The Outcome of Fatherhood in Patients With Philadelphia-Negative Myeloproliferative Neoplasms: A Single-Institution Experience

Abstract

Background

Fertility is a highly complex subject; it involves more than one individual and has profound psychological and economic implications. Moreover, it is affected by several factors, including age, significant systemic illness in either partner, exposure to environmental toxins, medications, or radiation. In patients with malignancy, fertility is more complicated. Patients with a malignancy might have reduced fertility due to the disease, medication, and radiation. Besides the reduced fertility, there are more concerns regarding the subsequent effect of cancer treatment on their offspring and the possibility of having healthy children. There were many studies regarding fertility in patients with cancer; however, in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), there are very limited data.

Objectives

In this study, we aim to see the outcome of fatherhood in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) whether on treatment or not.

Methods

A retrospective mixed-design study of male patients with Philadelphia-negative MPN was followed up in our institute (National Center for Cancer Care and Research (NCCCR)), Doha, Qatar, between January 1, 2008, and January 1, 2020. Patients were interviewed regarding fertility-related information. All included patients had a confirmed diagnosis of Philadelphia-negative MPN according to World Health Organization (WHO) 2008 or WHO 2016 criteria for MPN, aged more than 18 years old.

Results

A total of 124 male patients were interviewed, and only 20 patients met the inclusion criteria. The majority of the patients were lost to follow-up or could not be contacted, and 28.8% of the excluded patients had their families completed by the time of diagnosis. The treatment received included hydroxycarbamide (n=8), pegylated interferon 2 alpha (n=10), ruxolitinib (n=1), and phlebotomy (n=1). The mean duration of exposure to treatment before pregnancy was 4.7 years. The mode of delivery was normal vaginal delivery in 71.4% of the pregnancies. The total number of offspring was 30, and the total number of conceptions was 30.

Conclusion

Our data showed that most Philadelphia-negative MPN male patients on treatment had their offspring born normally with no serious complications, congenital anomalies, or reports of MPN-related cancers. Patients’ concerns regarding fertility should be addressed well to ensure a better quality of life.

Read more

Introducing PAN’s Newly Expanded Transportation Fund

The PAN Foundation today announced an expansion of its transportation fund, providing up to $500 per year to help eligible patients access affordable and reliable transportation to services and activities that improve their overall health outcomes.

PAN’s transportation program, which first launched in 2020, addresses socioeconomic barriers to medical care and medication adherence. A survey of PAN patients in 2021 showed that after receiving a transportation grant, medication adherence increased by 52 percent and adherence to physician visits increased by 29 percent.

Under the expanded program, patients will be able to use their grants to pay for transportation to access healthcare services, get social support, and even travel to the grocery store.

Expanding the program and covered services will better serve the holistic needs of each patient. Improving access to transportation removes barriers to medical care, reduces social isolation, and decreases risks for food insecurity, particularly for older adults and people living with serious illnesses.

“Since its inception, PAN’s transportation fund has led to better health outcomes for thousands of patients who needed help getting to their medical care,” said PAN President Kevin L. Hagan. “We know this expansion will help even more patients, who will now be able to use funding to better access social support and healthy food. We are grateful for the continued support of our generous donors, who enabled the expansion of this program that will reduce health barriers and improve lives.”

Patients who qualify are eligible to receive $500 per year in financial assistance in the form of a prepaid debit card, which is authorized for eligible expenses.

Eligibility requirements

To get financial assistance for transportation, patients must:

  • Be currently enrolled in a co-pay or premium disease fund at the PAN Foundation and receiving treatment for that disease.
  • Reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)
  • Have health insurance that covers the qualifying medication or product.
  • Have an income that falls at or below 500 percent of the federal poverty level.

How to apply

Patients or caregivers applying on their behalf can apply for assistance using the PAN Foundation’s online patient portal. A series of how-to guides are also available for the patient portal, including common tasks like creating an account and applying for assistance online.

 

Read more…

GSK Reaches Agreement to Acquire Late-Stage Biopharmaceutical Company Sierra Oncology For $1.9bn

04/13/2022
  • Sierra Oncology’s differentiated momelotinib has the potential to address the critical unmet medical needs of myelofibrosis patients with anemia
  • Momelotinib complements GSK’s existing expertise in haematology, with Sierra Oncology anticipating US regulatory submission in Q2 this year and EU submission in the second half of 2022
  • Sales contribution expected to start in 2023 with significant growth potential thereafter
  • Supports development of strong portfolio of new specialty medicines and vaccines

GlaxoSmithKline plc (LSE/NYSE: GSK) and Sierra Oncology, Inc (Nasdaq: SRRA) today announced that the companies have entered into an agreement under which GSK will acquire Sierra Oncology, a California-based, late-stage biopharmaceutical company focused on targeted therapies for the treatment of rare forms of cancer, for $55 per share of common stock in cash representing an approximate total equity value of $1.9 billion (£1.5 billion).

