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Low-Pressure Compression Garments Helpful for Pediatric Post-Thrombotic Syndrome
Use of graduated compression garments , a standard management for post-thrombotic syndrome ( PTS ) in adults , was associated with modest improvements in disease severity in children , according to a new study published in the Journal of Thrombosis and Haemostasis . The authors reported that low-pressure compression garments were particularly helpful .
“ Until now , we did not have information specific to pediatric patients on how to prescribe compression garments and their efficacy in the management of PTS in this population ,” commented lead study investigator Laura Avila , MD , PhD , of the Hospital for Sick Children in Toronto , Ontario . “ In addition , our study shows that we can prescribe relatively lowerpressure compression garments , between 15 to 20 mmHg , than those typically used in adults with PTS , which may play a role in improving adherence – a common problem in PTS therapy .”
The prospective study by Dr . Avila and colleagues included 45 children with PTS , all of whom were enrolled at the time of receiving a compression garment prescription . At baseline and follow-up , the investigators measured PTS severity using the index for the Clinical Assessment for Post-Thrombotic Syndrome in children ( CAPTSure ), a validated and reliable tool that assesses PTS with a continuous score between 0 and 100 points . A total of 100 points on the scale represents the worst possible disease severity . Researchers also captured patients ’ attitude toward wearing compression garments .
The median age of the cohort was 13 years and 53 % of patients were male . Four patients did not return for their follow-up visits . The median follow-up among the remaining 41 patients was 4.6 months after receiving a compression garment prescription . The majority of patients were prescribed compression socks ( 71 %), while the remaining patients were prescribed compression sleeves ( 29 %). The pressure was between 15 and 20 mmHg in the majority of compression garments ( 84 %).
At baseline , the median CAPTSure score was 31 points . According to self-reported follow-up assessments , approximately 49 % of patients said the compression garments were helpful , 27 % said the garments were not helpful , and 16 % either did not purchase or use their prescribed compression garments ( TABLE ).
Most of the children who said the prescribed compression garments were helpful wore the garments for
TABLE . Comparison of Patients According to Attitude Toward Compression Garments
Helpful n = 22
Not helpful n = 12
Did not buy / did not wear , n = 7
Age in years at enrollment , median ( 25th−75th percentile ) 15 ( 9 – 16 ) 15 ( 8 – 16 ) 9 ( 8 – 13 ) 0.53 Deep vein thrombosis in the lower limb , n (%) 14 ( 64 %) 9 ( 75 %) 6 ( 86 %) 0.37 Baseline PTS score , median ( 25th−75th percentile ) 30 ( 20 – 40 ) 29 ( 24 – 49 ) 29 ( 24 – 49 ) 0.58
Baseline PODCI global functioning score , median ( 25th−75th percentile ) p Value
91 ( 84 – 97 ) 86 ( 80 – 94 ) 94 ( 90 – 98 ) 0.58
Frequency of dissatisfied participants at baseline , n (%) 12 / 21 ( 57 %) 4 / 11 ( 36 %) 2 / 6 ( 33 %) 0.21 Frequency of dissatisfied participants at baseline , n (%) 12 / 21 ( 57 %) 4 / 11 ( 36 %) 2 / 6 ( 33 %) 0.21 Felt the same or better than before at follow-up , n (%) 15 ( 79 %) 3 ( 40 %) 3 ( 43 %) 0.03
CG = compression garments ; PODCI = Pediatric Outcomes Data Collection Instrument ; PTS = post-thrombotic syndrome three or more days per week ( 95 %). At follow-up , the investigators found a non-linear association between the hours of compression garment wear time and lower PTS scores . For instance , wearing the compression garments for 12 hours per day versus 0 hours per day was associated with a 16-point reduction in PTS scores at the follow-up assessment ( 95 % CI −29 to −2 ).
Dr . Avila also noted that in this study the patients were diagnosed with moderate to severe PTS several years after their index thrombotic event . “ The finding emphasizes the concept that PTS can occur many years after the thrombotic event and that these children should be monitored long-term ,” she said .
In addition , most patients were relatively young at the time of their thrombotic event , and 70 % of patients had a central venous catheter thrombosis , which typically carries a lower risk for PTS . “ The need for long-term screening in all children with deep vein thrombosis is a concept our team is advocating for so these patients can have proper follow-up ,” explained Dr . Avila . “ We have developed tools that can be reliably used by primary care providers to screen for PTS .”
A primary limitation of the study was the use of self-reported assessment to measure adherence to compression garments , which could be subject to bias and is difficult to measure in chronic diseases . “ My team is ... interested in finding ways to improve adherence to therapy , which is a very complex task ,” said Dr . Avila .
The authors report no relevant conflicts of interest .
Reference Avila L , Amiri N , De R , Vincelli J , Pullenayegum E , Brandão LR . Compression garments for the management of pediatric post-thrombotic syndrome : A prospective longitudinal study [ published online ahead of print , 2021 Aug 21 ]. J Thromb Haemost . doi : 10.1111 /
Ixazomib-Based Regimen Induces Responses in Heavily Pretreated Waldenström Macroglobulinemia
jth . 15507 .
Treatment with proteasome inhibitor ixazomib plus subcutaneous rituximab and dexamethasone ( IRD ) was associated with high rates of response and manageable toxicity in patients with relapsed or refractory Waldenström macroglobulinemia ( WM ), according to a study led by Marie José Kersten , MD , PhD , of the University of Amsterdam in the Netherlands .
Patients with WM are primarily treated with anti- CD20 monoclonal antibody – based combinations , yet significant challenges in managing relapsed or refractory disease remain . According to Dr . Kersten , previous results suggest IRD may be associated with high response rates and prolonged progression-free survival ( PFS ) in treatment-naïve patients with WM . However , the data regarding the clinical activity and safety of IRD in relapsed / refractory WM are sparse .
The international phase I / II HOVON124 study was conducted at 18 centers : 14 in the Netherlands , three in Belgium , and one in Greece . During phase I , six patients with relapsed or refractory WM were enrolled , followed by 54 patients in the phase II portion of the study . Phase II included a total of eight 28-day treatment cycles of ixazomib at the recommended dose level ( 4 mg orally on days 1 , 8 , and 15 ) and dexamethasone ( 20 mg orally on days 1 , 8 , 15 , and 22 ).
One patient was ineligible for inclusion in the phase II analysis by Dr . Kersten and colleagues from the HOVON Lymphoma Group , the Greek Myeloma Study Group , and the European Consortium for WM , because of disease that was refractory to rituximab . The phase II analysis included 59 patients with progressive or relapsed WM and measurable disease following prior systemic treatment . To reduce the risk
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