Blood Cancer Talks

In this episode, we reviewed the hottest updates in lymphoma from ASCO and EHA 2024, held in Chicago and Madrid respectively, with Dr. Gloria Iacoboni, a haematologist from University Hospital Vall d'Hebron, in Barcelona, Spain. Here are the key abstracts we discussed: 1.      STARGLO: Glofit-GEMOX vs R-GEMOX in relapsed/refractory DLBCLhttps://library.ehaweb.org/eha/2024/eha2024-congress/4136516 2.     Epco-Pola-R-CHP for 1st line DLBCL (EPCORE NHL-5 study):https://library.ehaweb.org/eha/2024/eha2024-congress/422343 3.     3-year follow-up of TRANSFORM (Liso-Cel vs CITàASCT in R/R DLBCL): https://meetings.asco.org/abstracts-presentations/232740 4.     ECHO RCT: Acalabrutinib-BR vs Placebo-BR in previously untreated elderly MCL: https://library.ehaweb.org/eha/2024/eha2024-congress/4136515 5.     HD21: escBEACOPP vs BrECADD in 1st line classical HL: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01315-1/fulltext 6.     Combination pirtobrutinib, venetoclax, and obinutuzumab in 1st line CLL: https://library.ehaweb.org/eha/2024/eha2024-congress/422268 7.      Single-agent epcoritamab in Richter’s transformation: EPCORE CLL-1: https://library.ehaweb.org/eha/2024/eha2024-congress/422267

Dr. Benjamin Derman and Dr. Manni Mohyuddin discuss updates in Minimal Residual Disease (MRD) in multiple myeloma, including the potential use of MRD as a surrogate endpoint for accelerated FDA approval. They explore the benefits and challenges of achieving MRD negativity, advancements in MRD detection technologies, implications of MRD resurgence, and the impact of MRD negativity on treatment decisions and discontinuation. The podcast sheds light on the complexities of utilizing MRD in myeloma treatment strategies.

In this episode, we discuss updates in primary myelofibrosis with Dr. Ayalew Tefferi from the Mayo Clinic. The key studies and trials discussed are as follows: ·       GIPSS: Genetically inspired prognostic scoring system that is exclusively based on genetic markers. §  https://www.nature.com/articles/s41375-018-0107-z ·       MIPSS70+ Version 2.0: Mutation and Karyotype-Enhanced International Prognostic Scoring System for Primary Myelofibrosis §  https://ascopubs.org/doi/10.1200/JCO.2018.78.9867?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed ·       TRANSFORM-1: A Randomized, Double-Blind, Placebo-Controlled, Multicenter, International Phase 3 Study of Navitoclax in Combination with Ruxolitinib Versus Ruxolitinib Plus Placebo in Patients with Untreated Myelofibrosis §  https://ashpublications.org/blood/article/142/Supplement%201/620/502738/Transform-1-A-Randomized-Double-Blind-Placebo ·       MANIFEST-2: Pelabresib in Combination with Ruxolitinib for Janus Kinase Inhibitor Treatment-Naïve Patients with Myelofibrosis: Results of the MANIFEST-2 Randomized, Double-Blind, Phase 3 Study §  https://ashpublications.org/blood/article/142/Supplement%201/628/502728/Pelabresib-in-Combination-with-Ruxolitinib-for ·       XPORT-MF-034: Selinexor Plus Ruxolitinib in JAK Inhibitor (JAKi)-Naïve Patients with Myelofibrosis: Long Term Follow up from XPORT-MF-034 Suggestive of Disease Modification 

Experts Dr. Hira Mian and Dr. Manni Mohyuddin discuss maintenance therapy in multiple myeloma, exploring studies like Meta-analysis of CALGB, Myeloma XI RCT, Canadian real-world data, and more. They analyze trials like FORTE and ATLAS, debating options for high-risk patients and emphasizing personalized treatment approaches.