Myelofibrosis is a fatal cancer of the bone marrow impacting the normal production of blood cells. Anaemia represents a high unmet medical need in patients with myelofibrosis. At diagnosis, approximately 40% of patients are already anaemic, and it is estimated that nearly all patients will eventually develop anaemia.1,2 Patients treated with the most commonly used JAK inhibitor will often require transfusions, and more than 30% will discontinue treatment due to anaemia.3 Anaemia and transfusion dependence are strongly correlated with poor prognosis and decreased overall survival.4

Momelotinib has a differentiated mode of action with inhibitory activity along key signalling pathways. This activity may lead to beneficial treatment effects on anaemia and reduce the need for transfusions while also treating symptoms. In January 2022, Sierra Oncology announced positive topline results from the MOMENTUM phase III trial. The study met all its primary and key secondary endpoints, demonstrating that momelotinib achieved a statistically significant and clinically meaningful benefit on symptoms, splenic response, and anaemia.

Luke Miels, Chief Commercial Officer, GSK said: “Sierra Oncology complements our commercial and medical expertise in haematology. Momelotinib offers a differentiated treatment option that could address the significant unmet medical needs of myelofibrosis patients with anaemia, the major reason patients discontinue treatment. With this proposed acquisition, we have the opportunity to potentially bring meaningful new benefits to patients and further strengthen our portfolio of specialty medicines.”

Stephen Dilly, MBBS, PhD, President and Chief Executive Officer, Sierra Oncology said: “Uniting with GSK creates the best opportunity for Sierra Oncology to realise its mission of delivering targeted therapies that treat rare forms of cancer while also delivering compelling and certain value for our stockholders. Now we have a partner with a global infrastructure and oncology expertise that enables us to deliver momelotinib to patients as quickly as possible and on a global scale.”

Momelotinib complements GSK’s Blenrep (belantamab mafodotin), building on GSK’s commercial and medical expertise in haematology. The proposed acquisition aligns with GSK’s strategy of building a strong portfolio of new specialty medicines and vaccines. If the transaction is completed and momelotinib is approved by regulatory authorities, GSK expects momelotinib will contribute to GSK’s growing specialty medicines business, with sales expected to begin in 2023, with significant growth potential and a positive benefit to the Group’s adjusted operating margin in the medium term.

Financial considerations

Under the terms of the agreement, the acquisition will be effected through a one-step merger in which the shares of Sierra Oncology outstanding will be cancelled and converted into the right to receive $55 per share in cash. Subject to customary conditions, including the approval of the merger by at least a majority of the issued and outstanding shares of Sierra Oncology, and the expiration or earlier termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, the transaction is expected to close in the third quarter of 2022 or before.

The per share price represents a premium of approximately 39 per cent to Sierra Oncology’s closing stock price on 12 April 2022 and a premium of approximately 63 per cent to Sierra’s volume-weighted average price (VWAP) over the last 30 trading days. Sierra Oncology’s Board of Directors has unanimously recommended that Sierra’s stockholders vote in favour of the approval of the merger. Additionally, stockholders of Sierra Oncology holding approximately 28 per cent of Sierra’s outstanding shares, have agreed to vote their shares in favour of approval of the merger.

GSK will account for the transaction as a business combination and expects it to be accretive to adjusted EPS in 2024, the expected first full year of momelotinib’s sales. New GSK reaffirms its full-year 2022 guidance, the medium-term outlook for 2021-2026 of more than 5% sales and 10% adjusted operating profit CAGR* at CER**, and long-term sales ambition.

The value of the gross assets of Sierra Oncology to be acquired (as of 31 December 2021) is $109 million (£83 million at the rate of £1 = $1.312, being the 31 March 2022 spot rate). The net losses of the business were $95 million for the 12 months ended 31 December 2021 (£70 million, at the rate of £1 = $1.38, being the average rate for the period).

