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Global Joint Pain Injections Market Report 2023: Growing Occurrence of Osteoarthritis Fuels the Sector – Yahoo Finance

By adminApril 13, 2023Platelet Rich Plasma Injections

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Dublin, April 07, 2023 (GLOBE NEWSWIRE) -- The "Global Joint Pain Injections Market Size, Share & Industry Trends Analysis Report By Injection Type, By Distribution Channel, By Joint Type Channel, By Regional Outlook and Forecast, 2022 - 2028" report has been added to ResearchAndMarkets.com's offering.

The Global Joint Pain Injections Market size is expected to reach $9.9 billion by 2028, rising at a market growth of 7.7% CAGR during the forecast period.

Key Market Players

Bioventus Inc.

Pacira BioSciences, Inc.

AbbVie, Inc.

Teva Pharmaceuticals Industries Ltd.

Pfizer, Inc.

Anika Therapeutics, Inc.

Zimmer Biomet Holdings, Inc.

Eli Lilly And Company

Ferring Holdings SA

Sanofi S.A.

Direct injections into the joints are used to treat joint pain and reduce swelling and inflammation. Geriatric patients typically have joint discomfort as a consequence of pre-existing medical conditions or illnesses.

For example, joint pain from arthritis, a common condition that primarily affects the knee, ankle, hip, shoulder, elbow, and facet joints of the spine, causes inflammation and adds to joint discomfort. The market for joint pain injections is also anticipated to grow due to the rising prevalence of rheumatoid arthritis and osteoarthritis and the rising demand for economic therapies for these diseases.

The demand for joint pain treatment solutions is increased by the aging population and the rising prevalence of obesity. To meet this rising demand, the main market participants are doing research and development operations to produce more effective treatment options, such as prolotherapy, autologous conditioned serum, platelet-rich plasma, and plasma matrix therapy.

Moreover, platelet-rich plasma (PRP) is created from the patient's blood and injected into a troublesome joint to reduce arthritis-related pain and stiffness.

Furthermore, developing such cutting-edge procedures offers major market participants chances for investment, which is expected to fuel the market's expansion throughout the forecast period. In addition, the primary reason driving the expansion of the joint pain injections market is the rise in the frequency of accident-related injuries in modern society.

Increased R&D efforts by the major market players and innovations like single injection therapy and plasma matrix therapy will present profitable opportunities for the market players to invest.

Story continues

Other factors driving the growth of the joint pain injections market include the prevalence of obesity globally, the rise in geriatric patients, and the increase in the number of arthritis cases along with joint disorders. Nonetheless, physical therapy is frequently used with injections to preserve or increase joint stability and mobility. While physical therapy alone may not be sufficient to control pain &inflammation, the pairing typically produces superior benefits.

Market Growth Factors

Growing occurrence of osteoarthritis

Osteoarthritis is one of the leading causes of disability among the elderly and a prevalent illness (OA). As the population's average age rises, the incidence of knee osteoarthritis (OA) increases. OA is the leading cause of chronic disability and the most common articular disease in the industrialized world, with knee and/or hip OA being the most common form.

As a result of population aging and the incidence of obesity and overweight in the overall population, it is anticipated that the number of people with symptomatic knee OA will increase. Joint stiffness and pain may become severe enough to make ordinary tasks difficult. Due to the rising prevalence of osteoarthritis, it is anticipated that the market for injections to treat joint pain will undergo significant growth.

Increasing global geriatric population

The World Health Organization predicts that by 2030, one in six people will be 60 or older. By this date, there will be 1.4 billion persons aged 60 or older, up from 1 billion in 2020. By 2050, the number of people worldwide aged 60 or older will have doubled. (2.1 billion). The number of persons aged 80 or older is anticipated to triple between 2020 and 2050, reaching 426 million. By 2050, two-thirds of the world's over-60 population will dwell in low- and middle-income countries.

In the elderly, back and neck pain, osteoarthritis, COPD, diabetes, depression, and dementia are all frequent diseases. As people age, they are more likely to suffer from many ailments simultaneously. In light of this, the need for joint pain injections would increase dramatically over the forecast period due to the population's aging trend.

Market Restraining Factors

Lack of knowledge regarding this treatment option

Injections for joint discomfort are unheard of by the general public. Joint soreness is treated with hyaluronic acid injections, corticosteroids, and platelet-rich plasma. It takes extensive knowledge and training to use these injections. Injections for joint pain are often given to patients by doctors and other medical personnel. Professionals are provided the equipment and instruction required to complete this. However, the market's expansion is constrained by the absence of government initiatives to support joint pain injections.

Scope of the Study

By Injection Type

By Distribution Channel

By Joint Type

For more information about this report visit https://www.researchandmarkets.com/r/qx7ca2

About ResearchAndMarkets.comResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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Global Joint Pain Injections Market Report 2023: Growing Occurrence of Osteoarthritis Fuels the Sector - Yahoo Finance

‘Orgasm Shot’ Caused Excruciating Pain, San Diego Jury Told in … – Times of San Diego

By adminApril 13, 2023Platelet Rich Plasma Injections

On March 30, 2021, Dr. Nadine Haddad was excited to test a new service at her Fifth Avenue elective medicine spa near Balboa Park. Shed just been certified to give the O-Shot.

But before she could offer clients the clitoral and vaginal injections of their own blood PRP platelet-rich plasma she needed practice.

According to court testimony last week, Haddad asked four or five of her own employees at the B Medical Spa and Wellness Center to volunteer as models for the controversial shot which she promised improved sex drive and oh-my-God orgasms.

Jaime Herwehe, an esthetician, was one of two employees who agreed to the shot.

Two years later, testifying in downtown Superior Court, Herwehe (pronounced HER-way) described a terrifying ordeal.

With another staffer holding open her vagina by hand and the Syrian-trained physician sometimes using an iPhone to shine a light, an extremely nervous and scared Herwehe was injected with a local anesthetic that had expired three years earlier, she said.

Unaware that the liquid lidocaine offered no numbness, Haddad injected PRP into her nerve-rich clitoris, Herwehe told a jury of nine men and three women.

It was beyond excruciating, said the 32-year-old mother and former San Diego City College student. The most excruciating pain in my life.

She soon passed out on the floor a possible seizure, a witness said and has since suffered vaginal numbness.

After the botched O-Shot procedure, plaintiff was unable to have enjoyable sexual relations with her partner, her lawyers wrote. Plaintiff and her boyfriend of almost eight years and the father of her daughter broke off their longtime relationship because of the lack of intimacy and plaintiffs change in mentality towards sex.

