scholarly journals Social and Demographic Factors Contributing to COVID-19 Vaccine Hesitancy in Patients with Hematologic Malignancies

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 841-841
Author(s):  
Karen Sweiss ◽  
Meredith Russell ◽  
Gregory S Calip ◽  
Ryan Nguyen ◽  
Meshaal Khan ◽  
...  
Keyword(s):  
Social Media ◽  
Side Effects ◽  
High Risk ◽  
Healthcare Professionals ◽  
Hematologic Malignancies ◽  
Vaccine Hesitancy ◽  
Depth Information ◽  
Hematopoietic Stem ◽  
Personal Impact ◽  
Vaccine Refusal

Abstract Background Vaccine hesitancy, defined as the delay in acceptance or refusal of safe vaccines, remains a challenge in the general population. Given that patients with hematologic malignancies frequently encounter healthcare professionals and are at high risk of severe COVID-19 infection, their attitudes towards vaccines may differ from other patient groups. We therefore performed a survey-based study to investigate vaccine hesitancy within an ethnically diverse group of patients diagnosed with hematologic malignancies. Methods We administered a 122-item questionnaire from December 2020 to January 2021 (prior to commercial availability of the COVID-19 vaccines) to 60 patients with hematologic malignancies. Questions were separated into the following categories: demographic and socioeconomic data; personal impact of COVID-19 infection; COVID-19 pandemic experience; COVID-19 infection perceptions; COVID-19 vaccine perceptions; and baseline COVID-19 vaccine knowledge. Results The majority of patients were Black (n=33, 55%) or Hispanic (n=11, 18.3%) and were undergoing active treatment (n=43, 71.7%) or had received prior hematopoietic stem cell transplantation (n=9, 15%). Eight (13.3%) patients had prior COVID-19 infection. Sixteen (26.7%) patients reported infection in an immediate family member while 15 (25%) reported infection in a friend. 20 of these cases were moderate in severity requiring healthcare interaction, and 17 of these cases were reported to result in severe infection (n=7, 9.6%) or death (n=10, 13.7%). Only 16 (29.6%) patients perceived themselves to be at high or very high risk of COVID-19 infection. The COVID-19 pandemic was reported to moderately or severely affect employment/income in 10 (22.8%) patients and led to worse mental health in 10 (22.3%) patients. However, the majority of patients reported no negative impact on their cancer treatment (n=37, 88.1%) or prognosis (n=45, 93.8%). Of the 60 patients, 22 (40.7%) reported that if a COVID-19 vaccine was made publicly available in the next 30 days, they would not vaccinate themselves, either due to safety concerns (n=4, 20%) or indifference (n=6, 30%). Despite this, 43 (78.2%) patients stated that vaccination was an important tool in ending the pandemic. More patients agreed to accept the vaccine if it was made available in 6 months from the time of survey (n=40, 76.9%). Only 32 (59.3%) patients were extremely or very likely to accept a yearly vaccine. In terms of perception on cancer outcomes, 31 (62%) patients were uncertain if the vaccine would interact negatively with their current chemotherapy treatment, while 27 (52.9%) believed the vaccine would make their cancer worse. The biggest fear patients had about COVID-19 vaccines were side effects or death (n=15, 38.5%) and complications to cancer/cancer therapy (n=5, 12.8%). Only 6 (15.4%) patients stated they had no fears related to COVID-19 vaccination. In fact, only 21 (39.6%) patients agreed or strongly agreed that the side effects of most vaccines outweigh the benefits. In a modified (age- and sex-adjusted) Poisson regression model (Table 1) that included baseline demographics and answers to select survey questions, older age was associated with a stronger likelihood of vaccine acceptance (RR 1.73, 95% CI 1.11-2.71; p=0.016), while female gender was associated with less likelihood to accept the vaccine (RR 0.58, 95% CI 0.37-0.90; p=0.016). Patients reported as "other" race (e.g., Asian) were more inclined to accept the vaccine (RR. 2.21, 95% CI 1.16-4.20; p=0.016) compared to White patients. Finally, when compared to patients who receive information primarily from medical professionals, those patients who received their information from social media or friends were far less likely to accept the vaccine (RR 0.02, 95% CI 0.01-0.04; p<0.001). Conclusion This is the first study to report that although patients with hematologic malignancies experienced significant medical and social burdens from the COVID-19 pandemic and have frequent interaction with healthcare professionals, a high rate of COVID-19 vaccine hesitancy still exists. We provide in depth information on the potential reasons for vaccine refusal in a diverse patient population and highlight potential areas for improvement in patient education. In particular, we show that vaccine disinformation received from friends and social media is a significant reason for vaccine refusal. Figure 1 Figure 1. Disclosures Calip: Pfizer: Research Funding; Roche: Current equity holder in publicly-traded company; Flatiron Health: Current Employment. Rondelli: Vertex: Membership on an entity's Board of Directors or advisory committees. Patel: Celgene: Consultancy.

