Our research featured at the American Society of Hematology

The diverse research from our group was well represented at this year’s 62nd ASH Annual Scientific Meeting, held entirely online from 5-8 December:

• A/Prof Zoe McQuilten presented on the ASPREE CHIP (clonal haematopoiesis of indeterminate potential) project in the Scientific Workshop on Hematology and Aging
• Dr Lucy Fox presented on “understanding the patient and physician perspective on barriers to optimal care” in the Scientific Workshop on Germline Predisposition to Hematopoietic Malignancies and Bone Marrow Failure
• Professor P. Joy Ho from Royal Prince Alfred Hospital in Sydney presented a poster (3227) on behalf of the Myeloma and Related Diseases Registry: The impact of S-Li-M criteria in myeloma in a real-life population: Patient & disease characteristics, treatment and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR)
• Professor Erica Wood presented on “Outpatient transfusion for patients with myelodysplastic syndromes” in the session on Chronic Transfusion Support: Challenging Cases. The accompanying monograph, co-authored with Zoe McQuilten, is published in the ASH Education Program book.

A/Prof Zoe McQuilten awarded the Vice-Chancellor’s Prize for Excellence by an Early Career Researcher

Congratulations to Zoe, who received this prestigious award for her outstanding research – in addition to being awarded the Dean’s Award this year!

News from the Asia-Pacific Myeloma and Related Diseases Registry

The APAC-MRDR held its annual investigator open meeting online on 2 December, which was very well attended by participants from the region and internationally. The audience enjoyed an update on progress with the registry, and scientific presentations on the potential of ‘liquid biopsy’ in myeloma, and the MRFF-funded EPIMAP (epidemiological modelling) study.

Registry investigators were also delighted to announce that Janssen have confirmed ongoing support for the next 5 years.

More information is available at: apacmrdr.org

The Lymphoma and Related Diseases Registry (LaRDR) holds its annual investigator meeting

More than 70 participants attended the LaRDR Investigator open meeting on 26 November, again this year held in collaboration with the Australasian Lymphoma Alliance. Due to the COVID-19 situation, the meeting was entirely online. It was a pleasure to provide updates on the many projects underway, including those of several young investigators, and our international collaborations. Registry recruitment is nearing 4000 participants.

More information is available at: lardr.org/2020/12/15/alalardr-investigator-meeting-2020

Recent publications from the Transfusion Research Unit

1. Wood EM, McQuilten ZK. Outpatient transfusions for myelodysplastic syndromes. Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):167-174. doi: 10.1182/hematology.2020000103.
2. Keragala CB, Woodruff TM, Liu Z, Niego B, Ho H, McQuilten Z, Medcalf RL. Tissue-type plasminogen activator and tenecteplase-mediated increase in blood brain barrier permeability involves cell intrinsic complement. Front Neurol. 2020 Dec 8;11:577272. doi: 10.3389/fneur.2020.577272.
3. Wood EM, Estcourt LJ, McQuilten Z. How should we use convalescent plasma therapies for COVID-19? Blood. 2020 Nov 17:blood.2020008903. doi: 10.1182/blood.2020008903.
4. Sparrow RL, Payne KA, Adams GG. Higher donor body mass index is associated with increased hemolysis of red blood cells at 42-days of storage: A retrospective analysis of routine quality control data. Transfusion. 2020 Nov 24. doi: 10.1111/trf.16203.
5. Angus DC, Derde L, Al-Beidh F, et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1317-1329. doi: 10.1001/jama.2020.17022
6. Vogel JP, Tendal B, Giles M, et al. National COVID-19 Clinical Evidence Taskforce. Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce. Aust N Z J Obstet Gynaecol. 2020 Oct 29. doi: 10.1111/ajo.13270.
7. Lucas R, Dennington P, Wood E, Dionne A, de Ferranti SD, Newburger JW, Dahdah N, Cheng A, Burgner D, Singh-Grewal D. Variation in the management of Kawasaki disease in Australia and New Zealand: A survey of paediatricians. J Paediatr Child Health. 2020 Dec 9. doi: 10.1111/jpc.15290.

First patient for the REDDS-2 study

After some delays, in part due to the COVID-19 pandemic, the first participant has been randomised to the REDDS-2 study of transfusion for patients with myelodysplastic syndromes. Congratulations to Dr Dorothea Evers and team at Radboud University Medical Centre in Nijmegen, the Netherlands! More information on the study is available at monash.edu/medicine/redds2.

Blood Synergy update

Dr Khaili Chai discusses COVID-19 convalescent plasma in Cochrane review podcast

The latest update of the Cochrane living systematic review has been published:

Chai KL, Valk SJ, Piechotta V, Kimber C, Monsef I Doree C,, Wood EM, Lamikanra A, Roberts DJ, McQuilten Z, So-Osman C, Estcourt LJ, Skoetz N. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev. 2020;Oct 12;10:CD013600. doi: 10.1002/14651858.CD013600.pub3.

Dr Khaili Chai discusses the main findings in a podcast, available on the Cochrane Library website.

IMPROVE study reaches target recruitment

The National Blood Authority-funded IMPROVE (Immunoglobulins in Myeloma Patients: Research into Outcomes, Variation in practice, and Epidemiology) study is studying infections and immunoglobulin use in patients with myeloma. Participants are enrolled through the Myeloma and Related Diseases Registry, and a sub-set of patients are also providing samples for immune profiling studies.

The TRU team, and especially Sabine Albold, IMPROVE project officer, were delighted to reach our target of 300 participants recently. A huge ‘thank-you’ to everyone involved, especially the patients and staff at participating hospitals – and particularly given the COVID-19-related disruptions to many aspects of clinical research.

IMPROVE will provide valuable new Australian data to inform national policy, immunoglobulin stewardship and patient outcomes.

TRU contributes to the October scientific meeting of the Australasian Leukaemia and Lymphoma Group

Research led by the Transfusion Research Unit was featured at the recent ALLG meeting.

• As part of the Supportive Care Working Party plenary session, updates on the RATIONAL systematic review and trial and plans for the RATIONALISE (immunoglobulin stopping or extension) study were presented to members by Dr Jonathan Wong, Dr Khaili Chai and A/Prof Zoe McQuilten;
• In a new session on ‘classical haematology’ Dr Lucy Fox presented an overview of the Aplastic Anaemia and Other Bone Marrow Failure Disorders Registry, and the DIAAMOND study of avatrombopag; and
• In a plenary session on COVID-19, A/Prof Zoe McQuilten provided an update on the convalescent plasma trials underway in Australia and internationally.

Australian and NZ Myeloma and Related Diseases Registry reaches 4000 patients

Congratulations to Wellington Hospital, who recruited the 4000th patient on 30th September 2020, and to the whole MRDR team. This is a wonderful achievement, representing the contributions of patients and staff at 48 sites across Australia and New Zealand, the bi-national steering committee chaired by Professor Andrew Spencer, our funders and supporters, and the MRDR operations team at Monash University. Well done everyone!

International haemovigilance at the China Blood Safety Symposium

Professor Erica Wood joined the Chinese Academy of Medical Sciences, Peking Union Medical College and National Center for Disease Control and Prevention on 19 September 2020 for the First China Blood Safety Symposium, to discuss “International haemovigilance: Status and challenges”.

