Episode 36. ASH 2023 Lymphoma Recap with Dr. Toby Eyre
Dec 20, 2023
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Dr. Toby Eyre, a consultant haematologist at the University of Oxford in the UK, joins the hosts to review the hottest updates in lymphoma from the ASH 2023 meeting. They discuss topics like the promising results of a novel triplet treatment for mantle cell lymphoma and the challenges of conducting trials in high-risk groups. They also explore the question of stopping therapy without consolidation, the use of a BCL2 inhibitor in lymphoma treatment, and the comparison of different treatments for CLL and Hodgkin lymphoma.
The BOVen trial demonstrated promising results for TP53-mutated mantle cell lymphoma, with a high complete response rate and improved progression-free survival.
The SYMPATICO trial suggests a potential new standard of care for relapsed and refractory mantle cell lymphoma using Ibrutinib plus phonetic lacs with the addition of rituximab.
The FLAIR trial showed the advantage of MRD-guided therapy with Ibrutinib plus venetoclax in previously untreated CLL patients, leading to improved progression-free survival and overall survival.
Deep dives
The Bovin trial shows promising results for TP53-mutated mantle cell lymphoma
The Bovin trial focused on TP53-mutated mantle cell lymphoma, a high-risk subgroup with poor outcomes. The trial combined Zana-brute plus phonetic lacs and a bit of twos map. The results showed a high complete response rate and undetectable minimal residual disease rates. Two-year progression-free survival was over 70%, representing a significant advancement in treatment options for this high-risk patient population.
The Cinpatico trial demonstrates improved outcomes for relapsed and refractory mantle cell lymphoma
The Cinpatico trial compared Ibrutinib plus phonetic lacs with the addition of rituximab versus Ibrutinib plus placebo in relapsed and refractory mantle cell lymphoma. The study showed a 10-month improvement in median progression-free survival, as well as an increase in complete response rates. Though further analysis is needed, these results suggest the potential for a new standard of care in this patient population.
The FLAIR trial presents a significant improvement in treatment outcomes for CLL
The FLAIR trial compared FCR chemoimmunotherapy with MRD-guided duration of Ibrutinib plus venetoclax in previously untreated CLL patients. The study demonstrated an advantage in progression-free survival and overall survival in favor of Ibrutinib plus venetoclax. The MRD-guided approach showed promise in providing personalized therapy and minimizing toxicity, potentially leading to improved treatment algorithms for CLL.
The potential of MRD-guided therapy in CLL
The study presented by FLAIR trial researchers highlighted the effectiveness of MRD-guided therapy in CLL. By tailoring treatment based on the sensitivity of the disease, patients experienced deep remission and reduced toxicity. However, the wider applicability of MRD-guided therapy and the acceptance of this approach by regulators and the field at large is still under consideration and requires further study.
Emerging treatments for elderly or unfit patients with DLBCL
The SMART Stop study explored novel treatment options for elderly or unfit patients with DLBCL. The study combined lenalidomide, tafosinb, rituximab, and acalabrutinib to induce deep remission and limit the use of chemotherapy. The results were encouraging, with a high overall response rate and undetectable ctDNA in a significant proportion of patients. However, access to the experimental arm and coordination between different agents and companies remain challenges.
In this episode, we review the hottest updates in lymphoma from the American Society of Hematology 2023 meeting with Dr Toby Eyre, a consultant haematologist at the University of Oxford in the UK.
Here are the abstracts that were discussed:
Mantle Cell Lymphoma
1. BOVen trial-A Multicenter Phase 2 Trial of Zanubrutinib, Obinutuzumab, and Venetoclax in Patients with Treatment-Naïve, TP53-Mutant Mantle Cell Lymphoma
1. Smart STOP study: Lenalidomide, Tafasitamab, Rituximab, and Acalabrutinib Alone and with Combination Chemotherapy for the Treatment of Newly Diagnosed Diffuse Large B-Cell Lymphoma
2. Mosunetuzumab and Polatuzumab Vedotin Demonstrates Preliminary Efficacy in Elderly Unfit/Frail Patients with Previously Untreated Diffuse Large B-Cell Lymphoma