/bloodadvances.2019000010. PMID: 31201169;PMCI : PMC6595251. Disclosures: O'Dwyer: ONK Therapeutics: Current Employment, Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees;Janssen: Consultancy;Bristol Myers Squibb: Research Funding. Quinn: Takeda: Honoraria. Szegezdi: ONK Therapeutics: Research Funding.

5.
Neurology ; 96(15 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1407876

ABSTRACT

Objective: The objective of this study was to evaluate mortality patterns among patients with history of stroke/TIA who were enrolled in a retrospective study of patients hospitalized with COVID-19 at eight different hospitals in the city of Louisville, Kentucky. Background: The global coronavirus disease (COVID-19) pandemic has been associated with increased Mortality. It is essential to identify comorbidities associated with this increased risk. Design/Methods: Records from the Louisville COVID-19 Study database met inclusion if they were hospitalized between the dates March 15 to June 20, 2020. Groups with and without past history of stroke were compared for significant events in the clinical course (e.g., Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, acute stroke, cardiac arrest and mortality) using chi-square test. The mortality between these groups were compared stratified by age groups 86 yrs. Results: 692 COVID-19 positive patients were admitted during this period, 93 (13%) had a past history of stroke. The mortality among patients with past history of stroke, 26 (28%) was higher than patients without past history of stroke, 85 (14%);p=0.001. Clinic Patients 35 years of age had mean mortality of 25%. Among middle aged patients (36-65 years group), the mortality was six times higher (30%) when there was a past history of stroke compared to no past history of stroke (5%). The mortality among older patients (>66 years) was similar With in these groups (~20%).Other significant clinical outcomes like Pulmonary embolism, cardiac arrest were not significantly elevated with past history of stroke. Conclusions: In this cohort of COVID-19 patients in our registry, a history of past stroke confers a high risk of mortality, which is especially high among middle aged patients. These results beckon further analyses to identify underlying pathophysiological mechanisms and biomarkers related to such age-specific mortality.

6.
Critical Care Medicine ; 49(1):97-97, 2021.
Article in English | Web of Science | ID: covidwho-1326437
7.
Critical Care Medicine ; 49(1 SUPPL 1):97, 2021.
Article in English | EMBASE | ID: covidwho-1193910

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a multisystem disease. It can affect the central and peripheral nervous systems. Neurological manifestations at the time of disease presentation may have severe outcomes of COVID-19. The objective of our study is to evaluate the outcomes of hospitalized COVID-19 patients admitted in the intensive care unit who presented with neurological symptoms. METHODS: This is a multi-center, retrospective, and observational study of hospitalized COVID-19 patients in the city of Louisville, Kentucky, and southern Indiana region from March 10, 2020 to June 20, 2020. Patients were included in this analysis if they were: tested positive for COVID-19 by reverse transcriptase-polymerase chain reaction and admitted to the intensive care unit (ICU) in one of the nine hospitals in Louisville, Kentucky. Patients were considered to have a neurological symptom if one of the following clinical features was present during admission: 1) headache 2) dizziness 3) confusion 4) anosmia 5) ageusia and 6) altered mental status. Baseline characteristics and outcomes were compared using t-tests of means for continuous data, and t-test of proportions for categorical data. P-values < 0.05 was considered statistically significant. RESULTS: Out of 700 hospitalized COVID-19 patients in the study, 231 were admitted to ICU. Among 231 ICU patients, 92 (39.82%) patients had neurological symptoms at the presentation. Among the patients admitted to ICU, those who presented with neurological symptoms have higher mortality than those who had no neurological symptoms at presentation (50% vs 30%, p=0.003). In addition, ICU patients who presented with neurological symptoms had a higher rate of cardiac arrest (16% vs 2%, p<0.001) and cerebrovascular accident (7% vs 1%, p=0.034) during hospitalization in comparison to ICU patient without neurological symptoms at presentation. CONCLUSIONS: Our study demonstrated that among the patients admitted in ICU, patients who presented with neurological symptoms have higher mortality than those without neurological symptoms. In addition, ICU patients have a higher rate of cardiac arrest and cerebrovascular accidents if they presented with neurological symptoms.

SELECTION OF CITATIONS
SEARCH DETAIL