A/Prof Zoe McQuilten and Dr Allison Mo speak at Transfusion United conference

At the online conference, supported by Lifeblood, ANZSBT, RCPA and HOW, Zoe provided an overview of hospital transfusion services’ responses to COVID-19 which featured in a Vox Sanguinis International Forum. Allison presented data on the changing transfusion needs of patients with myelodysplastic syndromes as part of an analysis of longitudinal data from the Victorian Admitted Episodes Dataset, which forms part of her PhD studies.

Dr Lucy Fox presents at the Maddie’s Vision Patient and Family Forum on Bone Marrow Failure Syndromes

Lucy shared an update on the Aplastic Anaemia and Other Bone Marrow Failure Syndromes Registry and the DIAAMOND trial as part of the event on 28^th August 2020, which brought together over 200 patients, families, clinicians and scientists.

The full recording of the event is available on YouTube
(with Lucy’s presentation commencing at 3:26:25)

Professor Erica Wood presents at the NIH/Versiti Red Cell Genotyping Symposium 2020

Hosted by the National Institutes of Health, Versiti Blood Centers and the US Department of Health and Human Services, the 10th annual red cell genotyping symposium was held online on 9 September 2020. Erica delivered the opening lecture “Red cell genotyping for improving patient care and clinical outcomes.”

Australian and NZ Myeloma and Related Diseases Registry holds its annual investigator meeting online

The MRDR was delighted to welcome a large group to its 2020 investigator meeting, this year held online on September 5 as part of the National Myeloma Workshop, with thanks to Myeloma Australia.

Special thanks to guest speakers A/Prof Dennis Petrie from the Centre for Health Economics, speaking about the MRFF-funded myeloma epidemiological modelling study, and Dr Cecily Forsyth from Gosford speaking about participating in the MRDR from private practice. Prof Andrew Spencer delivered the annual update on MRDR activities, and Dr Kim Huynh provided an update on progress with the Asia-Pacific Myeloma Registry (more info at apacmrdr.org).

Dr Karina Brady joins TRU as Blood Synergy Program Manager

TRU welcomes Karina as the new Program Manager for the Blood Synergy Program – an NHMRC-funded program addressing Australia’s national transfusion research priorities. She coordinates Blood Synergy activities and provides leadership, project and strategic support to the Synergy grant investigators team. Karina has a background in scientific and clinical research, and a PhD in neurophysiology. Prior to joining TRU, she was a Laboratory Head/Senior Research Fellow at the University of Melbourne, and Project Lead at the HEARing Cooperative Research Centre. She has experience in a broad range of preclinical, multidisciplinary and clinical studies, with particular focus on neuroscience, hearing loss and cochlear implant technology.

Recent publications from the Transfusion Research Unit

1. Hervig TA, Doughty HA, Cardigan RA, Apelseth TO, Hess JR, Noorman F, Bohoněk M, Yazer MH, Lu J, Wendel S, Sparrow RL; Biomedical Excellence for Safer Transfusion Collaborative. Re-introducing whole blood for transfusion: considerations for blood providers. Vox Sang 30 September 2020. doi: 10.1111/vox.12998.
2. Sanderson B, Coiera E, Asrianti L, Field J, Estcourt LJ, Wood EM. How well does your massive transfusion protocol perform? A scoping review of quality indicators. Blood Transfus 18 September 2020. doi: 10.2450/2020.0082-20.
3. Eisen DP, Leder K, Woods RL, Lockery JE, McGuinness SL, Wolfe R, Pilcher D, Moore EM, Shastry A, Nelson MR, Reid CM, McNeil JJ, McBryde ES. Effect of aspirin on deaths associated with sepsis in healthy older people (ANTISEPSIS): a randomised, double-blind, placebo-controlled primary prevention trial. Lancet Respir Med. 17 September 2020. doi: 10.1016/S2213-2600(20)30411-2.
4. Wolfe R, Wetmore JB, Woods RL, McNeil JJ, Gallagher H, Roderick P, Walker R, Nelson MR, Reid CM, Shah RC, Ernst ME, Lockery JE, Tonkin AM, Abhayaratna WP, Gibbs P, Wood EM, Mahady SE, Williamson JD, Donnan GA, Cloud GC, Murray AM, Polkinghorne KR; ASPREE Investigator Group: Subgroup analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial suggests aspirin did not improve outcomes in older adults with chronic kidney disease. Kidney International 10 Sep 2020:S0085-2538(20)30973-X. doi: 10.1016/j.kint.2020.08.011.
5. Cheok KPL, Chhetri R, Wee LYA, Salvi A, McRae S, Bardy P, Singhal D, Roxby DJ, Wood EM and Hiwase DK: The burden of immune-mediated refractoriness to platelet transfusions in myelodysplastic syndromes. Transfusion 9 September 2020. doi:10.1111/trf.16029
6. Kiely P, Seed CR, Hoad VC, Gambhir M, Cheng AC, McQuilten ZK, Wood EM: Modelling the West Nile virus transfusion-transmission risk in a non-outbreak country associated with travelling donors. Transfusion 31 August 2020. doi: 10.1111/trf.16060.
7. Ket SN, Sparrow RL, McQuilten ZK, Gibson PR, Brown GJ, Wood EM: Critical peptic ulcer bleeding requiring massive blood transfusion: outcomes of 270 cases. Internal Medicine Journal 12 August 2020; doi: 10.1111/imj.15009.
8. Fox LC, Wood EM, Ritchie DS, Blombery P. Diagnostic evaluation and considerations in hypocellular bone marrow failure-A focus on genomics. Int J Lab Hematol. 2020;42 Suppl 1:82-89. doi: 10.1111/ijlh.13179.

Convalescent plasma trials for COVID-19 open to recruitment in Australia

Convalescent plasma to treat SARS-CoV-2 (COVID-19) infection is now being used as part of the Australasian COVID-19 Trial (ASCOT) and the international Randomised, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) trial.

The Australian Convalescent Plasma Study, led A/Prof Zoe McQuilten and supported by the Medical Research Future Fund, is a collaboration between the Monash University Transfusion Research Unit/Blood Synergy investigators, Australian and New Zealand Intensive Care Research Centre, REMAP-CAP and ASCOT investigators, and Australian Red Cross Lifeblood.

A big ‘thank-you’ to the blood donors and the hard-working teams who have made these trials a reality.

More information is available at: abc.net.au/news/2020-08-06/coronavirus-treatments-and-covid19-cure-research/12527034 and doherty.edu.au/news-events/news/convalescent-plasma-treatment-for-covid-19-introduced-to-ascot-and-remap-cap-trials

Recent publications from the Transfusion Research Unit

Mahady SE, Margolis KL, Chan AT, Polekhina G, Woods RL, Wolfe R, Nelson MM, Lockery J, Wood EM, Reid CM, Ernst ME, Murray AM, Le LTP, McNeil JJ: Major gastrointestinal bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut 2020;0:1–8. doi:10.1136/gutjnl-2020-321585 (online 3 August).

