Social Media Network Utility in Disease Education: Experience from a CML-Disease Awareness Medical Education Program

Background: Digital platforms designed for medical specialists have potential to enhance the delivery of continued education for healthcare professionals (HCPs). Chronic myeloid leukemia (CML) is a relatively rare disease: some HCPs may treat only a handful of patients per year, but nonetheless need to be up-to-date with the latest advances in therapy and treatment recommendations. Achievement of sustained deep molecular response with tyrosine kinase inhibitors (TKIs) is associated with improved long-term clinical outcomes, and potentially provides patients with the option of treatment discontinuation/treatment-free remission (TFR). Monitoring of molecular response - and adjusting treatment or initiating TFR - is an increasingly important part of CML management. The aim of this digital medical education program was to educate an online community of HCPs on CML using an interactive, case-based, on-demand approach to medical education. Here we report the uptake and impact of this program. Methods: The program comprised three components. Two hypothetical case studies were developed based on typical challenges in CML management (Case study 1, molecular monitoring; Case study 2, TFR). These were shared with a digital community of HCPs who were invited by email to engage with these cases. This network included medical oncologists, hematologists, pathologists, internists, cardiologists, medical residents, nurse practitioners and advanced practice registered nurses, physician assistants, and medical students. Each case study included 3 multiple choice questions designed to assess the educational impact of the content. When an incorrect answer was selected, a detailed explanation of the correct answer was provided, ensuring that the educational gap was addressed. The third component of the CML digital education program was an expert question and answer (Q&A) session with a CML specialist. In place of a live Q&A, members of the network were invited to post questions for the specialist at any time prior to or during a scheduled Q&A. These were addressed during a 1-hour virtual event that could be followed for a real-time discussion on CML-related topics such as mutation testing, risk scores, molecular monitoring, the International Scale (IS), and sensitivity of BCR-ABL1 testing for monitoring. Results: Case study engagement was high: 3202 recipients interacted with the cases and 2144 HCPs responded to the 6 questions relating to those 2 case studies. Overall, 41% of respondents did not know that patients with CML should be monitored every 3 months. Only 30% of respondents knew that when starting therapy, polymerase chain reaction (PCR) testing should use a threshold of at least MR4.5 (BCR-ABL1IS ≤0.0032%). Over two thirds of respondents did not know that MR3.0 (BCR-ABL1IS ≤0.01%) was the BCR-ABL1 level at which TKI therapy should be restarted in patients in TFR, and only 16% of respondents knew that BCR-ABL1 level should be assessed monthly in this population. Over half of respondents were not familiar with the eligibility criteria (MR4.5 for ≥2 years with sensitivity of PCR test at least MR4.5) that indicate a patient can discontinue TKI therapy. A total of 2844 HCPs engaged in the expert virtual Q&A forum 5989 times. Participants included medical students (46%), nursing professionals (22%), physician assistants (14%), medical residents (11%), other target physicians (6%) and hematologists/oncologists (1%). HCPs posed 17 questions/comments to the expert, including 8 questions from hematologists/medical oncologists. The expert posted 22 responses, thereby increasing the educational material shared with the participants. Conclusions: During this medical education program, over 2100 HCPs accessed and interacted with the on-demand CML education. The proportion of correct responses to the questions about each case study indicates a gap in HCP knowledge around molecular monitoring and TFR. This digital medical education pilot supported a need for further education in these topics and provided a new approach via medical network learning, using interactive case studies and expert discussion. It illustrates the potential utility of such resources in the continuing education of HCPs on a larger scale. Further study may improve audience targeting and educational yield. Disclosures Atallah: Helsinn: Consultancy; Helsinn: Consultancy; Novartis: Consultancy; Pfizer: Consultancy; Jazz: Consultancy; Takeda: Consultancy, Research Funding; Jazz: Consultancy. Kota:Novartis: Honoraria; Amgen: Honoraria; Pfizer: Honoraria; Xcenda: Honoraria; Takeda: Honoraria. Sadek:Novartis: Employment. Damon:Novartis: Employment, Other: Stock. Jen:Novartis: Employment. Landy:Figure 1: Employment, Other: Shareholder and co-founder; Novartis: Research Funding. Vorona:Incyte Corporation: Research Funding; Tolero Pharmaceuticals: Research Funding; Takeda Oncology: Research Funding; Novartis: Research Funding. Radich:TwinStrand Biosciences: Research Funding; Novartis: Other: RNA Sequencing.

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Evaluation of the Different Stratification Models for POD24 Prediction in Patients with Follicular Lymphoma

Blood ◽

10.1182/blood-2020-142000 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 24-25

Author(s):

Wei Wu ◽

Alessio Bruscaggin ◽

Alexandra Valera ◽

Elena Flospergher ◽

Ferdinando Bonfiglio ◽

...