Prospective Evaluation Of Allo-HSCT From Haploidentical-Related Donors Compared With Matched Sibling Donors and Unrelated Donors For Patients With Hematological Malignancies: Results From An Open-Label Trial

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3338-3338
Author(s):  
Yi Luo ◽  
Haowen Xiao ◽  
Xiaoyu Lai ◽  
Jimin Shi ◽  
Yamin Tan ◽  
...  
Keyword(s):  
High Risk ◽  
Conflicts Of Interest ◽  
Prospective Trial ◽  
Hematologic Malignancies ◽  
Treatment Schedule ◽  
Hematopoietic Stem ◽  
High Risk Patients ◽  
Risk Patients ◽  
Unrelated Donors ◽  
Matched Sibling

Abstract Introduction The order of alternative donor selection for hematopoietic stem cell transplantation (HSCT) for patients with hematologic malignancies has not been addressed. We performed the first prospective trial to compare the effect of HSCT from matched sibling donors (MSDs), unrelated donors (URDs) and haploidentical- related donors (HRDs) in a contemporary protocol. Methods From 2008 to 2012, 234 patients with hematologic malignancies were enrolled. The treatment schedule was as follows: if a fully MSD was available, patients were assigned treatment with MSD-HSCT. If an MSD was unavailable, a suitably matched URD was used as the alternative, where a suitable match involved matching more than 8 of 10 HLA-A, -B, -C, -DRB1and DQ allele loci ( ¡Ý 8/10) and at least 5 of 6 matching HLA-A, -B, and -DRB1 antigen loci. If only URDs with > 2 mismatching allele loci were available, patients were allowed treatment with HRD-HSCT. Results (1) Sixty-eight patients underwent MSD-HSCT, 98 patients underwent URD-HSCT, and 68 patients underwent HRD-HSCT (Table 1). (2) Grades II¨CIV and severe aGVHD were all significantly more frequent in patients undergoing HRD-HSCT compared with those undergoing MSD-HSCT (II¨CIV: 42.6% vs 19.1%, P = 0.0015; severe aGVHD: 17.65% vs 5.88%, P = 0.03). However, the incidences of II¨CIV and severe aGVHD were comparable in patients receiving transplants from HRDs to those from URDs (II¨CIV: 42.6% vs 40.8%, P = 0.89; severe aGVHD: 17.65% vs 13.27%, P = 0.48). The incidence of cGVHD was not significantly affected by donor types. (3) The 4-year incidence of relapse was not significantly affected by donor types according to all patients (24.2% in the MSD cohort, 22.8% in the URD cohort, 11.9% in the HRD cohort, P > 0.05). However, after controlling for high-risk patients, a superior graft-versus-leukemia (GVL) effect was observed in patients undergoing HRD-HSCT compared to MSD-HSCT or URD-HSCT. In high-risk patients receiving MSD, 36.8% experienced relapse, as did 33.6% in the URD cohort, but the incidence decreased to11.1% in the HRD cohort (MSD vs HRD, P = 0.015; URD vs HRD, P = 0 .028). (4) HRD-HSCT yielded comparable rates of 4-year overall survival (OS) and disease-free survival (DFS) to MSD-HSCT ( OS: 66.4% vs 79.5%, P = 0.071; DFS: 66.4% vs 78.2 %, P = 0.109) or URD-HSCT (OS: 66.4% vs 59%, P = 0.952; DFS: 66.4% vs 58.1%, P = 0.864) (Figure 1). Conclusion Our data provide convincing clinical evidence to support the use of HRDs, as well as URDs, can be selected as first-line alternative donors, especially for high-risk patients. Disclosures: No relevant conflicts of interest to declare.