Piechotta V, Chai KL, Valk SJ, Doree C, Monsef I, Wood EM, Lamikanra A, Kimber C, McQuilten Z, So-Osman C, Estcourt LJ, Skoetz N. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev. 2020 Jul 10;7:CD013600. doi: 10.1002/14651858.CD013600.pub2.PMID: 32648959.

Alves D, Curvello R, Henderson E, Kesarwani V, Walker JA, Leguizamon SC, McLiesh H, Raghuwanshi VS, Samadian H, Wood EM, McQuilten ZK, Graham M, Wieringa M, Korman TM, Scott TS, Banaszak Holl MM, Garnier G, Corrie SR: Rapid gel-card agglutination assays for serological analysis following SARS-CoV-2 infection in humans. ACS Sensors Jul 16. doi: 10.1021/acssensors.0c01050.

Al-Riyami AZ, Schäfer R, van der Berg K, Bloch EM, Estcourt EJ, Goel R, Hindawi S, Josephson C,  Land K, McQuilten ZK,  Spitalnik S, Wood EM, Devine DV  and So-Osman C: Clinical use of convalescent plasma in the COVID-19 pandemic; a transfusion-focussed gap analysis with recommendations for future research priorities. Vox Sanguinis 15 Jun 2020. doi: 10.1111/vox.12973.

Ashby M, Attwood L, Graham M, Wood E: Challenges for pathology laboratories during the COVID-19 pandemic: the view from Australia. Bulletin of the Royal College of Pathologists (UK), 2020;191;151-152. Available at: rcpath.org/profession/publications/college-bulletin/july-2020/covid-19-challenges-for-pathology-laboratories-during-the-covid-19-pandemic-the-view-from-australia.html.

Yazer MH, Jackson B, Pagano M, Rahimi-Levene N, Peer V, Bueno JL, Jackson RP, Shan H, Amorim-Filho L, Lopes ME, Boquimpani C, Sprogøe U, Bruun MT, Titlestad K, Rushford K, Wood EM, McQuilten ZK, de Angelis V, Delle Donne M, Murphy M, Staves J, Cho D, Nakamura F, Hangaishi A, Callum J, Lin Y, Mogaddam M, Gharehbaghian A, Lozano M. Vox Sanguinis International Forum on transfusion services about response to COVID-19. Vox Sanguinis 2020 May 8. doi: 10.1111/vox.12943.

A new, rapid test for COVID-19 antibody detection

In collaboration with Monash BioPRIA and Chemical Engineering, TRU researchers have contributed to development of a new assay for SARS-CoV-2 antibodies. The world-first research was published on 17 July 2020 in the prestigious journal ACS Sensors. The test incubates patient plasma or serum with reagent red blood cells previously coated with short peptides representing pieces of the SARS-CoV-2 virus, and uses red cell agglutination to determine a positive or negative result. The new assay, using column agglutination cards and automated readers already widely available in pathology laboratories, gives results in 20 minutes and could be used for high-throughput screening. “We found that by producing bioconjugates of anti-D-IgG and peptides from SARS-CoV-2 spike protein, and immobilising these to RRBCs, selective agglutination in gel cards was observed in the plasma collected from patients recently infected with SARS-CoV-2 in comparison to healthy plasma and negative controls,” said Professor Gil Garnier, Director of BioPRIA.

For more information:
monash.edu/news/articles/breakthrough-blood-test-detects-positive-covid-19-result-in-20-minutes

To download a copy of the research, please visit doi.org/10.1021/acssensors.0c01050

To watch a video of this research in action, please visit youtu.be/9WBQUC43u9Q

Haemoglobinopathy Registry

The Australian Haemoglobinpathy Registry (HbR) reached an important milestone recently, with more than 500 participants now contributing from 9 hospitals across Australia.

The goal of the HbR is to better understand the picture of haemoglobinopathies in Australia, with the aim to improve outcomes for patients, families and the community. Approximately half the HbR participants to date have beta thalassaemia major, and about one-third have a sickling disorder. Additional hospitals have ethics approval to participate and are anticipated to commence recruitment during 2020.

The HbR is currently conducting a study of diagnoses, management and outcomes for Australian adults with sickle cell disease, and this will be extended to paediatric patients during 2020.

Thank you to all the participants, staff and investigators around Australia contributing to the HbR! If your hospital is interested in joining the registry, or you have questions about the HbR please contact the Monash team at:
monash.edu/medicine/sphpm/registries/hbr

Prof Erica Wood becomes president of the International Society of Blood Transfusion

Congratulations to Professor Erica Wood who took up her role as president of the International Society of Blood Transfusion on 9 June 2020, for a two-year term. Due to the COVID-19 pandemic, the first time, the ISBT General Assembly was held by webinar – a first for the Society. For more information: isbtweb.org/about-isbt/board-of-directors

Monash researchers awarded MRFF funding for epidemiological modelling study of myeloma treatments

Congratulations to A/Prof Zoe McQuilten and the team of researchers from SHPHPM (Dr Elizabeth Moore, Dr Cameron Wellard, Prof Erica Wood), Alfred Health (Prof Andrew Spencer) and the Monash Centre for Health Economics (Prof Tony Harris, A/Prof Dennis Petrie and Dr Laura Fanning) who were awarded funding from the MRFF through the call for Targeted Health System and Community Organisation Research. The group will use data from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR), in combination with national population level data on myeloma incidence, to model estimated transplant-eligible and ineligible myeloma patient populations at different treatment stages and according to performance status. The models will be validated with external, international datasets and input from a national and international network of clinical experts.

TREATT trial update

The TREATT trial is reopened to recruitment after a COVID-related hiatus affecting all participating Australian and UK hospitals. In a briefing for Australian investigators on 9 June, trial coordinator Amber Degelia updated the group on recent activities. Well done to the team at Monash Medical Centre who recruited the first post-COVID participant. Only 57 more patients are needed to reach the goal of 616 total participants – the finish line is in sight! Thank you to all the patients and staff working on TREATT across the country.

Convalescent plasma study for COVID-19 funded by the MRFF

Congratulations to A/Prof Zoe McQuilten and colleagues, whose SARS-CoV-2 Australian Convalescent Plasma Study has been awarded support from the Medical Research Future Fund (Antiviral Development for COVID-19 Funding). The study is a collaboration between the Australian and New Zealand Intensive Care Research Centre, the Randomised, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) investigators, the Australasian COVID-19 Trial (ASCOT) investigators, the Monash University Transfusion Research Unit/Blood Synergy investigators, and the Australian Red Cross Lifeblood.

Myeloma and lymphoma registries highlighted at the National Oncology Alliance/Rare Cancers Australia workshop

Professor Andrew Spencer, chair of the Myeloma and Related Diseases Registry steering committee, and Professor Stephen Opat, chair of the Lymphoma and Related Diseases Registry steering committee, shared their experiences of collecting and analysis of ‘real world’ data using registries for blood cancers at the NOA Vision 20-30 workshop. They emphasised the value of these data for patients, clinicians, governments and industry, and how registry data complement the information provided by clinical trials. More information on these registries is available at: www.mrdr.net.au and www.lardr.org

TRU contributes to Cochrane rapid review of convalescent plasma or hyperimmune immunoglobulin for COVID-19, and to guidelines for managing haematology/ oncology patients during the COVID-19 pandemic

Haematologist and TRU PhD student Dr Khaili Chai and colleagues contributed to a Cochrane rapid review of convalescent plasma or hyperimmune immunoglobulins for COVID-19. The study was published on 14th May 2020. The work will be updated as a living review, as more data on the safety and efficacy of these therapies become available.

