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Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018
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Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
The premier event in hematology celebrated its diamond anniversary this year. The 60th annual meeting of the American Society of Hematology (ASH) was held November 30 to December 4 in San Diego, California. The meeting attracted more than 25,000 attendees from 155 countries, and more than 4800 abstracts were presented.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
The meeting featured "big trials with big results," said ASH secretary Robert Brodsky, MD. Among the highlights:
Ibrutinib alone the new standard untreated chronic lymphocytic leukemia (CLL) in elderly
Validation that CAR T cells "keep living and keep working"
Four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) instead of six for favorable diffuse large B-cell lymphoma (DLBCL)
Daratumumab plus Len/Dex a new standard of care in myeloma?
Why some CLL patients stop responding to venetoclax
Microbiome before allogeneic hematopoietic stem cell transplantation (HSCT) predicts survival and complications
First-in-class drug reduces blood transfusions in myelodysplastic syndrome (MDS) and beta-thalassemia
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Ibrutinib Alone for Older Patients With Untreated CLL
In patients older than 65 with untreated CLL, ibrutinib (Imbruvica, Pharmacyclics/Janssen), alone or with rituximab (Rituxan, Roche/Genentech), provides superior progression-free survival (PFS) compared with the standard-of-care combination of bendamustine (Bendeka, Teva) and rituximab, according to the National Cancer Institute (NCI)-funded ALLIANCE study. There was no significant difference in PFS between the two ibrutinib groups, suggesting that the addition of rituximab was unnecessary. "Our results establish that ibrutinib should be a standard of care for older patients with CLL — it is more effective than the best available chemoimmunotherapy regimen," said lead author Jennifer Woyach, MD, of the Ohio State University Comprehensive Cancer Center in Columbus. "The findings also suggest that when designing trials for CLL in older patients, ibrutinib is the efficacy standard by which other drugs should be measured," she added. The results of the trial were simultaneously published in the New England Journal of Medicine.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Ibrutinib and Rituximab for Untreated CLL: "Practice Changing"
The combination of ibrutinib and rituximab also beat the current gold standard of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with untreated CLL in the large E1912 study trial, also funded by the NCI. Ibrutinib plus rituximab showed superior PFS and overall survival compared with FCR, and was less toxic. "These findings have immediate practice-changing implications and establish ibrutinib as the single most effective first-line therapy for patients with CLL," said lead author Tait D. Shanafelt, MD, from Stanford University, California. Commenting on the new results, Aaron Gerds, MD, of the Cleveland Clinic Taussig Cancer Institute, noted that three trials presented at the meeting suggest, in turn, that ibrutinib alone, ibrutinib plus rituximab, or ibrutinib plus obinutuzumab should be the new standard for CLL. How are clinicians to choose between these regimens when treating patients with CLL? "This is an embarrassment of riches," he said. Ultimately, clinicians will have to weigh all the factors before choosing, he added.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
CAR T Cells: "Validation That They Keep Living and Keep Working"
New longer-term data with chimeric antigen receptor (CAR) T-cell therapies are showing durable responses, with many patients sustaining deep responses that are now lasting for a number of years, according to several studies presented at ASH. "What we are seeing is a validation that these therapies aren't just something that are a temporizing measure...based upon the duration of the effectiveness of these therapies, there are patients for whom you really can look at the prospect of a cure," commented Joseph Alvarnas, MD, from the City of Hope in Duarte, California. As the data go farther out, now approaching 3 years, "we are becoming more excited that this technology in fact changes the nature of the disease for some patients," he said. "With other therapies, we have seen responses, but in time the responses diminish and the patients may submit to a relapse, but what you see now are that these CAR T cells persist in the body," he explained. Patients who respond develop B-cell aplasia as a side effect, and this is validation that these products persist in the body, he commented. "This is a living drug, and this is validation that it keeps living and keeps working."
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
"Marginal Benefit" With Rivaroxaban in Cancer Patients
A new study that explored the use of the oral agent rivaroxaban (Xarelto, Janssen) as prophylaxis against venous thromboembolism (VTE) in ambulatory cancer patients who were being treated in the outpatient setting failed to meet its primary endpoint. At 180 days, the rate of thrombotic events was not statistically significantly different between the patients who received rivaroxaban (5.95%) and those who received placebo (~8.79%). However, this was primarily because a large proportion of patients stopped taking the medication before the end of the study period, noted lead author Alok Khorana, MD, of the Cleveland Clinic and Case Western Reserve University, Ohio. More than half of patients taking placebo and almost 44% of those taking rivaroxaban stopped the regimen before 180 days, and more than one third of clotting events occurred after participants had discontinued their assigned regimen. In a prespecified analysis that only evaluated the on-treatment period, the difference between the two groups was statistically significant. In the rivaroxaban group, 2.6% of patients experienced an event, as compared to 6.4% of patients who received placebo (P = .007).
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Four Cycles of CHOP Instead of Six for Favorable DLBCL
Standard therapy for young patients with favorable-prognosis DLBCL is six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunomycin], vincristine [Oncovin], and prednisolone) given every 21 days. But data from the German FLYER trial suggest that these patients can be spared two cycles of CHOP, with rituximab still given over six cycles, and have excellent clinical outcomes, similar to those seen after the standard six cycles of R-CHOP. The results show that 3-year PFS with four cycles of CHOP was 96%, which was noninferior to the 94% seen with six cycles of CHOP. The 3-year event-free survival rates were identical in both groups. The corresponding 3-year overall survival rates were 99% and 98%. "We showed that efficacy was maintained with four cycles of R-CHOP followed by two cycles of rituximab and toxicity was considerably reduced," said lead author Viola Poeschel, MD, from the Saarland University Medical School, Homburg/Saar, Germany. With the new regimen of four cycles of CHOP, chemotherapy lasts a total of 84 days compared with 126 days with the six-cycle regimen, she added.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Daratumumab Plus Len/Dex: New Standard of Care in Myeloma?
