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Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
The 61st annual meeting of the American Society of Hematology was held December 6-10 at the Orange County Convention Center in Orlando, Florida. The premier event in hematology attracted more than 25,000 attendees from over 115 countries and featured 4900 abstracts.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Two clinical trials demonstrating the promise of 'off-the-shelf' products to rival individually grown CAR T-cell products for blood cancers generated much excitement this year. Among the other highlights:
First maintenance therapy for acute myeloid leukemia (AML) improves survival
Triplet therapy a new standard of care in relapsed/refractory multiple myeloma
Blinatumomab better than more chemo in relapsed B-cell ALL
No need for radiation for some with diffuse large B-cell lymphoma (DLBCL)
Expensive CAR T-cell therapies appear cost-effective in real world
Allogeneic transplant best in follicular lymphoma, but questions remain
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Oral Azacitidine: First Maintenance Therapy for AML
For the first time, there is a maintenance therapy for patients with acute myeloid leukemia (AML) in remission that can improve overall survival — a new oral formulation of an old drug, azacitidine, known as CC-486 (Celgene). The results of the QUAZAR AML-001 study, conducted in 472 patients with poor-risk AML in first remission, show that CC-486 significantly improved outcomes compared with placebo plus best supportive care in terms of median overall survival (24.7 vs 14.8 months) and median relapse-free survival (10.2 vs 4.8 months). "Oral azacitidine represents a newtherapeutic standard for patients with AML in remission," said lead author Andrew H. Wei, MBBS, PhD, from the Alfred Hospital in Melbourne, Australia. He explained that AML often responds well to initial chemotherapy and puts patients into remission, but the problem is keeping them in remission. Despite various attempts, there has been no success over the past 30 years in defining maintenance treatment for these patients, Wei said. The new results suggest that oral azacitidine could be an effective maintenance therapy.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
New Triplet, New Standard of Care in Relapsed Myeloma?
A new triplet therapy, comprising carfilzomib (Kyprolis, Amgen), dexamethasone, and daratumumab (Darzalex, Amgen), known as KdD, should become a new standard for relapsed or refractory multiple myeloma, say researchers reporting results of the phase 3 CANDOR trial. At present, daratumumab is approved for use in relapsed/refractory multiple myeloma as monotherapy, in combination with dexamethasone, or with dexamethasone and lenalidomide. In the CANDOR trial, the new triplet of daratumumab, carfilzomib, and dexamethasone yielded "markedly improved" progression-free survival compared with the doublet of carfilzomib and dexamethasone (Kd, median not reached vs 15.4 months), "with a 37% reduction in the risk of progression or death," said lead author Saad Z. Usmani, MD, MBBS, from Atrium Health, Charlotte, North Carolina. "Patients treated with KdD also achieved deeper responses than patients treated with Kd, with a nearly 10 times higher MRD-negative complete response rate at 12 months vs Kd-treated patients."
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Blinatumomab Instead of Chemo in Young Patients With Relapsed ALL
In young patients who relapse after chemotherapy for B-cell acute lymphoblastic leukemia (B-ALL), the novel agent blinatumomab (Blincyto, Amgen) can be used instead of intensive chemotherapy in an attempt to achieve a second remission, say experts. The Children's Oncology Group Study AALL1331 trial was conducted in 208 children and adolescents and young adults with B-ALL after a first relapse. Median follow-up was 1.4 years. Blinatumomab was superior in achieving both disease-free survival and overall survival, and more patients who received blinatumomab subsequently underwent transplant, reported Patrick A. Brown, MD, of the Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland. These results are "truly practice changing," commented Robert A. Brodsky, MD, professor of medicine and director of the Division of Hematology at Johns Hopkins School of Medicine in Baltimore. Blinatumomab should be the new standard of care in these patients, he said.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
In Follicular Lymphoma, Can MRD Predict Relapse or Define Cure?
