Physicians’ Perceptions of Clinical Utility of a Digital Health Tool for Electronic Patient-Reported Outcome Monitoring in Real-Life Hematology Practice. Evidence From the GIMEMA-ALLIANCE Platform

Digital health tools are increasingly being used in cancer care and may include electronic patient-reported outcome (ePRO) monitoring systems. We examined physicians’ perceptions of usability and clinical utility of a digital health tool (GIMEMA-ALLIANCE platform) for ePRO monitoring in the real-life practice of patients with hematologic malignancies. This tool allows for the collection and assessment of ePROs with real-time graphical presentation of results to medical staff. Based on a predefined algorithm, automated alerts are sent to medical staff. Participating hematologists completed an online survey on their experience with the platform. Of the 201 patients invited to participate between December 2020 and June 2021 (cut-off date for current analysis), 180 (90%) agreed to enter the platform and had a median age of 57 years. Twenty-three hematologists with a median age of 42 years and an average of 17 years of experience in clinical practice were surveyed. All hematologists agreed or strongly agreed that the platform was easy to use, and 87%, agreed or strongly agreed that ePROs data were useful to enhance communication with their patients. The majority of physicians (78%) accessed the platform at least once per month to consult the symptom and health status profile of their patients. The frequency of access was independent of physician sex (p=0.393) and years of experience in clinical practice (p=0.404). In conclusion, our preliminary results support the clinical utility, from the perspective of the treating hematologist, of integrating ePROs into the routine cancer care of patients with hematologic malignancies

Determinants of frontline tyrosine kinase inhibitor choice for patients with chronic-phase chronic myeloid leukemia: A study from the Registro Italiano LMC and Campus CML

BackgroundImatinib, dasatinib, and nilotinib are tyrosine kinase inhibitors (TKIs) approved in Italy for frontline treatment of chronic-phase chronic myeloid leukemia (CP-CML). The choice of TKI is based on a combined evaluation of the patient's and the disease characteristics. The aim of this study was to analyze the use of frontline TKI therapy in an unselected cohort of Italian patients with CP-CML to correlate the choice with the patient's features. MethodsA total of 1967 patients with CP-CML diagnosed between 2012 and 2019 at 36 centers throughout Italy were retrospectively evaluated; 1089 patients (55.4%) received imatinib and 878 patients (44.6%) received a second-generation (2G) TKI. ResultsSecond-generation TKIs were chosen for most patients aged <45 years (69.2%), whereas imatinib was used in 76.7% of patients aged >65 years (p < .001). There was a predominant use of imatinib in intermediate/high European long-term survival risk patients (60.0%/66.0% vs. 49.7% in low-risk patients) and a limited use of 2G-TKIs in patients with comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, previous neoplasms, ischemic heart disease, or stroke and in those with >3 concomitant drugs. We observed a greater use of imatinib (61.1%) in patients diagnosed in 2018-2019 compared to 2012-2017 (53.2%; p = .002). In multivariable analysis, factors correlated with imatinib use were age > 65 years, spleen size, the presence of comorbidities, and & GE;3 concomitant medications. ConclusionsThis observational study of almost 2000 cases of CML shows that imatinib is the frontline drug of choice in 55% of Italian patients with CP-CML, with 2G-TKIs prevalently used in younger patients and in those with no concomitant clinical conditions. Introduction of the generic formulation in 2018 seems to have fostered imatinib use

Effects of fibre orientation on the behaviour of RC beams in vibrated and self-compacting concrete

Structural design of fibre-reinforced members should take into consideration fibre orientation since the residual properties of the material can be different as a function of the cracking plane position and inclination. Designers must be aware of the possible negative influence of fibre orientation and they may take advantages from its positive effect. Some international standards (i.e., fib Model Code 2010 and German standard DafStb) define a factor that should take into account the orientation effects. In this context, the present paper presents the results of an experimental program aimed at evaluating steel fibre orientation in RC beams. Three beams (0.15 m x 0.70 m x 4.10 m) were cast at Magnetti Building (Carvico, Italy) factory following the most common casting process adopted in practice by using vibrated and self-compacting concrete

Influence of fibre orientation on the structural response of FRC slabs

The structural design of elements reinforced by fibres requires to take into consideration fibre orientation, since the material residu-al properties can vary as a function of element zone and cracking plane inclination. Therefore, designers have to consider the influ-ence of fibre orientation, both for its negative and positive effects. In this context, the present paper presents the results of an ex-perimental program aimed at evaluating fibre distribution and orientation in FRC slabs, as well as design implications at both mate-rial and structural level. Four elevated slabs (2.50 m x 2.50 m x 0.15m) were casted at Magnetti Building factory following the most common casting process adopted in practice (in order to be as close as possible to real situations). Two slabs were cut either orthog-onal or parallel to casting direction in order to obtain small beams 15x15x55 cm, while the remaining two slabs were first subjected to flexural tests and then numerically studied. Both vibrated and self-compacting concrete reinforced by 50 kg/m3 of steel fibres were studied