In the MAIA study, adding the monoclonal antibody daratumumab (Darzalex, Janssen) to standard therapy significantly extended PFS in patients newly diagnosed with multiple myeloma who were ineligible for stem cell transplant. As compared to standard therapy with lenalidomide (Revlimid, Celgene) and dexamethasone (Rd), the addition of daratumumab to lenalidomide and dexamethasone (D-Rd) significantly reduced the risk for disease progression or death by 44%. The estimated 30-month PFS was 71% with the triplet vs 56% with Rd. "These results support daratumumab and lenalidomide as a new standard of care for patients with transplant-ineligible newly diagnosed multiple myeloma," said lead author Thierry Facon, MD, of Hôpital Claude Huriez in Lille, France. He noted that daratumumab and lenalidomide induced significantly deeper responses; more than three times as many patients who received the combination were free of minimal residual disease.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Why Some CLL Patients Stop Responding to Venetoclax
Acquisition of a specific mutation may explain why some patients with CLL stop responding to venetoclax (Venclexta, AbbVie/Genentech). The acquired mutation Gly101Val in B-cell leukemia/lymphoma 2 protein occurs at the venetoclax binding site, thereby decreasing its effectiveness. "Although venetoclax is a highly effective drug for CLL, most patients eventually relapse," said lead author Piers Blombery, MBBS, of the University of Melbourne, Australia. "The mutation, we have found, helps to explain why venetoclax stops working in some patients. Furthermore, we have shown that in some cases, the mutation can be detected in patients' bone marrow years before clinical signs of relapse appear," he added. "Venetoclax is an amazingly effective and powerful drug in CLL, and it has taken a relatively short time to define a resistance mechanism," commented Kanti Rai, MD, of the Feinstein Institute of Medical Research at Hosftra/Northwell, Hempstead, New York. This is a "relatively new drug, and not too many venetoclax failures have emerged. This is the first warning, but it is not going to adversely affect using venetoclax," he predicted.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Microbiome Before HSCT Predictive of Survival and Complications
The risk for complications from HSCT is greater if a patient has a lower diversity of microbes in the gut prior to beginning the transplant process, according to a new study. Patients with the lowest microbial diversity had poorer overall survival and a higher risk for graft-versus-host disease (GVHD), and this was observed across many different countries. "The association of diversity with overall survival is reproducible over time and across geography," said lead author Jonathan Peled, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York City. "Looking at the microbiota of our gut helps us understand the prognosis of patients undergoing HSCT," commented press briefing moderator Joseph Mikhael, MD, of the Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona. "We've come to appreciate that the microbiome of patients undergoing transplant can help us appreciate the nature of GVHD," said Mikhael.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Model Improves Predictions of Myelodysplastic Syndrome Prognosis
Patients with MDS, which rarely causes symptoms in its early stages, may now obtain a better idea of what may lie ahead for them. A machine-learning approach that analyzes genomic and clinical data can give a personalized risk assessment for each individual. It can provide overall survival estimates at different time points and predict the risk for transformation to acute myeloid leukemia (AML). It has been shown to outperform currently used risk stratification models, such as IPSS-R (Revised International Prognosis Risk Stratification). "We are optimistic an improved prediction will lead to more personalized care," said presenter and model-developer Aziz Nazha, MD, from the Cleveland Clinic, Ohio. Nazha is developing a Web application in which the trained model can be used to provide overall survival and AML transformation probabilities for each patient at different time points. "The Web application will make it more physician and patient friendly," he said.
Image from Darbe Rotach/Medscape
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
Luspatercept Reduces Blood Transfusions in MDS and Beta-Thalassemia
The investigational drug luspatercept (Acceleron/Celgene) has been shown to reduce the need for blood transfusions in two separate patient populations. The product, a first-in-class erythroid maturation agent that enhances late-stage erythropoiesis, significantly reduced the need for frequent blood transfusions in patients with MDS in the MEDALIST trial and patients with beta-thalassemia in the BELIEVE trial. ASH President Alexis Thompson, MD, said it appears that luspatercept can improve the production of endogenous red blood cells (RBCs) by enhancing the maturation of these cells in the bone marrow. The drug significantly reduced the need for RBC transfusions, and "this is a very exciting advance for patients who would have few other treatment options," she said. Luspatercept has orphan drug status and a fast track designation for both indications. The drug is moving toward approval in the United States and elsewhere. "This is one to watch out for, as it is potentially practice changing," said Thompson.
Top News From ASH 2018: Slideshow
Zosia Chustecka; Darbe Rotach; Roxanne Nelson; Alexander Castellino; Sandy Huffaker; Megan Brooks | December 17, 2018 | Contributor Information
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Zosia Chustecka
Medscape Oncology News Editor
London, England
Darbe Rotach
Medscape Senior Photo Editor
New York City
Roxanne Nelson
Freelance Journalist
Bellingham, Washington
Alexander Castellino
Freelance Journalist
New York City
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