Alleging medical malpractice, a lawsuit suit filed Sept. 15, 2021, against medical director Haddad and Haddads husband, office manager Mark Khashram, also claims that Herwehe didnt give written consent for the procedure gone awry.

And wasnt told its risks beforehand.

And according to the complaint filed by San Diego attorneys Josh Gruenberg and Pamela Vallero, Herwehe was fired May 11, 2021, for refusing to sign an O-Shot consent form 42 days after the fact.

No monetary figure is specified, but the legal team that also helped Sandra Maas win a judgment against KUSI-TV seeks a variety of penalties, including punitive damages in an amount necessary to make an example of, and to punish, defendant, and to deter future similar misconduct.

Medical battery and retaliation are also alleged, but several of the original claims were dropped.

In the formal answer to the complaint, submitted Nov. 22, 2021, the defendants said in part that Herwehe had the express knowledge of the risks and hazards set forth in the Complaint, as well as the magnitude of the risks and hazards, and thereafter knowingly and willingly assumed those risks.

The response also said:

Times of San Diego attended trial sessions Monday, Wednesday and Thursday in the fifth-floor Hall of Justice courtroom of Judge Carolyn Caietti Department 70.

Current and former B Med Spa employees testified, text messages were shown and expert testimony given.

Haddad who appeared only days before on Fox5 News and Khashram are represented by Maya Fawcett and Jack Reinholtz of Prindle, Goetz, Barnes & Reinholtz LLP, which has a University City office.

Reinholtz also is defending Haddad and Khashram in a separate lawsuit involving Jessyca De Lara Herwehes older sister who was B Med Spas manager during the same period and alleges wage violations, business fraud and intentional infliction of emotional distress.

(Trial is set for January 2024 in Judge Keri Katzs court, with Gruenberg representing De Lara.)

In Herwehes case, the spas co-owners since January 2021 have mainly attempted to throw cold water on Herwehes motives and veracity and deny she gave no prior consent. At one point, they argued a text suggested Herwehe offered a bribe to a colleague in the case.

With lawyers for both sides using sexual terms seldom heard in a court, the defense team Monday challenged expert witness James Tappan, who has 50 years of experience as an obstetrician and gynecologist.

Bottom line, youre not an expert in performing an O-Shot, Reinholtz told San Mateo-based Tappan, being paid more than $15,000 as a witness for Herwehe and appearing virtually on a video screen.

Happily, yes (not an expert), the 79-year-old Tappan replied after previously labeling the PRP shot not a recognized and accepted modality. He said it was useless to treat sexual dysfunction and that 64 risks are associated with the shot. He also said OB-GYNs dispute the existence of a G-spot, which the O-shot also promises to enhance.

Haddads certificate of completing O-Shot training with inventor Dr. Charles Runels, Tappan said, is a piece of paper not recognized by any national body. (Runels and the O-Shot are roundly mocked by other OB-GYNs.)

Ex-boyfriend Brandon Smith an SDG&E high-voltage lineman who used to live with Herwehe provided some of the most searing (and explicit) testimony.

Under questioning by Vallero, he described their sex life, which he said was great before the March 2021 procedure. But after her O-Shot, the boyfriend since 2014 said he couldnt touch her without her being uncomfortable.

She was so sensitive, she wouldnt want me to touch her anywhere, Smith said. She did a whole 180 from her previous self, showed zero patience, becoming a completely different person. Their relationship constantly turned into a fight, an argument.

Vallero asked Smith if he blamed the O-Shot for the end of their relationship.

Yeah, absolutely, he said. That whole process takes a toll and snowballed since the start of it.

Herwewe dabbed her eyes as Smith said hed made clear he never wanted to wed but planned to have a child, which they did in 2019.

Asked if hed like to get back together, Smith said: Id love to if we could work this stuff out. if we could get back to where we were.

But Herwehe didnt want to, he said.

At the next jury break, in the courtroom hallway, Smith put his arms around Herwehe.

Also on the witness stand Monday was Haddad, who said she told potential volunteers that the O-Shot improves blood supply to that area (and) overall it improves sex drive and sensitivity.

She said spa manager De Lara reported that Herwehe was fine with having the procedure and I thought I could trust her.

I asked consent and she said she signed and was ready. Haddad repeated: I was told it was signed. I hadnt seen it.

Herwehe attorney Gruenberg displayed a printout from the Medical Board of California showing that Haddads medical license had expired the previous Friday and was now delinquent.

Haddad said she had been preoccupied with this case and didnt get to it. (By late Tuesday, the license was renewed and current with an expiration date of March 31, 2025.)

Haddad acknowledged having used expired lidocaine on both her subjects, first on employee volunteer, Jessica Nieto, who didnt proceed to the actual O-Shot because it was so painful she asked me to stop.

On Wednesday, the defense called Andrea Muoz, a physicians assistant who works at Sharp Rees-Stealy but also part time at B Med Spa.

Muoz said that after discussing contraceptive options with Herwehe, she inserted an IUD in July 2021 four months after the O-Shot. She said Herwehe mentioned no pain, sensitivity or numbness.

No abnormalities in the vagina. No abnormal findings, she testified.

Muoz said she hadnt heard of Herwehes O-Shot until yesterday, having learned of it in the past 24 hours through counsel.

Herwehe, an El Cajon native who graduated from Grossmont High School in 2009 (two years after her sister), took the stand next and began describing work-related complaints.

She said everyone was promised pay raises after Haddad and Khashram took over. But it never happened. She said Khashram pressed her to expand her volunteer social media postings for the business, especially Instagram.

Soon she was doing it all the time, including her free hours, and it became exhausting.

It wasnt fun anymore, she said. And worse despite a marketing company posting we werent getting paid for it.

On the day of the O-Shot, Herwehe said colleague Evelyn Hernandez-Cardenas, who had just assisted with Nietos aborted procedure, looked very nervous, very uncomfortable.

But the doctor was still excited, telling how it was the greatest treatment ever, Herwehe testified.

Despite an excruciating lidocaine shot to the clitoris, Haddad told Herwehe: If you are past lidocaine, you should be good to go.

Haddad said shed let the area get numb and then inject PRP into the G-spot of the lying down Herwehe. Haddad used an iPhone flashlight to find the spot and said: I thought you had a kid, Herwehe told the court.

Haddad was heard saying the process was successful.

I couldnt even speak it hurt so bad, Herwehe recalled, saying co-worker Cardenas was out of breath, shaking and crying.

When helped to her feet, Herwehe felt as if she would pass out. Waking up later, as if after a long sleep, Herwehe said Haddad told her: You passed out 30 seconds, tops.

Cardenas looked like shed seen a ghost, Herwehe said. (Later that evening, the aide told Herwehe she had a two-minute seizure.)