Valk SJ, Piechotta V, Chai KL, Doree C, Monsef I, Wood EM, Lamikanra A, Kimber C, McQuilten Z, So-Osman C, Estcourt LJ, Skoetz N. Convalescent plasma or hyperimmune immunoglobulin for people with COVID‐19: a rapid review. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD013600. DOI: 10.1002/14651858.CD013600.

A/Prof Zoe McQuilten and colleagues developed guidance for clinicians managing haematology patients during the pandemic. The recommendations were endorsed by a large number of professional organisations across Australia and New Zealand.

Weinkove R, McQuilten ZK, Adler J, Agar MR, Blyth E, Cheng AC, Conyers R, Haeusler GM, Hardie C, Jackson C, Lane SW, Middlemiss T, Mollee P, Mulligan SP, Ritchie D, Ruka M, Solomon B, Szer J, Thursky KA, Wood EM, Worth LJ, Yong MK, Slavin MA, Teh BW. Managing haematology and oncology patients during the COVID-19 pandemic: interim consensus guidance. Med J Aust. 2020 Jun;212(10):481-489.

NHMRC Investigator Grant for A/Prof Zoe McQuilten

Well done, Zoe! A/Prof Zoe McQuilten has been awarded an NHMRC Investigator Grant for her research: “Improving patient outcomes through better use of blood products”. The highly competitive award will support Zoe’s research for 5 years from 2021.

My-PROMPT study results published

Congratulations to Dr Elizabeth Moore and colleagues on publication of the MY-PROMPT study results. This pilot randomized controlled trial showed that it was feasible to collect patient-reported outcomes on quality-of-life issues important to patients with myeloma, and provide real-time feedback of these results to clinicians. The study’s findings will help inform a future study in this area.

Moore EM, King TA, Wood EM, Ruseckaite R, Klarica D, Spencer A, Ho PJ, Quach H, Prince HM, McQuilten ZK. Patient-reported outcome measures in multiple myeloma: real-time reporting to improve care (My-PROMPT) - a pilot randomized controlled trial. Am J Hematol 2020 Apr 3. doi: 10.1002/ajh.25815.

Fiona Stanley Prize for NHMRC Synergy Grant

Professor Erica Wood was delighted to receive the inaugural Fiona Stanley Prize for the top-ranked 2019 Synergy grant: “Addressing Australia’s national transfusion research priorities”. It was extra-special that Professor Stanley herself presented the award at the NHMRC Research Excellence Awards dinner, held in Canberra in March 2020.

Victorian Cancer Agency Clinical Research Fellowship for A/Prof Zoe McQuilten

Congratulations to A/Prof Zoe McQuilten who has been awarded a 5-year Victorian Cancer Agency Clinical Research Fellowship. This funding will support her work on the IMPACT program: Immunoglobulin replacement versus Prophylactic Antibiotics to prevent infections in patients with hypogammaglobulinaemia due to blood Cancers Trials.

Immunoglobulin products made from donated plasma are routinely used to supplement antibody levels to prevent infections for patients with blood cancers such as myeloma and lymphoma. However, treatment of these disorders has changed dramatically since the original studies on immunoglobulin replacement were conducted, and there is little up-to-date evidence on optimal use of these blood products or alternative therapies. Zoe will continue and expand the TRU clinical trials program to identify which patients are most likely to benefit from immunoglobulin and whether alternatives, such as antibiotics, could also be effective, aiming to improve patient outcomes, reduce risks and costs, and improve stewardship of these precious community resources.

NHMRC Synergy Grant kicks off with planning day

The investigators of the successful NHMRC Synergy grant met for the first time on 21st February to get underway with the 5-year program of work: “Addressing Australia’s national transfusion research priorities.” Main themes of the research include major haemorrhage and massive transfusion, prevention and management of bleeding and anaemia in patients with blood cancers, bleeding and platelet transfusions in patients with critical illness, and efficient and effective use of immunoglobulins.

Pictured left: Investigators and guests

Absent: Prof Jamie Cooper, A/Prof Craig French, Prof Enrico Coiera, Prof Simon Stanworth

Recent publications from the Australian and New Zealand Massive Transfusion Registry

Congratulations to the ANZ-MTR team on two recent publications:

“Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry” was published in the British Journal of Haematology in February 2020, led by Dr Masa Lasica and A/Prof Rosemary Sparrow.

“Clinical coding data algorithm to categorize type of gastrointestinal bleeding as a primary reason for massive transfusion: results from the Australian and New Zealand Massive Transfusion Registry”, was published online in Vox Sanguinis in November 2019, led by Dr Shara Ket and A/Prof Rosemary Sparrow.

TRU welcomes new staff and students for 2020

Prof Erica Wood participates in the APEC Life Science Innovation Forum on Blood Screening and Processing Centralisation through development of Centres of Excellence

Transfusion Research Unit NHMRC Synergy Grant success

Congratulations to all investigators and supporters on the award of a $5 million NHMRC Synergy Grant: “Addressing Australia’s national transfusion research priorities”.

The research focusses on two major themes:

1. Evidence gaps in patient blood management, both in critical bleeding and for support of patients with blood cancers
2. Evidence gaps in immunoglobulin use

The research will include observational studies and interventional trials of new approaches and new blood products.

The Chief Investigators are: Prof Erica Wood, A/Prof Zoe McQuilten, Prof Peter Cameron, Prof D Jamie Cooper, Prof Michael Reade, Ms Alisa Higgins, Prof Judith Trotman, Prof Simon Stanworth and Ms Linley Bielby. The Associate Investigators are: Prof Enrico Coiera, Dr Andrew Flint, A/Prof Craig French, Prof Anthony Harris, Dr Allison Mo, A/Prof John Reynolds, Dr Brenton Sanderson, and Dr Rosemary Sparrow.

Prof Erica Wood attends meeting of World Health Organization anaemia guideline development group

WHO has convened a new guideline development group on the use and interpretation of haemoglobin concentrations for assessing anaemia in both individuals and populations. The multi-disciplinary group met for the first time in Barcelona in November 2019 to identify available evidence and priorities for research and implementation to address these important issues.

The Transfusion Research Unit team at Blood 2019

The TRU team had a strong presence at the Blood 2019 conference. TRU and our collaborators delivered nine oral abstracts and one invited presentation, and presented seven posters, along with hosting well-attended investigator meetings of the Myeloma and Related Diseases Registry (MRDR) and the Lymphoma and Related Diseases Registry (LaRDR, in collaboration with the Australasian Lymphoma Alliance). There were also many visitors to the Monash University booth in the exhibition hall.

Congratulations to Dr Allison Mo, haematologist and TRU PhD student, who was presented with an ANZSBT Research Grant for her work on transfusion practice in myelodysplasia.

Congratulations also to Dr Khai Li Chai, haematologist, who was presented with her HSANZ Leukaemia Foundation Scholarship, which will support her PhD studies with TRU commencing in 2020.

