ORCID Profile
0000-0001-6341-2537
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 10-2021
DOI: 10.1111/IMJ.15457
Abstract: Imaging modalities for multiple myeloma (MM) have evolved to enable earlier detection of disease. Furthermore, the diagnosis of MM requiring therapy has recently changed to include disease prior to bone destruction, specifically the detection of focal bone lesions. Focal lesions are early, abnormal areas in the bone marrow, which may signal the development of subsequent lytic lesions that typically occur within the next 18–24 months. Cross‐sectional imaging modalities are more sensitive for the detection and monitoring of bone and bone marrow disease and are now included in the International Myeloma Working Group current consensus criteria for initial diagnosis and treatment response assessment. The aim of this consensus practice statement is to review the evidence supporting these modalities. A more detailed Position Statement can be found on the Myeloma Australia website.
Publisher: Wiley
Date: 05-2023
DOI: 10.1111/IMJ.16049
Abstract: Multiple myeloma (MM) is a disease of older people, yet factors relating to comorbidity and frailty may threaten treatment tolerability for many of this heterogenous group. There has been increasing interest in defining specific and clinically relevant frailty assessment tools within the MM population, with the goal of using these frailty scores, not just as a prognostic instrument, but also as a predictive tool to allow for a frailty‐adapted treatment approach. This paper reviews the various frailty assessment frameworks used in the evaluation of patients with MM, including the International Myeloma Working Group Frailty Index (IMWG‐FI), the Mayo Frailty Index and the simplified frailty scale. While the IMWG‐FI remains the most widely accepted tool, the simplified frailty scale is the most user‐friendly in busy day‐to‐day clinics based on its ease of use. This paper summarises the recommendations from the Myeloma Scientific Advisory Group (MSAG) of Myeloma Australia, on the use of frailty assessment tools in clinical practice and proposes a frailty‐stratified treatment algorithm to aid clinicians in tailoring therapy for this highly heterogeneous patient population.
Publisher: MDPI AG
Date: 07-02-2022
DOI: 10.3390/CURRONCOL29020077
Abstract: People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) in idualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.CLNU.2019.06.012
Abstract: Nutrition support is an important component of care to prevent malnutrition during allogeneic haematopoietic progenitor cell transplantation (HPCT) however there is no consensus on the optimal method of nutrition support. It is currently unclear whether enteral nutrition (EN) via nasogastric (NG) feeding is tolerated and improves clinical outcomes in comparison with parenteral nutrition (PN). This randomised study aimed to determine the tolerability and outcomes of proactive EN in comparison to PN (standard care). Patients aged ≥18 years undergoing allogeneic transplantation with reduced intensity (fludarabine/melphalan) or myeloablative (cyclophosphamide/TBI) conditioning at a tertiary Australian hospital were eligible to participate. Patients were recruited pre-transplant and randomised to proactive enteral nutrition (EN) or standard care. The EN group underwent NG tube insertion the day after stem cell infusion with feeding commenced at 30 ml/h. Rate of feeding was increased to goal as oral intake declined. If patients were intolerant to NG feeding they were changed to PN if required. The standard care group commenced PN when oral intake was ≤60% of requirements for three days and was unlikely to improve for at least another week as per standard unit protocol. The primary endpoint was tolerance of EN. Forty-four patients, (median age [Q1-Q3]: 52 [38-59], 25 male, 19 female) were recruited and randomised to EN (n = 22) or standard care (n = 22). In the EN group eleven tolerated EN (55%), nine changed to PN and two withdrew from study. The median (Q1-Q3) duration of NG feeding was nine days (4-13) and this provided 86% of goal nutrition. In the standard care group 68% required PN, the median duration was nine days (0-17) and patients met 97% of goal nutrition. There were no statistically significant differences between groups for any clinical outcomes or grade 3-4 (CTCAE version 4) complications. Half of patients receiving allogeneic transplantation tolerate EN when commenced early post-conditioning. As the use of proactive EN will reduce the use of PN (and associated costs and risks), it should be considered first line nutritional support. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) trial number ACTRN12615000284561.
Publisher: S. Karger AG
Date: 05-11-2019
DOI: 10.1159/000501791
Publisher: Wiley
Date: 29-05-2015
DOI: 10.1002/AJH.24041
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-08-2023
DOI: 10.1249/MSS.0000000000003267
Abstract: High rates of disease- and treatment-related symptoms, such as bone lesions, in people with multiple myeloma (MM) create uncertainty on the safety and feasibility of exercise. This study determined the safety, feasibility, and acceptability of an in idualized exercise medicine program for people with MM at any disease stage. A multi-site, randomized waitlist-controlled trial was conducted of an in idualized, high intensity aerobic, resistance, and impact loading exercise program. The exercise sessions were supervised twice-weekly by accredited exercise physiologists, with one additional unsupervised session per week, for 12 weeks. Safety was determined by number of adverse and serious adverse events. Feasibility outcome measures were study eligibility, recruitment, adherence, and attrition. Acceptability was determined by qualitative interviews and subjective levels of enjoyment. Of 203 people with MM screened, 88% were eligible, with 34% accepting participation (60 people) and 20% attrition for the between-group analysis, meeting a priori criteria (≥25% and 25%, respectively). No adverse or serious adverse events attributed to testing and/or exercise training were reported. Attendance at supervised exercise sessions was 98%, with 45% completion of the home-based exercise sessions. Adherence was 35%, 63% and 34% for the aerobic, resistance and impact loading protocols, with 55%, 80% and 37% of participants meeting a priori criteria (75% of protocol). Acceptability of the exercise program was high (mean 82%, 95%CI 78, 87), and highly supported by qualitative responses. An in idualized, high intensity aerobic, resistance, and impact loading exercise medicine program is safe and acceptable, and feasible by some measures for people with MM. Adherence to the prescribed exercise protocols was limited by comorbidities and disease symptoms. Strategies to improve unsupervised exercise completion are warranted in this population.
