A consensus statement on the use of biosimilar medicines in hematology in Australia

Despite their availability for over a decade, the exact nature of biosimilar medicines is still poorly understood with paucity of clear treatment guidelines for their use in clinical practice in Australia. Although hematologists have had experience with biosimilars in the setting of supportive care, with the approval of the first biosimilar rituximab in hematological malignancies, it is important to revisit this topic. To inform the use of biosimilar medicines in clinical practice, we have developed a consensus statement from an Expert Panel of Australian hematologists, oncologists, and cancer pharmacists. These recommendations address the approach to use of biosimilar products in place of the corresponding reference medicine in a number of different clinical contexts. Our recommendations are based on the premise that biosimilar medicines can be considered therapeutically equivalent to their reference brand and used in a similar way to the reference product in any approved indication. We advocate for local approaches to the provision of patient information, dispensing of the intended brand and pharmacovigilance, to be developed in consultation with local hematologists and aim to improve confidence in the appropriate use of biosimilar medicines and their expected outcomes among hematologists.

A 14-year retrospective analysis of indications and outcomes of autologous haemopoietic stem cell transplantation in regional Queensland: a single-centre experience

BACKGROUND

The Townsville Hospital is a tertiary hospital in North Queensland with one of the largest regional transplant centres in Australia, performing primarily autologous haemopoietic stem cell transplants (HSCT) for various haematological malignancies.

AIMS

This single-centre, retrospective, observational study aims to describe the activity and outcomes of autologous HSCT at The Townsville Hospital between 2003 and 2017 to verify safety standards.

METHODS

Patient-level data were collected, including demographics, frequency and indication for transplant, conditioning, current clinical status and cause of death. Key outcomes included overall survival, non-relapse mortality, incidence of therapy-related neoplasm and causes of death. Progression-free survival in the multiple myeloma (MM) subgroup was also assessed.

RESULTS

There were 319 autologous HSCT in 286 patients, with a median age of 58 years (range 14-71 years); 62% of patients were male. Indications for transplantation were: MM 53.7%, non-Hodgkin lymphoma 29.4%, Hodgkin lymphoma 5.0% and other 11.9%. Causes of death were: disease progression/relapse (65.2%), second malignancy (17.0%), infection (9.8%) and other (8.0%). Non-relapse mortality was 1.2% (95% confidence interval 0.4-3.0) and 3.2% (1.7-5.7) at 100 days and 1 year, respectively, post-HSCT. Overall survival at 2 years was 81.0% (73.8-86.4) for MM and 69.6% (58.8-78.1) for non-Hodgkin lymphoma. The median progression-free survival in the MM cohort was 3.3 years.

CONCLUSION

The Townsville Hospital transplant centre provides an important transplant service in regional Queensland, with outcomes comparable to national data. We reported a relatively high rate of second malignancy as a cause of death.

Does fetal gut obstruction cause hydramnios and growth retardation?

In order to study the effects of impaired fetal intestinal absorption of amniotic fluid, two series of neonates (551 from Liverpool and 172 from Rome) with different types of congenital gut obstruction were divided into two groups and compared. Group A consisted of patients with complete obstruction at or above the proximal jejunum (within 15 cm of the ligament of Treitz). Patients of group B had either incomplete obstruction at group A level or either incomplete or complete obstruction at a lower level. Maternal hydramnios and fetal growth retardation rates were found to be significantly higher in group A than in group B. Maternal hydramnios was associated with an increased prematurity rate (P less than .001). Fetal growth retardation was not related to the presence of additional anomalies. In group A growth retardation was more frequent in babies born after 37 weeks of gestation (P less than .05). No differences were found between the Liverpool and Rome series of patients. These findings suggest that fetal gut function not only contributes to the control of amniotic fluid volume but also, in the final stages of pregnancy, to normal fetal growth. Maternal hydramnios may be the cause of premature delivery of fetuses with upper gut obstructions.