Neil Waters attends AABB and BEST Collaborative meetings in the US

Neil Waters attended the AABB Annual Meeting in San Antonio. AABB is one of the premier international meetings focused on transfusion and cellular therapies science and practice. Neil presented, on behalf of the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR) team, an analysis of data from the New Zealand ANZ-MTR sites on their use of whole blood in massive transfusion.

Neil was also able to attend the Biomedical Excellence for Safer Transfusion (BEST) meeting. The BEST collaborative is a group of over 150 clinicians, scientists and blood services from 22 countries that conducts international studies addressing questions regarding safe transfusion. Monash is an institutional member of BEST.

The Transfusion Research Unit team will be at Blood 2019

Join us in Perth at our Monash University booth in the exhibition hall, at one of our presentations or posters, or for the interest group meetings of the Myeloma and Related Diseases Registry (Monday morning) or Lymphoma and Related Diseases Registry (Tuesday morning). For these meetings please do RSVP so there are enough seats and breakfast!

DIAAMOND trial in aplastic anaemia opens to recruitment!

The DIAAMOND trial (Diagnosis of aplastic anaemia, management and outcomes utilising a national dataset) has opened to recruitment, with Princess Alexandra Hospital in Brisbane being the first site.

DIAAMOND is a phase II, single-arm, registry-based trial which investigates whether avatrombopag, an oral, second-generation thrombopoietin-stimulating agent, improves bone marrow function in patients with either treatment-naïve or relapsed/refractory severe aplastic anaemia.

The trial is funded by the Medical Research Future fund, and uses the platform of the Aplastic Anaemia Registry (AAR), a national registry for patients with AA and other bone marrow failure syndromes.

More information is available at: monash.edu/medicine/sphpm/units/transfusionresearch/diaamond

500th patient recruited to the TREATT trial

TREATT is a randomised placebo-controlled trial of tranexamic acid (TXA, an anti-fibrinolytic agent to prevent clot breakdown) to investigate whether TXA prevents bleeding in patients with blood cancers and low platelets. TXA is already widely used in this setting, but its optimal use, clinical benefit, and safety, need to be established.
TREATT is a collaboration between the NHS Blood and Transplant in the UK and Monash University. The Australian arm of the trial is funded by the NHMRC and the Australian and New Zealand Society of Blood Transfusion. Eleven Australian hospitals are currently participating.

More information is available at treatt.org

Congratulations to the team at Alfred Health who recruited the 500th patient!

International Myeloma Workshop in Boston productive for the Myeloma and Related Diseases Registry (MRDR)

The MRDR team presented at the recent International Myeloma Workshop (IMW) in Boston, attended by over 3200 delegates. In a special Nursing Symposium, Dr Elizabeth Moore, MRDR research fellow, presented results of “My-PROMPT”: a pilot randomised trial testing the feasibility of real-time reporting to clinicians of myeloma patient-reported outcome measures; and Prof Andrew Spencer, MRDR Coordinating Principal Investigator, gave an invited presentation on the role of myeloma registries in improving real-world outcomes. In a plenary session, Andrew Spencer and MRDR steering committee member Prof Joy Ho represented Australia in an update on clinical trials around the world.

MRDR posters included the impact of number of cycles of therapy on outcomes in patients treated with bortezomib induction (A/Prof Peter Mollee), and myeloma in Pacific Islanders in New Zealand (A/Prof Hilary Blacklock).

The inaugural Asia-Pacific MRDR (APAC MRDR: a sister registry of the MRDR) Investigators’ Meeting was held during IMW. It was well attended by investigators from Korea, China, Hong Kong, Taiwan, Singapore and Australia, who discussed progress with Andrew Spencer and APAC MRDR Project Manager Naomi Aoki.

Dr Andrew Flint presents at the Military Health System Research Symposium, Florida

Dr Andrew Flint, Monash PhD candidate, recently presented his work on the ACSePT score for predicting platelet transfusion in cardiac surgery, with an oral abstract entitled “Predictive model for platelet transfusion in patients with acute haemorrhage” at the Military Health System Research Symposium in Florida, USA. Andrew is supervised by Prof Michael Reade, A/Prof Zoe McQuilten and Prof Erica Wood.

Using data from the Massive Transfusion Registry to understand and improve inventory management for major haemorrhage

Helen Haysom, transfusion scientist and project coordinator for the Massive Transfusion Registry (MTR), recently updated members of the Victorian Immunohaematology Discussion Group on two interesting MTR analyses focussing on (1) the use of group O, RhD negative red cells in urgent bleeding situations, and (2) supply of RhD compatible red cells to RhD negative females of child-bearing potential – for whom the two most common major bleeding contexts were trauma and obstetric bleeding. The data were originally presented at the International Society of Blood Transfusion international congress in Toronto in 2018. The MTR provides valuable data for a wide range of purposes, including understanding and improving inventory management.

ICAN study open to recruitment – Immunoglobulin use in Chronic lymphocytic leukaemia And Non-Hodgkin lymphoma

The ICAN project, led by A/Prof Zoe McQuilten, and funded by the National Blood Authority, is collecting data on immunoglobulin replacement and other infection prevention strategies, as well as patient-centred outcomes, in 500 patients with chronic lymphocytic leukaemia (CLL) and non-Hodgkin lymphoma (NHL). In a subgroup of participants, the study will also collect serial blood samples for novel immune-profiling studies. The project uses the network and infrastructure of the Lymphoma and Related Diseases Registry, which includes patients with (CLL), managed by TRU. It complements the work of the IMPROVE study in myeloma, also currently underway. Further information is available below, or by contacting the Lymphoma and Related Diseases Registry (sphpm-lymphoma@monash.edu).

NHMRC Investigator Grant awarded to Professor Erica Wood

Congratulations to Erica Wood, who has been awarded an L2 Investigator Grant by the NHMRC. This prestigious award will support the work of Erica and the Transfusion Research Unit over the next 5 years.

3000^th patient recruited to the Myeloma and Related Diseases Registry

Congratulations to the Myeloma and Related Diseases Registry (MRDR) team – the registry has now recruited more than 3000 patients! The MRDR captures and analyses data on diagnoses, treatment and outcomes for patients with multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS), and supports a number of important linked research activities.

The MRDR is chaired by Professor Andrew Spencer (Alfred Hospital) and managed by the Transfusion Research Unit at SPHPM. Thirty-six sites are already participating across Australia and New Zealand, and more are joining. Congratulations to Northern Hospital in Melbourne who recruited the 3000th patient!

More information on the MRDR and its projects: mrdr.net.au

Information on the Asia-Pacific expansion of the MRDR: apacmrdr.org

Professor Erica Wood delivers plenary lecture at the South African National Blood Transfusion Congress

Erica Wood was an invited international speaker at the recent South African National Blood Transfusion Congress, held in Sun City. Erica shared her experience in three invited presentations on patient blood management, international haemovigilance, and careers in transfusion medicine, and also participated in judging the congress singing competition!

Professor Johanna van der Bom visits the Transfusion Research Unit

Professor Johanna (Anske) van der Bom, Professor of Clinical Epidemiology at the University of Leiden in The Netherlands, and head of Sanquin's Center for Clinical Transfusion Research (CCTR) visited the TRU in July, while in Melbourne for the congress of the International Society of Thrombosis and Haemostasis. Anske shared some of her research group's activities, including the role of the CCTR’s "scientific integrity committee" -- a governance and quality review mechanism for research proposals, publications and data management. Anske was the primary PhD supervisor for Dr Nic Saadah, who re-joined the TRU earlier this year.

