Targeting patient blood management's first pillar: A multicentric retrospective study on preoperative anemia

ABSTRACT Introduction: Anemia is a common issue in surgical patients and has been associated with worse clinical outcomes, such as a higher probability of transfusions and longer hospital stay. Therefore, Patient Blood Management programs are actively aiming to achieve early identification and treatment of anemia, previous to the surgery. Methods and materials: In this study, preoperative hemoglobin within the Blood Order Schedule (BOS) at 16 blood centers in several Brazilian regions were retrospectively evaluated. Data regarding hemoglobin, age, gender and Brazilian regions were further analyzed. Results: From the 20,201 BOSs evaluated, the mean age was 55.65 ± 23.52 years old, with an overall prevalence of preoperative anemia of 60.9%. Women had a lower mean preoperative hemoglobin (11.74 ± 2.84 for women and 12.27 ± 3.06 for men) and higher prevalence of anemia than men (66% of females and 52.2% of males). The individuals over 65 years old and under 18 were the most affected by preoperative anemia. All regions had a high prevalence of preoperative anemia, without any direct association with the Human Development Index. Conclusion: In summary, upon evaluating the BOS, our study showed a high prevalence of preoperative anemia in all Brazilian regions, regardless of the gender and age group, but that women and individuals less than 18 or over 65 years old have an even higher prevalence of preoperative anemia. This information can identify the institutions in which preoperative anemia is a critical issue and in which new strategies, such as preoperative screening clinics, might be helpful.

Development and implementation of a COVID-19 convalescent plasma program in a middle-income economy

Abstract Introduction Convalescent Plasma therapy is one of the therapeutic strategies that has been used for patients with the Covid-19 disease. Implementing a program with national extension to supply hospitals with this blood component is a great challenge mainly in a middle-income economy. Objectives Our objective was to develop and implement a Covid-19 Convalescent Plasma Program which met established quality standards and was adapted to a reality of limited resources. Methods A multicentric convalescent plasma collection program was developed and implemented, based on four main sequential procedures: selective donor recruitment, pre-donation antibody screening (Anti-SARS-CoV-2- Chemiluminescence IgG Abbott), convalescent plasma collection by apheresis or whole-blood processing and distribution to the hospitals according to local demand. Results From the 572 candidates submitted to the pre-donation antibody screening, only 270 (47%) were considered eligible for plasma donation according to the established criteria. Higher levels of total antibody were associated with the donor age being above 45 years old (p= 0.002), hospital admission (p= 0.018), and a shorter interval between the diagnosis of the SARS-CoV-2 infection and plasma donation (p < 0.001). There was no association between the ABO and Rh blood groups and their antibody levels. Of the 468 donations made, 61% were from the collection of whole-blood and 39%, from apheresis. The Covid-19 Convalescent Plasma units obtained were distributed to 21 different cities throughout the country by air or ground transportation. Conclusion The implementation of a Covid-19 Convalescent Plasma program in a continental country with relatively scarce resources is feasible with alternative strategies to promote lower cost procedures, while complying with local regulations and meeting quality standards.

Evaluation of miR-15a, miR-16-1, ZAP-70, Ang-2, and Bcl-2 as potential prognostic biomarkers in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a blood cancer characterized by the accumulation of clonal B-lymphocytes. This study evaluated the mRNA gene expression of miR-15a, miR-16- 1, ZAP-70, and Ang-2 by qPCR, as well as the plasma levels of Bcl-2 by Elisa immunoassay, in CLL patients and healthy controls. Significant differences were observed when comparing patients and controls regarding miR-15a (p < 0.001), miR-16-1 (p < 0.001) mRNA, Ang-2 gene expression, and Bcl-2 plasma levels (p < 0.001). When stratified by risk, differences were maintained with a significantly reduced expression in high-risk patients. A positive correlation was observed between miR-15a and platelets (R2 = 0.340; p = 0.009) as well as between Bcl-2 and leukocytes (R2 = 0.310; p = 0.019). Conversely, negative correlations were observed between ZAP-70 and platelets (R2 = - 0.334; p = 0.011), between miR-15a and lymphocytes (R2 = - 0.376; p = 0.004), as well as between miR-16-and lymphocytes (R2 = - 0.515; p = 0.00004). The data suggest that a reduction in miR-15a and miR-16-1 expressions, in addition to an overexpression of Bcl-2, are associated with the reduction in apoptosis and, consequently, to a longer survival of lymphocytes, thus contributing to lymphocyte accumulation and aggravation of the disease. By contrast, Ang-2 expression was significantly higher in A than in B + C Binet groups. This context leads to the speculation that this biomarker should be investigated in more robust studies within populations with a still relevantly indolent form of the disease in an attempt to identify those patients with a greater potential for an aggravation of the disease

Managing patients with multiple myeloma during the COVID-19 pandemic: recommendations from an expert panel - ABHH monoclonal gammopathies committe

ABSTRACT Since the World has been facing the COVID-19 pandemic, special attention has been taken concerning cancer patients; related to their immunosuppression status, adding risk for more aggressive COVID-19 and mortality, but also concerns about the access and the quality of care in cancer therapy. The COVID-19 pandemic impacts the number of infected, its related mortality, as well as the care of cancer patients. Multiple myeloma patients are a particular group with several important aspects to be considered during pandemic times. In essence, they are immunosuppressed in different intensities during their treatment. Most of them are elderly and all of them require long-term therapy, with prolonged contact with the health care system, possibly including a stem cell transplant during the treatment. A panel of experts in multiple myeloma and infectious diseases discusses pieces of evidence and the lack of the same in the scenario of COVID-19 in myeloma patients, while also exposing what is expected for the next phases of the COVID-19 pandemic.

