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Improving the care of haematology patients during COVID-19

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Dr Philip Murphy

Head of Haematology Department, Beaumont Hospital and Director of Clinical Trials, Blood Cancer Network Ireland

The pandemic has had a dramatic effect on the lives of people worldwide, but we must adapt and continue the vital work we are doing in the blood health sector.

Patients with blood cancers would be expected to be at increased risk of severe sequelae from COVID-19 infection due to their age profile, their underlying condition and their treatment.

Thus, Irish healthcare professionals have had to take unprecedented steps to protect patients with blood cancers from the effects of infection by COVID-19.

Many patients are being monitored remotely by phone or video consultation to reduce risk of exposure. Decisions about whether to proceed with strongly immunosuppressive therapy or to delay treatment with careful monitoring have been carefully made.

Each individual case is carefully considered, using a multidisciplinary approach, national and international guidelines and taking into account experience from other countries.

Testing for white blood cell abnormalities in COVID-19 patients

The unsung heroes in the fight against COVID-19 are our hospital laboratory staff.

Despite the stressful circumstances, the hospital laboratory staff continue to perform the molecular testing for COVID-19, provide excellent 24-hour laboratory cover, generate rapid blood test results and provide blood products for COVID-19 patients with severe bleeding problems.

We must adapt and continue the vital work we are doing in the blood health sector.

In my laboratory, white blood cell abnormalities distinctive to COVID-19 infection can be detected by microscopy in about 70% of COVID-19 positive patients and may aid in the early detection of this viral infection.

Hope for chemotherapy-resistant patients, despite COVID-19

Myeloma is a cancer of plasma cells in the bone marrow, which usually presents with severe bone and/or kidney disease.

This year, we have seen patients with advanced, chemotherapy-resistant myeloma, enter complete remission using an oral therapy targeting BCL2 protein.

Targeting BCL2 and similar proteins offers great hope for many other patients with blood cancers in the future.

Hodgkin lymphoma is a cancer of lymph nodes with a generally excellent response to combination chemotherapy. However, a minority of patients are resistant.

An ongoing study is researching using a combination of chemotherapy and an antibody-drug conjugate as initial therapy for Hodgkin lymphoma. This study is a BCNI and the European Organisation for Research and Treatment of Cancer (EORTC) collaboration.

There is an antibody-drug conjugate that specifically targets the Hodgkin cancer cell and its combination with chemotherapy promises to improve the prognosis of this lymphoma even further.

Blood conditions must not be overlooked

Haemophilia is a hereditary disorder affecting males, who are at risk of severe bleeding due to low levels of clotting factors.

Traditional treatment includes replacement of the missing clotting factor by intravenous infusion. However, in the recent past, gene therapy offers the hope of long-term cure for such patients.

In a ground-breaking development, three Irish patients with haemophilia B have entered an international clinical trial, which uses a viral vector to deliver gene therapy. The first Irish patient received the gene therapy in March of this year.

Based on earlier studies, it is expected that the effects of a single gene therapy may last for many years or even a lifetime.

Women may overlook symptoms of bleeding disorders

Heavy periods or heavy menstrual bleeding (HMB) affect many women and, in one fifth of cases, may be due to an underlying bleeding disorder. With early diagnosis, HMB may be effectively treated, significantly improving quality of life.

Recognition of bleeding disorders is essential to reduce the risk of future bleeding at operations or childbirth.

A new Health Research Board funded public awareness campaign “Know Your Flow”, which was launched this year, seeking to educate women about heavy periods and their impact as well as signs of an underlying bleeding disorder.

About Blood Cancer Network Ireland (BCNI)

BCNI was established by Professor Michael O’Dwyer of University College Galway as a collaborative national network to promote early clinical trials in blood cancers, provide a national biobank for blood cancers and maintain a register of patients with blood cancers. Its current Clinical Director is Dr Eva Szegezdi.

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