Then Haddad noted the 2018 expiration date of the lidocaine and slapped her head, said Herwehe, licensed to give various skin and face treatments.

When Herwehe later texted Haddad about whether she needed to see a doctor, Haddad said no, suggesting she didnt have enough fluids at the time.

On her drive home, starting to feel dizzy, I was very paranoid, Herwehe said. Every injection site was red, puffy and inflamed.

When Cardenas took the stand, she recalled Herwehe falling to the floor and having some kind of convulsion or seizure.

She kept grabbing at her face, Cardenas testified. I panicked and went down to help Dr. Haddad, trying to move her arms away from her. I was scared. I was very much in shock.

Asked about the earlier procedure on colleague Nieto, Cardenas said Nieto screamed and had a lot of blood coming right out of her vaginal area. It wasnt like splashing out, but there was blood.

Cardenas said Haddad told Nieto: Dont tell Jaime how much pain you were in because she wouldnt want to go through with this.

On the stand Thursday was B Med Spa assistant manager Nieto, promoted from front-desk worker.

Attorney Vallero asked Nieto if written consent were obtained before her procedure.

Well, it was a verbal consent, not written, she said.

Nieto confirmed she had felt a high level of pain, but Haddad stopped after Nieto called for a halt. She said her vagina bled, but it wasnt excessive.

Was she asked to sign a consent form after the procedure?

Yes, Nieto said. She signed May 11, 2021 the day Herwehe balked and was fired.

Testimony resumes Monday, with closing arguments expected Tuesday or Wednesday.

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'Orgasm Shot' Caused Excruciating Pain, San Diego Jury Told in ... - Times of San Diego

How Hair-Loss Treatments Have Evolved Over Time – NewBeauty Magazine

By adminApril 13, 2023Platelet Rich Plasma Injections

Since the dawn of time, men and women have been combating sparse strands with a myriad of odd treatments and protocols. In the 21st century, we may have cracked the code and stopped the speed of shedding using breakthrough science and innovation.

In Ancient Egypt, castor oil and almond oil were often used to promote hair growth. They would also use concoctions made of dates, dog paws and donkey feet, says New York facial plastic surgeon Yael Halaas, MD. In India, they also had a tradition of standing on your head to increase blood flow to the scalp to improve hair loss, adds New York dermatologist Julie Russak, MD.

Spices, beetroot, myrrh, and some eyeopening ingredients like urine were used during the Greco-Roman era, when hair was an indicator of youth, wealth and status. The famous Greek physician Hippocrates believed that a mixture of spices, pigeon droppings, horseradish, beetroot, and opium could cure hair loss, which he suffered from himself, says Dr. Halaas.

In 8th century China, safflower oil, rosemary, Fo-Ti root, and various Chinese herbs were ground together with animal parts and used as a hair growth potion. Across Scandinavia, follicularly challenged Vikings would rub goose droppings on their heads in hopes of growing new strands. Saint Hildegard of Bingen, who lived in 12th century Germany, wrote of a baldness cure that called for leaving bear fat and ashes on the scalp for a long while.

Like the Ancient Egyptians, Victorians used castor oil, almond oil and gentle tonics, but also relied on rigorous scalp massages to promote blood flow. Silk nightcaps were also introduced to fight friction and minimize hair loss.

Modern-day restoration stems back to work done in Japan in the 30s, but it wasnt until the 50s that hair transplant surgery was born. A dermatologist named Dr. Norman Orentreich discovered that hair follicles could survive when moved from one site to another, says New York dermatologist Doris Day, MD. At first, the outcomes appeared unnatural in that clumps of follicles, called plugs, were placed with little regard to the natural hairline or final look.

Hair transplant surgery evolved in the 90s with Follicular Unit Transplants, where donor follicles are removed as a full strip from an area of healthy growth, explains Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD. Follicular Unit Extraction, a technique whereby grafts are harvested individually using a small punch, emerged in the 2000s.

Thankfully, today we dont rely on antiquated animal-based mixtures, but we are using follicle-stimulating growth factors. A treatment plan might include platelet-rich plasma injections, topicals, supplements like Nutrafol, nutritional changes, and lasers, notes Dr. Day. Doctors may prescribe medications like finasteride and topical minoxidil says Dr. Russak. Recently, low-dose oral minoxidil has also emerged as an effective hair growth solution.

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How Hair-Loss Treatments Have Evolved Over Time - NewBeauty Magazine

Dermatologist Jessie Cheung on How to Make Your Penis Bigger – Men’s Health

By adminApril 13, 2023Platelet Rich Plasma Injections

NO SURPRISE TO anyone whos been living on planet Earth, but a lot of men want to have a bigger penis. The thing is, we cant go to the gym, do three sets of dumbbell penis reps, and get a larger schlong. If it were that easy, nearly every guy would be walking around with a snake in his pants.

Still, there actually are some things you can do to get a bigger penis, but many of these procedures are not cheap and come with some serious health risks. Nevertheless, we know you're probably curious about the wild world of penis enlargement, which is why we reached out to Jessie Cheung, M.D., a board-certified dermatologist who specializes in some of these techniques. Cheung has been a dermatologist for nearly 20 years, and six years ago, she moved from doing medical dermatology to focusing exclusively on cosmetic and sexual dermatology.

In addition to standard facial cosmetic procedures, Cheungwho's based in Manhattan and Chicagoperforms a slew of penis procedures, including fillers, fat injections, Bocox (that's Botox for your cock, FYI), and Emsella (a form of electromagnetic therapy that helps with premature ejaculation and erection strength.)

We interviewed Cheung about her dermatological methods for making patients' penises bigger, longer, and even capable of lasting longer during sex.

This interview has been lightly edited and condensed for clarity.

I dont want to brag, but a lot, hundreds. As a dermatologist, I'm used to looking at skin everywhere, including the penis, anus, scrotum, and perineum, and dealing with warts, hemorrhoids, and fissures. I stopped doing medical dermatology years ago and now focus on cosmetics, hormones, and sexual health. So that brings in men who need help with their erectile function, libido, premature ejaculation, and men who have purely cosmetic issues. The big one, of course, is increasing their penis size.

Actually, I see more men who complain about erectile dysfunction instead of size, but they always say that even if they are happy with their size, they wouldn't mind more length or girth.

I give them statistics: Numbers are facts. Interestingly, many of my men who want bigger penises have above-average length and girth. I think porn makes them lose touch with reality, just like we're seeing social media distort our perception of beauty.

Penis length must be 2.5 standard deviations below the average for that age to be considered a micropenis. For adults, that is 9.3 cm when stretched or 3.6 inches. In my office, I consider it a micropenis if they are too short to penetrate their partner.