A first-of-its-kind study has shown that for patients with follicular lymphoma (FL), measurements of minimal residual disease (MRD) can be used to predict risk for relapse. Researchers at Georgetown University's Lombardi Comprehensive Cancer Center in Washington, DC, showed that when MRD was at the 10-5 level of sensitivity (1 in 100,000 cells), the majority of patients in their study who had been in remission for more than 2 years were free of disease. "This disease has been considered incurable, but for some patients who have been disease-free for at least 2 years after remission, our pilot study gives hope that calling the disease incurable may no longer be accurate," said lead author Maryam Sarraf Yazdy, MD. "This study is the first to examine patients in remission for more than 2 years using a sensitive next-generation assay for minimal residual disease," said senior author Bruce Cheson, MD. "This study is of importance in that patients with FL may no longer have to worry that death from their disease is inevitable," Cheson commented.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Aspirin Plus a DOAC May Do More Harm Than Good in Some
In patients on direct oral anticoagulant (DOAC) therapy for the secondary prevention of venous thromboembolism (VTE) or the prevention of stroke associated with nonvalvular atrial fibrillation, the addition of aspirin without a clear indication was associated with increased bleeding risks in a large registry-based cohort. The study also found no apparent improvement in thrombosis incidence with the addition of aspirin, reported Jordan K. Schaefer, MD, University of Michigan, Ann Arbor. "These findings need to be confirmed in larger studies, but until such data [are] available, clinicians and patients should continue to balance the relative risks and benefits of adding aspirin to their direct oral anticoagulant therapy," Schaefer said. "Further research needs to evaluate key subgroups to see if any particular population may benefit from combination therapy compared to DOAC therapy alone."
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Study Halted; 'Hyperprogression' Seen With Nivolumab for R/R PTCL
There is an urgent need for new therapies to treat relapsed or refractory peripheral T-cell lymphoma (PTCL), but results of a phase 2 study suggest that monotherapy with the immune checkpoint inhibitor nivolumab (Opdivo, Bristol-Myers Squibb) is not the hoped-for salvage treatment. An interim analysis of data on 12 patients with PTCL treated with nivolumab monotherapy showed an overall response rate of 33%, consisting of 2 complete responses and 2 partial responses. But the responses were short-lived, and one patient had hyperprogressive disease — dramatic progression within one cycle of treatment — while two more had progression within two cycles, leading to a trial halt, reported N. Nora Bennani, MD, from the Mayo Clinic in Rochester, Minnesota. "It was staggering to see this: the duration of response was significantly short, less than 2 months," Bennani said. "These findings likely reflect the distinct biology of PTCL and should be considered when designing future studies using checkpoint inhibitors in these diseases."
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Allogeneic Transplant Best in Follicular Lymphoma, but Worth It?
A comparison of two types of transplant used in patients with relapsed follicular lymphoma has shown, for the first time, better overall survival following an allogeneic transplant (using stem cells from a donor) than with an autologous transplant (using stem cells harvested from the patient). The researchers conclude that these long-term data (out to 200 months, 16.6 years) should now be used in a collaborative effort to allow Medicare/Medicaid patients to receive allogeneic transplants for relapsed follicular lymphoma. "This is the first study to show that nonmyeloablative allogeneic transplantation confers a superior survival in patients with relapsed follicular lymphoma compared with autologous transplantation," said Issa Khouri, MD, from University of Texas MD Anderson Cancer Center in Houston. However, another expert said that the data do not actually show a cure with transplant — which is the aim of this intervention — and now that there are new therapies available, questioned whether going through a transplant is worth it.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Increase in Autologous HSCT for Myeloma, Decline in Allogeneic
A global survey has found an increase in the number of autologous hematopoietic stem cell transplants (HSCT) in patients with multiple myeloma. "We have reported, for the first time, data on stem cell transplantation for multiple myeloma," said lead author Andrew J. Cowan, MD, from the Fred Hutchinson Cancer Research Center, Seattle, Washington. "Transplantation for myeloma remains highly utilized globally, and we consider it to be part of the standard of care." During the period from 2006 to 2015, the global number of autologous HSCT procedures increased by 107% for patients with multiple myeloma. However, for allogeneic stem cell transplants, the numbers have remained largely stable, and some regions, notably North America, have seen about a 50% decline. Overall, there was a global 3% decline in the number of first allogeneic HSCT that were performed for patients with multiple myeloma, after peaking in 2012, and rates remain highest in Europe with an increase of 8%.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Some Patients with DLBCL Can Skip Radiation: 'It's a Win'
