Preemptive Tocilizumab for Cytokine-Release Syndrome in Pediatric Patients With B-Cell ALL Receiving CAR T-Cell Therapy
In a single-institution study reported in the Journal of Clinical Oncology, Kadauke et al found that risk-adapted tocilizumab reduced the expected incidence of grade 4 cytokine-release syndrome in pediatric patients receiving CD19-directed chimeric antigen receptor (CAR) T-cell...
Expert Point of View: Marlise Luskin, MD
Commenting on this trial, Marlise Luskin, MD, of Dana-Farber Cancer Institute, Boston, explained that the treatment of AML in older adults remains a particular challenge for leukemia clinicians. “Although many older patients eligible for intensive induction chemotherapy achieve complete remission,...
Oral Azacitidine Is Noninferior to Placebo for Health-Related Quality of Life in AML
Health-related quality of life was sustained in patients taking oral azacitidine (also known as CC-486) compared with placebo in patients with acute myeloid leukemia (AML), according to results of the phase III QUAZAR AML-001 trial reported at the 2020 American Society of Hematology (ASH) Annual...
Reduced Frequency of Vincristine/Dexamethasone Pulses in Maintenance Therapy for Pediatric Patients With Average-Risk B-Cell ALL
As reported in the Journal of Clinical Oncology by Angiolillo et al, findings from the phase III Children’s Oncology Group (COG) AALL0932 trial indicated that “outstanding outcomes” can be achieved with maintenance therapy with a reduced frequency of vincristine/dexamethasone pulses in pediatric...
Maintenance Oral Azacitidine for Patients With AML in First Remission: QUAZAR AML-001 Trial
As reported in The New England Journal of Medicine by Andrew H. Wei, MBBS, PhD, and colleagues, the phase III QUAZAR AML-001 trial has shown prolonged overall survival with oral azacitidine maintenance therapy vs placebo in patients with acute myeloid leukemia (AML) in first remission. The oral...
Intensified Reduced-Intensity Conditioning for Allogeneic Stem Cell Transplantation in AML or MDS
In the phase II FIGARO trial reported in the Journal of Clinical Oncology, Craddock et al found that intensified reduced-intensity conditioning with fludarabine/amsacrine/cytarabine–busulfan (FLAMSA-Bu) did not improve outcomes following allogeneic stem cell transplantation vs standard...
Sara Zarnegar-Lumley, MD, on AML: Prognostic Effects of IDH Mutations
Sara Zarnegar-Lumley, MD, of Vanderbilt University Medical Center, discusses an analysis of a large cohort confirming the age-associated prevalence of IDH mutations in patients, across the age spectrum, with acute myeloid leukemia and therapeutic implications. IDH-mutated genes were found to co-occur frequently with other mutations, some of which favorably impact outcomes in patients younger than 60 (Abstract 388).
Three vs Four Courses of Chemotherapy in Younger Patients With AML
As reported in the Journal of Clinical Oncology by Burnett et al, findings from the phase III MRC AML17 trial indicated that four courses of chemotherapy, compared to three courses, reduced the cumulative incidence of relapse and improved relapse-free survival, but not overall survival, in younger...
Total-Body Irradiation/Etoposide vs Chemotherapy Conditioning Before Stem Cell Transplant for Pediatric Patients With ALL
As reported in the Journal of Clinical Oncology by Peters et al, the phase III FORUM trial showed superior overall survival with total-body irradiation plus etoposide vs combination chemoconditioning in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic...
Christian Marinaccio, PhD Candidate: Genetic Driver May Play a Role in Progression of Myeloproliferative Neoplasms to AML
Christian Marinaccio, PhD Candidate, of Northwestern University, describes research he is conducting in the laboratory of John D. Crispino, PhD, which shows the loss of the tumor suppressor gene LKB1/STK11 facilitates progression of myeloproliferative neoplasms to acute myeloid leukemia (Abstract 1).
Use of a Novel CAR T-Cell Therapy in Pediatric and Adult Patients With Advanced B-Cell ALL
Pooled results of two phase I studies, reported in The Lancet by Benjamin et al, indicate that the genome-edited, donor-derived allogeneic anti-CD19 chimeric antigen receptor (CAR) T-cell product UCART19 is active and has a manageable toxicity profile in pediatric and adult patients with relapsed...