Spontaneous Mutations of Bcor and Jak1/2 genes Lead to an Aggressive Leukemia of B-1 Progenitor B Cells

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3573-3573
Author(s):  
Sheryl M Gough ◽  
Liat Goldberg ◽  
Marbin Pineda ◽  
Robert L Walker ◽  
Yuelin J Zhu ◽  
...  
Keyword(s):  
High Risk ◽  
B Cell ◽  
Progenitor Cell ◽  
Conflicts Of Interest ◽  
Fusion Gene ◽  
Hot Spot ◽  
Lymphoblastic Leukemia ◽  
Hematologic Malignancies ◽  
Janus Kinase ◽  
Hematopoietic Stem

Abstract NUP98 gene fusions, generated by non-random chromosomal translocations, are associated with a wide spectrum of high risk hematologic malignancies and have been shown to alter normal hematopoietic stem and progenitor cell (HSPC) gene expression programs. A recurrent t(11;17)(p15;p13) translocation in patients with AML leads to the production of a NUP98–PHF23 (NP23) fusion gene. The consequent NP23 fusion protein retains the PHD domain, known to bind H3K4me3, and is thought to have aberrant chromatin regulation properties. We have generated a transgenic mouse model of the NUP98-PHF23 gene fusion which develops a range of hematologic malignancies, most commonly pre-T LBL and AML. However, approximately 10% of NP23 mice develop an aggressive B-1 progenitor acute lymphoblastic leukemia (pro B-1 ALL). B-1 and B-2 lymphocytes have distinct developmental pathways and are thought to represent arms of the innate and adaptive immune systems, respectively. Mature B-2 lymphocytes predominate in the peripheral circulation, and are characterized by expression of B220; whereas B-1 lymphocytes are more prevalent in the pleural and peritoneal cavities, and do not express B220. Murine B cell malignancies typically stain positive for B220, and represent transformed B-2 cells. In the present study, NP23 progenitor ALLs displayed an immunophenotype (Lin-B220- CD19+ AA4.1+) that was identical to that of the recently described B-1 progenitor cell. All B-1 progenitor ALLs exhibited clonal rearrangements of the IgH gene locus. Specifically, these rearrangements involve favored usage of 3’ VH regions, similar to observations with fetal B-1 progenitor cells, further supporting the notion that these are leukemias of B-1 progenitors. Using whole exome sequencing, we found acquired mutations in the BCL6 interacting corepressor (Bcor) gene in 5 out of 7 B-1 progenitor leukemias. The mutations were all frame shift or nonsense mutations, and were located within a 9 bp “hot spot” in Bcor exon 8. In addition, 4 of 7 cases had somatic mutations of Janus kinase 1 (Jak1) or 2 (Jak2), and 7/7 cases showed hyperphosphorylation of Stat3 or Stat5, consistent with the contention that the Jak1/2 mutations are activating mutations, and leading to a hypothesis that the NP23 pro B-1 ALLs which do not harbor Jak1/2 mutations may have acquired an unidentified mutation in the Jak-Stat pathway. Of note, Jak1/2 mutations have previously been identified in a subset of high-risk pediatric B-cell precursor ALL patients. The striking correlation between Bcor and Jak1/2 mutations, occurring specifically in a subset of NP23 leukemias, implies that these three mutations (NP23, Bcor, and Jak1/2) collaborate and provide the oncogenic setting for B-1 progenitor transformation. Disclosures No relevant conflicts of interest to declare.

Identification of Highly Clonal Cells in CD34+ and Unselected Bone Marrow Samples From Patients with Myelodysplastic Syndrome Using a Sensitive Quantitative PCR Approach.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1760-1760
Author(s):  
Maximilian Mossner ◽  
Daniel Nowak ◽  
Ouidad Benlasfer ◽  
Jana Reins ◽  
Olaf Joachim Hopfer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
High Risk ◽  
Progenitor Cells ◽  
Quantitative Pcr ◽  
X Chromosome ◽  
Hematologic Malignancies ◽  
Hematopoietic Progenitor Cells ◽  
Hematopoietic Progenitor ◽  
Hematopoietic Stem ◽  
Cd34 Cells

