Current opinion in hematology
-
Modern immunotherapies, most notably in the form of anti-CD19 chimeric antigen receptor (CAR) T cells, have produced significant clinical responses in otherwise refractory pre-B-cell acute lymphoblastic leukemia patients. Several groups have simultaneously reported robust response rates in children and adults alike. These early studies indicate an impending shift in paradigm for the treatment of acute lymphoblastic leukemia. Incorporating CD19 CAR T-cell therapy into upfront or salvage regimens has its challenges and opportunities. ⋯ CD19 CAR T-cell therapy is a powerful new tool in the oncologist's arsenal. How it is incorporated into standard practice and how it will shift survival curves are the exciting questions that are waiting to be answered.
-
Curr. Opin. Hematol. · Nov 2015
ReviewMassive transfusion: red blood cell to plasma and platelet unit ratios for resuscitation of massive hemorrhage.
The aim of this short study is to review recently published data bearing on how to resuscitate massive uncontrolled hemorrhage. ⋯ The bulk of currently available data support the use of a 1 : 1 : 1 ratio for the resuscitation of patients with severe injury, shock, and uncontrolled hemorrhage. The application of this formulaic approach to massive blood product-based resuscitation in other clinical situations is less well supported in the literature.
-
Curr. Opin. Hematol. · Sep 2015
ReviewAn update on the management of bleeding disorders during pregnancy.
The morbidity and mortality of postpartum hemorrhage (PPH) in women with an underlying bleeding disorder requires vigilance by the hematologist. ⋯ Women with an underlying bleeding disorder appear to be at a heightened risk for PPH if the respective coagulation factor level is not appropriately replaced to the level that is physiologically achieved in a normal pregnancy. Furthermore, there appears to be underuse of tranexamic acid for prophylaxis of PPH in this population.
-
This review provides a summary of the most recent clinical trials evaluating the hemostatic agents for the treatment of coagulopathy associated with critical bleeding. In particular, antifibrinolytic agents (i.e., aprotinin, tranexamic and ε-aminocaproic acids), desmopressin, recombinant activated factor VII, fibrinogen and prothrombin complex concentrates are evaluated. ⋯ Although preliminary data document a potential therapeutic role for prohemostatic pharmacologic approaches, further evidence arising from randomized controlled trials is needed to assess the safety and efficacy of such agents in the setting of critical bleeding.
-
Curr. Opin. Hematol. · Nov 2014
ReviewProphylactic platelet transfusions: should they be a treatment of the past?
For decades, prophylactic platelet transfusions have been a standard practice for treatment-related thrombocytopenia in patients with hematologic malignancies, although evidence supporting this practice was limited. Two recent randomized controlled studies were carried out to challenge this practice by comparing prophylactic to therapeutic-only platelet transfusion strategies. This review compares and contrasts the study findings to provide further insight into the study conclusions and their application to practice. ⋯ The majority of this adult patient population should continue to receive prophylactic platelet transfusions to prevent high-grade bleeding. Stable autologous stem cell transplant patients appear to be at a lower risk of thrombocytopenia-related bleeding and are candidates for therapeutic-only platelet transfusions in expert centers with careful monitoring.