Not that often. I would say my whole career, probably two that were so small they couldn't penetrateand that's really short. When its that small, they may want surgical intervention, and I dont do penis surgeries. So because of that, I don't see many men with a proper micropenis.

Yeah, so I perform filler injections. I also perform P-shots, which are designed to treat ED but have the additional benefit of increasing size, specifically girth. P-shots involve injecting biological substances such as Platelet-rich plasma (PRP). PRP is a source of growth factors for blood vessels and tissue, so activating the hibernating stem cells in the arteries and nerves stimulates repair and the production of healthy tissue.

P-shots start at $1800 and increase depending on the protocol used.

Ill try not to be too technical, but we draw your blood in these special tubes. We spin it down on the centrifuge, and on the top coat, there's a layer that's kinda yellowy, that's very rich with platelets, which contains eight to ten growth factors that are good for your blood vessels, collagen, and stem cell activation. So we inject that into places where you want to turn on stem cells, whether into your scalp to grow hair, your skin to help with wound healing, or the penis to activate stem cells to make blood vessels and nerves again. That said, PRP is about 10 to 15 years old. I prefer to use exomes.

So, I perform a topical infusion of exosomes, which really is the cutting edge of regenerative medicine. Exosomes are basically little email packets of information that your stem cells secrete to turn each other on and talk to each other. And they're filled with RNA, proteins, and peptides. Exomes have hundreds of more growth factors than PRP. They're also anti-inflammatory. So I use exosomes the exact same way I use P-shots, to help with ED, functionality, and size.

Anti-inflammation helps prevent tissue from aging. So in the case of penises, this will help you retain your functionality and erection strength as you age.

Fat is a great filler, and since fat is full of stem cells, I recommend fat for improving size and restoring erectile function. You will see increased girth and can regain lost length, both flaccid and erect.

A fat transfer to the penis is very straightforward. The injection technique is similar to how we inject the penis with regular fillers, but we are harvesting your own fat with gentle liposuction and processing the fat with PRP or exomes. I like to take fat from the pubic mound, which helps to expose more of the base of the penis to create more visible length. I call it pulling the turtle out of the shell.

Fat is a very cost-effective filler, and since fat functions as a natural implant, it lasts much longer than other fillers. The most significant benefit of using fat is the improvement of functionality, as the wound-healing activation of stem cells will target nerves and blood vessels to improve sensitivity and circulation. I like to transfer at least 20 mL of fat, which starts at $8,000.

There are risks associated with any injection! But understanding the anatomy and potential complications will mitigate those risks. For example, you don't want any material getting into large arteries, which can cause tissue to die. You also have to respect the layers and boundaries of the penis to avoid migration of the filler (i.e., the filler all moving to one place and sitting there). Bruising, swelling, uneven appearance, and infection are potential complications that I warn my patients about.

No, I have never had a patient who asked for a smaller penis. But penises do shrink over time, as testosterone levels fall and there is a decrease in blood flow. The blood vessels and tissue scar down and get stiff, so they can't stretch and fill up with blood for a full erection. As a result, men will notice their penis looking smaller while flaccid and erect and report softer erections.

Typically men in their fifties and sixties, though Ive seen men coming and seeking help for their shrinkage in their thirties.

Staying healthy [and] keeping your hormone levels optimized. [And you do that by] having a good quality of sleep, a healthy diet, keeping stress levels low, and not smoking. So things that are generally thought of as bad for you will negatively affect your penis size as you age.

Yes, my patients love Bocox! It helps with size and erections. Botulinum toxin works by relaxing the smooth muscle in the blood vessels of the penis. This means the blood vessels are more dilated and filled with blood at rest, so the penis hangs longer and thicker when flaccid. So its great if youre a grower and not a shower. But even with an erection, the penis is even more full of blood than usual, so it is harder and may be thicker. Bocox is a relatively safe treatment. It's usually two pokes after the application of a topical numbing cream. Risks include mild bruising and swelling.

So it's electromagnetic therapy. Basically, you're sitting on a chair, and a powerful magnet is at the chair's base. That magnet makes your pelvic floor muscles activate. So essentially, you're doing kegel exercises, whether it be for the penis, the vagina, or the anus. For the penis, that can help with premature ejaculation, but also erection strength and even size because of the increased blood flow. We have men who do Emsella for the anus, specifically sphincter control. There's a statistic that you complete over 11,000 Kegel exercises in 28 minutes on the Emsella chair. So it's very legit, and I love using it on my patients.

I will refuse to treat a patient who has unrealistic expectations. Beyond that, everyone has their own desired aesthetic, so I won't judge a man if he wants to have a huge penis. To each their own!

Social media and porn have created unrealistic expectations for bodies, faces, and genitalia. It's difficult to maintain a smooth, pink anus or vagina or penis or even nipples as we age, and sexual confidence is at an all-time low. Sex is excellent for your physical and mental health and appearance, so a therapeutic procedure that encourages sexual wellness and confidence is not really up to public judgment. It's a private health issue.

I had a patient who had filler injections done elsewhere. He had 15 syringes done in one session, and all the filler clumped up at the head of his penis. It was this huge blob. It looked like a golf ball.

So he came after it was botched to get it fixed. But didnt want to get the filler removed. So what I did was add more filler at the shaft and base, essentially to blend it in better.

Aside from the usual wows, what's memorable are the stories I hear when my patients return: sex multiple times a day, getting propositioned on Snapchat, video parties, and underground fame. My patients are definitely more confident. I had one patient who was too short to penetrate his partner, and after a combination of hormones, a P-shot, and fat transfer, he was finally able to have penetrative sex!

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Dermatologist Jessie Cheung on How to Make Your Penis Bigger - Men's Health

Stem cell research can help people with hard-to-heal wounds – EurekAlert

By adminApril 13, 2023Stem Cell Clinic

Advances in burns treatment open up new possibilities for healing other complicated wounds. For the first time, stem cells produced in compliance with the regulations governing the manufacture of medicinal products, are now being tested as a treatment for hard-to-heal leg ulcers in Linkping, Sweden.

Using stem cells in the treatment of hard-to-heal wounds and burns is a new method under development. Its success depends on close collaboration between researchers and health care staff. The objective is clear: meeting health care needs.

I recall a man in his 40s, this was a couple of months after I came to Linkping Universityas a researcher, who was fighting for his life. Im sad to say he died. If wed had the technologies we have now, we might have been able to help him. I still think about him, says Ahmed Elserafy, who was recruited to Linkping University (LiU) as a researcher to find the right type of cells to treat wounds.