In this episode, we discuss the diagnosis and management of Essential Thrombocythemia with Dr. Raajit Rampal. Here are the shownotes:1.     IPSET (revised) system, risk categories are defined by the presence of a prior thrombosis, age, and JAK2 mutation status:·        Very low risk: No prior thrombosis, age ≤60 years, JAK2-unmutated·        Low risk: No prior thrombosis, age ≤60 years, JAK2-mutated·        Intermediate risk: No thrombosis, age >60 years, JAK2-unmutated·        High risk: History of thrombosis (any age/genotype), or age >60 years with JAK2 mutationhttps://ashpublications.org/blood/article/120/26/5128/30914/Development-and-validation-of-an-International                      2.    The MIPSS-ET provides points for:·        Age > 60 years (3 points)·        Adverse mutation (SF3B1/SRSF2/U2AF1/TP53) (2 points)·        Male sex (1 point)·        White blood cell count ≥11 × 10^9/L (1 point)·        https://onlinelibrary.wiley.com/doi/abs/10.1111/bjh.16380?sid=nlm%3Apubmed 3.    Aspirin o   Is there a benefit of twice-daily aspirin dosing, especially in high-risk or JAK2-mutant disease?https://ashpublications.org/blood/article/136/2/171/454293/A-randomized-double-blind-trial-of-3-aspirin 4.     Cytoreduction in High-risk ET Hydroxyurea: https://www.nejm.org/doi/full/10.1056/NEJM199504273321704 Pegylated interferon alfa MPD-RC 112 Mascarenhas J et al. A randomized phase 3 trial of interferon- α vs hydroxyurea in polycythemia vera and essential thrombocythemia. Blood . 2022) https://ashpublications.org/blood/article/139/19/2931/483404/A-randomized-phase-3-trial-of-interferon-vs Anagrelide in EThttps://ashpublications.org/blood/article/121/10/1720/31186/Anagrelide-compared-with-hydroxyurea-in-WHO 5.    Ruxolitinib  In a randomized study phase 2 study (MAJIC-ET), ruxolitinib treatment did not deliver better rates of hematological response than best-available therapy, although symptoms did improve.  ·        MAJIC-ET study which is a randomized phase 2 trial ·        ET patients resistant/intolerant to HU were randomized to receive RUX or standard treatment (HU 71%, anagrelide 48%, IFN 40%). The primary study outcome was CR, defined by normal platelet and white cell counts and normal spleen size.  ·        At 1 year, response was achieved in 46% of patients in the RUX group and in 44% in the standard arm, without statistically significant difference between the two groups.  ·        In addition, no difference was observed in the rates of thrombosis, hemorrhage, and disease transformation after 2 years of follow-up.  ·        MRs were also uncommon. RUX was superior, however, in symptom control. https://ashpublications.org/blood/article/130/17/1889/36509/Ruxolitinib-vs-best-available-therapy-for-ET

In this episode, we talked about overall survival data from CARTITUDE-4 and KarMMa-3 that was presented at FDA ODAC meeting with Dr. Samer Al Hadidi from University of Arkansas Myeloma Center. RCTs of BCMA CAR T-cell Therapy in Early Relapsed Multiple Myeloma:a) KarMMa-3 (ide-cel): https://pubmed.ncbi.nlm.nih.gov/36762851/b) CARTITUDE-4 (cilta-cel): https://pubmed.ncbi.nlm.nih.gov/37272512/FDA ODAC on overall survival data from KarMMa-3 and CARTITUDE-4:https://www.youtube.com/watch?v=VSjdGeeXb40

In this episode, we discuss mentorship and career development as a clinician-investigator with Dr. Ayalew Tefferi from the Mayo Clinic. 

