ASH Clinical News Advances in Hematology Research & Patient Care: Hi | Page 21

“Most PE research has focused on outcomes such as mortality and
PE recurrence,” Dr. Kahn and co-authors wrote. “Patient-centered
outcomes such as persistent dyspnea, impaired QOL, and reduced
walking capacity after PE have been largely unstudied.”
The prospective, observational, multicenter ELOPE trial addressed this knowledge gap, looking specifically at these outcomes
after one year in 100 patients (mean age = 50 years old) with a first
episode of acute PE who were recruited from five Canadian centers.
Patients were excluded from the study if they had sub-segmental–
only PE, preexisting severe cardiopulmonary comorbidity, previous
proximal deep-vein thrombosis (DVT), contraindication to CT
pulmonary angiography, and a life expectancy of less than one year.
Most of the patients (80%) were outpatients, and 33 percent had
concomitant DVT. PE was provoked in 21 percent of cases (meaning there was an identifiable risk factor that likely caused the PE)
and unprovoked in 79 percent (the absence of an identifiable risk
factor for PE). None of the incidences of PE were cancer-related.
Dr. Kahn and colleagues assessed patients at baseline (the first
visit for PE), one, three, six, and 12 months after PE, using the following measures to quantify outcomes:
• Dyspnea = UCSD Shortness of Breath Questionnaire (SOBQ)
• Generic QOL = SF-36
• PE-specific QOL = PEmbQoL
• Walking capacity = 6-minute walk test (6MWT)
The study’s primary outcome was maximal aerobic capacity. Maximal aerobic capacity one year after PE was calculated by comparing a
patient’s peak oxygen uptake (VO2; measured with a cardiopulmonary
exercise testing or a stress test) with the patient’s predicted maximal VO2
(VO2max). If a patient’s VO2max was <80 percent of his or her predicted
VO2max (according to the American Thoracic Society guidelines), the
VO2max was considered “abnormal.”
During one year of follow-up:
• Dyspnea scores improved by an average of 16.9 points on SOBQ
(on a scale of 1-120) compared with baseline
• QOL was better on both the physical and mental components of
the SF-36 PCS (improving by 9.0 and 5.6 points, respectively, on
a scale of 1-100)
• For PE-specific QOL, the intensity of complaints was reduced by
33.4 points (on the PEmbQoL, on a scale of 1-100)
• Walking capacity increased by 43 meters over baseline
“Improvement tended to be more marked during the first three
months after PE and tapered off thereafter,” the authors noted,
adding that patients with abnormal VO2max did not experience improvements in outcomes to the same extent as patients with normal
VO2max. “For all measures, degree of improvement was significantly reduced and one-year scores [of maximal aerobic capacity] were

significantly worse among the 46.5 percent (40/86) of patients with
[abnormal] VO2max.”
This group of symptoms is what Dr. Kahn and colleagues,
in a separate abstract presented at this year’s meeting, refer to as
“post-pulmonary embolism syndrome.” Again using data from
the ELOPE study, the researchers determined that almost half of
patients who experience PE can be said to have post-PE syndrome,
characterized by exercise limitation, which in turn influences their
QOL and degree of dyspnea.
Future analyses, the authors concluded, should focus on
identifying clinical, biomarker and imaging-based determinants of
dyspnea, poor QOL, and reduced walking capacity in patients with
post-PE syndrome.
References
Kahn SR, Hirsch A, Beddaoui M, et al. Dyspnea, quality of life and walking capacity
during 1 year follow-up after a first episode of pulmonary embolism: results of the
E.L.O.P.E. study. Abstract #750. Presented at the 2015 ASH Annual Meeting, December
7, 2015; Orlando, Florida.
Kahn SR, Hirsch A, Beddaoui M, et al. “Post-pulmonary embolism syndrome” after
a first episode of PE: results of the E.L.O.P.E. study. Abstract #650. Presented at the
2015 ASH Annual Meeting, December 7, 2015; Orlando, Florida.

Genetic Variants Predict
Osteonecrosis in Children
with ALL
Pediatric patients with acute lymphocytic leukemia (ALL)
and chemotherapy-induced osteonecrosis are significantly
more likely to possess certain genetic variants near genes
essential to bone development and adipogenesis, according
to results from a study of 82 ALL patients younger than 10
years old presented at the ASH annual meeting last month.
Osteonecrosis, which is caused by reduced blood flow to bones in
the joints that results in pain and decreased mobility, is a significant
toxicity of ALL, limiting the ability to intensify treatment in young
ALL patients – particularly among patients 10 to 20 years of age.
The risk of osteonecrosis is lower among younger patients but,
despite the lower risk, children under 10 years of age make up 40
percent of cases of osteonecrosis. While