Dear colleagues,

I’m pleased to introduce the winter edition of The New Gastroenterologist – the first issue of 2021! The start of the new year has been very much anticipated because many hope that this year will bring some resolution to the challenges we faced in 2020.

With the pandemic came the widespread use of telemedicine, a feature of patient care that is likely here to stay. As physicians, it is imperative that we understand the legal implications of virtual medicine. Experienced medical malpractice lawyers Ashton Hyde and Grace Johnson (Younker Hyde Macfarlane) offer advice on this rapidly evolving realm of medicine.

Early career gastroenterologists often fall victim to self-doubt in a phenomenon referred to as impostor syndrome. Dr. Kimberly Brown (Wayne State University) discusses this important topic: what it is, how to recognize it, and how to mitigate it. One way to temper the effects of impostor syndrome is utilizing the art of coaching. Dr. Ami N. Shah (Rush) takes us through her journey and reviews the personal and professional benefits of implementing coaching in medicine.

Consults about feedings tubes can be daunting because experience with the placement and management of feeding tubes can be limited during training. This quarter’s “In Focus” article, written by Dr. John Fang and Dr. Gregory Toy (University of Utah) reviews the indications for placement, type of tubes available, and common complications and how to troubleshoot them. This is an absolute must-read for any new gastroenterologist.

How do you approach the patient who shows up for an open access endoscopy, but a quick chart review leads you to the realization that the procedure, is in fact, not indicated? There tends to be a lot of inertia which prevents cancellation of cases like this because the patient is already in the endoscopy suite, prepped, and has planned for this procedure in the preceding weeks or months. Dr. Laurel R. Fisher (University of Pennsylvania) unpacks the ethical considerations of this familiar scenario in this fantastic addition to our ethics case series.

In our postfellowship pathways section, Dr. Rena Yadlapati (University of California San Diego) and Dr. Kelli DeLay (University of Colorado) guide us through the path to becoming an esophagologist. In the DHPA Private Practice Perspectives article this quarter, Dr. Nadeem Baig (Allied Digestive Care) and Kevin Harlen (Capital Digestive Care) explain how clinical productivity is measured and how this translates into compensation in practice.

A silver lining of the pandemic is the way in which social media has been used to connect colleagues around the world in fostering medical education. Dr. Sultan Mahmood (State University of New York at Buffalo), Dr. Atoosa Rabiee (Washington DC VA Medical Center), Dr. Sunil Amin (University of Miami), Dr. Allon Kahn (Mayo Clinic Scottsdale), and Dr. Ijlal Akbar Ali (University of Oklahoma) discuss the inception of @GIJournal, a Twitter-based online journal club, and how it has gained popularity in recent months.

The AGA launched a new podcast, “Small Talk, Big Topics,” geared toward trainees and early career gastroenterologists, and through a brief question and answer session, we get to know the hosts: Dr. Matthew Whitson (Zucker School of Medicine at Hofstra-Northwell), Dr. Nina Nandy (Presbyterian Medical Group), and Dr. C.S. Tse (Brown University).

Lastly, I’d like to take a moment to recognize Lora McGlade, who has been instrumental in The New Gastroenterologist as the Medical Communications Editor for our publisher, Frontline. She assumed a new role at the end of last year, and I cannot thank her enough for her contributions in making this publication a success.

If you have interest in contributing or have ideas for future TNG topics, please contact me (vijayarao@medicine.bsd.uchicago.edu) or Ryan Farrell (rfarrell@gastro.org), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor-in-Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition

Dear colleagues,

I’m pleased to introduce the winter edition of The New Gastroenterologist – the first issue of 2021! The start of the new year has been very much anticipated because many hope that this year will bring some resolution to the challenges we faced in 2020.

With the pandemic came the widespread use of telemedicine, a feature of patient care that is likely here to stay. As physicians, it is imperative that we understand the legal implications of virtual medicine. Experienced medical malpractice lawyers Ashton Hyde and Grace Johnson (Younker Hyde Macfarlane) offer advice on this rapidly evolving realm of medicine.

Early career gastroenterologists often fall victim to self-doubt in a phenomenon referred to as impostor syndrome. Dr. Kimberly Brown (Wayne State University) discusses this important topic: what it is, how to recognize it, and how to mitigate it. One way to temper the effects of impostor syndrome is utilizing the art of coaching. Dr. Ami N. Shah (Rush) takes us through her journey and reviews the personal and professional benefits of implementing coaching in medicine.

Consults about feedings tubes can be daunting because experience with the placement and management of feeding tubes can be limited during training. This quarter’s “In Focus” article, written by Dr. John Fang and Dr. Gregory Toy (University of Utah) reviews the indications for placement, type of tubes available, and common complications and how to troubleshoot them. This is an absolute must-read for any new gastroenterologist.

How do you approach the patient who shows up for an open access endoscopy, but a quick chart review leads you to the realization that the procedure, is in fact, not indicated? There tends to be a lot of inertia which prevents cancellation of cases like this because the patient is already in the endoscopy suite, prepped, and has planned for this procedure in the preceding weeks or months. Dr. Laurel R. Fisher (University of Pennsylvania) unpacks the ethical considerations of this familiar scenario in this fantastic addition to our ethics case series.