In this episode we discuss the management of newly diagnosed AL amyloidosis with Dr. Angela Dispenzieri from the Mayo Clinic. Here are the key articles discussed:1.      Optimal use of tissue biopsy in AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/28271734/ 2.     Mayo 2004 staging:  https://pubmed.ncbi.nlm.nih.gov/15365071/ 3.     Mayo 2012 staging: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675680/ 4.     Renal staging: https://pubmed.ncbi.nlm.nih.gov/25115890/ 5.     Hematologic and cardiac response criteria in AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/23091105/ 6.     ANDROMEDA Trial: Dara-VCD vs VCD in newly diagnosed AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/34192431/ 7.      How I Treat AL Amyloidosis: https://pubmed.ncbi.nlm.nih.gov/34517412/ 8.     Venetoclax in AL amyloidosis (largest retrospective study till date): https://pubmed.ncbi.nlm.nih.gov/33431806/

In this episode, we discuss top abstracts in the myeloid space from the American Society of Hematology 2023 meeting with Dr. Anand Patel. Here are the abstracts that were discussed:1. TRANSFORM-1: A Randomized, Double-Blind, Placebo-Controlled, Multicenter, International Phase 3 Study of Navitoclax in Combination with Ruxolitinib Versus Ruxolitinib Plus Placebo in Patients with Untreated Myelofibrosis https://ash.confex.com/ash/2023/webprogram/Paper173509.html 2. MANIFEST-2: Pelabresib in Combination with Ruxolitinib for Janus Kinase Inhibitor Treatment-Naïve Patients with Myelofibrosis: Results of the MANIFEST-2 Randomized, Double-Blind, Phase 3 Study https://ash.confex.com/ash/2023/webprogram/Paper179141.html 3. Venetoclax + Decitabine vs 7+3 in AML https://ashpublications.org/blood/article/142/Supplement%201/970/503790/Comparing-the-Efficacy-and-Safety-of-Venetoclax 4. FILO study: Acute Myeloid Leukemia Patients Who Stopped Venetoclax or/and Azacytidine for Other Reasons Than Progression Have a Prolonged Treatment Free Remission and Overall Survival. https://ash.confex.com/ash/2023/webprogram/Paper185437.html  5. AUGMENT-101: Revumenib Monotherapy in Patients with Relapsed/Refractory KMT2Ar Acute Leukemia: Topline Efficacy and Safety Results https://ash.confex.com/ash/2023/webprogram/Paper172422.html 6. VEN+HMA in HR MDS: Safety, Efficacy, and Patient-Reported Outcomes of Venetoclax in Combination with Azacitidine for the Treatment of Patients with Higher-Risk Myelodysplastic Syndrome: A Phase 1b Study https://ash.confex.com/ash/2020/webprogram/Paper139492.html

In this episode, we talk about GVHD prophylaxis, including recent data on post-transplant cyclophosphamide and abatacept with Dr. Shernan Holtan from the University of Minnesota. Here are the key trials we discussed:1. BMT CTN 1203 trial: Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of GVHD in allogeneic transplantation. https://pubmed.ncbi.nlm.nih.gov/30824040/ 2. BMT CTN 1703 study: Post-Transplantation Cyclophosphamide-Based GVHD prophylaxis  https://pubmed.ncbi.nlm.nih.gov/37342922/ 3. Patient-Reported Outcomes of BMT CTN 1703 https://ash.confex.com/ash/2023/webprogram/Paper187859.html 4. Phase II Study of Myeloablative 7-8/8-Matched Allotransplantation with Post-Transplantation Cyclophosphamide, Tacrolimus, and Mycophenolate Mofetil https://pubmed.ncbi.nlm.nih.gov/37311510/ 5. BMT CTN 1301 trial: Randomized Phase III BMT CTN Trial of Calcineurin Inhibitor-Free Chronic Graft-Versus-Host Disease Interventions in Myeloablative Hematopoietic Cell Transplantation for Hematologic Malignancies https://pubmed.ncbi.nlm.nih.gov/34855460/ 6. Phase II Trial of Costimulation Blockade With Abatacept for Prevention of Acute GVHD (ABA2) https://pubmed.ncbi.nlm.nih.gov/33449816/ 7. Aurora Kinase a Inhibition for Gvhd and Relapse Prevention after Allogeneic HCT: Phase I Trial in Combination with Ptcy/Sirolimus https://ash.confex.com/ash/2023/webprogram/Paper181292.html