One of Swedens two national Burn Centres is located at Linkping University Hospital. Here, near-clinical and internationally recognised research is carried out next to advanced burns care. One important task is developing the burn care of the future.

Burn treatment has been the same for a very long time and is based on taking skin grafts from the patient for transplant to the wound area. Our research focuses on finding other ways to cover open wounds, says Folke Sjberg, professor at LiU and consultant at the Linkping national Burn Centre (Brnnskadecentrum).

But not only burns cause serious open wounds. A very large group of wounds identified as hard-to-heal wounds, cause extensive suffering and present a difficult health care challenge.

There are significant differences between burns and hard-to-heal wounds. Burns occur suddenly. Burn patients do not normally have underlying diseases adversely affecting the healing of wounds. A hard-to-heal wound, however, is caused by underlying conditions that impair healing, such as diabetes, or multimorbidity in the case of elderly people.

The prognosis is grim for the around 100,000 people in Sweden with hard-to heal wounds. In more than half of the cases, such wounds lead to amputation of the limb affected. Hard-to-heal wounds are most often treated with dressings and wound care products. It is also possible to transplant the patients own skin to the wound.

The team of researchers and care staff have developed a model for growing new skin cells from a tissue sample from the patient. The cells are administered to the wound area in the form of a solution. The team has shown that the wound heals from the edges to the centre, just like it would naturally. Most wounds have shrunk to only half the size after 15 days.

This model forms the basis for the researchers next step, where they investigate the viability of using cells from another person instead of the patients own.

Cells from elderly patients are not optimal for transplantation. What were doing now is that we use cells from younger individuals with much better healing potential, says Folke Sjberg.

Specialist nurse Matilda Karlsson and consultant Moustafa Elmasry are working on a clinical study at the Burn Centres wound clinic. It is the first study in the world where stem cells, produced in compliance with the regulations governing the manufacture of medicinal products, are tested on patients with hard-to-heal leg ulcers.

Its a revolutionising, active treatment compared with traditional treatment using dressings or transplantation of the patients own skin, which is a very invasive procedure, says Moustafa Elmasry.

The cells used are derived from fat harvested from plastic surgery patients. The researchers collaborate with the company Xintela in Lund, which purifies a well-defined group of stem cells. What is unique about stem cells is that they can be developed into any type of cell in the body. Studies have shown that even if the cells come from another person, the bodys immune defence system does not react to them.

The study, which will comprise eight patients, is in its start-up phase. As with all clinical studies, the first step is to find out whether the treatment is safe. The researchers hope that the stem cells will also have a positive effect on wound healing. Should this turn out to be the case, it will be interesting to develop the process to ensure a sufficiently large amount of cells at a reasonable cost, to enable broad application in health care. The larger the wound, the more cells are required.

If the treatment proves successful, the researchers hope that, in the long term, it can also be used to cover extensive burns. Matilda Karlsson does not hesitate for a second when asked what they hope their research will eventually lead to:

A product that can heal all types of hard-to-heal wounds, with no need for skin grafts from the patient. This could hopefully save people from amputation of the limbs affected and, in the case of severe burns, save lives.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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Stem cell research can help people with hard-to-heal wounds - EurekAlert

Girl in the fight of her life looks for stem cell donor – BlackburnNews.com

By adminApril 13, 2023Stem Cell Clinic

By Paul Pedro April 12, 2023 11:28am

A little girl who desperately needs a Stem Cell Transplant to survive is asking area residents for help.

Zoe Dudzianiec, 7, of Tecumseh has a rare disease called Diamond-Blackfan Anemia, which is a very rare bone marrow disorder with no cure.

She has been getting treatment since birth and must receive 10 hours of medical treatment every day. Zoe also gets blood transfusions every 10 days at Sick Kids Hospital in Toronto because the blood she requires isnot available to her in Windsor anymore.

Her best treatment option is a stem cell transplant. She needs to rely on the generosity of a stranger to save her life by registering as a potential donor, said officials with The Katelyn Bedard Bone Marrow Association.

They are hosting a swab clinic at St. Clair College in Chatham next week to find a potential donor for Zoe. The clinic will be held at the Chatham Campus of St. Clair College on Monday, April 17, 2023 from 10 a.m. to 2 p.m. The swabbing event will be held in the lobby of the main building at 1001 Grand Avenue West.

Zoe needs someone who shares her Middle Eastern/European ethnic background to donate stem cells to save her life.

Sign up here to become a stem cell donor if you cant make it to the clinic in Chatham. Your stem cells could give her the carefree childhood she deserves. Those wishing to register must be between the ages of 17 and 35. Potential donors of all ethnic backgrounds are welcome, according to organizers.

Diversification of the Canadian Registry is vital, organizers said.

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Girl in the fight of her life looks for stem cell donor - BlackburnNews.com

Clinical Commentary: Tawbi Assesses Toxicities of Therapies in … – Targeted Oncology

By adminApril 13, 2023Stem Cell Clinic

We have randomized phase 3 data for pembrolizumab [Keytruda], nivolumab, andnivolumab plus ipilimumab [Yervoy], so I completely agree that all of these [agents are considered] category 1 treatments by the NCCN [National Comprehensive Cancer Network] because all have shown improvements over single-agent ipilimumab.1 That is kind of where the category 1 comes from when including overall survival [OS] benefit. I consider NCCN guidelines to bevery safe. They dont include options just because they exist.

However, [combination] pembrolizumab and low-dose ipilimumab has been tried in 1 large single-arm study called KEYNOTE-29 [NCT02089685] and [found to be]safer than the combination of ipilimumab and nivolumab or high-dose ipilumumab.2 Yet, most of[the] relevant data are from a second-line study that showed about a 25% response rate in the second line low dose of ipilimumab or pembrolizumab. So, personally, I dont necessarily agree with this recommendation as a first-line regimen for low-dose ipilimumab/ pembrolizumab, but obviously this is up for discussion.

Relatlimab is a novel antibody that blocks LAG3. Its one of those interesting receptors and is quite different than PD-1. Its expressed on activated T cells and exhausted T cells. Initially, people were thinking that it has an association with MHC class II, the primary ligand, but more and more data are arising to show that its directly associated with the TCR CD3, basically signaling cascade.3 It actually modulates TCR signaling, so it makes a bigger impact in a place where theres a lot more TCR signaling happening, and thats probably why it works better in the first line than in the second line.