In our postfellowship pathways section, Dr. Rena Yadlapati (University of California San Diego) and Dr. Kelli DeLay (University of Colorado) guide us through the path to becoming an esophagologist. In the DHPA Private Practice Perspectives article this quarter, Dr. Nadeem Baig (Allied Digestive Care) and Kevin Harlen (Capital Digestive Care) explain how clinical productivity is measured and how this translates into compensation in practice.

A silver lining of the pandemic is the way in which social media has been used to connect colleagues around the world in fostering medical education. Dr. Sultan Mahmood (State University of New York at Buffalo), Dr. Atoosa Rabiee (Washington DC VA Medical Center), Dr. Sunil Amin (University of Miami), Dr. Allon Kahn (Mayo Clinic Scottsdale), and Dr. Ijlal Akbar Ali (University of Oklahoma) discuss the inception of @GIJournal, a Twitter-based online journal club, and how it has gained popularity in recent months.

The AGA launched a new podcast, “Small Talk, Big Topics,” geared toward trainees and early career gastroenterologists, and through a brief question and answer session, we get to know the hosts: Dr. Matthew Whitson (Zucker School of Medicine at Hofstra-Northwell), Dr. Nina Nandy (Presbyterian Medical Group), and Dr. C.S. Tse (Brown University).

Lastly, I’d like to take a moment to recognize Lora McGlade, who has been instrumental in The New Gastroenterologist as the Medical Communications Editor for our publisher, Frontline. She assumed a new role at the end of last year, and I cannot thank her enough for her contributions in making this publication a success.

If you have interest in contributing or have ideas for future TNG topics, please contact me (vijayarao@medicine.bsd.uchicago.edu) or Ryan Farrell (rfarrell@gastro.org), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor-in-Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition

Dear colleagues,

I’m pleased to introduce the winter edition of The New Gastroenterologist – the first issue of 2021! The start of the new year has been very much anticipated because many hope that this year will bring some resolution to the challenges we faced in 2020.

With the pandemic came the widespread use of telemedicine, a feature of patient care that is likely here to stay. As physicians, it is imperative that we understand the legal implications of virtual medicine. Experienced medical malpractice lawyers Ashton Hyde and Grace Johnson (Younker Hyde Macfarlane) offer advice on this rapidly evolving realm of medicine.

Early career gastroenterologists often fall victim to self-doubt in a phenomenon referred to as impostor syndrome. Dr. Kimberly Brown (Wayne State University) discusses this important topic: what it is, how to recognize it, and how to mitigate it. One way to temper the effects of impostor syndrome is utilizing the art of coaching. Dr. Ami N. Shah (Rush) takes us through her journey and reviews the personal and professional benefits of implementing coaching in medicine.

Consults about feedings tubes can be daunting because experience with the placement and management of feeding tubes can be limited during training. This quarter’s “In Focus” article, written by Dr. John Fang and Dr. Gregory Toy (University of Utah) reviews the indications for placement, type of tubes available, and common complications and how to troubleshoot them. This is an absolute must-read for any new gastroenterologist.

How do you approach the patient who shows up for an open access endoscopy, but a quick chart review leads you to the realization that the procedure, is in fact, not indicated? There tends to be a lot of inertia which prevents cancellation of cases like this because the patient is already in the endoscopy suite, prepped, and has planned for this procedure in the preceding weeks or months. Dr. Laurel R. Fisher (University of Pennsylvania) unpacks the ethical considerations of this familiar scenario in this fantastic addition to our ethics case series.

In our postfellowship pathways section, Dr. Rena Yadlapati (University of California San Diego) and Dr. Kelli DeLay (University of Colorado) guide us through the path to becoming an esophagologist. In the DHPA Private Practice Perspectives article this quarter, Dr. Nadeem Baig (Allied Digestive Care) and Kevin Harlen (Capital Digestive Care) explain how clinical productivity is measured and how this translates into compensation in practice.

A silver lining of the pandemic is the way in which social media has been used to connect colleagues around the world in fostering medical education. Dr. Sultan Mahmood (State University of New York at Buffalo), Dr. Atoosa Rabiee (Washington DC VA Medical Center), Dr. Sunil Amin (University of Miami), Dr. Allon Kahn (Mayo Clinic Scottsdale), and Dr. Ijlal Akbar Ali (University of Oklahoma) discuss the inception of @GIJournal, a Twitter-based online journal club, and how it has gained popularity in recent months.

The AGA launched a new podcast, “Small Talk, Big Topics,” geared toward trainees and early career gastroenterologists, and through a brief question and answer session, we get to know the hosts: Dr. Matthew Whitson (Zucker School of Medicine at Hofstra-Northwell), Dr. Nina Nandy (Presbyterian Medical Group), and Dr. C.S. Tse (Brown University).

Lastly, I’d like to take a moment to recognize Lora McGlade, who has been instrumental in The New Gastroenterologist as the Medical Communications Editor for our publisher, Frontline. She assumed a new role at the end of last year, and I cannot thank her enough for her contributions in making this publication a success.

