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21 Feb 2021
The efficacy and safety of the two-bag (TB) system are comparable to those of the one-bag (OB) system in adults with diabetic ketoacidosis (DKA), results of a study have shown. Both approaches can be considered in adult DKA patients.
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
05 Feb 2021

Primary immunodeficiency disease (PIDD) and allergies are two groups of conditions related to the immune system. However, they are uniquely different in terms of symptoms and treatment.

High morbidity and mortality among COVID-19 patients with haematologic malignancies

Natalia Reoutova
26 Jan 2021

Patients with coronavirus disease 2019 (COVID-19) who have haematologic malignancies have a 28 percent mortality rate, according to data collected from 250 patients by the ASH Research Collaborative COVID-19 presented at the 62nd American Society of Hematology Annual Meeting and Exposition (ASH 2020).

“Early in the COVID-19 pandemic, reports emerged that patients with active or resolved cancers may be at particularly high risk of adverse outcomes from COVID-19. This was especially concerning to patients with haematologic malignancies as many of them have an underlying immune dysfunction and are uniquely vulnerable to viral and other infections. Additionally, blood cancer treatments, including cytotoxic agents, immunomodulators, haematopoietic stem cell transplantation, and chimeric antigen receptor T-cell therapy, are profoundly immunosuppressive,” wrote the study authors. [Lancet Oncol 2020;21:e181; Infect Dis Clin North Am 2019;33:523-544]

The ASH Research Collaborative COVID-19 Registry for Hematology opened for data collection on 1 April 2020, and data reported at ASH 2020 were collected through 8 July 2020. Data from 250 patients with blood cancers from 74 sites around the world (including 35 patients from Asia) had been entered into the registry. The most common malignancies were acute leukaemia (33 percent), non-Hodgkin lymphoma (27 percent), and myeloma or amyloidosis (16 percent). Physician-estimated prognosis for survival before COVID-19 diagnosis was >12 months for 62 percent of patients. [Wood W, et al, ASH 2020, abstract 215; Blood Adv 2020;4:5966-5975]

At COVID-19 diagnosis, 78 percent of patients were >40 years of age, and 36 percent were aged >70 years. “Older age was associated with moderate or severe disease [p<0.001], a decision to forgo ICU care in favour of a palliative approach [p<0.001], and mortality [p=0.01],” noted the researchers. The mortality rate was 11–13 percent in patients <40 years of age, 27 percent in those 40–70 years of age, and 39 percent in those aged >70 years.

Among patients with moderate (n=96; 38 percent) or severe (n=72; 29 percent) COVID-19, mortality rate was 42 percent. Of those with at least moderately severe COVID-19 for whom ICU admission was forgone in favour of palliative care (n=37), 33 died (89 percent). “Of those with at least moderate-severity infection who did not forgo ICU admission [n=131], 35 died [27 percent; p<0.001 for those who did vs did not forgo ICU admission],” noted the researchers. “Male sex was associated with more frequent preference for a palliative approach [p=0.03] and mortality [p=0.008].”

“Patients with haematologic malignancies and COVID-19 presented with a myriad of symptoms, the most common being fever [73 percent], cough [67 percent], dyspnoea [50 percent], and fatigue [40 percent]. A high index of suspicion for COVID-19 is needed during periods of high disease prevalence in the overall population,” suggested the researchers.

The most common COVID-19–specific therapies for patients with at least moderate-severity disease were hydroxychloroquine and azithromycin, used in 76 (64 percent) and 59 (50 percent) patients, respectively. “Although we do not know which of these treatments were offered as part of a clinical trial, it is reasonable to assume that this percentage was low, given the historically low rates of enrollment of cancer patients onto clinical trials before the COVID-19 pandemic. Off-label use of COVID-19–directed therapies in patients with haematologic malignancies could be potentially problematic due to unexpected toxicities of these agents, potential drug-drug interactions in cancer patients, and emerging data suggesting ineffectiveness or potential harm from these treatment approaches in COVID-19 and cancer,” warned the authors. [Cancer 2018;124:4601-4609; Cancer Chemother Pharmacol 2005;56:286-290; Cancer Discov 2020, doi: 10.1158/2159-8290.CD-20-0941]

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Most Read Articles
21 Feb 2021
The efficacy and safety of the two-bag (TB) system are comparable to those of the one-bag (OB) system in adults with diabetic ketoacidosis (DKA), results of a study have shown. Both approaches can be considered in adult DKA patients.
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
05 Feb 2021

Primary immunodeficiency disease (PIDD) and allergies are two groups of conditions related to the immune system. However, they are uniquely different in terms of symptoms and treatment.