Citations

Many clinical laboratories supporting solid organ transplant programs use multiple HLA genotyping technologies, depending on individual laboratory needs. Sequence‐specific primers and quantitative polymerase chain reaction (qPCR) serve the rapid turnaround necessary for deceased donor workup, while sequence‐specific oligonucleotide probe (SSOP) technology is widely employed for higher volumes. When clinical need mandates high‐resolution data, Sanger sequencing‐based typing (SBT) has been the “gold standard.” However, all those methods commonly yield ambiguous typing results that utilize valuable laboratory resources when resolution is required. In solid organ transplantation, high‐resolution typing may provide critical information for highly sensitized patients with donor‐specific anti‐HLA antibodies (DSA), particularly when DSA involve HLA alleles not discriminated by SSOP typing. Arguments against routine use of SBT include assay complexity, long turnaround times (TAT), and increased costs. Here, we compare a next generation sequencing (NGS) technology with SSOP for accuracy, effort, turnaround time, and level of resolution for genotyping of 11 HLA loci among 289 specimens from five clinical laboratories. Results were concordant except for SSOP misassignments in eight specimens and 21 novel sequences uniquely identified by NGS. With few exceptions, SSOP generated ambiguous results while NGS provided unambiguous three‐field allele assignments. For complete HLA genotyping of up to 24 samples by either SSOP or NGS, bench work was completed on day 1 and typing results were available on day 2. This study provides compelling evidence that, although not viable for STAT typing of deceased donors, a single‐pass NGS HLA typing method has direct application for solid organ transplantation.

Background:The treatment paradigm for multiple myeloma (MM) has evolved rapidly following new drug approvals and combinations. These improvements have the potential to improve outcomes for patients, but only if specialists in hematology/oncology (hem/oncs) have up‐to‐date knowledge on selection of treatments, prevention and management of adverse events (AEs), and comfort with emerging clinical trial data.Aims:We sought to determine if a curriculum of online continuing medical education (CME) activities could improve hem/onc knowledge and competence in treating patients with MM.MethodsThis analysis included hem/onc data from a MM curriculum spanning over 4 years, with 54 activities. For each year of the curriculum, an expert panel identified knowledge/competence gaps to be addressed through CME. Within the analysis, assessment questions were grouped into learning topics and the average for pre and post‐education was calculated for 2016‐2018 of the curriculum for each topic. The analysis elucidated the impact of the curriculum on narrowing gaps in knowledge/competence using a pre/post design. Statistical significance was assessed using a chi‐square statistic (P < .05 level).Results:As of December 2018, the curriculum had reached 33,699 US hem/onc learners and 2144 participated in the outcomes assessment. Treatment Selection: The curriculum significantly improved hem/onc knowledge/competence over time for selecting treatment for patients with relapsed/refractory (R/R) MM (pre/post: 2016, 41%/51%, P < .001; 2018, 48%/64%, P < .001). Managing AEs: The curriculum led to sustained knowledge gains for hem/oncs over time related to managing treatment‐related AEs in patients with MM (pre/post: 2016, 39%/53%, P < .001; 2018, 80%/84%, P = .427). Knowledge of Clinical Trial Data: Activities within the curriculum also significantly improved hem/onc knowledge of clinical trial data for consolidation and maintenance therapy (pre/post: 2016, 63%/76%, P < .001; 2017, 68%/74%, P < .05; 2018, 62%/76%, P < .001). Potential Patient Impact: The reach of Medscape Oncology CME has a large impact on how US hem/oncs treat patients with MM. Of all hem/onc specialists with MM diagnostic encounters, 64% are members of Medscape. Additionally, 70% of all high decile (deciles 7‐10) hem/onc specialists with MM diagnostic encounters are members of Medscape. Based on the number of learners for the curriculum and the average number of patient encounters, this education has the potential to impact 33,894 MM patient encounters.[IQVIA Data]Summary/Conclusion:This analysis shows that online CME, as part of a sustained educational curriculum, using various formats (video, text, panel discussion, case‐based) can significantly improve the knowledge and competence of hem/oncs in multiple areas related to MM. Statistically significant gains in knowledge and competence selecting treatment for R/R MM were seen even with the introduction of new clinical evidence in this area. The analysis also shows the potential impact on patients and the large reach that is achievable with online education. As new therapies and combinations of treatments continue to change practice, additional education is needed to aid hem/oncs in staying abreast of new data, managing AEs, and tailoring therapy selection for individual patients with MM.