If you have interest in contributing or have ideas for future TNG topics, please contact me (vijayarao@medicine.bsd.uchicago.edu) or Ryan Farrell (rfarrell@gastro.org), managing editor of TNG.
 

Stay well,

Vijaya L. Rao, MD
Editor-in-Chief
Assistant Professor of Medicine, University of Chicago, Section of Gastroenterology, Hepatology & Nutrition

Key clinical point: Information of the flow cytometry immunophenotyping (FCI) data during therapy combined with the hematological response can help physicians identify patients with myelodysplastic syndrome (MDS) with a higher probability of maintaining a good quality of response to 5-azacitidine (AZA) therapy for a longer period of time.

Major finding: After a median of 6 cycles of AZA, an FCI improvement was found in 41% of patients, and this finding correlated with a better clinical response (P less than .001). FCI improvement correlated with hematological improvement (HI), and the probability of maintaining a clinical response at 12 cycles of AZA was twice as large (67%) for those who achieved an HI and an FCI improvement after 6 cycles of AZA compared with patients who only achieved an HI (33%).

Study details: The data come from a study of 81 patients diagnosed with MDS in 5 European centers.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Subirá D et al. Ann Hematol. 2021 Jan 9. doi: 10.1007/s00277-021-04411-4.

Key clinical point: Information of the flow cytometry immunophenotyping (FCI) data during therapy combined with the hematological response can help physicians identify patients with myelodysplastic syndrome (MDS) with a higher probability of maintaining a good quality of response to 5-azacitidine (AZA) therapy for a longer period of time.

Major finding: After a median of 6 cycles of AZA, an FCI improvement was found in 41% of patients, and this finding correlated with a better clinical response (P less than .001). FCI improvement correlated with hematological improvement (HI), and the probability of maintaining a clinical response at 12 cycles of AZA was twice as large (67%) for those who achieved an HI and an FCI improvement after 6 cycles of AZA compared with patients who only achieved an HI (33%).

Study details: The data come from a study of 81 patients diagnosed with MDS in 5 European centers.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Subirá D et al. Ann Hematol. 2021 Jan 9. doi: 10.1007/s00277-021-04411-4.

Key clinical point: Information of the flow cytometry immunophenotyping (FCI) data during therapy combined with the hematological response can help physicians identify patients with myelodysplastic syndrome (MDS) with a higher probability of maintaining a good quality of response to 5-azacitidine (AZA) therapy for a longer period of time.

Major finding: After a median of 6 cycles of AZA, an FCI improvement was found in 41% of patients, and this finding correlated with a better clinical response (P less than .001). FCI improvement correlated with hematological improvement (HI), and the probability of maintaining a clinical response at 12 cycles of AZA was twice as large (67%) for those who achieved an HI and an FCI improvement after 6 cycles of AZA compared with patients who only achieved an HI (33%).

Study details: The data come from a study of 81 patients diagnosed with MDS in 5 European centers.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Subirá D et al. Ann Hematol. 2021 Jan 9. doi: 10.1007/s00277-021-04411-4.

Key clinical point: Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) and azacitidine appears tolerable when given over 5 days and has encouraging response rates in patients with myelodysplastic syndromes (MDS).

Major finding: Two complete responses and 6 marrow responses were seen for an overall response rate (ORR) of 36% in evaluable patients. The ORR for patients receiving plerixafor (any dose), G-CSF, and azacitidine was 53%. Blast mobilization during treatment correlated with response, with patients that mobilized greater than 2-fold having an ORR of 60% vs. 17% for those that did not (P = .035).

Study details: The data come from an open-label, phase 1 study of 28 MDS patients treated with plerixafor, G-CSF, and azacitidine with a standard 3 + 3 design with 3 dose escalation cohorts of plerixafor 320 mg/kg/day, 440 mg/kg/day, and 560 mg/kg/day.

Disclosures: The study was supported by the American Society of Hematology Clinical Research Training Institute. Four of the authors reported receiving honoraria from Sanofi and 1 received honoraria from Bristol Myers Squibb.

Source: Huselton E et al. Leuk Lymphoma. 2021 Jan 19. doi: 10.1080/10428194.2021.

Key clinical point: Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) and azacitidine appears tolerable when given over 5 days and has encouraging response rates in patients with myelodysplastic syndromes (MDS).

Major finding: Two complete responses and 6 marrow responses were seen for an overall response rate (ORR) of 36% in evaluable patients. The ORR for patients receiving plerixafor (any dose), G-CSF, and azacitidine was 53%. Blast mobilization during treatment correlated with response, with patients that mobilized greater than 2-fold having an ORR of 60% vs. 17% for those that did not (P = .035).

Study details: The data come from an open-label, phase 1 study of 28 MDS patients treated with plerixafor, G-CSF, and azacitidine with a standard 3 + 3 design with 3 dose escalation cohorts of plerixafor 320 mg/kg/day, 440 mg/kg/day, and 560 mg/kg/day.

Disclosures: The study was supported by the American Society of Hematology Clinical Research Training Institute. Four of the authors reported receiving honoraria from Sanofi and 1 received honoraria from Bristol Myers Squibb.