Prevalence of allo-immunization anti-HLA and anti-integrin alpha IIb beta 3 in Glanzmann thromboasthenia patients

Platelet transfusions, main therapy of Glanzmann Thromboasthenia (GT), can induce an allo-immunization against human leucocyte antigen and integrin alpha IIb beta 3. We have investigated in our GT patients the rate of allo-immunization and of refractoriness to platelet transfusions. From 1975 until December 2005, we have followed 17 GT patients: 14 type 1, 3 variant type; nine females, eight males; median age at diagnosis 9.8 years (range 1-44.5); median age at the time of the study 35.5 years (range 23.6-68.5). In our patients, 121 bleeding episodes occurred (24 severe, 37 moderate, and 60 mild). Ten major and 22 minor surgical procedures have been performed. Two spontaneous deliveries and three caesarian sections with five live births were performed; moreover, one late foetal loss occurred, and one voluntary abortion was performed. Sixteen of 17 patients have been transfused at least once in life with platelets and/or red blood cells (RBC). All transfused patients have been investigated for the presence of anti-HLA and anti-integrin alpha IIb beta 3 allo-antibodies. The positiveness of allo-antibodies has been demonstrated in 4/16 transfused patients (25%): isolated for anti-HLA in two; isolated for anti-integrin alpha IIb beta 3 in one; and combined in one. In spite of the presence of allo-antibodies, platelet transfusions have always been effective and the haemostasis was not compromised

Clinical follow-up of 378 patients with autoimmune hemolytic anemia: prognostic impact of hemoglobin levels, autoantibody class, and reticulocytopenia at onset on the relapse risk and outcome

Autoimmune hemolytic anemia (AIHA) is greatly heterogeneous, from mild/compensated to life-threatening, due to autoantibody class/thermal amplitude and bone marrow compensatory response. Here we studied 378 patients (135 M and 243 F, median age 61 yrs, range 19-100), followed-up for 4.3 yrs (range 0.5-27), classified in warm (w)AIHA (DAT positive for IgG and IgG+C), cold agglutinin disease, CAD (C), mixed (IgG+C with high titer cold agglutinins) and atypical (DAT-, IgA+, wIgM). Anemia was categorized in Hb<6, 6-8, 8-10 and >10 g/dl, LDH expressed as fold upper the limit of normality (ULN) and reticulocytes as absolute count and index. The therapy lines were: steroids, rituximab, splenectomy, immunosuppressors, and transfusions/plasma exchange/erythropoietin. Hb was lower in IgG+C wAIHA and atypical cases (p<0.001), LDH higher in IgG+C wAIHA, mixed and atypical forms (p=0.01), and Hb and LDH values were negatively correlated (r=-0.25,p<0.001)[Table1]. Reticulocytes were lowerin CAD, mixed and IgG+C wAIHA (p<0.001) with inadequate reticulocytosis (p=0.01). Moreover, reticulocyte index was lower in cases with Hb<6 g/dL (p<0.001), with inadequate reticulocytosis (87 vs 70%,p=0.01).1st line therapy was administered in all cases but 25 CAD. 2nd line was mostly required in IgG+C wAIHA, mixed, and CAD (p=0.005). Ultra-refractory cases requiring 4 or> lines were mixed, atypical, and CAD. Patients with Hb<8 g/dL frequently required a 2nd line (51 vs 33%, p=0.004; p=0.03), or 3 or > lines (73% vs 26%, p<0.001). The following hazard ratios (HR) emerged from multivariate analysis: 3.2 (95% CI 1.4-7), 2.9 (1.4-6.2), 3.4 (1.6-7.5), for Hb<6, 6-8, and 8-10 g/dL compared to patients with Hb>10. Infections occurred in 14% of cases (mostly mixed AIHA, p=0.02), thrombosis in 10%, and acute renal failure (ARF) in 3% with no relationship with AIHA type/Hb. Evans\u2019 syndrome was frequent in mixed or atypical (p=0.04) and in severe forms (74% with Hb<8 g/dL vs 26%, p=0.005), and associated with higher relapse risk (HR 2.3, 95% CI 1.4-3.9). Seventy patients died, 12 because of AIHA complications. Mortality correlated with infections (HR 5.8),ARF (HR 7.6) and Evans\u2019 syndrome (HR 8.3). In conclusion, we found that anemia severity at onset was the major determinant of relapse risk. The lowest Hb levels were observed in patients with IgG+C WAIHA and atypical cases along with higher LDH levels and inadequate reticulocytosis, advising strict clinical observation in these patients