How to manage lymphoid malignancies during novel 2019 coronavirus (CoVid-19) outbreak: a Brazilian task force recommendation

ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.

Custo-efetividade do esquema com daratumumabe, bortezomibe e dexametasona em comparação com terapias à base de carfilzomibe, elotuzumabe e ixazomibe para o tratamento de mieloma múltiplo recidivado e refratário na perspectiva de um pagador do sistema de saúde suplementar brasileiro / Cost-effectiveness analysis of daratumumab, bortezomib, and dexamethasone combination in comparison to carfilzomib, elotuzumab and ixazomib-based therapies for the treatment of patients with relapsed and refractory multiple myeloma from a Brazilian private payer perspective

Objetivo: O objetivo deste estudo é estimar a razão de custo-efetividade incremental da combinação de daratumumabe, bortezomibe e dexametasona (DVd) em comparação com carfilzomibe com dexametasona (Kd); carfilzomibe, lenalidomida e dexametasona (KRd); elotuzumabe, lenalidomida e dexametasona (ERd); e ixazomibe, lenalidomida e dexametasona (IRd) no tratamento do mieloma múltiplo refratário ou recidivado (MMRR) sob a perspectiva de um pagador privado no Brasil. Métodos: Foi utilizado um modelo de transição com três estados, baseado no método de área sob a curva, para simular a trajetória de uma coorte com MMRR: pré-progressão, pós-progressão e morte. Parâmetros clínicos foram obtidos por meio de uma metanálise e os custos incluídos foram aquisição e administração de medicamentos e serviços médicos. O horizonte de tempo adotado foi de 30 anos e descontos de 5% foram aplicados tanto a custos quanto a desfechos de efetividade. Análise de sensibilidade probabilística foi realizada. Resultados: Demonstrou-se que o esquema terapêutico DVd é dominante sobre Kd, KRd, ERd e IRd. DVd gerou 1,09 ano de vida incremental versus Kd com economia de R$ 174.227; 0,15 ano de vida incremental com redução de R$ 238.324 em comparação com KRd; incremento de 0,06 ano de vida com redução de R$ 641.021 comparado com ERd; e 0,59 ano de vida incremental com economia de R$ 254.367 comparado com IRd. A análise de sensibilidade probabilística confirmou a consistência e a robustez do modelo e demonstrou que DVd tem probabilidades de 92,9%, 89,1%, 99,9% e 94,2% de ser custo-efetivo em comparação com Kd, KRd, ERd e IRd, respectivamente, assumindo um limiar de disposição a pagar de 3 PIB per capita. Conclusão: DVd demonstrou ser superior aos comparadores tanto em desfechos clínicos quanto econômicos no tratamento do MMRR, dados a maior sobrevida e os menores custos.

Objective: To estimate the incremental cost-effectiveness ratio of daratumumab, bortezomib, and dexamethasone (DVd) combination in comparison to carfilzomib and dexamethasone (Kd); carfilzomib, lenalidomide and dexamethasone (KRd); elotuzumab, lenalidomide and dexamethasone (ERd); and ixazomib, lenalidomide and dexamethasone (IRd) for the treatment of patients with relapsed and refractory multiple myeloma (RRMM) from a Brazilian private payer perspective. Methods: It was used a three-health state transition model based on the area under the curve method to simulate the cohort trajectory: pre-progression, post-progression, and death. Clinical parameters were obtained in a meta-analysis and considered costs were: drugs acquisition and administration, and medical services. Time-horizon was 30 years, and discount rates applied to costs and outcomes were 5%. A probabilistic sensitivity analysis was performed to evaluate the impact of the uncertainty of the input values. Results: The analysis demonstrated that DVd treatment is dominant over Kd, KRd, ERd, and IRd, providing an increment of 1.09 life year with cost reduction of R$174.227 when compared to Kd, an increment of 0,15 life year with cost reduction of R$238.324 when compared to KRd, an increment of 0,06 life year with cost reduction of R$641.021 when compared to ERd, and an increment of 0,59 life year with cost reduction of R$254.367 when compared to IRd. The probabilistic sensitivity analysis confirms the robustness of the model and results consistency, demonstrating that DVd has 92.9%, 89.1%, 99.9%, and 94,2% probability of being cost-effective versus Kd, KRd, Erd, and IRd, respectively, when an ICER of 3 per-capita GDP is assumed. Conclusion: DVd combination demonstrated superior clinical and economic outcomes in RRMM patients when compared to Kd, KRd, Erd, and IRd, since the therapy provides longer survival to patients at a lower cost to payers.