We just published in Nature [results of a] neoadjuvant study where the response rate in our neoadjuvant patients was 57%, so the earlier you use it, the more signaling happens through TCR, and the more you can modulate anti-LAG3.4 Now, the RELATIVITY-047 study [NCT03470922] was a phase 3 trial followed by the FDA approval of nivolumab plus relatlimab [for patients 12 years and older with unresectable/metastatic melanoma].5,6

With ipilimumab/nivolumab in any setting, you get grade 3 to 4 toxicity of at least 50%, and the highest discontinuation rate because of an adverse event [AE] was 36% in the CheckMate 067 [NCT01844505] study.7 [The rate of any grade 3/4 AEs with] nivolumab and relatlimab was 21%, and this is why I do feel like its slightly more toxicbut the pattern oftoxicity is similar [Table7]. With [this combination] every toxicity Ive encountered feels the same as when you encounter a singleagent toxicity. It doesnt feel a lot more recalcitrant and its not a lot harder, and you get 1 toxicity per patient, just like you would get it with the single-agent PD-1 inhibitor. The other factor that I share with [patients] is that Ive run 2 trialswith it. Both are randomized, double-blind studies vs nivolumab as a single agent. I had a fellow in my clinic who was seeing a patient on the adjuvant trial,[and I challenged him to find out which treatment the patient was on based on toxicity presentation]. He told me he wasnt sure he could do that and thats the point. If we were treating the patient with ipilimumab/nivolumab, you would know which arm. If it was blinded and [using] ipilimumab/nivolumab, you would know which arm, but because its nivolumab/relatlimab, it was impossible to tell.

The phase 1 [portion of the] study had about 25 patients treated with [relatlimab as a] single agent in the second line, and it had no activity, but we only use it in combination because of the way it works; it has a lot more potential for working only in combination because it potentiates the TCR signaling. So once you use a PD-1 [inhibitor], you increase the TCR signaling, and then the LAG3 amplifies that signal and makes it better.

If you have an immune-suppressed individual who is already [being treated in the] second line and [is] resistant to immunotherapy, the TCR signaling is going to be so much more limited, and youll not [be] able to reverse the exhaustion with either single agent, whereas with a combination, you get about a 13% response in the second line [From the Data5]. Now, 13% [is a smaller response] and 1 out of 7 patients responded, so Im not surprised that some patients feel like it never works. Every time Ive used it in the metastatic [setting] in the second or third line, Im just candid with patients [and I discuss how much of a response] I expect. I dont do 3 months in that situation. I just repeat their scans in 2 months because if they are going to progress I may want to do something different.

The data that we have [show] that if the patient is requiring steroids at the time of initiation, when youre starting ipilimumab and nivolumab, their chances of a response are only 18%, so its limited. If you have already treated them with ipilimumab and nivolumab, and now youre treating the toxicity with steroidsI would focus on finishing the steroids completely tapering them off if you canand thenconsider rechallenging.

In CheckMate 067, the study that I ran in that population, if you had a grade 3 to 4 toxicity, they basically never rechallenged you with immunotherapy. They just took you off. We allowed [rechallenging] on the study after they taper off steroidsand we got away with it about half the time. The other halfwould get hepatitis back or other things back, but you can get away with a rechallenge about half the time.

KEYNOTE-006 [NCT01866319], which compared 2 doses of pembrolizumab with single agent ipilimumab,is interesting because we used to dose [patients] so high, [at about] 10 mg/kg every 2 weeks.8 The 200 mg that you currently use every 3 weeks is equivalent to 3 mg/kg every 3 weeks, so imagine how much more of a dose that was. And it didnt matter, so theres not a lot of dose-response relationship with pembrolizumab. By even decreasing the dose by almost twothirds, you still get the same outcome.

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Clinical Commentary: Tawbi Assesses Toxicities of Therapies in ... - Targeted Oncology

American Association for Cancer Research Recognizes 2022-2023 … – American Association for Cancer Research (AACR)

By adminApril 13, 2023Stem Cell Clinic

PHILADELPHIA TheAmerican Association for Cancer Research(AACR) is proud to announce its newest class of grant recipients.

Since 1993, the AACR has allocated $133 million and awarded 880 research grants to support hundreds of scientists devoted to advancing the understanding, prevention, diagnosis, and treatment of cancer. Our grants support researchers domestically and abroad at every stage of their careers, representing a global commitment to cancer prevention, early detection, interception, and cure.

Fellowships

2021 AACR-Bristol Myers Squibb Immuno-oncology Research Fellowship

2022 AACR-Amgen Fellowship in Clinical/Translational Cancer Research

2022 AACR-Day One Biopharmaceuticals Pediatric Cancer Research Fellowship

2022 AACR-Exelixis Renal Cell Carcinoma Research Fellowship

2022 AACR-Genmab Non-Hodgkin B-Cell Lymphoma Research Fellowship

2022 AACR-Merck Cancer Disparities Research Fellowship

2022 AACR-Merck Immuno-oncology Research Fellowship

2022 AACR-Mirati Cancer Chemical Biology Research Fellowship

2022 AACR-QuadW Foundation Sarcoma Research Fellowship, in Memory of Willie Tichenor

2023 AACR Fellowship to Further Diversity, Equity, and Inclusion in Cancer Research

2023 AACR-Bristol Myers Squibb Immuno-Oncology Research Fellowship

2023 AACR-D-Team Sarcoma Research Fellowship

2023 AACR-Incyte Immuno-oncology Research Fellowship

2023 AACR-John and Elizabeth Leonard Family Foundation Basic Cancer Research Fellowship

2023 AACR-QuadW Foundation Sarcoma Research Fellowship, in Memory of Willie Tichenor

Career Development Awards

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Cancer Research

2022 AACR Career Development Award to Further Diversity, Equity, and Inclusion in Clinical Cancer Research

2022 AACR-MPM Oncology Charitable Foundation Transformative Cancer Research Grant

2022 AACR-Novocure Career Development Award for Tumor Treating Fields Research

2022 Victorias Secret Global Fund for Womens Cancers Career Development Award, in Partnership with Pelotonia & AACR

2023 Lustgarten Foundation-AACR Pancreatic Cancer Career Development Award, in Honor of John Robert Lewis

2023 Lustgarten Foundation-AACR Pancreatic Cancer Career Development Award, in Honor of Ruth Bader Ginsburg

Independent Investigator Awards

2021 AACR-Bayer Innovation and Discovery Grant

2021 AACR-Bristol Myers Squibb Midcareer Female Investigator Grant

2021 AACR-Novocure Tumor Treating Fields Research Grant

2022 Friends of the AACR Foundation Early Career Investigator Award

2023 Lustgarten Foundation-Swim Across America-AACR Pancreatic Cancer Early Detection Research Grant

2023 Victorias Secret Global Fund for Womens Cancers Rising Innovator Research Grant, in Partnership with Pelotonia & AACR

Grants Supporting Researchers in Africa

2022 Beginning Investigator Grant for Catalytic Research (BIG Cat)

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American Association for Cancer Research Recognizes 2022-2023 ... - American Association for Cancer Research (AACR)

2023 drug discovery forecast: emerging trends and disruptors … – Drug Target Review

By adminApril 13, 2023Stem Cell Clinic

With advancements in artificial intelligence, precision medicine and gene editing, the field of drug discovery is undergoing a rapid transformation. In this article, Drug Target Reviews Izzy Wood gets the insider knowledge from industry leaders at SLAS 2023, who are experiencing these changes first hand.

