Medicine (St Vincent's) - Research Publications
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ItemImproving outcomes for patients with lymphoma: design and development of the Australian and New Zealand Lymphoma and Related Diseases Registry(BMC, 2022-10-10)BACKGROUND: Lymphoma is a malignancy of lymphocytes and lymphoid tissues comprising a heterogeneous group of diseases, with up to 80 entities now described. Lymphoma is the 6th most common cancer in Australia, affecting patients of all ages, with rising incidence rates. With the proliferation of efficacious novel agents, therapeutic strategies are increasingly diverse and survival is improving. There is a clear need for contemporary robust and detailed data on diagnostic, investigational and management strategies for this disease in Australia, New Zealand and worldwide, to inform and benchmark local and international standards of care. Clinical quality registries can provide these data, and support development of strategies to address variations in management, including serving as platforms for clinical trials and other research activities. The Lymphoma and Related Diseases Registry (LaRDR) was developed to capture details of patient demographics, disease characteristics, and management throughout their disease course and therapy and to develop outcome benchmarks nationally and internationally for lymphoma. This report describes the aims, development and implementation of the LaRDR, as well as challenges addressed in the process. METHODS: The LaRDR was established in 2016 as a multicentre, collaborative project at sites across Australia with a secure online database which collects prospective data on patients with a new diagnosis of lymphoma or chronic lymphocytic leukaemia (CLL). LaRDR development required multidisciplinary participation including specialist haematology, information technology, and biostatistical support, as well as secure funding. Here we describe the database development, data entry, ethics approval process, registry governance and support for participating sites and the coordinating centre. RESULTS: To date more than 5,300 patients have been enrolled from 28 sites in Australia and New Zealand. Multiple challenges arose during the development, which we describe, along with approaches used to overcome them. Several confirmed international collaborations are now in place, and the registry is providing valuable data for clinicians, researchers, industry and government, including through presentations of results at major national and international conferences. CONCLUSION: Challenges in establishing the LaRDR have been successfully overcome and the registry is now a valuable resource for lymphoma clinicians, researchers, health economists and others in Australia, New Zealand and globally.
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ItemNo Preview AvailableCOVID-19 vaccination in haematology patients: an Australian and New Zealand consensus position statement(WILEY, 2021-05)Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives from the Haematology Society of Australia and New Zealand and infectious diseases specialists have collaborated on this consensus position statement regarding COVID-19 vaccination in patients with haematological disorders. It is our recommendation that patients with haematological malignancies, and some benign haematological disorders, should have expedited access to high-efficacy COVID-19 vaccines, given that these patients are at high risk of morbidity and mortality from COVID-19 infection. Vaccination should not replace other public health measures in these patients, given that the effectiveness of COVID-19 vaccination, specifically in patients with haematological malignancies, is not known. Given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority.
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ItemAustralian and New Zealand consensus statement on the management of lymphoma, chronic lymphocytic leukaemia and myeloma during the COVID-19 pandemic(WILEY, 2020-06)The COVID-19 pandemic poses a unique challenge to the care of patients with haematological malignancies. Viral pneumonia is known to cause disproportionately severe disease in patients with cancer, and patients with lymphoma, myeloma and chronic lymphocytic leukaemia are likely to be at particular risk of severe disease related to COVID-19. This statement has been developed by consensus among authors from Australia and New Zealand. We aim to provide supportive guidance to clinicians making individual patient decisions during the COVID-19 pandemic, in particular during periods that access to healthcare resources may be limited. General recommendations include those to minimise patient exposure to COVID-19, including the use of telehealth, avoidance of non-essential visits and minimisation of time spent by patients in infusion suites and other clinical areas. This statement also provides recommendations where appropriate in assessing indications for therapy, reducing therapy-associated immunosuppression and reducing healthcare utilisation in patients with specific haematological malignancies during the COVID-19 pandemic. Specific decisions regarding therapy of haematological malignancies will need to be individualised, based on disease risk, risks of immunosuppression, rates of community transmission of COVID-19 and available local healthcare resources.
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ItemAddition of low dose acetazolamide as an adjunct in patients undergoing high dose methotrexate is safe and beneficial(WILEY, 2020-03)BACKGROUND: High-dose methotrexate (HDMTx) is utilised in central nervous system lymphoma and acute lymphoblastic leukaemia due to its ability to penetrate the blood-brain barrier. Despite its efficacy, nephrotoxicity is a potentially serious toxicity that could also exacerbate other methotrexate-related toxicities and compromise dose intensity. Acetazolamide (AZL) is a carbonic anhydrase inhibitor that causes an increase in bicarbonate excretion and consequently urine alkalinisation. Following occurrences of HDMTx-induced acute kidney injury (AKI) due to inadequate urine alkalinisation at our institution, routine AZL was administered to appropriate patients from 2010 onwards. AIMS: To analyse the addition of AZL to routine renoprotective measures, given that inadequate urinary alkalinisation is the major risk factor for methotrexate crystal precipitation and prolonged excretion. In addition, since fluid overload is a common consequence of HDMTx treatment, the effect of AZL on fluid balance was also examined. METHODS: This is a retrospective, single-centred cohort study examining the mitigation of HDMTx-induced toxicities by AZL in 92 patients over a 6-year period. RESULTS: AZL showed a strong trend of preventing either AKI (as per CTCAE version 4.03) or delayed methotrexate elimination (>5 days), especially in males. Furthermore, AZL also resulted in reduced weight gain and fewer episodes of urinary pH <7.0. CONCLUSION: AZL appeared to diminish the incidence of HDMTx-induced toxicities, including reducing oedema-related weight gain. With mild, preventable hypokalaemia as the only noteworthy toxicity, AZL could be considered as an adjunct to HDMTx patient care.