New results suggest that it's okay to skip radiotherapy in some patients with diffuse large B-cell lymphoma (DLBCL). Patients with non-bulky DLBCL (stage I or II disease) typically receive chemotherapy with abbreviated R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunomycin], vincristine, and prednisolone), followed by radiation. But the new results suggest that patients with an interim positron emission tomography (iPET)-negative scan may forego radiation therapy altogether. The finding comes from the Intergroup National Clinical Trials Network (NCTN) study S1001. The study showed that 89% of patients with stage I/II DLBCL maintained excellent outcomes after four cycles of R-CHOP with PET-directed therapy. Only 11% of patients with an interim PET-positive scan required radiation therapy. "Together with the FLYER results in younger patients, this NCTN trial has established four cycles of R-CHOP alone as a new standard approach to limited-stage disease for a majority of patients," said lead author Daniel O. Persky, MD, from University of Arizona, Tucson.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
An Off-the-Shelf Drug to Rival CAR T Cells: 'Very Exciting'
An investigational drug that can achieve the same results as complex cell therapy created a buzz here. For the last few years, attention at this meeting has focused on the chimeric antigen receptor (CAR) T cells, mainly "because of their incredible efficacy," commented ASH Secretary Robert A. Brodsky, MD. But new results with an off-the-shelf product are "very exciting" he said, because the drug can be given immediately and appears to achieve similar results. The new product is mosunetuzumab (Genentech/Roche), a bispecific antibody that targets both CD3 (on the surface of T cells) and CD20 (on the surface of B cells). It works by redirecting T cells to engage and eliminate malignant B cells. "The concept here is that this monoclonal antibody engages T cells and directs their cytotoxicity against B cells — it's basically an antibody using the patient's own T cells to do what a CAR T cell would do," Brodsky explained. However, unlike CAR T cells, which are prepared for each individual patient in a complex process, mosunetuzumab is an off-the-shelf product that can be given to patients immediately (by intravenous infusion).
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
'Real-World' Data Show CAR-T Therapies Are Cost Effective
Chimeric antigen receptor (CAR) T-cell therapy has been hailed as a major advance and a game changer, but the cost, north of $300,000, has redefined the meaning of "expensive." However, new "real-world" data now suggests that CAR T-cell therapy may actually be cost effective, as it may lower other expenses related to the illness. As an example, when used in a population of older adults with non-Hodgkin lymphoma, these new data show that CAR T-cell therapy cut related expenditures compared with healthcare costs prior to receiving this treatment. "CAR T therapy was associated with fewer hospitalizations, shorter time in the hospital, fewer ED visits, and lower total healthcare costs," said lead study author Karl M. Kilgore, PhD, of Avalere Health in Washington, DC. Data was obtained from the Centers for Medicare & Medicaid Services 100% Medicare Fee-for-Service Part A and B claims data, and patients were included in the study if they had been diagnosed with lymphoma and received CAR T therapy between October 1, 2017 and September 30, 2018.
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Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
Choosing Wisely: 5 Recommendations in Pediatric Hematology
There's a new Choosing Wisely list in hematology focused specifically on children. The list includes five tests or procedures that are considered unnecessary: 1) Don't perform routine preoperative hemostatic testing in an otherwise healthy child with no prior personal or family history of bleeding; 2) Don't transfuse platelets in a nonbleeding pediatric patient with a platelet count greater than 10,000/mcL, unless other signs of bleeding are present, or if the patient is set to undergo an invasive procedure; 3) Don't order thrombophilia testing on children with venous access-associated thrombosis in the absence of a positive family history; 4) Don't transfuse packed RBCs for iron-deficiency anemia in asymptomatic pediatric patients when there is no evidence of hemodynamic instability or active bleeding. 5) Don't routinely administer granulocyte-colony stimulating factor (G-CSF) for empiric treatment of pediatric patients with asymptomatic autoimmune neutropenia in the absence of recurrent or severe bacterial and/or fungal infections.
Image from Benjamin Pena/Medscape.
Top News From ASH 2019: Slideshow
Zosia Chustecka; Darby Rotach; Roxanne Nelson; Alex Castellino; Megan Brooks; Benjamin Pena | January 9, 2020 | Contributor Information
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Zosia Chustecka
Medscape Oncology News Editor, London, England
Darby Rotach
Medscape Senior Photo Editor, New York City
Roxanne Nelson
Medscape Oncology Journalist, Bellingham, Washington
Alex Castellino
Freelance Medical Journalist, New York
Benjamin Pena
Freelance Photographer, Orlando, Florida
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