Abstract Abstract 1760 Poster Board I-786 Myelodysplastic syndromes (MDS) are clonal hematologic malignancies with molecular defects most probably arising in the hematopoietic stem or progenitor compartment. However, due to a frequent lack of trackable cytogenetic aberrations in a large proportion of MDS patients the capability to monitor the manifestation and origin of malignant MDS clones remains limited. To elucidate clonal dominance in a given cell population, the analysis of skewed X-chromosome inactivation patterns in females, based on the methylation analysis of X-chromosomal HUMARA alleles has been used widely. However, this method has several technical and biological drawbacks as methylation changes can be induced with increasing age leading to inaccuracy of the method in this context. Recently, the application of a quantitative PCR-based method to accurately detect single nucleotide polymorphism (SNP) allele-specific RNA transcription from the X-chromosome (Swierczek et al, Blood, 2008) has shown robust results for reliable calculation of X-chromosome allelic ratios. In our study we employed this method to assess clonality in CD34+ selected and unselected bone marrow cells derived from MDS patients and provide evidence for distinct clonal manifestations of MDS clones in hematopoietic progenitor cells of all analysed MDS samples as compared to healthy controls. Bone marrow (BM) cells were obtained from patients with MDS (IPSS-low/int-1-risk n=9, IPSS-int-2/high-risk n=9) after informed consent. Immunomagnetic selection of CD34+ cells was performed from the BM samples of MDS patients (IPSS-low/int-1-risk n=8, IPSS-int-2/high-risk n=10) and age related healthy donors (n=6) served as controls for normalization. Genomic DNA SNP genotyping using Taqman SNP Genotyping Assays (Applied Biosystems, Foster City, CA) was carried out in order to screen for informative clonality marker genes located on the X-chromosome, namely BTK, FHL1, IDS and MPP1. RNA transcripts from different alleles were quantified using SNP/allele-specific primers in a Taqman based quantitative PCR approach. Individual allelic ratios were calculated as previously described. Clonality values were assigned to 0 % according to an allelic ratio of 50/50 (polyclonal) up to 100 % for a ratio of 100/0 (clonal). All clonality values are presented as mean. Our analyses revealed a remarkably elevated proportion of clonal cells in all purified CD34+ cells from MDS low/int-1-risk (88 %) and MDS int-2/high-risk patients (98 %) compared to the cells from healthy donors (16 %, p<0.001). The degree of clonality in unselected BM samples was similarly increased in MDS low/int-1-risk (74 %) and MDS int-2/high-risk specimen (87 %, both p<0.001 as compared to controls). However, whereas all purified CD34+ samples from MDS patients appeared to be highly clonal, 2 of 9 (22 %) of the MDS low/int-1-risk samples exhibited distinctively lower clonality in unselected BM cells with values comparable to the healthy control group. Furthermore, we observed nearly identical high clonality values in 12 paired BM/CD34+ MDS samples, except for 1 of 6 MDS low/int-1-risk samples with significantly lower clonality in the unselected bone marrow as compared to purified CD34+ cells of the same patient. Our observation of specific clonality in both unselected bone marrow and purified CD34+ cells of MDS patients as compared to healthy controls underlines the proliferative manifestation of malignant MDS clones even in early hematopoietic progenitor cells. Furthermore, the high degree of clonality in all purified CD34+ cells suggests a clonal involvement of not only myeloid but also lymphoid lineages. Interestingly, we also identified 2 patients harboring polyclonal cells in the unselected bone marrow. In these cases differentiating cells in the bone marrow may be sustained by residual healthy hematopoietic progenitor cells. The determination whether patients with this constellation have a different clinical prognosis from patients with clonality of the complete bone marrow may be interesting to pursue. In summary, determination of clonality levels in distinct cell populations of hematologic malignancies using quantitative PCR appears to be highly suitable for monitoring the manifestation and origin of a malignant hematopoietic stem/precursor cell. Disclosures No relevant conflicts of interest to declare.

scholarly journals Co-Transplantation of Mesenchymal Stem Cells Further Improves the Prognosis of Allo-HSCT in the Treatment of High Risk and Refractory/Relapse Hematologic Malignancies: A Single-Center Retrospective Study of 175 Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5721-5721
Author(s):  
Jinhua Ren ◽  
Xiaofeng Luo ◽  
Minmin Chen ◽  
Min Xiao ◽  
Qian Li ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Retrospective Study ◽  
High Risk ◽  
Recurrence Rate ◽  
Conditioning Regimen ◽  
Hematologic Malignancies ◽  
Single Center ◽  
Hematopoietic Stem ◽  
Significant Difference