A/Prof Zoe McQuilten speaks at the CICM Trauma conference

A/Prof Zoe McQuilten presented an invited lecture on Innovations in Transfusion: Management of Traumatic Haemorrhage at the College of Intensive Care Medicine’s Annual Scientific Meeting in Cairns in June.

TRU at the International Society of Blood Transfusion congress in Basel

Dr Allison Mo and Prof Erica Wood represented TRU at the recent ISBT congress in Basel, Switzerland. Allison made an invited presentation on the multidisciplinary management of anaemia in a session focussed on the role of the transfusion practitioner, and participated in a panel discussion. Erica is president-elect of ISBT.

Photo: L-R: Linley Bielby, Rachel Moss and Allison Mo at the ISBT session. Photo with thanks to Dr Chris Hogan.

Aplastic Anaemia Registry and DIAAMOND study profiled at inaugural National Symposium on Bone Marrow Failure Syndromes, 25–26 May 2019

Data from the Aplastic Anaemia Registry were presented at the inaugural National Symposium on Bone Marrow Failure Syndromes on 25–26 May 2019. Supported by Maddie Riewoldt’s Vision, the symposium attracted nearly 200 participants, including clinicians, research scientists and patients from across Australia and New Zealand.

Dr Lucy Fox, TRU clinical research fellow, provided an overview of registry activities to date and plans for the future. A/Prof Zoe McQuilten presented a summary of the DIAAMOND study of avatrombopag, a second-generation thrombopoietin receptor agonist, which will be trialled in both treatment-naïve and relapsed/refractory adult patients with AA. DIAAMOND study is funded by the Medical Research Future Fund. Prof Erica Wood was a member of the symposium steering committee.

AAR investigators also recently published a review of AA in the Internal Medicine Journal: ncbi.nlm.nih.gov/pubmed/30324755

Celebrating 10 years of the Thrombotic Microangiopathies Registry with a symposium at the International Society on Thrombosis and Haemostasis and TTP practice survey

TRU is celebrating 10 years of the Thrombotic Thrombocytopenic Purpura (TTP)/Thrombotic Microangiopathies Registry, and hosting a one-day symposium on Friday 5 July 2019, as one of the pre-congress symposia ahead of the meeting of the International Society on Thrombosis and Haemostasis in Melbourne, 6–10 July 2019.

The interactive seminar, “Making sense of thrombotic microangiopathies”, features international and Australian invited speakers and interesting case discussions. All are welcome and the symposium is free to attend.

Program and registration information: isth2019.org/pre-congress-symposia

For more information, please contact us via email: Med-TTPRegistry@monash.edu

The TTP Registry is conducting a survey of practice in managing patients with TTP and other TMAs. This survey updates a similar survey performed in 2015, and seeks to determine how widely specialised testing (ADAMTS13 levels, anti-ADAMTS13 antibodies, genetic testing etc) is being performed, the range of therapies used in the management of TTP/TMAs and if, or how, this has changed over the last 4 years.

This survey should take only 15 to 20 minutes: monash.az1.qualtrics.com/jfe/form/SV_0PtGBZ9fqmJaZkV

International REDDS-2 trial – A feasibility randomised pilot trial of weekly-interval red cell transfusion schedule in myelodysplastic syndromes

Building on the success of the REDDS-1 trial of Hb thresholds in MDS, presented at the American Society of Hematology in 2018 (bloodjournal.org/content/132/Suppl_1/527) we are conducting a randomised pilot clinical trial to assess feasibility of delivery of a weekly red cell transfusion schedule using matched red cells, and impact on quality of life and physical function outcomes, in patients with transfusion-dependent myelodysplasia (MDS).

A collaboration between Australia and the UK, the aim of this study is to inform the design and conduct of a definitive international randomised trial to compare different strategies for RBC transfusion in outpatients with MDS. The Australian arm of the study is funded in part by a 2018 research grant from the Australian and New Zealand Society of Blood Transfusion.

A longitudinal population study of current transfusion needs and changes over time in elderly patients with myelodysplastic syndromes

Congratulations to TRU’s Dr Allison Mo (haematologist and PhD student), A/Prof Zoe McQuilten and Prof Erica Wood, and their collaborators A/Prof Jake Shortt of Monash University and Mr Ani Goswami and Ms Christine Quek of Western and Central Melbourne Integrated Cancer Services, who have been awarded 2019 research grant funding from the Australian and New Zealand Society of Blood Transfusion for this project. The research will analyse multiple linked statewide population-based datasets to investigate the current needs and changing trends of transfusion requirements in MDS patients in Victoria over 15 years.

The project will provide new information to clinicians, patients, health services and policy makers on current transfusion needs for MDS patients, and inform policy development and health resource allocation.

2000^th patient recruited to the Lymphoma and Related Diseases Registry

Congratulations to the team at Peter MacCallum Cancer Centre, who recruited the 2000^th patient to the Lymphoma and Related Diseases Registry (LaRDR) on 9th May 2019. Managed by TRU, and established with a pilot in 2016, LaRDR is now open at 17 sites across Australia, collecting data on non-Hodgkin and Hodgkin lymphoma and chronic lymphocytic leukaemia. Several collaborative research projects are underway using the registry, and more are planned.

Further information is available at lardr.org.

Myeloma and Related Diseases Registry participates in Myeloma UK patient workshop

As part of the Myeloma Patient Registry Stakeholder Workshop, held in London on 5th April 2019, the MRDR was pleased to be invited to provide information on our experience in developing a myeloma registry in Australia and New Zealand. Myeloma UK is scoping out a project to establish a registry, and MRDR Research Fellow Dr Elizabeth Moore recorded a narrated slide presentation to share at the workshop, covering research and operational aspects, including governance and funding.

Recruitment completed for the RATIONAL trial

Thanks and congratulations to all patients, site staff and investigators involved in the RATIONAL study. The study completed recruitment in March 2019.

Funded by the National Blood Authority, RATIONAL is a phase II, randomised controlled feasibility trial comparing the efficacy of prophylactic immunoglobulin with prophylactic antibiotics in patients with acquired hypogammaglobulinemia secondary to haematological malignancies. Patients enrolled in the trial are randomised to receive either immunoglobulin replacement therapy, or prophylactic oral antibiotics. The primary outcome is adherence to and acceptability of assigned treatment, with secondary outcomes including infectious outcomes, admissions, costs and quality of life being followed for 12 months.

More information is available at anzctr.org.au/Trial/Registration/TrialReview

2,500^th patient recruited to the MRDR

Among its registry projects, TRU manages the Myeloma and Related Diseases Registry (MRDR). The MRDR, chaired by Professor Andrew Spencer of the Alfred Hospital, captures and analyses data on patterns of treatment and variation in patient outcomes (both survival and quality of life) for patients with multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS). The first patients were enrolled in 2013. More than 30 sites from Australia and New Zealand are already participating and additional sites are continuing to join.