Source: Huselton E et al. Leuk Lymphoma. 2021 Jan 19. doi: 10.1080/10428194.2021.

Key clinical point: Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) and azacitidine appears tolerable when given over 5 days and has encouraging response rates in patients with myelodysplastic syndromes (MDS).

Major finding: Two complete responses and 6 marrow responses were seen for an overall response rate (ORR) of 36% in evaluable patients. The ORR for patients receiving plerixafor (any dose), G-CSF, and azacitidine was 53%. Blast mobilization during treatment correlated with response, with patients that mobilized greater than 2-fold having an ORR of 60% vs. 17% for those that did not (P = .035).

Study details: The data come from an open-label, phase 1 study of 28 MDS patients treated with plerixafor, G-CSF, and azacitidine with a standard 3 + 3 design with 3 dose escalation cohorts of plerixafor 320 mg/kg/day, 440 mg/kg/day, and 560 mg/kg/day.

Disclosures: The study was supported by the American Society of Hematology Clinical Research Training Institute. Four of the authors reported receiving honoraria from Sanofi and 1 received honoraria from Bristol Myers Squibb.

Source: Huselton E et al. Leuk Lymphoma. 2021 Jan 19. doi: 10.1080/10428194.2021.

Key clinical point: The addition of lenalidomide (LEN) to epoetin (EPO) alfa offers a superior probability of clinically meaningful and highly durable erythroid response vs. LEN alone in patients with lower-risk, non-del (5q) myelodysplastic syndromes (MDS) who have anemia that is refractory to recombinant erythropoietin.

Major finding: After 4 cycles of treatment, major erythroid response was significantly higher with the combination of LEN and erythropoietin vs. LEN alone (28.3% vs. 11.5%; P = .004). Responses to the combined treatment were highly durable with a median major erythroid response duration of 23.8 months in the combined therapy cohort vs. 13 months in the LEN cohort.

Study details: In this phase 3 US intergroup trial, 195 patients with MDS and anemia were randomly assigned to receive LEN and EPO alfa (n = 99) or LEN alone (n = 96) following stratification by serum erythropoietin concentration and prior erythropoietin treatment.

Disclosures: The study was supported by the ECOG-ACRIN Cancer Research Group Study, the National Cancer Institute (NCI) of the National Institutes of Health, and NCI. The authors reported ties with various pharmaceutical companies.

Source: List AF et al. J Clin Oncol. 2021 Jan 13. doi: 10.1200/JCO.20.01691.

Key clinical point: The addition of lenalidomide (LEN) to epoetin (EPO) alfa offers a superior probability of clinically meaningful and highly durable erythroid response vs. LEN alone in patients with lower-risk, non-del (5q) myelodysplastic syndromes (MDS) who have anemia that is refractory to recombinant erythropoietin.

Major finding: After 4 cycles of treatment, major erythroid response was significantly higher with the combination of LEN and erythropoietin vs. LEN alone (28.3% vs. 11.5%; P = .004). Responses to the combined treatment were highly durable with a median major erythroid response duration of 23.8 months in the combined therapy cohort vs. 13 months in the LEN cohort.

Study details: In this phase 3 US intergroup trial, 195 patients with MDS and anemia were randomly assigned to receive LEN and EPO alfa (n = 99) or LEN alone (n = 96) following stratification by serum erythropoietin concentration and prior erythropoietin treatment.

Disclosures: The study was supported by the ECOG-ACRIN Cancer Research Group Study, the National Cancer Institute (NCI) of the National Institutes of Health, and NCI. The authors reported ties with various pharmaceutical companies.

Source: List AF et al. J Clin Oncol. 2021 Jan 13. doi: 10.1200/JCO.20.01691.

Key clinical point: The addition of lenalidomide (LEN) to epoetin (EPO) alfa offers a superior probability of clinically meaningful and highly durable erythroid response vs. LEN alone in patients with lower-risk, non-del (5q) myelodysplastic syndromes (MDS) who have anemia that is refractory to recombinant erythropoietin.

Major finding: After 4 cycles of treatment, major erythroid response was significantly higher with the combination of LEN and erythropoietin vs. LEN alone (28.3% vs. 11.5%; P = .004). Responses to the combined treatment were highly durable with a median major erythroid response duration of 23.8 months in the combined therapy cohort vs. 13 months in the LEN cohort.

Study details: In this phase 3 US intergroup trial, 195 patients with MDS and anemia were randomly assigned to receive LEN and EPO alfa (n = 99) or LEN alone (n = 96) following stratification by serum erythropoietin concentration and prior erythropoietin treatment.

Disclosures: The study was supported by the ECOG-ACRIN Cancer Research Group Study, the National Cancer Institute (NCI) of the National Institutes of Health, and NCI. The authors reported ties with various pharmaceutical companies.

Source: List AF et al. J Clin Oncol. 2021 Jan 13. doi: 10.1200/JCO.20.01691.

The United States is facing a “Category 5” storm as coronavirus variants begin to spread across the country, one of the nation’s top infectious disease experts said Sunday.

“We are going to see something like we have not seen yet in this country,” Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis, said on NBC’s Meet the Press.