BACKGROUD: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory and pro-angiogenic properties and thus have the potential to improve the likelihood of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of hematologic malignancies. OBJECTIVE: To explore the efficacy and safety of allo-HSCT by co-transplantation with MSCs in hematologic malignancies patients. METHODS: We conducted a single-center retrospective study to comparing the incidence and severity of acute GVHD, recurrence rate and overall survival (OS) of high risk and refractory/relapse hematologic malignancies patients undergoing allo-HSCT with or without co-injection of MSCs. A total of 175 patients (113males/62 females) at Fujian Medical University Union Hospital from January 2016 to June 2019 were analyzed. The median age of the patients is 22 (range 1-65 years). Patients received salvaged conditioning regimens FA5-BuCy as previous reported for high risk and refractory/relapse hematologic malignancies, registered on http://ClinicalTrials.gov (NCT02328950), among whom 31(17.7%)were MSD-HSCT, 21(12%) MUD-HSCT and 123(70.3%)haplo-HSCT. All patients received ATG, cyclosporine A with short course methotrexate for prevention of GVHD. 85 patients transplanted with donor HSCs only, and 90 patients transplanted with HSCs and MSCs .MSCs infusion dose was 1-2×106/kg, at -1~+1 days following HSCs infusion. RESULTS: The two groups were well matched demographically. All patients achieved successful engraftment within one month post-HSCT. There was no difference in time to leukocyte and platelet engraftment in the two groups. The incidence of aGVHD (36.5 % versus 26.7 %, P =0.163) was similar in the HSC versus MSC groups. With a median follow-up time of 373 days (range:29-1265days), the 2-yr OS was much better in MSC co-injection groups (77.6% versus 48.4%, P =0.005). Moreover, there was no significant difference in the 2-yr cumulative recurrence rate between the two groups (25.1% vs 16.2%, P = 0.4). CONCLUSION: FA5-BUCY as an intensive conditioning regimen facilitates the outcome of advanced diseases with allo-HSCT, and co-transplantation with MSCs could further improve the survival of hematologic malignancies patients who did not reach remission. Disclosures No relevant conflicts of interest to declare.

scholarly journals Demographic and KAP determinants of COVID-19 vaccine hesitancy and vaccine refusal: a cross-sectional study in Indian population

2021 ◽  
Author(s):  
Meghna Gupta ◽  
Rohit Goyal ◽  
Shruti Aggarwal ◽  
Mansunderbir Singh ◽  
Vitull K. Gupta ◽  
...  
Keyword(s):  
Social Media ◽  
Indian Population ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Vaccine Hesitancy ◽  
Cross Sectional ◽  
Web Based ◽  
Vaccine Refusal ◽  
Adequate Knowledge ◽  
Practice Characteristics

Background: Recent rise in vaccine non-acceptance is a threat to global health, especially with the ongoing   COVID-19 pandemic. Examining the intentions of the Indian population towards the COVID-19 vaccine and the determinants of vaccine hesitancy and vaccine refusal is of utmost importance.Methods: We conducted a cross-sectional web-based anonymous survey, using pre-validated questionnaires. Demographic and knowledge, attitude, and practice characteristics were collected, and a binary logistic regression was applied to analyse the association between these characteristics and the participants’ intention to for the COVID-19 vaccine. Reasons for vaccine non-acceptance were then determined using a pre-validated vaccine hesitancy questionnaire.Results: Out of the 1172 non-vaccinated participants, 190 (16.2%) refused vaccination, and 219 (18.6%) were hesitant. Adequate knowledge about the COVID-19 disease, made people less likely to be hesitant for vaccination (OR=0.39; 95% CI=0.27-0.57), and less likely to refuse it (OR=0.41; 95% CI=0.27-0.61). Females had a higher tendency to refuse the vaccination (OR=1.47; 95% CI=1.02-2.14), or to be hesitant for it (OR=1.80; 95% CI=1.29-2.52). Social media played an important role in decreasing vaccination refusal (OR=0.40; 95% CI=0.22-0.73), when compared to evidence-based literature.Conclusions: Knowledge about the COVID-19 disease can help people make a more informed decision towards vaccination, and social media can be utilised as a medium to address the gaps in knowledge of the Indian population.

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