Queuing up Dr. Kwiatkowski's of @CHOP_Research giving updated results of the #HGB-206 lentiglobin gene therapy for #sicklecelldisease in today's plenary session at #ASPHO2021. Follow this thread for more 1/n
Why are we talking about gene therapy for #sicklecell. It's estimated <15% of patients have a sibling matched stem cell transplant donor! 2/n
Today's talk is going over group C - eligibility included here. Enrollment has been completed. This is for SS and S beta0 and S beta+ genotypes. 3/n
Lentiglobin modified stem cells are infused after busulfan myeloblative conditioning. There will be 13 years of long term follow-up - 32 have completed infusion thus far with 13 month follow-up.
Complete resolution of the VOE's 6 months after post-lentiglobin treatment in these patients. Of note, you can follow HbA^T87Q is the transduced product - its's in Red here. Median hgb ~11 at 6 months 5/n
Markers of hemolysis significantly improved (to near-normal) - retic, LDH, and total bilirubin. 6/n
Safety data is important for our patients - see this slide for more. No insertional mutagenesis. Many adverse events related to treatment with conditioning regimen. 7/n
There is a CLINICAL HOLD on bluebird bio studies with bb1111 (this lentiglobin therapy). See details of this below -- transfusion dependent anemia is the revised diagnosis for the prior reported MDS case possibly related to the lentiglobin therapy. More information is needed! 8/n
And the conclusions -- Thank you Dr. Kwiatkowski for your summary of this result. Stay tuned for Q&A. 9/n
Q&A thoughts: a) Adol had higher Hgb levels (~13) - still need more numbers to figure out why. b) Busulfan is myeloablative so they anticipated it can/will impact fertility and fert. preservation was offered/taken up by all patients. 10/n
c) Allowed stroke pts initially but subsequently did not allow -- but as of now, no cases of stroke. d) Asking whether the two cases that led to the hold was above busulfan-related known rates. Says it's unclear at this point - concerning that we've seen a couple events. 11/n
e) The patient with AML has checked where integration occurred - in the AML blasts there was insertion in VAMP4 gene (but no known association in this gene with cancer per their review) but this doesn't mean that the gene therapy wasn't the problem - must research more. 12/n
Of note, they are checking every 6 months for insertional data collection and monitoring closely.
Okay, that's it folks! Stay tuned and follow me for more from #ASPHO2021. 13/13 (end!)
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Two oral abstracts on the #STELLAR study (Sickle Cell Transplant Evaluation of Long-term and Late Effects Registry) presented by Dr. Sobenna George (hi!) and Dr. Lillian Meacham #ASH22 1/n
What's the problem? You can get DOR = diminished ovarian reserve or POI = primary ovarian insufficiency (early menopause). This is SUCH a good explanation!! #ASH22 2/n
Small numbers but such great data, 30 females and 18 males, about 4-6 years post therapy (myeloablative transplants (mostly matched sib) and one each with gene tx) #ASH22 3/n
They looked at 5022 patients with Rx of DMTs. Those on DMTs were surprisingly mostly in the 18-45 group (the box is wrong on the screenshot) and mostly male and had more VOCs. #ASH22 3/n
Management of pregnant women with #SCD in high income countries with Dr. Eugene Oteng-Ntim (with the cutest intro from Dr. Eugenia Asare). Writing down the #pearls here so I can share with my patients for their future and so I can advocate for them. #ASH22 1/n
As we know, more low/not detectable AMH levels in women with #SCD. Know that preimplantation diagnosis and successful transfer is possible with data to support that. And many want #NIPT secondary to fear of amnio or CVS, which can be done. (w/ @Nonacus) #ASH22 2/n
What risks are we talking about in sickle cell disease and pregnancy? 1/4 of the patients in their cohort required transfusion during pregnancy and RR of preeclampsia is 2.43 and 3x risk of SGA, 4x risk of stillbirth. #ASH22 3/n
Dr. Mark Fleming talking about pathology vs molecular testing in MDS. He first reminds us the difference of childhood MDS from adult MDS -- and these WHO guidelines, childhood MDS is only classified into these two subtypes. #ASH22 1/n
The issue is that the "dysplasia" definition has been defined by the cytogenetic abnormalities and genotypes of adult MDS so the criteria for blast %age, extent of dysplasia -- but does this apply?? #ASH22 2/n
MDS in pediatric patients is more normo or hypocellular than hypercellular. There is not ringed sideroblasts in persons <30 and he also reminds us that there are a number of baseline dysplasias in germline BMF pts that are mistaken for MDS! #ASH22 3/n
#ASH22 Bone marrow failure syndromes: diagnostic principles in 2022. Starting with Sara Lewis, a genetic counselor in hematology. Follow this tweet for more. 1/n
Sara reminds us that she feels patients think more about their family history as they see her draw the pedigree. Time for me to start doing this! #phodocs#ASH22#pearl 2/n
Here are the options for diagnostic workup - genetic tests can be done from somatic genes or germline! #ASH22 3/n
@bhwords Dr. Beverley Hunt presenting on #COVID19 and #thrombosis. She wants to chronologically review the battles we have fought! #ASH22 1/n
@bhwords This story (clinical presentation) -- a reminder of the patients from the front lines in the beginning and what some docs went through! #COVID19#ASH22 2/n
@bhwords#COVID19 is the 'perfect suit for VTE' ... inflammation, sticky blood, vessel wall changes. The amazingly high levels of fibrinogen (14g/L! (normal is 2-4g/L)) D-dimers reported on a log scale because of the significant increase. #ASH22 3/n