Most Read Articles
Rachel Soon, 16 Aug 2019

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.

Abatacept cuts severe graft-vs-host disease after stem cell transplant

Pearl Toh
21 Dec 2017

Adding the immunotherapy abatacept to standard drug regimen used for preventing graft-versus-host disease (GvHD) significantly reduced, and almost eliminated, life-threatening severe acute GvHD in patients undergoing haematopoietic stem cell transplants.

Abatacept is a soluble fusion protein that has been approved by the FDA for renal transplant and rheumatoid arthritis. Abatacept has been shown to block T cell activation that can lead to debilitating joint inflammation in rheumatoid arthritis.

“Preventing GvHD and relapse after transplant requires a difficult balance of eliminating the bad, overactive effector T cells, without suppressing the good, regulatory T cells,” said lead author Dr Leslie Kean of Seattle Children's Ben Towne Center for Childhood Cancer Research in Seattle, Washington, US.  

“Given the serious threat of GvHD … to see such striking results in patients at extremely high risk for GvHD is incredibly encouraging,” she added.

At 100 days after transplant, the cumulative incidence of grade III-IV acute GvHD was significantly lower in abatacept-treated patients who underwent mismatched unrelated donor stem cell transplants vs matched control patients receiving standard regimens of calcineurin inhibitor plus methotrexate only (CNI/MTX; 3 percent vs 32 percent; p=0.007). Similar reduction was also seen when compared with controls receiving CNI/MTX plus anti-thymocyte globulin (+ATG; 3 percent vs 22 percent). [ASH 2017, abstract 212]

Of note, the reduction in severe acute GvHD with abatacept was achieved without significant adverse impact on patient safety, hence improving transplant-related mortality at 12 months (12.5 percent vs 34 percent in CNI+MTX and 27 percent in +ATG; p=0.002 and 0.04, respectively).   

Also, no increase in disease relapse was seen at 12 months in the abatacept arm vs controls (7.5 percent vs 15 percent and 11 percent; p=0.04 and 0.26, respectively).     

According to Kean, analyses on viral reactivation and other infectious outcomes are still ongoing, “but uncontrolled infections were not a major problem.”

As a result, patients receiving abatacept had significant survival advantage over controls, in terms of disease-free survival (81 percent vs 50 percent and 63 percent; p=0.0003 and 0.016, respectively) and overall survival at 1 year post-transplant (85.4 percent vs 57 percent and 68 percent; p=0.0025 and 0.048, respectively). The results are consistent thus-far through 2 years.

The multicentre study comprised two cohorts, one single-arm stratum involving 43 patients who received mismatched unrelated donor transplant, and another double-blind stratum randomizing 140 patients who underwent HLA-matched unrelated donor transplant to receive abatacept in addition to CNI/MTX vs CNI/MTX alone. The current analysis included only data from the single-arm stratum, with matched controls from a national database.

“As a transplant physician, it’s beyond heart-breaking to witness a patient develop severe acute GvHD after having their leukaemia cured through bone marrow transplant,” said Kean. “To have a therapy at our disposal that safely targets just the T cells causing GvHD would represent a major step forward in stem cell transplantation. It not only offers new hope that we can prevent GvHD upfront, but that we can also significantly improve outcomes for patients requiring high-risk transplants.” 

Dr Leslie Kean
Dr Leslie Kean
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Most Read Articles
Rachel Soon, 16 Aug 2019

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

Jackey Suen, 08 Oct 2018

Adding pertuzumab to trastuzumab plus an aromatase inhibitor (AI) improves progression-free survival (PFS) in patients with HER2-positive metastatic or locally advanced breast cancer, the phase II PERTAIN study has shown.

05 Aug 2019
Use of alpha blockers in the treatment of hypertension in women is associated with an increased risk of hypotension and related events as compared with other blood pressure-lowering drugs, as reported in a recent study.
Dr. Bryan Li, Dr. Gerry Kwok, Dr. Thomas Yau, 07 Aug 2019

Case 1: A 59-year-old gentleman with advanced HCC was referred to our centre for management. He had a history of diabetes, hypertension and ischaemic heart disease. He was a nondrinker and not a carrier of hepatitis B or C.

Case 2: A 65-year-old man with a history of alcoholic cirrhosis and oesophageal varices was found to have rising AFP levels on routine follow-up. He also had a 3-year history of diabetes and was on diet control, with an HbA1c of 6.2 percent and fasting glucose of 6.8 mmol/L. He did not need any diabetic medications.