The United States has reported 467 cases of the coronavirus variant first identified in the United Kingdom, across 32 states, according to the CDC variant tracker. The United States has also reported three cases of the variant first identified in South Africa in South Carolina and Maryland. One case of the variant first identified in Brazil has been found in Minnesota.

Although overall COVID-19 cases and hospitalizations have declined during the past few weeks, another storm is brewing on the horizon with the variants, Dr. Osterholm told host Chuck Todd. The U.K. variant will likely cause a surge in COVID-19 cases during the next 6-14 weeks, he said. “You and I are sitting on this beach where it’s 70 degrees, perfectly blue skies, gentle breeze. But I see that hurricane 5, Category 5 or higher, 450 miles offshore. And telling people to evacuate on that nice blue sky day is going to be hard. But I can also tell you that hurricane is coming.”

Dr. Osterholm urged federal and state officials to vaccinate as many people as possible to reduce the oncoming storm. The United States has distributed 49.9 million doses and administered 31.1 million doses, according to the latest CDC data updated Sunday, including 25.2 million first doses and 5.6 million second doses.

Doling out more doses to older Americans, rather than holding onto the second dose of the two-shot regimen, is an urgent decision, Dr. Osterholm said.

“I think right now, in advance of this surge, we need to get as many one doses in as many people over 65 as we possibly can to reduce serious illnesses and deaths that are going to occur over the weeks ahead,” he said.

The U.K. variant will likely become the dominant coronavirus strain in the United States in coming weeks, Dr. Osterholm said, adding that COVID-19 vaccines should be able to protect against it. In the meantime, however, he’s worried that the variant will cause more infections and deaths until more people get vaccinated.

“What we have to do now is also anticipate this and understand that we’re going to have change quickly,” he said. “As fast as we’re opening restaurants, we’re likely going to be closing them in the near term.”

A version of this article first appeared on WebMD.com.

The United States is facing a “Category 5” storm as coronavirus variants begin to spread across the country, one of the nation’s top infectious disease experts said Sunday.

“We are going to see something like we have not seen yet in this country,” Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis, said on NBC’s Meet the Press.

The United States has reported 467 cases of the coronavirus variant first identified in the United Kingdom, across 32 states, according to the CDC variant tracker. The United States has also reported three cases of the variant first identified in South Africa in South Carolina and Maryland. One case of the variant first identified in Brazil has been found in Minnesota.

Although overall COVID-19 cases and hospitalizations have declined during the past few weeks, another storm is brewing on the horizon with the variants, Dr. Osterholm told host Chuck Todd. The U.K. variant will likely cause a surge in COVID-19 cases during the next 6-14 weeks, he said. “You and I are sitting on this beach where it’s 70 degrees, perfectly blue skies, gentle breeze. But I see that hurricane 5, Category 5 or higher, 450 miles offshore. And telling people to evacuate on that nice blue sky day is going to be hard. But I can also tell you that hurricane is coming.”

Dr. Osterholm urged federal and state officials to vaccinate as many people as possible to reduce the oncoming storm. The United States has distributed 49.9 million doses and administered 31.1 million doses, according to the latest CDC data updated Sunday, including 25.2 million first doses and 5.6 million second doses.

Doling out more doses to older Americans, rather than holding onto the second dose of the two-shot regimen, is an urgent decision, Dr. Osterholm said.

“I think right now, in advance of this surge, we need to get as many one doses in as many people over 65 as we possibly can to reduce serious illnesses and deaths that are going to occur over the weeks ahead,” he said.

The U.K. variant will likely become the dominant coronavirus strain in the United States in coming weeks, Dr. Osterholm said, adding that COVID-19 vaccines should be able to protect against it. In the meantime, however, he’s worried that the variant will cause more infections and deaths until more people get vaccinated.

“What we have to do now is also anticipate this and understand that we’re going to have change quickly,” he said. “As fast as we’re opening restaurants, we’re likely going to be closing them in the near term.”

A version of this article first appeared on WebMD.com.

The United States is facing a “Category 5” storm as coronavirus variants begin to spread across the country, one of the nation’s top infectious disease experts said Sunday.

“We are going to see something like we have not seen yet in this country,” Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis, said on NBC’s Meet the Press.

The United States has reported 467 cases of the coronavirus variant first identified in the United Kingdom, across 32 states, according to the CDC variant tracker. The United States has also reported three cases of the variant first identified in South Africa in South Carolina and Maryland. One case of the variant first identified in Brazil has been found in Minnesota.

Although overall COVID-19 cases and hospitalizations have declined during the past few weeks, another storm is brewing on the horizon with the variants, Dr. Osterholm told host Chuck Todd. The U.K. variant will likely cause a surge in COVID-19 cases during the next 6-14 weeks, he said. “You and I are sitting on this beach where it’s 70 degrees, perfectly blue skies, gentle breeze. But I see that hurricane 5, Category 5 or higher, 450 miles offshore. And telling people to evacuate on that nice blue sky day is going to be hard. But I can also tell you that hurricane is coming.”

