scispace - formally typeset
Search or ask a question
Author

Dawn Swan

Bio: Dawn Swan is an academic researcher from University Hospital Galway. The author has contributed to research in topics: Medicine & Internal medicine. The author has an hindex of 5, co-authored 13 publications receiving 72 citations. Previous affiliations of Dawn Swan include University of Manchester & University Hospital Waterford.

Papers
More filters
Journal ArticleDOI
TL;DR: The pathogenesis of thrombosis in multiple myeloma, its relation to some of the commonly used chemotherapeutic regimens, current risk stratification and the evidence supporting the different anticoagulants used as thromBoprophylaxis are discussed.
Abstract: Multiple myeloma is associated with a significant risk of venous thromboembolism (VTE), causing substantial levels of morbidity and mortality. The thrombogenicity of myeloma is multifactorial, with disease- and treatment-related factors playing important roles. Immunomodulatory drugs (IMiDs) and high-dose dexamethasone, in particular, are known to enhance the thrombotic potential of myeloma. For this reason, assessment of the VTE risk has long been advocated prior to treatment initiation in patients with myeloma requiring IMiD-based regimens. However, despite routine use of thromboprophylaxis, these patients can still develop VTE and its sequelae. The optimum choice and dose of thromboprophylactic drug is not entirely clear, and with this, there is growing interest regarding use of the direct oral anticoagulants in this setting. In this review we discuss the pathogenesis of thrombosis in multiple myeloma, its relation to some of the commonly used chemotherapeutic regimens, current risk stratification and the evidence supporting the different anticoagulants used as thromboprophylaxis. We propose an amended risk stratification, and consider management of challenging patients, including those with renal impairment and recurrent thrombosis.

54 citations

Journal ArticleDOI
03 Apr 2020
TL;DR: The effects cyclophosphamide has on the immune system is discussed, and how it can be used synergistically with other treatment modalities including the immunomodulatory agents, monoclonal antibodies and cellular therapies are discussed.
Abstract: The alkylating agent cyclophosphamide has been used in the treatment of multiple myeloma for over 60 years. At low doses, cyclophosphamide also has significant immunomodulatory activity, which can be used to modify the immunosuppressive tumor microenvironment in order to augment responses to existing therapies. Immune-mediated therapies are becoming more widespread in modern approaches to myeloma treatment. In this review, we discuss the effects cyclophosphamide has on the immune system, and how it can be used synergistically with other treatment modalities including the immunomodulatory agents, monoclonal antibodies and cellular therapies.

31 citations

Journal ArticleDOI
TL;DR: In this paper, the authors discuss the epidemiology, aetiology and management of thrombotic events in patients with ITP, and consider the impact of ITP therapies on the increased risk of bleeding, in particular the use of Thrombopoietin-receptor agonists.
Abstract: Immune thrombocytopenia (ITP) is an autoimmune disorder in which a combination of defective platelet production and enhanced clearance leads to thrombocytopenia. The primary aim for therapy in patients with this condition is the prevention of bleeding. However, more recently, increased rates of venous and arterial thrombotic events have been reported in ITP, even in the context of marked thrombocytopenia. In this review we discuss the epidemiology, aetiology and management of thrombotic events in these patients. We consider the impact of ITP therapies on the increased thrombotic risk, in particular the use of thrombopoietin-receptor agonists (TPO-RAs), as well as factors inherent to ITP itself. We also discuss the limited evidence available to guide clinicians in the treatment of these complex cases.

18 citations

Journal ArticleDOI
TL;DR: In this paper, the authors provide updated guidance on the management of bleeding and surgery on antiplatelet drugs while stressing the need for further studies to provide evidence-based guidelines, although there is very limited evidence on how to manage urgent surgery in patients receiving these medications.

16 citations

Journal ArticleDOI
TL;DR: Two issues of under- Diagnosis and over-diagnosis of PE in the current era are reviewed, including whether the chance finding of PE requires anticoagulation, especially when identified only at the subsegmental level are reviewed.

16 citations


Cited by
More filters
Journal Article

544 citations

Journal Article
TL;DR: In this article, a review of the use of the Wells rule with D-dimer testing to make decisions about imaging in patients with suspected pulmonary embolism is presented. But this review is limited to the case of lung cancer.
Abstract: This review contributes new information on use of the Wells rule with D-dimer testing to make decisions about imaging in patients with suspected pulmonary embolism.

95 citations

Journal ArticleDOI
TL;DR: In this article, the authors summarized the available clinical and preclinical evidence for the role of tumour burden in determining the outcomes of patients receiving immune-checkpoint inhibitors and highlighted areas that are likely to be of future research interest in this emerging area.
Abstract: Accumulating evidence suggests that a high tumour burden has a negative effect on anticancer immunity. The concept of tumour burden, simply defined as the total amount of cancer in the body, in contrast to molecular tumour burden, is often poorly understood by the wider medical community; nonetheless, a possible role exists in defining the optimal treatment strategy for many patients. Historically, tumour burden has been assessed using imaging. In particular, CT scans have been used to evaluate both the number and size of metastases as well as the number of organs involved. These methods are now often complemented by metabolic tumour burden, measured using the more recently developed 2-deoxy-2-[18F]-fluoro-d-glucose (FDG)-PET/CT. Serum-based biomarkers, such as lactate dehydrogenase, can also reflect tumour burden and are often also correlated with a poor response to immune-checkpoint inhibitors. Other circulating markers (such as circulating free tumour DNA and/or circulating tumour cells) are also attracting research interest as surrogate markers of tumour burden. In this Review, we summarize evidence supporting the utility of tumour burden as a biomarker to guide the use of immune-checkpoint inhibitors. We also describe data and provide perspective on the various tools used for tumour burden assessment, with a particular emphasis on future therapeutic strategies that might address the issue of inferior outcomes among patients with cancer with a high tumour burden. A high tumour burden has long been associated with inferior outcomes on traditional cancer therapies and emerging evidence suggests that tumour burden is particularly relevant for patients receiving immune-checkpoint inhibitors. Here, the authors summarize the available clinical and preclinical evidence for the role of tumour burden in determining the outcomes of patients receiving immune-checkpoint inhibitors and highlight areas that are likely to be of future research interest in this emerging area.

64 citations