Congratulations to Christchurch Hospital in New Zealand who recruited the 2,500^th patient!

Ultimately, MRDR data will help clinicians and hospitals to provide the best possible care to people with myeloma and MGUS and allow evaluation of the translation of advances in therapy (such as the introduction of new targeted therapies) into long-term outcomes, outside the setting of clinical trials.

More information on the MRDR and its projects is available at: mrdr.net.au
Information on the Asia-Pacific expansion of the MRDR is available at: apacmrdr.org

400^th patient recruited to the TREATT trial

TREATT is a randomised trial of tranexamic acid (TXA, an anti-fibrinolytic agent to prevent clot breakdown) or placebo to investigate whether TXA prevents bleeding in adult patients with a haematologic malignancy and profound thrombocytopenia.

TREATT is a collaboration between the NHS Blood and Transplant in the UK and Monash University. The Australian arm of the trial is funded by the NHMRC and the Australian and New Zealand Society of Blood Transfusion. Ten Australian hospitals are currently participating.

More information is available at treatt.org

Congratulations to the team at Peter MacCallum Cancer Centre in Melbourne who recruited the 400^th patient!

TRU at the American Society of Hematology conference

Prof Erica Wood, A/Prof Zoe McQuilten and Dr Lucy Fox represented TRU at the recent ASH meeting in San Diego.

Data from the UK-Canada-Australian REDDS pilot study of red cell transfusion in patients with myelodysplasia were presented as an oral abstract by Dr David Bowen, with Zoe McQuilten as a co-author. See abstract 527: A Feasibility Randomized Trial of Red Cell Transfusion Thresholds in Myelodysplasia. Available at: https://ash.confex.com/ash/2018/webprogram/Paper112949.html

Lucy Fox and Erica Wood were co-authors on a poster presenting data from the Melbourne Genomics Health Alliance Bone Marrow Failure Flagship. See abstract 3867: Providing Diagnoses in Bone Marrow Failure Syndromes through Multimodal Comprehensive Genomic Evaluation and Multidisciplinary Care: The Melbourne Genomics Health Alliance Bone Marrow Failure Flagship. Available at https://ash.confex.com/ash/2018/webprogram/Paper114410.html

Zoe and Erica also met with colleagues for a steering committee meeting of the Asia-Pacific Myeloma and Related Diseases Registry, and made a presentation to the Myeloma Canada Research Network.

ICAN study – Immunoglobulin use in Chronic lymphocytic leukaemia And Non-Hodgkin lymphoma – funded by the National Blood Authority

Patients with certain types of non-Hodgkin lymphoma (NHL), including chronic lymphocytic leukaemia (CLL), are at increased risk of infections due to the effects of their disease and treatment on levels of protective antibodies. Immunoglobulin therapy (made from donated plasma) is commonly used to prevent infections by replacing protective antibodies in this patient group, and is one of the most common and fastest growing indications in Australia. Availability of novel treatments with profound and protracted immunosuppressive effects will likely mean that immunoglobulin demand will continue to grow.

However, there is limited evidence from clinical studies to guide clinicians on which patients are most likely to benefit, when to commence treatment, or for how long. The role of other strategies to prevent infection, such as prophylactic antibiotics and immunisations, have not been well studied.

Working with the Australian Lymphoma and Related Disease Registry and the newly established CLL Registry, both managed by TRU, the ICAN project will collect data on current immunoglobulin replacement and other infection prevention strategies, as well as patient-centred outcomes, in Australian patients with CLL and NHL. In a subgroup of participants, the study will also collect serial blood samples for novel immune-profiling studies.

The ICAN investigators are Zoe McQuilten, Erica Wood and Neil Waters from Monash University’s Transfusion Research Unit; other Monash University colleagues Orla Morrissey, Stephen Opat, Jonathan Wong and John Zalcberg; Philip Crispin from Canberra Hospital; Stephen Mulligan and Kyle Crassini from Royal North Shore Hospital/University of Sydney; and Monica Slavin and Benjamin Teh from Peter MacCallum Cancer Centre/ NHRMC National Centre for Infections in Cancer.

NHMRC success with the ASPREE-CHIP study for TRU’s A/Prof Zoe McQuilten and colleagues

A/Prof Zoe McQuilten and colleagues have been awarded $1.416 million for a study of clonal haematopoiesis of indeterminate potential (CHIP) in the elderly. This project will investigate CHIP in participants from the ASPirin in Reducing Events in the Elderly (ASPREE) study, a randomised controlled trial of daily low-dose aspirin or placebo in over 19,000 elderly but otherwise well individuals (www.aspree.org).

CHIP is the presence of a haematological malignancy-associated somatic mutation in blood or marrow without evidence of haematological disease. CHIP is increasingly common with increasing age, and is associated with risk of haematological cancers, coronary heart disease and ischemic stroke. Mouse models support a causative link between CHIP and development of atherosclerosis. However, very few studies have been performed in humans to date, and fundamental gaps remain in our understanding.

Using ASPREE trial data on incident haematological cancers, cardiovascular events, stroke, dementia and all-cause mortality, and biobanked samples at baseline and 3 years, we will study CHIP and its clinical consequences. We will also investigate the role of inflammation, and whether reducing inflammation through use of low-dose aspirin alters incidence, progression and consequences of CHIP.

Investigators on the NHMRC-funded grant are: Zoe McQuilten and Erica Wood from Monash University’s Transfusion Research Unit, other Monash University colleagues David Curtis, Rory Wolfe, Paul Lacaze, John McNeil, Andrew Murphy, Moeen Riaz, Nick Wong and Robyn Woods, and Robert Sebra Icahn School of Medicine at Mount Sinai, USA.

CLIP-II study of frozen platelets funded by NHMRC

CLIP-II is a phase III, multicentre blinded randomised controlled clinical non-inferiority trial of cryopreserved platelets versus conventional liquid-stored platelets for the management of post-cardiac surgical bleeding.

The CLIP-II team have been awarded $1.825 million by the NHMRC for the project.

CLIP Chief Investigator Dr Michael Reade leads a team of experts from around Australia and New Zealand, including Drs Zoe McQuilten and Erica Wood of the Transfusion Research Unit at Monash University.

Sharing Massive Transfusion Registry data with transfusion practitioners

Dr Rosemary Sparrow and Mrs Helen Haysom provided an update on the Massive Transfusion Registry as part of the Blood Matters Transfusion Forum in November.

The MTR now has data on over 8,000 cases of critical bleeding from 29 hospitals across all clinical contexts, including trauma, obstetrics, surgery and gastrointestinal haemorrhage. An additional 20 sites are in the process of joining. The MTR is proving valuable for both research and for clinical practice improvement and benchmarking, and data are provided to participating sites via hospital data reports, letters and presentations. Results have been presented this year at the BLOOD 2018 conference in Brisbane, the International Society of Blood Transfusion congress in Toronto, and the AABB conference in Boston, as well as through several publications.