Keyword(s):

Medical Education ◽

High Risk ◽

Follicular Lymphoma ◽

Board Of Directors ◽

Education Program ◽

Continuing Medical Education ◽

Research Funding ◽

Prognostic Index ◽

Advisory Committees ◽

Medical Education Program

Introduction Progression of disease within 2 years after starting rituximab-chemotherapy (POD24) has been identified as a convincing adverse prognostic factor for follicular lymphoma (FL), and can serve as a clinical endpoint to identify patients at high risk of early lymphoma-related mortality. However, POD24 is not accessible at diagnosis. Several stratification models adopting baseline variables have been developed for predicting outcomes in FL patients. The Follicular Lymphoma International Prognostic Index (FLIPI) and PRIMA Prognostic-Index (PRIMA-PI) include clinical characteristics, while m7- Follicular Lymphoma International Prognostic Index (m7-FLIPI) and POD24 Prognostic Index (POD24-PI) integrate gene mutations with clinical features. Moreover, the mutation status of specific genes (including TP53, EZH2, TNFRSF14, and BCL2) has been reported to be relevant to early progression. It has been reported that m7-FLIPI and POD24-PI are predictive for POD24. Here we compare the diagnostic accuracy for POD24 of various stratification models and gene mutations in an institutional cohort of FL. Methods Consecutive patients diagnosed as FL grades 1-3a were enrolled from the Oncology Institute of Southern Switzerland (n=75), the University of Eastern Piedmont (n=118), and the Hematology of the AUSL IRCCS of Reggio Emilia (n=59). DNA was extracted from FFPE tissue specimen obtained at diagnosis. We performed CAPP-seq to detect the mutation status of the genes included in m7-FLIPI and POD24 PI (EZH2,ARID1A, MEF2B, EP300, FOXO1, CREBBP, and CARD11), as well as BCL2, TNFRSF14 and TP53. POD24 was the primary endpoint of this research. Sensitivity, specificity, predictive values and balanced accuracy of every stratification model were calculated to estimate the prognostic efficacy. Results With FLIPI score, 34% of patients were classified as low risk, 22% as intermediate risk, and 41% as high risk. With PRIMA-PI, the fractions for low risk, intermediate risk and high risk group were 24%, 21% and 49%, respectively. With m7-FLIPI, 82% of patients were low risk, and 15% high risk. For POD24-PI, 65% of patients were low risk, and 32% high risk. The mutation frequencies of TP53, TNFRSF14, EZH2 and BCL2 were 8%, 28%, 27% and 38%, respectively. We validated the prognostic utility of FLIPI, PRIMA-PI, m7-FLIPI and POD24-PI for progression free survival (PFS) and OS. However, no statistically significant relevance with PFS or OS has been found for TP53, TNFRSF14, EZH2 or BCL2 mutations. POD24 was calculated in the 142 patients who received systemic treatment (immunotherapy or chemoimmunotherapy) within 6 months from diagnosis: 18% of them were POD24-positive. POD24 positivity associated with shorter overall survival (OS) (p=0.0138). After adjusting for multiple comparisons, no high-risk groups identified by TNFRSF14, EZH2 or BCL2 gene mutations, FLIPI, PRIMA-PI, m7-FLIPI or POD24-PI were associated with POD24. In terms of diagnostic performance for POD24, PRIMA-PI showed the highest accuracy (57%), FLIPI had the highest positive predictive value (64%), and m7-FLIPI had the highest negative predictive value (82%). Conclusion The mutation status of specific single genes were not related to POD24, PFS nor OS, indicating that the mutation of single gene may not be sufficient to identify high-risk FL patients. Though retaining their prognostic value, the integration of mutations onto the clinical biomarker-based prognostic scores has a limited discrimination capacity for POD24. Our results prompt the investigation of: i) POD discrimination capacity of prognostic models based on molecular phenotypes (i.e. gene expression) reflecting the tumor-microenvironment milieu; ii) new models based on a combination of biomarkers capturing the most informative clinical, genetic and phenotypic features. Figure 1 Disclosures Moccia: Takeda: Consultancy, Other: Advisory Boards: Roche, Janssen, Takeda; Roche: Consultancy, Other: Advisory Boards: Roche, Janssen, Takeda; Janssen: Consultancy, Other: Advisory Boards: Roche, Janssen, Takeda. Stathis:ADC Therapeutcis: Other, Research Funding; Abbvie: Other: Travel Grant; MEI Pharma: Other, Research Funding; Novartis: Other, Research Funding; Roche: Other, Research Funding; Pfizer: Other, Research Funding; PharmaMar: Other: Travel Grant; Cellestia: Research Funding; Loxo: Honoraria, Other, Research Funding; Member of the steering committee of the trial of this abstract: Other; Bayer: Other, Research Funding; Merck: Other, Research Funding. Gerber:Alnylam: Other: funding for accredited continuing medical education; Axonlab: Other: funding for accredited continuing medical education program ; Bayer: Other: funding for accredited continuing medical education program ; Bristol Myers Squibb: Other: funding for accredited continuing medical education program ; Daiichi-Sankyo: Other: funding for accredited continuing medical education program ; Janssen: Other: funding for accredited continuing medical education program ; Mitsubishi Tanabe Pharma: Other: funding for accredited continuing medical education program ; NovoNordisk: Other: funding for accredited continuing medical education program ; Octapharma: Other; Takeda: Other; Sanofi: Other; SOBI: Other; Thermo Fishe: Other; Axonlab: Other; Pfizer: Other: personal fees ; Sanofi: Other: funding for accredited continuing medical education. Gaidano:Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Astrazeneca: Membership on an entity's Board of Directors or advisory committees; Sunesys: Membership on an entity's Board of Directors or advisory committees. Rossi:Gilead: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding. Zucca:Roche: Membership on an entity's Board of Directors or advisory committees, Other: Travel Grants, Research Funding; Celltrion Healthcare: Membership on an entity's Board of Directors or advisory committees; Kite: Membership on an entity's Board of Directors or advisory committees; Abbvie: Other: Travel Grants; Beigene: Membership on an entity's Board of Directors or advisory committees; Incyte: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Membership on an entity's Board of Directors or advisory committees, Research Funding.

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