Justin Arnall, PharmD, BCOP, FCCP, on Complicating “Factors”: When Malignancy and Non-Malignant Hematology Collide

Justin Arnall, PharmD, BCOP, FCCP: This recent JADPRO Live 2024, my colleague, Chris Parrish from Wake Forest, and I had the opportunity to present a presentation on a topic where non-malignant or classical hematology and oncology intersect. And so this year, both of us being pharmacists who practice in classical heme and malignant hematology, decided that it was a relevant, worthwhile topic to talk about bleeding disorders in the setting and context of malignancies. And so for our presentation, we reviewed both congenital and acquired bleeding disorders and in cases where we have encountered those being relevant to the coordination of care around particular malignancies. And so over the course of our presentation, we highlighted a case where a multiple myeloma patient with hemophilia A and on prophylaxis, there was some coordination and a degree of manipulation between relatively novel products over the course of his care. And so in that particular case, we discussed the conversion of Hemlibra, or emicizumab, prophylaxis to ALTUVIIIO, a novel extended half-life factor product prophylaxis, and talk about how these novel agents really impacted the overall course of his myeloma care. And then also we discussed how a patient with a solid terminal malignancy needing to be surgically removed within underlying rare bleeding disorder, or RVD, was managed perioperatively. Chris was really able to showcase how the team at Wake Forest planned, coordinated, and overall managed this particular patient who was highlighted. In the congenital bleeding disorders part of our presentation, really wanted to highlight both novel agents and the importance of multidisciplinary care and coordination. And then in the acquired part, we really highlighted updated guidelines for acquired factor VIII deficiency as well as acquired Von Willebrand disease. These are two conditions that have some overlap and some similarities between them, but do frequently come up in the context of malignancy. And so we were highlighting, one, the importance here of treating the underlying malignancy, but then we also touched on and highlighted relevant updates and overall considerations when it comes to coordinating care and managing both the bleeding disorder, again, and the underlying malignancies for these particular syndromes. Our goal in this presentation was to highlight the occurrence of these syndromes in the context of malignancy, provide relevant updates that I think are important for any practitioners to be aware of, one, because certainly the acquired syndromes may be rare but may and do occur in the setting of malignancies with the malignancies being the underlying ideology. And then for the congenital disorders, this is a relevant conversation, as our congenital bleeding disorder patients are fortunately living longer with improvements to therapy. And so it's important to take these syndromes into account when they occur, when any practitioner encounters them in practice. And so hopefully in giving this presentation, we can raise the level of awareness, and by being aware of the discussion, practitioners can make sure that they're prepared and are following along with the general conversations around these disorders, especially in the context of cancer care.