* CAGR: Compound Annual Growth Rate; **CER: Constant Exchange Rate

Read more

AbbVie Presents Positive Investigational Navitoclax Combination Data in Phase 2 REFINE Study Suggesting Anti-Fibrosis Activity for Patients with Myelofibrosis

–          Navitoclax is being studied in myelofibrosis, a rare, difficult-to-treat blood cancer
–          Results are from an exploratory analysis of 34 myelofibrosis patients who received at least one dose of navitoclax in combination with ruxolitinib after suboptimal response or disease progression with ruxolitinib monotherapy
–          Median overall survival was not reached for patients who had a ≥ 1 grade improvement in bone marrow fibrosis or ≥ 20% variant  allele frequency reduction
–          At the time of analysis with > 2 year follow up the survival estimate was 100% in patients who had improvements in bone marrow fibrosis or variant allele frequency
–          Results were presented at the American Association for Cancer Research annual meeting

NORTH CHICAGO, Ill.April 12, 2022 /PRNewswire/ — AbbVie (NYSE: ABBV) today announced new data from a Phase 2 trial of navitoclax in combination with ruxolitinib in patients with myelofibrosis. The results were presented at the American Association for Cancer Research annual meeting (AACR 2022, abstract #LB108). Navitoclax is an investigational, first-in-class, oral BCL-XL/BCL-2 inhibitor that is designed to activate programmed cell death (apoptosis) in cancer cells. Navitoclax and its safety and efficacy are under evaluation as part of ongoing Phase 2 and registrational Phase 3 studies.

“Myelofibrosis is a cancer that originates in the bone marrow, leading to fibrosis. Currently, available therapies do not address the underlying disease biology and have not shown a consistent effect on both biomarkers of disease modification and overall survival. Disease control with reversal of bone marrow fibrosis is a key objective for improving patient outcomes,” said Mohamed Zaki, M.D., Ph.D., vice president and global head of oncology clinical development at AbbVie. “That’s why we are especially pleased about these early results of navitoclax in combination with ruxolitinib that indicate its novel mechanism of action of inducing cell death may cause reversal of bone marrow fibrosis and extend survival for patients who respond to treatment.”

Myelofibrosis is a rare, difficult-to-treat blood cancer that results in excessive scar tissue formation (fibrosis) in the bone marrow. Anti-fibrosis activity, measured by reversal of bone marrow fibrosis (BMF) and reduction in driver gene variant allele frequency (VAF) have been suggested as potential biomarkers to measure disease modification in myelofibrosis, but their association with a survival benefit have not been widely described.These data build on AbbVie’s history of transforming standards of care in blood cancers with significant unmet needs.

The results presented at AACR 2022 were from REFINE (NCT03222609) – a Phase 2 trial evaluating navitoclax in combination with ruxolitinib (a JAK1/2 inhibitor), which included patients with myelofibrosis who had progressed on or had a suboptimal response to at least 12 weeks of ruxolitinib monotherapy. Median exposure to prior ruxolitinib was 91 weeks (range: 19 weeks – 391 weeks) in the first 34 patients enrolled earlier in the trial.

In the exploratory analysis of 32 patients who were evaluable for improvements in BMF, 12 (38%) had a ≥1 grade improvement during any time point in the study. For driver gene VAF reduction, 26 patients were evaluable and 6 (23%) achieved a ≥20% reduction at week 24. Five patients achieved both BMF and VAF responses.

Median overall survival (OS) for all patients was not reached as presented previously by Harrison2 et al. For patients who had a ≥1 grade improvement BMF median OS was not reached compared with 28.5 months for patients who did not experience an improvement. Similarly, median OS was also not reached for patients who achieved a ≥20% driver gene VAF reduction versus 28.5 months for patients who did not.

All 34 patients (100%) experienced at least one adverse event (AE), and 15 (44%) experienced a serious adverse event (SAE).2 The most common AEs of any grade were thrombocytopenia  (n= 30, 88%), diarrhea (n= 24, 71%), fatigue (n= 21, 62%), and nausea (n= 13, 38%). The most common SAEs were pneumonia (n= 4, 12%) and splenic infarction (n= 2, 6%).2 There were no SAEs of bleeding and thrombocytopenia was manageable and reversible with dose reduction/interruption of navitoclax and/or ruxolitinib.2 REFINE was a dose-finding study and the target dose of navitoclax was reduced subsequent to these findings.