AI has seen quite a boom in the last couple of years, overcoming challenges such as limited and low-quality data. Researchers can avoid numerous delays by employing AI for drug discovery, often using computational approaches in combination with their own techniques, for a faster and smoother path to the clinic.1

Getting to grips with what AI can do and how best to acquire and utilise its skills.

According to Cyrill Brunner, Application Specialist at Bruker Daltonics, effective AI calls for good data because you can predict a lot of things, but if your data is not good, your results will lack quality. Its therefore vital to invest in high quality instruments that have the ability to deliver quality data in a short time.

Yet, even with the positive advances in AI, it does not come without its challenges. Brunner continued to explain that one of the biggest changes in the pharmaceutical industry is that AI has moved over from just making data predictions to also analysing data.

For instance, if we look at mass spectrometry, the data is increasingly being analysed by computational methods, so it can be faster to keep up with all of the other screening technologies. Given the increasing amounts of generated data, manual analysis becomes unfeasible from a timescale perspective.

Michael A Norman, Lab Automation GM & VP of Sales at Flow Robotics, concurred that advancements in AI and machine learning were disrupting the drug discovery landscape.

Norman reflected that AI and machine learning will usher in an era of quicker, cheaper and more effective drug discovery. But whether this remains a good or bad thing remains sceptical.2

Most experts do expect these tools to become increasingly important. This shift presents both challenges and opportunities for scientists, especially when the techniques are combined with automation.2 Yet it is this combination of tying in automation and equipment that will create the lab of the future.

As emphasised by the experts, it is a case of getting to grips with what AI can do and how best to acquire and utilise its skills.

According to the National Health Service (NHS), the basis for personalised medicine is understanding the role DNA plays in ones health, transforming healthcare by delivering the four Ps:

Analysing the genome allows patterns to be identified that can help determine individual risk of developing diseases.

Jovi Jenkins, VP of Business Development at SPT Lab Tech, explained: Scientifically, what we are seeing is a lot more interest in genomic applications within the drug discovery process. Using genomics is becoming routine, such as CRISPR screening.

Norman echoed these predictions, suggesting that there will be advancements in individualised personal medicine, like gene therapy and CRISPR, on a much larger level.

The use of automation in drug discoveryprovides more consistent data that allows labs to make better decisions, faster. It also facilitates the testing of hundreds of thousands of compounds and samples.

Automation involves a verybroad range of technologiesincluding robotics and expert systems.4

Nick Ritzo, Genie Life Sciences, suggested that a big trend in drug discovery is going to be how modular lab spaces can gain the ability to quickly pivot from the discovery of one molecule to another. In this space, that is going to be really important to bring more drugs into the market.

Following on, Steven Watters, North America Sales Manager at HighRes Biosolutions, explained how automation is all about how we get more connected data into scientists hands. He emphasised the importance of the enablement of scientists to review their work, make predictions, and then drive forwards.

References:

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2023 drug discovery forecast: emerging trends and disruptors ... - Drug Target Review

Roundtable Discussion: Kishtagari Reviews Treatment and … – Targeted Oncology

By adminApril 13, 2023Stem Cell Clinic

KISHTAGARI: The challenge as treating clinicians these days in the clinic is that almost 34% of the patients present with severe thrombocytopenia of less than 50 109/L platelets at the time of initial diagnosis of myelofibrosis. Most patients, 66%, presented with thrombocytopenia of over 50 109/L.1,2 This is a significant challenge when treating patients, especially with ruxolitinib [Jakafi], the medication that has had FDA approval for the longest time. The medication itself can cause [decreased] blood counts as well. A lot of patients do have anemia at baseline, and that gets worse with the disease evolution as well. So both thrombocytopenia and anemia are huge challenges for us. I think this is important in the sense that we need to monitor these patients frequently while they are on treatment. I think one [issue] is how frequently to monitor them. We should monitor them frequently initially, but once theyve stabilized, we can probably monitor them every 6 weeks to 2 months. Its been my practice to do 6 weeks to 2 months once they have

stability in their platelet counts, based on their treatment. Of course, if any drop in the platelet counts or hemoglobin happens, I tend to monitor them more frequently and include dose reduction of the treatment they are on.

ZAMAN: Recently I had a couple of patients who had hemolytic anemia, so they didnt take the prednisone. I gave rituximab [Rituxan] to a patient and she did not respond. I stopped it after 4 cycles with no response. Suddenly, 3 or 4 months later, she was not requiring as many transfusions. How often do you see hemolytic anemia?

KISHTAGARI: In my practice, I have seen 1 patient with hemolytic anemia with myelofibrosis. Its not that common, if you look at the literature as well. I keep thinking about management for this patient. Fortunately, my patient responded very well to high-dose steroids. But, like you said, its a challenge. That is something [that reminds us] when we see a drop in hemoglobin, we should always think broadly, not [only] of the disease but of the adverse effects [AEs] of the medication. We need to think broadly and keep our differentials broad. Look for hemolysis as a cause as well. But its rare, and it is reported in less than 5% [of patients], based on the literature.

BHANDARI: In my opinion, [the goals are] improvement of the symptoms and improved quality of life. The platelet count of 43 109/L is less concerning. I think the symptoms are more important.

KISHTAGARI: I think thats a good [approach]. A lot of these patients come with such a huge symptom burden, and I think thats the most important thing to address while we are thinking about the long term for this patient.

MAHAJAN: This is a 68-year-old patient. [Although] his ECOG performance status is 2, will a stem cell transplant [SCT] be a possibility for him? He is relatively young.

KISHTAGARI: Absolutely. I think a lot of times I give these patients the benefit of the doubt. I always refer for SCT, just for an evaluation. It doesnt mean that they will go for SCT. I think they need to at least be evaluated by a transplant physician to see if they can be considered for SCT. The oldest I have sent for transplant [was a 79-year-old patient], and this was a patient who was very active with an ECOG performance status of 0 to 1. This patients ECOG performance status of 2 is likely from the severe symptom burden he has been experiencing secondary to myelofibrosis. Given that, it is always good to initiate treatment and send them for transplant evaluation because we all know that the ultimate treatment or cure, especially for high-risk myelofibrosis, is SCT.