Dr. Osterholm urged federal and state officials to vaccinate as many people as possible to reduce the oncoming storm. The United States has distributed 49.9 million doses and administered 31.1 million doses, according to the latest CDC data updated Sunday, including 25.2 million first doses and 5.6 million second doses.

Doling out more doses to older Americans, rather than holding onto the second dose of the two-shot regimen, is an urgent decision, Dr. Osterholm said.

“I think right now, in advance of this surge, we need to get as many one doses in as many people over 65 as we possibly can to reduce serious illnesses and deaths that are going to occur over the weeks ahead,” he said.

The U.K. variant will likely become the dominant coronavirus strain in the United States in coming weeks, Dr. Osterholm said, adding that COVID-19 vaccines should be able to protect against it. In the meantime, however, he’s worried that the variant will cause more infections and deaths until more people get vaccinated.

“What we have to do now is also anticipate this and understand that we’re going to have change quickly,” he said. “As fast as we’re opening restaurants, we’re likely going to be closing them in the near term.”

A version of this article first appeared on WebMD.com.

Key clinical point: This study found no evidence of an association between nonsteroidal anti-inflammatory drug (NSAID) use and myelodysplastic syndromes (MDS).

Major finding: No significant association was seen between MDS and use of any NSAID (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.68-1.23), aspirin (aOR, 0.87; 95% CI, 0.67-1.14), ibuprofen (aOR, 0.91; 95% CI, 0.64-1.30), or acetaminophen (aOR, 1.29; 95% CI, 0.90-1.84). No association was observed in analyses stratified by sex; however, the direction of the effect between NSAID use and MDS varied by MDS subtype.

Study details: This population-based case-control study included 399 MDS cases and 698 controls using data from the Adults in Minnesota with Myelodysplastic Syndromes Study.

Disclosures: The study was funded by a National Institutes of Health grant. The authors declared no conflicts of interest.

Source: Hubbard AK et al. Leuk Lymphoma. 2021 Jan 8. doi: 10.1080/10428194.2020.

Key clinical point: This study found no evidence of an association between nonsteroidal anti-inflammatory drug (NSAID) use and myelodysplastic syndromes (MDS).

Major finding: No significant association was seen between MDS and use of any NSAID (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.68-1.23), aspirin (aOR, 0.87; 95% CI, 0.67-1.14), ibuprofen (aOR, 0.91; 95% CI, 0.64-1.30), or acetaminophen (aOR, 1.29; 95% CI, 0.90-1.84). No association was observed in analyses stratified by sex; however, the direction of the effect between NSAID use and MDS varied by MDS subtype.

Study details: This population-based case-control study included 399 MDS cases and 698 controls using data from the Adults in Minnesota with Myelodysplastic Syndromes Study.

Disclosures: The study was funded by a National Institutes of Health grant. The authors declared no conflicts of interest.

Source: Hubbard AK et al. Leuk Lymphoma. 2021 Jan 8. doi: 10.1080/10428194.2020.

Key clinical point: This study found no evidence of an association between nonsteroidal anti-inflammatory drug (NSAID) use and myelodysplastic syndromes (MDS).

Major finding: No significant association was seen between MDS and use of any NSAID (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.68-1.23), aspirin (aOR, 0.87; 95% CI, 0.67-1.14), ibuprofen (aOR, 0.91; 95% CI, 0.64-1.30), or acetaminophen (aOR, 1.29; 95% CI, 0.90-1.84). No association was observed in analyses stratified by sex; however, the direction of the effect between NSAID use and MDS varied by MDS subtype.

Study details: This population-based case-control study included 399 MDS cases and 698 controls using data from the Adults in Minnesota with Myelodysplastic Syndromes Study.

Disclosures: The study was funded by a National Institutes of Health grant. The authors declared no conflicts of interest.

Source: Hubbard AK et al. Leuk Lymphoma. 2021 Jan 8. doi: 10.1080/10428194.2020.

Key clinical point: A study found smoking, history of autoimmune disease and benzene exposure to significant risk factors for de novo myelodysplastic syndromes (MDS). These factors also had a similar yet non-significant association with therapy-related MDS (tMDS).

Major finding:  After adjusting for confounders, former smoking status (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.10-1.93), history of autoimmune disease (OR, 1.34; 95% CI, 0.99-1.82) and benzene exposure (OR, 1.48; 95% CI, 1.00-2.19) were significantly associated with de novo MDS. The risk estimates for these associations were similar in magnitude for tMDS, but non-significant.

Study details: The data come from a case-control study involving 346 de novo MDS cases, 37 tMDS cases and 682 controls matched by age and sex.

Disclosures: The study was funded by the National Institutes of Health. The authors declared no conflicts of interest.

Source: Yarosh R et al. Cancer Causes Control. 2021 Jan 4. doi: 10.1007/s10552-020-01378-x.

Key clinical point: A study found smoking, history of autoimmune disease and benzene exposure to significant risk factors for de novo myelodysplastic syndromes (MDS). These factors also had a similar yet non-significant association with therapy-related MDS (tMDS).