“Data obtained from this exploratory analysis holds promise for potential future clinical research,” said Jacqueline S. Garcia, M.D., Dana-Farber Cancer Institute, assistant professor of medicine at Harvard Medical School. “What is most notable in this analysis is the overall survival among patients who demonstrate VAF and BMF responses and all patients were alive at time of analysis. Patients in this Phase 2 trial had suboptimal response to ruxolitinib at time of study entry and then had navitoclax added to ruxolitinib on the trial. VAF and BMF responses occurred despite the presence of high molecular risk mutations, which suggests the potential efficacy of combination navitoclax and ruxolitinib could be independent of underlying risk factors.”

Read more

Women’s History Month – Jamile Shammo, MD

Dr Jamile Shammo  is a Professor of Medicine and Pathology in the Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, at Rush Medical College.

How did you become interested in hematology versus other areas of medicine?

As a medical student ( a very very long time ago!)  , I was fascinated and intrigued by the complexity and highly specialized role of each component of  what makes our blood. I remember thinking, how can red cells shed their nucleus and continue to function? The more I learned about blood, the more interesting it got! Furthermore, The growing body of science surrounding the field of hematology has grown and continues to do so in an exponential manner which keeps me challenged and I find it very satisfying to my scientific curiosity and interests in general. Finally, I find the concepts in hematology to be more abstract and “less palpable” than in any other field.  It is for all those reasons that I collectively chose hematology as a field of study and practice. I have never looked back!

What have been the highlights in your career, specifically in the area of MPNs?

Being a clinician and a pathologist granted me a much deeper understanding of  MPN’s as a disease entity and helped sharpen my diagnostic skills. I have participated in trials and witnessed the emergence of various effective therapies that I could now offer my patients which is greatly satisfying. I know we need to do more, but seeing the science in that area explode with the discovery of multiple disease-associated mutations, and the plethora of available clinical trials aiming to improve the response rate and duration in this disease, I know that we are coming on better times for our patients. 

As a female in this area of medicine, what advice would you give women grappling with career choices in hematology and medical research?

Know thyself! Identify an area of interest preferably early on in you academic career.  Identify a mentor who can support you through the process of establishing yourself as an investigator. Collaborate with your like-minded peers and never give up!

Women’s History Month – Linda Resar, MD

Dr. Linda Resar, is a Professor of Medicine at Johns Hopkins Medicine, where she studies molecular mechanisms leading to cancer, blood diseases, sickle cell anemia, hemophilia and other coagulopathies.

How did you become interested in hematology versus other areas of medicine?

  I first became interested in hematology during my pediatrics training at Hopkins as our institution serves a large community of children and young adults with sickle cell anemia and many other blood diseases.  I found it rewarding to care for these patients who face many challenges and are in great need of excellent hematologic care.  I fell in love with hematology because blood is essential for every organ in the body to function, and physicians caring for these patients must consider the effects of blood diseases on the entire body, making hematology a challenging but particularly rewarding field.  Moreover, blood diseases such as MPN involve blood stem cells which are fascinating from a scientific perspective since these remarkable stem cells must generate 200 billion red cells each day for many decades.  The opportunity to modulate stem cell function to improve outcomes for our MPN patients is particularly exciting.

What have been the highlights in your career, specifically in the area of MPNs?

My laboratory focuses on a  gene, called HMGA1, which is important regulator for normal stem cell function and becomes abnormally activated in cancer.  We recently discovered that HMGA1 plays a critical role in blood stem cell function in MPN, particularly when patients progress to more advanced disease.  We are currently searching for approaches to modulate HMGA1 in blood stem cells as therapy to treat, or even better, to prevent, progression in MPN.

As a female in this area of medicine, what advice would you give women grappling with career choices in hematology and medical research?

Please do not ever let anyone convince you that you are not suited for medicine, hematology, or research.  Unfortunately, women and others who are under-represented in medicine continue to confront unconscious bias, or even more blatant signals, that they do not belong since the field has been dominated by men.  However, it is clear that diversity in medicine, not only benefits our patients, but also scientific discovery.  Let any hurdles, failed experiments, and critiques serve to further ignite your passion for medicine, hematology, and research and work to foster the careers of other women in medicine, hematology, and MPN.

Women’s History Month – Angela Fleischman, MD, PhD

Dr. Angela Fleischman is an Associate Professor of Medicine in the Division of Hematology/Oncology at the University of California, Irvine. The Fleischman Lab is known nationwide for its research on the role of nutrition in MPN.

How did you become interested in hematology versus other areas of medicine?

 I started as a PhD student before going to medical school. I was very interested in hematopoiesis (blood cell development) and so went to medical school for the purpose of caring for people with blood conditions.

What have been the highlights in your career, specifically in the area of MPNs?