Current MTR research projects include analyses of:

• use of group O, RhD negative red cells in critical bleeding
• ratios of FFP to red cells transfused in early traumatic resuscitation
• management and outcomes of major obstetric haemorrhage
• impact of age of transfused red cells in massive transfusion events
• ultramassive transfusions
• rapid infusion practices
• age of platelets in massive transfusion events
• major bleeding in patients undergoing cardiac surgery in partnership with the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database

If you have an idea for a project using MTR data, please get in touch with us: sphpm.mtr@monash.edu

TRU at BLOOD 2018 conference

The Transfusion Research Unit was well represented at the recent Australian and New Zealand annual haematology and transfusion conference, BLOOD 2018, held in Brisbane. Staff and collaborators contributed two invited presentations, nine oral abstracts and seven posters. Congratulations to Dr Elizabeth Moore who received a poster prize.

TRU’s exhibition booth was a great opportunity to profile the Unit’s research and hold informal discussions with delegates. Breakfast meetings for the lymphoma and myeloma registries included presentations by invited speakers as well as review of registry data and project updates, and were well attended by clinicians and industry partners.

Dr Rosemary Sparrow awarded honorary membership of BEST Collaborative

Dr Rosemary Sparrow represented the Transfusion Research Unit team at the Biomedical Excellence for Safer Transfusion (BEST) Collaborative meeting that was held in Newport, Rhode Island (USA). BEST is an international research group, with scientific membership drawn from individuals recognised as having high-level accomplishments in transfusion research. TRU is an institutional member of BEST.

Congratulations to Rosemary for being made an honorary member for her previous and ongoing contributions to BEST and transfusion research, and becoming the first Australian to be awarded this honour.

TRU at AABB 2018 meeting

The Transfusion Research Unit was well represented at the AABB (formerly American Association of Blood Banks) annual meeting in Boston, USA. TRU team members contributed two posters and one oral abstract. Congratulations to PhD student Phil Kiely who received a top poster award for 'Modelling the transfusion-transmission risk of West Nile Virus in Australia associated with travelling blood donors'. Dr Rosemary Sparrow (left) presented a poster on the use of group O negative red cells in critical bleeding, on behalf of the Massive Transfusion Registry investigators.

Prof Erica Wood and Dr Zoe McQuilten co-authored an abstract on an Australian clinical trial of cryopreserved platelets in cardiac surgery, presented in the Plenary Oral Abstract Session for the top six submitted abstracts.

ASPREE trial published in New England Journal of Medicine

The results of the Australia-US ASPREE trial of low-dose aspirin in the elderly have been published in three concurrent papers in the New England Journal of Medicine.

One of the publications focussed on clinically significant bleeding. Prof Erica Wood of Monash University’s Transfusion Research Unit chaired the ASPREE clinically significant bleeding panel and was one of the authors on this paper.

See: McNeil JJ, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018 Oct 18;379(16):1509-1518. doi: 10.1056/NEJMoa1805819.

More information is available at: aspree.org/aus

Frailty-stratified, randomised controlled Bayesian adaptive trial of bortezomib versus lenalidomide in transplant-ineligible myeloma – the FRAIL-M study – funded by the Medical Research Future Fund

TRU’s Zoe McQuilten, Erica Wood, Elizabeth Moore and Cameron Wellard are investigators on the FRAIL-M study. The project will utilise the infrastructure of the Myeloma and Related Diseases Registry (MRDR) managed by Monash University’s Transfusion Research Unit. Professor Andrew Spencer (Monash University/Alfred Hospital) is Chief Investigator A on FRAIL-M and chair of the MRDR Steering Committee. Funding of $1.642 million has been awarded by the MRFF through its call for applications for “Low Survival Cancers and Diseases”.

Current Australian guidelines recommend that up-front therapy for transplant-ineligible myeloma patients should be either bortezomib- or lenlidomide-based regimens, with dosing adjusted according to patient frailty. However, adapting treatment dose according to frailty assessment has not been tested in a clinical trial.

FRAIL-M is a stratified randomised controlled trial to identify which competing treatment options are more appropriate in transplant-ineligible myeloma patients according to frailty status. Participants will be stratified into three groups (fit, intermediate-fit or frail) based on a standardised and validated frailty assessment, and randomised to a bortezomib- vs a lenalidomide-based regimen, with dosing adjusted according to frailty stratum. A Bayesian Optimal Phase II design will allow us to jointly monitor efficacy and toxicity, with further adjustments if individual treatment arms appear either too toxic or ineffective.

The FRAIL-M investigators are Andrew Spencer, Zoe McQuilten, Hang Quach, Peter Mollee, Erica Wood, John Reynolds, Ruth Hubbard, Richard De Abreu Lourenco, Cameron Wellard, Elizabeth Moore, Madeleine King, Steve Roach and Tracy King.

TRU congratulates Dr Nicholas Saadah who was awarded his PhD from the University of Leiden on 11 September 2018

Nic’s thesis was entitled: Hemovigilance, heterogeneity, and hyperfibrinolysis; evaluating the Netherlands’ switch to solvent/detergent plasma". His studies focussed on the changing use of plasma transfusions at national level in The Netherlands, and internationally, including an analysis of information from the ISTARE database of the International Haemovigilance Network. He was supervised by Prof. J.G. (Anske) van der Bom and Dr Martin Schipperus.

Nic was an academic visitor to Monash during 2017, working on a range of transfusion research projects. Prof Erica Wood from the TRU was a member of the PhD defence panel for the University of Leiden.

The Asia-Pacific Myeloma and Related Diseases Registry has opened to recruitment at Samsung Medical Center in Korea!

The APAC MRDR is a clinical registry which collects health information on patients diagnosed with multiple myeloma, or related diseases such as plasmacytoma, plasma cell leukaemia, or monoclonal gammopathy of undetermined significance (MGUS) living in the Asia-Pacific region.

The registry was established in 2018 by Monash University, and in collaboration with participating pilot hospitals in Korea, Singapore, Hong Kong and Taiwan, and is affiliated with the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR).

The APAC MRDR aims to provide health care services and researchers an important resource for investigating the best possible treatment options for people with these conditions. The Registry will tell us about:

• the usefulness and results of available treatments over time
• the variation in care provided and how this compares to best practice internationally

The Registry will also form a network of clinical experts from the Asia-Pacific region with a special interest in myeloma and related diseases.

Information on the Asia-Pacific expansion of the MRDR is available at: apacmrdr.org or please contact the project team at sphpm.apacmrdr@monash.edu

More information on the Australian and New Zealand MRDR and its projects is available at: mrdr.net.au

TRU awarded $1.75m for DIAAMOND PROJECT

Erica Wood and Zoe McQuilten of Monash University’s Transfusion Research Unit, in collaboration with colleagues from across Australia, have been awarded $1.75 million funding from the Medical Research Future Fund for the DIAAMOND project: Diagnosis of aplastic anaemia, management, and outcomes utilising a national dataset.

Aplastic anaemia is a life-threatening condition, and the only curative option, haematopoietic stem cell transplant, is not available to many patients. This study of avatrombopag (a second-generation thrombopoietin receptor agonist) in patients with treatment-naïve or relapsed/refractory aplastic anaemia, builds on promising results from recent studies with eltrombopag. The trial, using a novel Bayesian adaptive design, will be conducted using the Aplastic Anaemia Registry and is anticipated to open in early 2019.

If you are interested in participating in the Aplastic Anaemia Registry, or the DIAAMOND study, please contact us at: aar@monash.edu or sphpm.diaamond@monash.edu