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Accreditation/Credit Designation

Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Resources

PER Pulse™ Recaps highlight key elements of the Oncology Briefings™: Overcoming Chronic Iron Overload in Pediatric AML and MDS online CME activity.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

Oncology Briefings™: Overcoming Chronic Iron Overload in Pediatric AML and MDS

Release Date: June 30, 2017
Expiration Date: June 30, 2018
Media: Internet - based

 

Activity Overview

The Oncology Briefings™ format is an online interactive monograph that will include an overview of diagnostic guidelines and management strategies for treatment-associated adverse events, and a review of recent data regarding current and novel therapeutic approaches in chronic iron overload.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

CME Activity Table of Contents

  • Background and Biology of Iron in Blood Disorders
  • Detecting Iron Overload
  • Treating Iron-Overloaded Patients
  • Ensuring Patient Compliance in Chelation Therapy

Instructions for This Activity and Receiving Credit

  • You will need to log in to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review audio files/content until you finish the presentation.
  • At the end of the activity, "Educational Content/Audio Files" will be available for your reference.
  • In order to receive a CME certificate, participants must complete the activity.
  • Complete the Posttest and pass with a score of 70% or higher, complete the Evaluation, and then click on “Request for Credit.” Participants may immediately download a CME certificate upon completion of these steps.

Target Audience

This educational activity is directed toward medical oncologists and hematologists who treat patients with cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, fellows, and other healthcare professionals interested in the treatment of cancer also are invited to participate.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  1. Describe the etiology of iron overload and its impact in pediatric patients with thalassemia and myelodysplastic syndrome who are receiving blood transfusions
  2. Explain evidence concerning the efficacy and safety of current and emerging iron chelation therapies for the management of iron overload
  3. Discuss how to manage iron overload in pediatric patients and improve adherence to iron chelation strategies
  4. Implement individualized treatment approaches for iron chelation to optimize outcomes in pediatric patients

Faculty, Staff, and Planners' Disclosures

Faculty

Elias Jabbour, MD
Associate Professor and Section Chief in ALL
Department of Leukemia
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosure: Grant/Research Support – Ariad Pharmaceuticals, Novartis, Amgen, Pfizer; Consultant – Pfizer, Amgen, Bristol-Myers Squibb, Ariad Pharmaceuticals

Latika Puri, MD
Pediatric Hematologist-Oncologist
St. Jude Children’s Research Hospital
Le Bonheur Children’s Hospital
Memphis, TN
 

Disclosure: No relevant financial relationships with commercial interests to disclose

The staff of Physicians' Education Resource®, LLC have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic or treatment options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

Describing and Detecting Iron Overload

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This first of 3 PER Pulse™ Recaps from this program focuses on the underlying biology of iron overload and how to detect it in your pediatric patients.

Drs. Jabbour and Puri discussed the risk of developing chronic iron overload in patients with AML or MDS, and detailed key approaches on how to detect and address high iron levels and deposition:

  • Under normal physiological conditions, iron uptake is regulated by the binding of transferrin to its receptors on hepatocytes in the liver and erythrocyte precursor cells in the bone marrow. When overloaded, transferrin receptors cannot bind additional iron, resulting in plasma as non‒transferrin-bound iron (NTBI) that is readily taken up by the liver, heart, and other organs.
  • Each unit of red blood cells given as a transfusion contains 200 to 250 mg of iron, which can result in iron-overloaded patients after as few as 10 transfusions. Patients with AML, MDS, or other hematologic malignancies are particularly susceptible to iron overload. For example, patients with AML may require upwards of 30 blood product transfusions in the induction phase alone, and potentially 150 donations over an entire course of therapy.
  • Iron levels can be determined by measuring serum ferritin in units of ng/mL; patients with levels above 1000 ng/mL are considered overloaded. Liver iron concentration (LIC) is also standard for measuring body-iron stores; LIC greater than 3 mg/g dry weight is considered overloaded. LIC can be measured by direct biopsy or by T2 or T2* MRI.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.


2 of 3
PER Pulse™ Recap

Treating Patients With Iron Overload

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This second of 3 PER Pulse™ Recaps from this program focuses on the current treatments for pediatric patients with chronic iron overload, following treatment for AML or MDS.

Drs. Jabbour and Puri outlined the standard treatment options for chronic iron overload in pediatric patients with AML or MDS, and discussed challenges faced when treating this condition, specifically:

  • In patients who are not transfusion-dependent, phlebotomy is the standard method of practical chelation. In transfusion-dependent patients this is not an option. Instead, iron chelators work to reduce iron burden, controlling the rate of iron accumulation by increasing the rates of iron binding and excretion.
  • The National Comprehensive Cancer Network (NCCN) recommends chelation therapy for patients who have received or are expected to receive 20 transfusions, or those who have a serum ferritin level greater than 2500 ng/mL. The goal of chelation therapy is to reduce serum ferritin levels to below 1000 ng/mL.
  • There are currently 3 iron chelators approved by the US Food and Drug Administration: deferoxamine, approved in 1968, requires a subcutaneous or intravenous administration; deferasirox, approved in 2005, is an oral tablet taken once daily; and, deferiprone, another orally delivered iron chelator, approved in 2011.
  • Investigations into future treatment options and strategies include ongoing trials studying new combinations or formulations of existing, approved chelators.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.


3 of 3
PER Pulse™ Recap

Methods to Ensure Patient Compliance

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This third and final PER Pulse™ Recap from this program focuses on the essential practices to ensure treatment compliance in a pediatric population.

Drs. Jabbour and Puri discussed their approaches to patient compliance when treating chronic iron overload in a pediatric population. Topics included novel strategies and approaches to incorporate into practice:

  • Adherence to chelation therapy is critical and often challenging issue for patients due to the lengthy duration of treatment. Poor adherence can result from issues such as infusion difficulty, patient intolerance, or family and environmental factors.
  • Drs. Jabbour and Puri emphasized the vital role of patient education. Comprehensive information on chronic iron overload, its associated risk, patients’ current overload status, the function of treatment, and potential adverse events associated with treatment are all essential in working to ensure compliance.
  • As pediatric patients age and engage in more active lifestyles, compliance becomes an increasingly challenging issue, requiring specific attention from healthcare providers. Strategies to incorporate include: treatment management apps; continuous education and reinforcement; and coordination with a network of social workers, patient advocates, pharmacists, and family members.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.







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