I would say getting to know people with MPN is the most rewarding part of what I do.

As a female in this area of medicine, what advice would you give women grappling with career choices in hematology and medical research?

Identify what is important to you and what you are passionate about, as long as you keep your eye on that everything else is just details.

Adelaide researchers discover potential treatment for myelofibrosis

By Ethan Rix by abc net Australia
Posted 

 

When Bruce Glover was diagnosed with a rare blood cancer, he quickly realised life would not be the same.

“My doctor put her hand on my shoulder and said, ‘I’m your friend for life,’ and I realised at this stage it wasn’t going to be cured,” he said.

The 69-year-old runs his own business on the Gold Coast but has found it harder to stay on top of his game since being diagnosed with myelofibrosis in 2018.

“I used to be like the Energiser battery — I could outrun anyone in business, work and so forth,” he said.

“I can’t do the things I used to do, which gets extremely frustrating.”

But a recent stroke of luck for a team of Adelaide researchers could lead to the first possible effective treatment for the rare and crippling blood cancer.

Myelofibrosis, a type of bone marrow cancer, affects about one in 100,000 people in Australia and can often lead to complete marrow failure or even acute leukaemia.

Daniel Thomas, leader of the Myeloid Metabolism Lab at the South Australian Health and Medical Research Institute (SAHMRI), has been searching for better therapies for primary myelofibrosis for three years.

“It progresses over a period of three to five years, resulting in severe fibrosis of the marrow, and it can sometimes change into acute leukaemia where patients get sick extremely quickly,” he said.

Dr Thomas and his team of Adelaide researchers were trying to create a tool to help understand how the disease impacted the human body, but what they ended up discovering was much more extraordinary.

“As we were making an antibody to try and understand how calreticulin protein worked inside stem cells … we were completely shocked to find out that it actually stopped their (cancer cells’) growth,” he said.

Dr Thomas first assumed the results were a mistake.

“I said, ‘We have to repeat this. This is too good to be true,'” he said.

But after multiple tests, he was convinced they had found a treatment for what is often considered an “undruggable mutation”.

“And low and behold, the antibody actually stopped these [cancer cells] growing out but did not stop a single normal healthy stem cell growing,” Dr Thomas said.

The new antibody is currently being prepared for early-phase clinical trials set to run in South Australia later this year.

Read more

Women’s History Month – Dr. Catriona Jamieson

Dr. Catriona Jamieson is Professor of Medicine in the Division of Hematology-Oncology, Deputy Director of UC San Diego Moores Cancer Center, Co-Lear of Hematologic Malignancies Program, and Director of Stem Cell Research at UC San Diego Moores Cancer Center.

How did you become interested in hematology versus other areas of medicine?

My father’s mother died of leukemia when he was 18 and it had a profound impact on his life.

What have been the highlights in your career, specifically in the area of MPNs?

The capacity to translate discoveries to the clinic for the benefit of patients with MPNs, including fedratinib ® and glasdegib ®, has been the most important aspect of my career together with the recent discovery and development of our splicing modulator that inhibits splicing-mediated activation of both MCL1 and ADAR1.

As a female in this area of medicine, what advice would you give women grappling with career choices in hematology and medical research?

Persevere and surround yourself with supporters.

Women’s History Month – Nicole Kucine, MD, MS

Dr. Nicole Kucine is an Associate Professor of Clinical Pediatrics at Weill Cornell Medicine and Associate Pediatrician at NewYork-Presbyterian/Weill Cornell Medical Center. She is an advisor of our Pediatric & Young Adult MPNs focus.

Join our Pediatric & Young Adult Webinar with Dr. Kucine, March 24, 2022

How did you become interested in hematology versus other areas of medicine?

I always knew I wanted to be a pediatrician and found hematology/oncology most interesting, but during my residency and fellowship, I realized my heart was really in hematology. The variety of illnesses, the ability to see a mix of patients for both short-term and long-term follow-up, and the detective work involved in making a diagnosis appealed to me more than oncology.

What have been the highlights in your career, specifically in the area of MPNs?

I think working with children with MPNs and their families has been so rewarding. The fact that so many families want to partner with me and work as a team, and how dedicated families are to ensure we can learn more about these diseases has been so important and inspiring.

As a female in this area of medicine, what advice would you give women grappling with career choices in hematology and medical research?

Women still deal with gender discrimination in medicine. I would encourage any woman interested in a career in hematology and research to go for it. Don’t let anyone tell you that you can’t!