Major finding:  After adjusting for confounders, former smoking status (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.10-1.93), history of autoimmune disease (OR, 1.34; 95% CI, 0.99-1.82) and benzene exposure (OR, 1.48; 95% CI, 1.00-2.19) were significantly associated with de novo MDS. The risk estimates for these associations were similar in magnitude for tMDS, but non-significant.

Study details: The data come from a case-control study involving 346 de novo MDS cases, 37 tMDS cases and 682 controls matched by age and sex.

Disclosures: The study was funded by the National Institutes of Health. The authors declared no conflicts of interest.

Source: Yarosh R et al. Cancer Causes Control. 2021 Jan 4. doi: 10.1007/s10552-020-01378-x.

Key clinical point: A study found smoking, history of autoimmune disease and benzene exposure to significant risk factors for de novo myelodysplastic syndromes (MDS). These factors also had a similar yet non-significant association with therapy-related MDS (tMDS).

Major finding:  After adjusting for confounders, former smoking status (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.10-1.93), history of autoimmune disease (OR, 1.34; 95% CI, 0.99-1.82) and benzene exposure (OR, 1.48; 95% CI, 1.00-2.19) were significantly associated with de novo MDS. The risk estimates for these associations were similar in magnitude for tMDS, but non-significant.

Study details: The data come from a case-control study involving 346 de novo MDS cases, 37 tMDS cases and 682 controls matched by age and sex.

Disclosures: The study was funded by the National Institutes of Health. The authors declared no conflicts of interest.

Source: Yarosh R et al. Cancer Causes Control. 2021 Jan 4. doi: 10.1007/s10552-020-01378-x.

Key clinical point: Myelodysplastic syndrome (MDS) patients treated with hypomethylating agents (HMA), especially those with higher-risk MDS have unmet clinical needs in real-world setting.

Major finding: Median survival was 11.6 months, 18.4 months, and 19.1 months for the higher-risk, intermediate-risk, and unknown-risk groups, respectively. Corresponding median time-to-AML transformation for the 3 groups were 19.3 months, 50.4 months, and 'not reached', respectively.

Study details: The data come from 3,046 MDS patients treated with HMA from the SEER-Medicare database. The patients were categorized as higher-risk, intermediate-risk, and unknown-risk.

Disclosures: The study was sponsored by Novartis. I Sadek and X Cao are employees and stockholders of Novartis.  G Bonifacio was an employee and stockholder of Novartis at the time of the study. EM Stein provided paid consulting services to Novartis. D Latremouille-Viau, S Shi, A Guerin, and EQ Wu are employees of Analysis Group, Inc. which provided paid consulting services to Novartis.

Source: Stein EM et al. Leuk Lymphoma. 2021 Jan 11. doi: 10.1080/10428194.2020.1869959.

Key clinical point: Myelodysplastic syndrome (MDS) patients treated with hypomethylating agents (HMA), especially those with higher-risk MDS have unmet clinical needs in real-world setting.

Major finding: Median survival was 11.6 months, 18.4 months, and 19.1 months for the higher-risk, intermediate-risk, and unknown-risk groups, respectively. Corresponding median time-to-AML transformation for the 3 groups were 19.3 months, 50.4 months, and 'not reached', respectively.

Study details: The data come from 3,046 MDS patients treated with HMA from the SEER-Medicare database. The patients were categorized as higher-risk, intermediate-risk, and unknown-risk.

Disclosures: The study was sponsored by Novartis. I Sadek and X Cao are employees and stockholders of Novartis.  G Bonifacio was an employee and stockholder of Novartis at the time of the study. EM Stein provided paid consulting services to Novartis. D Latremouille-Viau, S Shi, A Guerin, and EQ Wu are employees of Analysis Group, Inc. which provided paid consulting services to Novartis.

Source: Stein EM et al. Leuk Lymphoma. 2021 Jan 11. doi: 10.1080/10428194.2020.1869959.

Key clinical point: Myelodysplastic syndrome (MDS) patients treated with hypomethylating agents (HMA), especially those with higher-risk MDS have unmet clinical needs in real-world setting.

Major finding: Median survival was 11.6 months, 18.4 months, and 19.1 months for the higher-risk, intermediate-risk, and unknown-risk groups, respectively. Corresponding median time-to-AML transformation for the 3 groups were 19.3 months, 50.4 months, and 'not reached', respectively.

Study details: The data come from 3,046 MDS patients treated with HMA from the SEER-Medicare database. The patients were categorized as higher-risk, intermediate-risk, and unknown-risk.

Disclosures: The study was sponsored by Novartis. I Sadek and X Cao are employees and stockholders of Novartis.  G Bonifacio was an employee and stockholder of Novartis at the time of the study. EM Stein provided paid consulting services to Novartis. D Latremouille-Viau, S Shi, A Guerin, and EQ Wu are employees of Analysis Group, Inc. which provided paid consulting services to Novartis.

Source: Stein EM et al. Leuk Lymphoma. 2021 Jan 11. doi: 10.1080/10428194.2020.1869959.