Prune belly syndrome associated with exomphalos and anorectal agenesis

We have recently treated a child with prune belly syndrome in association with exomphalos and anorectal agenesis. This case raises the total incidence of exomphalos and anorectal agenesis to four and five, respectively, in our series of 13 cases of prune belly syndrome. Our case report lays emphasis on the severe respiratory problems that can complicate surgery in prune belly patients. We also attempt to relate the pattern of anomalies in our series to the controversy surrounding the embryogenesis of prune belly syndrome and suggest that our case material lends support to the concept of prune belly syndrome being due to an early disturbance of mesodermal development in both the abdominal wall and the urinary tract. We also suggest that the reported occurrence of gastroschisis in association with prune belly syndrome adds weight to the unifying theory of the embryogenesis of gastroschisis and exomphalos.

Acute pancreatitis in children

Twenty-nine children with acute pancreatitis were managed during the period 1971 to 1983. Aetiology included trauma (5), mumps (5), drug therapy (4), biliary disease (1), and cystic fibrosis (1); 13 cases were classified as idiopathic. Diagnosis could be difficult, and unnecessary laparotomies were performed in 7 instances for suspected appendicitis. One patient, however, had a well-justified laparotomy revealing coexisting severe appendicitis and pancreatitis. Morbidity included relapses (7), pseudocysts (3), obstructive duodenal hematoma (1), and miscellaneous problems (4). Improvements in management included endoscopic retrograde cholangio-pancreatography (ERCP) to exclude anatomical anomalies in relapsing cases, ultrasonography for the diagnosis of pseudocysts and for follow-up measurements in two such cases successfully managed conservatively, and increasing use of total parenteral nutrition in cases with protracted disease or serious complications.

Annular pancreas in a fetus and its three-dimensional reconstruction

A three-dimensional 50-times scale reconstruction was made of an annular pancreas from an 18-week-old fetus. By the use of radio-opaque paint, the anatomy of the pancreaticobiliary system within the reconstructed duodenum was clearly revealed. The anatomical arrangement indicated that the annulus was formed from the ventral anlage of the pancreas and that part of the annulus intermingled with the duodenal wall. These findings are consistent with Lecco 's theory of the embryogenesis of annular pancreas. The visualisation of internal structures in a reconstruction by the use of radio-opaque paint has not been described previously. This could be a useful technique in other embryological studies of the continuity of microscopic internal structures. Annular pancreas has been described previously by Weissberg in a 16-mm embryo. This report is the second case of a fetal annular pancreas in the literature.

Endoscopic diathermy obliteration of recurrent tracheoesophageal fistulae

Recurrence of tracheoesophageal fistula after surgical repair for esophageal atresia occurs in approximately 5% to 15% of cases. Further surgery may be hazardous and mortality rates of up to 50% have been reported. We report two patients in whom successful obliteration of a recurrent fistula has been achieved by diathermy at bronchoscopy. This experience is compared to previous reports of fistula obliteration using tissue adhesives.

Massive adrenal hemorrhage in neonatal neuroblastoma

In a neonate with exsanguinating intraperitoneal bleeding admitted with a provisional diagnosis of ruptured liver due to birth trauma, laparotomy revealed the source of hemorrhage to be an adrenal neuroblastoma. This case prompted a review of cases of abdominal neuroblastoma admitted to the Neonatal Surgical Unit in Alder Hey Children's Hospital from 1953 to 1976. The features of 10 cases are presented: in three of them there was hemorrhage into the tumor. Of the 10 cases, six survived tumor free from 2 to 12 yr and there is one short-term survivor. The purpose of this presentation is to emphasize the possibility of an underlying neuroblastoma in cases of neonatal adrenal hemorrhage and also the relatively good prognosis in neuroblastoma presenting in the neonatal period.

Segmental dilatation of the ileum

Three new cases of congenital segmental dilatation of the ileum are presented and added to 12 cases of segmental dilatation found in the literature. The aspect of the condition which is of particular interest is the presence in 3 of the dilated segments of heteroplastic foregut derivatives of unusual varieties. The etiology of the condition is discussed; it does not appear to be a single distinct pathological entity.

Experiences with radioisotope renography in children

Images