ZAMAN: If they are symptomatic, we start them on ruxolitinib. We look for the risk assessment, and Johns Hopkins [Sidney Kimmel Comprehensive Cancer Center] is approximately 100 miles from here, so I call them for an evaluation to see what they think. I try to cover both things, unless they are frail and cannot travel, which also is sometimes an issue.

MENDOZA: I have a similar approach. I sit down with them, and tell them that they need pharmacologic intervention, and we look at the performance status. We say that if they have some comorbid conditions, and they are highly symptomatic andhigh-risk, typically by guidelines, they would be candidates for transplant. But if the performance status is 2 and we start treatment and that improves their symptoms, then thats when I say we are 50 miles away from [a transplant center in] Baltimore, Maryland. So we also do something different, and typically the response is quick. Now in this case, discussing the specific pharmacologic agent is a little bit tough because of the platelet count. I would be careful with the choice. I would probably phone the transplant [specialist], go over the case, and say this is what I want to do. I want to see if they improve on pacritinib [Vonjo] or some other type of agent, and if it is indicated, Ill start that, and 2 to 4 weeks later I will see them and they have improved. The patients can tell when the spleen gets smaller. That by itself improves their symptom burden, and if thats the case, then the next thing we do is send them to Baltimore [for transplant evaluation].

KISHTAGARI: Thats fantastic. I like that approach a lot.

KALRA: Most of us who are in the community dont have open trials for patients with myelofibrosis, but at least I am in Baltimore and have access to 2 large academic centers, and if this is a patient who would qualify for a trial, and its open at one of those centers, then [I would refer for clinical trials].

LANG: If a patient has high-risk myelofibrosis but does not have clinical symptoms and is a candidate for transplant, do they still benefit from bridging therapy with a JAK [Janus kinase] inhibitor?

KISHTAGARI: If they have splenomegaly, I would consider JAK inhibitor therapy prior to proceeding to allogeneic SCT because if you can control the spleen size as much as possible before going for transplant, [data from] multiple studies have shown that it has a good outcome post transplant.3,4 So at least for the spleen reduction, I recommend initiating a JAK inhibitor.

ISLAS-OHLMAYER: Would you continue the JAK inhibitor during SCT?

KISHTAGARI: That is something a lot of centers have been doing. We have also been doing it after SCT, not during SCT. After SCT we have been initiating JAK inhibitor therapy because the symptom burden sometimes comes back, and we continue them on ruxolitinib. [N]ot all of them, [however,] only a few patients. This is being done as a part of a clinical trial, not as a standard of care.

KISHTAGARI: Getting a donor is something we all face whenever we refer the patient for allogeneic SCT evaluation. I have a lot of patients in my clinic right now who do not have a donor, and thats a significant challenge. Access is also something we all face for transplant evaluation, and even the cost is something we dont talk about often, which we should. They need to be very close to the transplant center, at least for the 90 to 100 days when they are undergoing allogeneic SCT evaluation. Do you always refer for transplant if they have high-risk myelofibrosis?

MAITI: Yes, the high-risk patients. I am at a regional oncology center close to the Cleveland Clinic main campus [in Ohio], so if I see a patient with high-risk myelofibrosis, I would refer them to a [transplant physician] on the main campus and work on the bridging therapy.

KISHTAGARI: OK, good.

MISBAH: Usually [the transplant physician] will tell us the bridging therapy they want us to use.

KISHTAGARI: Do they have any preference for the bridging therapy that they recommend?

MISBAH: I havent referred anyone recently, so I wouldnt be able to speak to that. But usually they will guide us very well on what we should use or what their preference is.

KISHTAGARI: Do you have any experience? [For] how long do you use bridging therapy? I know that very few patients subsequently undergo transplant.

LANG: In the past couple of years, I referred 3 patients for transplant. I was thinking they continue the bridging therapy until you find a transplant donor.

KISHTAGARI: So until the transplant donor is identified, and then until they go to transplant, the bridging therapy is continued.

LANG: Right.

KALRA: I think its the patient population. Myelofibrosis is not a disease of young people. Its the comorbidities. Its obviously the availability of donors. Its a lot of those factors, and then, eventually, whether they can even tolerate a transplant.

KISHTAGARI: Good. I think those are the challenges we face as clinicians on getting these patients [to transplant] with their advanced age, as well as donor availability and their performance status. Other factors such as cost and access are at play. Lately we have been seeing debulking of the disease before going for transplant. I think thats less of a challenge compared with other diseases such as AML [acute myeloid leukemia] or MDS [myelodysplastic syndrome] where they prefer the [myeloablative conditioning] before going for SCT. I dont think we have that challenge here. We have other challenges with myelofibrosis.

BHANDARI: I think its promising. I have used it in 1 of my patients.

MAITI: I have not used pacritinib yet. I have only used ruxolitinib as first-line therapy. But with the data,5 I think especially in patients with a platelet count of less than 50 109/L, I would consider pacritinib.

KISHTAGARI: In patients with a platelet count greater than 50 109/L, also, one can consider pacritinib, especially in the second-line setting.

KNAPP: Patients had platelet counts of less than 100 109/L on the trial, but they only approved it for those with less than 50 109/L. Is there a reason for that?

KISHTAGARI: In the [PERSIST-2] clinical trial [NCT02055781], they looked at both groups, but patients with platelet counts below 50 109/L derived maximal benefit [From the Data5], and so the FDA only approved it for that.6

MENDOZA: If I have a patient who is on dose-adjusted ruxolitinib, hes borderline, he had initial counts greater than 50 109/L, but he developed a platelet count of less than 50 109/L, do you recommend switching to pacritinib at that point? Or would you rather hold the dose, wait, and then adjust ruxolitinib again?

KISHTAGARI: It all depends. If the patient is getting benefit from ruxolitinib and you only noticed significant thrombocytopenia, dose reduce first before switching to pacritinib. If with the dose reductions you do not see any improvement in blood counts, then definitely switch to pacritinib.

MAHAJAN: What about pacritinibs effect on anemia? Is it like ruxolitinib, or other than that do you have to wait for momelotinib [GS-0387] to be approved?

KISHTAGARI: What we have seen is pacritinib also inhibits a protein called ACVR1 more than momelotinib.7 We also see this in the clinic as well, where there is a significant improvement in hemoglobin. But you need to treat the patient longer, and there are some retrospective data where they are noticing an improvement in hemoglobin along with a stabilizing platelet count.8 So there might be a role for pacritinib in the future for patients with myelofibrosis and anemia.

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Roundtable Discussion: Kishtagari Reviews Treatment and ... - Targeted Oncology