Key clinical point: Preliminary data of a phase 2 study found that the combination of azacitidine and pembrolizumab was well-tolerated and demonstrated antitumor activity in treatment-naïve patients with higher-Risk myelodysplastic syndrome (MDS)

Major finding: The overall response rate was 80%, with 3 patients reaching complete remission, 4 patients achieving marrow CR (mCR), 4 patients achieving mCR with hematologic improvement (HI), and 1 patient demonstrating HI. Treatment was well-tolerated, the most common treatment-related adverse events being arthralgia, pneumonia, nausea, and skin rash.

Study details: The preliminary phase 2 trial data come from 17 treatment-naïve patients treated with frontline combination of azacitidine and pembrolizumab, with a median follow-up time of 13.8 months and 5 patients continuing on treatment in cycles 4-28.

Disclosures: The study is sponsored by M.D. Anderson Cancer Center. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Chien KS et al. ASH 2020. 2020 Dec 5. Abstract 1288.

Key clinical point: Preliminary data of a phase 2 study found that the combination of azacitidine and pembrolizumab was well-tolerated and demonstrated antitumor activity in treatment-naïve patients with higher-Risk myelodysplastic syndrome (MDS)

Major finding: The overall response rate was 80%, with 3 patients reaching complete remission, 4 patients achieving marrow CR (mCR), 4 patients achieving mCR with hematologic improvement (HI), and 1 patient demonstrating HI. Treatment was well-tolerated, the most common treatment-related adverse events being arthralgia, pneumonia, nausea, and skin rash.

Study details: The preliminary phase 2 trial data come from 17 treatment-naïve patients treated with frontline combination of azacitidine and pembrolizumab, with a median follow-up time of 13.8 months and 5 patients continuing on treatment in cycles 4-28.

Disclosures: The study is sponsored by M.D. Anderson Cancer Center. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Chien KS et al. ASH 2020. 2020 Dec 5. Abstract 1288.

Key clinical point: Preliminary data of a phase 2 study found that the combination of azacitidine and pembrolizumab was well-tolerated and demonstrated antitumor activity in treatment-naïve patients with higher-Risk myelodysplastic syndrome (MDS)

Major finding: The overall response rate was 80%, with 3 patients reaching complete remission, 4 patients achieving marrow CR (mCR), 4 patients achieving mCR with hematologic improvement (HI), and 1 patient demonstrating HI. Treatment was well-tolerated, the most common treatment-related adverse events being arthralgia, pneumonia, nausea, and skin rash.

Study details: The preliminary phase 2 trial data come from 17 treatment-naïve patients treated with frontline combination of azacitidine and pembrolizumab, with a median follow-up time of 13.8 months and 5 patients continuing on treatment in cycles 4-28.

Disclosures: The study is sponsored by M.D. Anderson Cancer Center. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Chien KS et al. ASH 2020. 2020 Dec 5. Abstract 1288.

Key clinical point: Older patients with advanced myelodysplastic syndrome (MDS) may benefit from allogeneic hematopoietic cell transplantation (HCT), which is usually reserved for younger patients.

Major finding: At 3 years, the donor vs no-donor group had a greater improvement in overall survival (absolute difference, 21.3%; P = .0001) and higher leukemia-free survival (35.8% vs 20.6%; P = .003).

Study details: The study included patients aged 50-75 years with newly diagnosed MDS of higher risk and who were eligible for reduced-intensity conditioning (RIC) allogeneic HCT. Patients were initially assigned to the "no-donor" group at enrollment and reassigned to the donor group when a suitable donor was identified.

Disclosures: No specific funding information was available for the study. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Nakamura R et al. ASH 2020. 2020 Dec 5. Abstract 75.

Key clinical point: Older patients with advanced myelodysplastic syndrome (MDS) may benefit from allogeneic hematopoietic cell transplantation (HCT), which is usually reserved for younger patients.

Major finding: At 3 years, the donor vs no-donor group had a greater improvement in overall survival (absolute difference, 21.3%; P = .0001) and higher leukemia-free survival (35.8% vs 20.6%; P = .003).

Study details: The study included patients aged 50-75 years with newly diagnosed MDS of higher risk and who were eligible for reduced-intensity conditioning (RIC) allogeneic HCT. Patients were initially assigned to the "no-donor" group at enrollment and reassigned to the donor group when a suitable donor was identified.

Disclosures: No specific funding information was available for the study. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Nakamura R et al. ASH 2020. 2020 Dec 5. Abstract 75.

Key clinical point: Older patients with advanced myelodysplastic syndrome (MDS) may benefit from allogeneic hematopoietic cell transplantation (HCT), which is usually reserved for younger patients.

Major finding: At 3 years, the donor vs no-donor group had a greater improvement in overall survival (absolute difference, 21.3%; P = .0001) and higher leukemia-free survival (35.8% vs 20.6%; P = .003).

Study details: The study included patients aged 50-75 years with newly diagnosed MDS of higher risk and who were eligible for reduced-intensity conditioning (RIC) allogeneic HCT. Patients were initially assigned to the "no-donor" group at enrollment and reassigned to the donor group when a suitable donor was identified.

Disclosures: No specific funding information was available for the study. The authors reported relationships with various pharmaceutical companies and/or research organizations.

Source: Nakamura R et al. ASH 2020. 2020 Dec 5. Abstract 75.