The HemOnc Pulse

The first episode of The HemOnc Pulse of the new year features an in-depth discussion by the leading researchers of the Hodgkin Lymphoma International Study for Individual Care (HoLISTIC) consortium. Principal investigators Susan Parsons, MD, MRP; and Andrew Evans, DO, MBA, MSc; are joined by Matthew Maurer, DMSc; to share the story behind harmonizing the world's Hodgkin lymphoma data, and what the effort means for both clinicians and patients.

Dr. Saad Usmani, Chief of the Myeloma Service at the Memorial Sloan Kettering Cancer Center, discusses the evolution in myeloma treatment and highlights the Perseus and IsKia trials. The podcast also covers advancements in achieving MRD negativity, personalized therapy for translocation 1114 myeloma, autologous stem cell transplant, maintenance therapy, and mechanisms of resistance to BCMA and GPRC 5D directed therapies in myeloma.

Sangeetha Venugopal, MD, of the University of Miami Sylvester Comprehensive Cancer Center, offers her thoughts on the investigational drug KER-050 in lower-risk myelodysplastic syndromes (MDS), the COMMANDS trial, and if she believes MDS is a distinct disease. She also highlights the latest research in MDS at the 65th American Society of Hematology Annual Meeting and Exposition.

In this episode of The HemOnc Pulse, Jerald Radich, MD, of the Fred Hutchinson Cancer Center, joins Chadi Nabhan, MD, MBA, FACP, to discuss various abstracts on acute myeloid leukemia (AML) presented at the 2023 American Society of Hematology (ASH) Annual Meeting & Exposition. The conversation centered around menin inhibitors for the treatment of AML, the effect of measurable residual disease-positivity on transplantation outcomes, and whether age plays a role in transplantation.

In this episode of The HemOnc Pulse, Grzegorz Nowakowski MD, a Professor of Oncology and Medicine in the Division of Hematology at the Mayo Clinic, recounts his experience serving on the FDA Oncologic Drugs Advisory Committee that reviewed and evaluated data from the POLARIX study and polatuzumab vedotin-piiq (Polivy)for patients with previously untreated LBCL.

In this episode of The HemOnc Pulse, Dr. Maddocks, Professor of Clinical Internal Medicine in the Division of Hematology at The Ohio State University, charts the treatment evolution of mantle cell lymphoma (MCL) from frontline therapy to future directions. She also explains her initial shock, and subsequent bittersweet reaction to the withdrawal of ibrutinib.

Dr. Cortes, who serves as Director of the Georgia Cancer Center at Augusta University, joins host Chadi Nabhan, MD, MBA, FACP, to chat about the “boom” in treatments for chronic myeloid leukemia (CML), and where he sees a need for balance. Dr. Cortes discussed the evolution of tyrosine kinase inhibitors (TKIs) and the multiple generations of TKIs that are now available. Second-generation TKIs can lead to earlier and deeper responses than first-generation TKIs, he said, noting that this means patients receiving second-generation TKIs are more likely to be able to discontinue treatment. “If I was diagnosed with CML, I would take a second-generation TKI,” Dr. Cortes said. However, Dr. Cortes emphasized that the first-generation TKI imatinib comes with a lower risk of serious side effects than second-generation TKIs. This is an important consideration because “most people are going to do well and have a normal life expectancy” on imatinib, he said. It is critical to evaluate multiple factors when choosing between a first-generation TKI and a second-generation TKI. This means involving patients in the decisions about treatment to ensure they are comfortable with the balance of efficacy and safety, he said. “I certainly would rather have more bags under my eyes than a heart attack,” Dr. Cortes said. “So, we need to balance that, and I think that sometimes we've been a little too obsessed on [obtaining] the lowest possible [polymerase chain reaction] value, and we lose the context of other elements that are important, such as risks, and comorbidities and side effects.” He also discussed a population of patients who remain challenging to treat despite the evolution of therapies for CML. “The most difficult patient is one without a mutation,” Dr. Cortes said, noting this is because response rates are lowest for those without a mutation and “you don’t know why they are not responding.”

Dr. Elias Jabbour, an Associate Editor of Blood Cancers Today, discusses the burning questions in acute lymphoblastic leukemia (ALL). Topics include approaches to treating Philadelphia-negative ALL, measuring MR-D in pH negative disease, treatment options for both younger and older patients with pH negative leukemia, and current treatment options for relapsed disease in ALL.

Dr. Rafael Fonseca, an expert in multiple myeloma treatment, discusses the future of MM treatment, the debate between CAR-T therapies and bispecifics, the role of measurable residual disease (MRD), the potential for bispecific therapies to democratize access to advanced treatments, and the paradigm shift toward prioritizing deeper responses, including MRD negativity, for long-term cure in myeloma patients.

On this episode of The HemOnc Pulse, guest Jonathan Friedberg, MD, MMSc, a hematologic oncologist at the University of Rochester Medicine – Wilmot Cancer Institute, chats with host Dr. Chadi Nabhan on the subtle but important shift in the treatment landscape of diffuse large B-cell lymphoma (DLBCL)in the post-POLARIX trial era. The POLARIX trial, which was designed to improve upon the standard R-CHOP regimen for DLBCL treatment, investigated the potential of polatuzumab vedotin. The phase III trial ultimately resulted in the US Food and Drug Administration approving the treatment in previously untreated DLBCL, not otherwise specified, or high-grade B-cell lymphoma. The approval is for patients with an International Prognostic Index (IPI) score of two or greater. "I think that this was a robustly done randomized placebo-controlled trial that showed a small but clinically significant benefit as far as progression-free survival in patients with IPI score of two and above [in] large B cell lymphoma," he said.