Bruce D. Cheson, MD


May 27, 2016

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Hello. This is Bruce Cheson from Georgetown University Hospital, the Lombardi Comprehensive Cancer Center, in Washington, DC, speaking to you for Medscape Hematology. This is the pre-ASCO (American Society of Clinical Oncology) 2016 edition. In the past, ASCO has been a forum for presenting exciting lymphoma and leukemia data. Let us see what they have this year.

What to Look for in Myeloma and Leukemia

In multiple myeloma, there will be an upfront study[1] of stem cell transplant vs "'novel" agents. When you see the abstract, you will realize that these agents are not terribly novel. We are always concerned about the toxicities and efficacy of lenalidomide maintenance, and that will be addressed in a meta-analysis of overall survival.[2] In addition, a few novel agents will be discussed: an anti-CD38 called plitidepsin[3] and some pomalidomide combinations, such as pomalidomide with ixazomib.[4]

Researchers in acute leukemia will present a very interesting study of CPX-351.[5] This is a liposomal version of Ara-C (cytarabine) and daunomycin, formulated so that the amount of each is well controlled and you get the right amount into the blood and the leukemia cells. This study compared CPX-351 versus 7+3 (cytarabine and daunorubicin) in older patients. (We love those older patients, especially as we have become older.)

Let us turn now to chimeric antigen receptor (CAR) T cells in acute lymphocytic leukemia. We will hear about another, and another, and another of the FLT3 antagonists,[6,7,8] and some data on venetoclax (ABT199), the BCL-2 inhibitor, in patients with acute leukemia.[9]

Developments in Lymphoma

Lymphoma and chronic lymphocytic leukemia are in the same session, which says something about the amount of material that was selected for presentation. Do you remember studies of alemtuzumab, an anti-CD52 monoclonal antibody (Campath), in patients with peripheral T-cell lymphoma? It was quite toxic. This year, we have a new study of CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) plus alemtuzumab,[10] and we will see whether this has any better results than previous studies. There will be data on the anti-CCR4 monoclonal antibody mogamulizumab for treatment of adult T-cell leukemia/lymphoma.[11] This agent is already approved in Japan. R-squared (rituximab plus lenalidomide), one of my favorite regimens, will be discussed for primary CNS lymphoma,[12] Another study will look at bendamustine plus or minus maintenance in mantle cell lymphoma.[13] I have a lot of patients who come to me and say, "My doctor treated me with bendamustine-rituximab and he wants to do maintenance." In the past I have said that there are no data. Now there will be data. Stay tuned on that one.

There will be another study of intensive rituximab in diffuse large B-cell lymphoma[14] and studies of some novel–or not so novel—agents such as everolimus,[15] bortezomib,[16] and, in patients with Hodgkin lymphoma, brentuximab vedotin as consolidation therapy.[17]

For those of you who are going to ASCO, these are some of the abstracts of interest. For those of you who are not going to ASCO, you can read the abstracts online afterwards and see whether these will enlighten you and change your future practice. This is Bruce Cheson, signing off for Medscape Hematology, with the prelude to ASCO 2016.


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