Publisher: Informa UK Limited
Date: 12-10-2017
Publisher: BMJ
Date: 18-04-2018
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JIAC.2019.02.014
Abstract: Piperacillin-tazobactam is commonly used in neutropenic sepsis at standard doses that do not account for inter-in idual differences in age, bodyweight and renal function. This study was designed to assess the rate of attainment of pharmacokinetic harmacodynamic (PK/PD) targets in patients receiving piperacillin/tazobactam therapy and to evaluate the effect on clinical outcomes. Patients undergoing intensive chemotherapy for aggressive hematological malignancies were enrolled and treated with piperacillin/tazobactam 4 g/0.5 g every 6 h as initial antimicrobial therapy for first fever. Plasma drug concentrations were assayed at 50% and 100% of the dosing interval and compared with target MIC breakpoint of 16 mg/L to calculate the primary endpoints of 50% and 100% time above MIC (fT > MIC), respectively. Secondary endpoints included time to clinical cure, length of hospital stay, duration of antibiotics, and clinical treatment success. Fifty-eight percent (14/24) of patients achieved 50% fT > MIC while only 4% (1/24) achieved 100% fT > MIC. Higher creatinine clearance was significantly associated with lower trough drug concentration and appeared to be the dominant reason for the poor PK/PD target attainment. Median time to clinical cure, duration of antibiotic therapy, and hospital length of stay was 3, 13 and 21 days, respectively. There were no statistically significant differences in these outcomes between patients who did and did not achieve 100% fT > MIC. A significant majority of febrile neutropenic patients fail to achieve PK/PD targets with 6-hourly piperacillin dosing, although the clinical implications of this finding are unclear. Larger studies are needed to assess any impact on morbidity and mortality. This trial is registered on the ANZCTR (ACTRN12618000110280).
Publisher: Wiley
Date: 14-10-2019
DOI: 10.1111/BJH.16218
Abstract: Nutrition support is frequently required post-allogeneic haematopoietic progenitor cell transplantation (HPCT) however, the impact of mode of feeding on the gastrointestinal microbiome has not been explored. This study aimed to determine if there is a difference in the microbiome between patients receiving enteral nutrition (EN) and parenteral nutrition (PN) post-allogeneic HPCT. Twenty-three patients received either early EN or PN when required. Stool s les were collected at 30 days post-transplant and analysed with shotgun metagenomic sequencing. There was no difference in microbial ersity between patients who received predominantly EN (n = 13) vs. PN (n = 10) however patients who received predominantly EN had greater abundance of Faecalibacterium (P < 0·001) and ruminococcus E bromii (P = 0·026). Patients who had minimal oral intake for a longer duration during provision of nutrition support had a different overall microbial profile (P = 0·044), lower microbial ersity (P = 0·004) and lower abundance of faecalibacterium prausnitzii_C (P = 0·030) and Blautia (P = 0·007) compared to patients with greater oral intake. Lower microbial ersity was found in patients who received additional beta lactam antibiotics (P = 0·042) or had a longer length of hospital stay (P = 0·019). Post-HPCT oral intake should be encouraged to maintain microbiota ersity and, if nutrition support is required, EN may promote a more optimal microbiota profile.
Publisher: Springer Science and Business Media LLC
Date: 30-06-2023
DOI: 10.1186/S13256-023-04014-9
Abstract: Hematological malignancies are an infrequent but important cause of liver dysfunction. There are several mechanisms by which this can occur, including direct malignant infiltration of the hepatic parenchyma and/or vasculature, vanishing bile duct syndrome, and paraneoplastic hepatitis. Paraneoplastic hepatitis is an extremely rare mechanism by which a hematological malignancy can cause liver dysfunction, and we present the first case, to our knowledge, of paraneoplastic hepatitis caused by nodular lymphocyte-predominant Hodgkin lymphoma in the literature. A 28-year-old Caucasian male presented with 3 weeks of fatigue, epigastric pain, and jaundice. His medical history was significant for early stage nodular lymphocyte-predominant Hodgkin lymphoma in the cervical region in remission for 5 years after primary treatment with involved-field radiotherapy. Liver biochemistry was normal at the time of treatment for lymphoma and there was no known liver disease before the current presentation. On physical examination, there was scleral icterus and ecchymoses, but no evidence of hepatic encephalopathy, other stigmata of chronic liver disease, or lymphadenopathy. A computed tomography scan of his neck, chest, abdomen, and pelvis showed heterogeneous enhancement of the liver, multiple enlarged upper abdominal lymph nodes, and an enlarged spleen with multiple rounded lesions. Portal and hepatic veins were patent. Initial workup for viral, autoimmune-, toxin-, and medication-related hepatitis was negative. A transjugular liver biopsy was performed with histology showing a predominantly T-cell mediated hepatitis with very extensive multiacinar hepatic necrosis, but no evidence of lymphoma within the liver. Retroperitoneal lymph node biopsy revealed nodular lymphocyte-predominant Hodgkin lymphoma. The patient’s symptoms, bilirubin, and transaminases improved significantly after treatment with oral prednisolone and a staged introduction of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Nodular lymphocyte-predominant Hodgkin lymphoma may cause paraneoplastic hepatitis. Physicians should be aware of the possibility of this life-threatening presentation and the importance of early liver biopsy and treatment before acute liver failure occurs. Interestingly, paraneoplastic hepatitis did not occur when nodular lymphocyte-predominant Hodgkin lymphoma was first diagnosed and confined to the cervical region, but was the presenting feature of the recurrence below the diaphragm.
No related grants have been discovered for Nicholas Weber.