Integrated Palliative and Oncology Care for Patients Receiving Treatment for AML
In a study reported in JAMA Oncology, Areej El-Jawahri, MD, and colleagues found that integrated palliative and oncology care was associated with better quality of life vs usual care among patients receiving treatment for acute myeloid leukemia (AML). The investigators stated, “Patients with AML...
Fixed-Duration First-Line Ibrutinib Plus Venetoclax Yields Treatment-Free Remission in Some Patients With CLL
The randomized phase II CAPTIVATE trial showed that a fixed-duration treatment approach with 12 cycles of ibrutinib and venetoclax as first-line therapy for chronic lymphocytic leukemia (CLL) achieved a 30-month progression-free survival of more than 95% in patients with undetectable minimal...
Disparities in Socioeconomic Status, Treatment Complications, and Obesity Impact Outcomes in Minority Patients With AML
A study by Ivy Abraham, MD, of the University of Illinois at Chicago, and colleagues, investigated the contribution of structural violence, specifically neighborhood socioeconomic status, on the racial/ethnic differences in the survival of patients with acute myeloid leukemia (AML). They found that ...
FDA Approves Rituximab-arrx, a Biosimilar to Rituximab
On December 17, the U.S. Food and Drug Administration (FDA) approved rituximab-arrx (Riabni), a biosimilar to rituximab (Rituxan), for the treatment of adult patients with non-Hodgkin lymphoma, chronic lymphocytic leukemia, granulomatosis with polyangiitis (Wegener's granulomatosis), and...
Study Finds Survival Disparities and Mutational Differences for Black Patients Younger Than 60 With AML
It has been well documented that, collectively, Black individuals have the highest death rates and shortest survival of any racial/ethnic group in the United States for most cancers. Black men also have the highest cancer incidence.1 Although the causes of these inequities are complex and include...
Nitin Jain, MD, on B-Cell ALL: Expert Perspective on Key CAR T-Cell Treatment Advances
Nitin Jain, MD, of The University of Texas MD Anderson Cancer Center, reviews six important abstracts on CAR T-cell treatments for B-cell acute lymphoblastic leukemia (ALL): successful 24-hour manufacture of CAR T-cell therapy; ALLCAR19, a novel fast-off rate therapy; donor-derived CD19-targeted treatment; CAR 2.0 therapy to manage post-transplant relapse; UCART22, allogeneic engineered T cells expressing anti-CD22 chimeric antigen receptor; and inotuzumab ozogamicin in pediatric CD-22–positive disease (Session 614, Abstracts 159-164).
Farhad Ravandi, MD, on AML: Novel Combination Therapies for Newly Diagnosed Disease
Farhad Ravandi, MD, of The University of Texas MD Anderson Cancer Center, offers his expert perspective on key treatment studies in acute myeloid leukemia on the use of gilteritinib, consolidation chemotherapy, venetoclax, cladribine, azacitidine, quizartinib, decitabine, and CPX-351 (Session 616 [Abstracts 24- 29]).
Jorge E. Cortes, MD, on CML: Expert Perspective on Key ASH Abstracts
Jorge E. Cortes, MD, of the Georgia Cancer Center at Augusta University, reviews four important studies of treatment advances in chronic myeloid leukemia (CML): nilotinib vs dasatinib in newly diagnosed disease; final 5-year results from the BFORE trial on bosutinib vs imatinib for chronic phase (CP) CML; data from the OPTIC trial on ponatinib for CP-CML; and a novel class of mutated cancer-related genes associated with the Philadelphia translocation (Abstracts 45, 46, 48, 49).
Hassan Awada, MD, on AML and Machine Learning: Improving Prognostication
Hassan Awada, MD, of the Taussig Cancer Institute, Cleveland Clinic Foundation, discusses the use of newer machine-learning techniques to help decipher a set of prognostic subgroups that could predict survival, thus potentially improving on traditional methods and moving acute myeloid leukemia into the era of personalized medicine (Abstract 34).
What Is the Measure of Minimal Residual Disease in AML?
Relapse is the primary obstacle to cure in leukemia. The term minimal residual disease (MRD) was coined in the early 1990s to describe finding a disease-specific marker in the context of a morphologic-appearing remission. The technique first used for MRD detection was the Southern blot (!), but the ...
Meta-analysis Shows Superior Disease-Free and Overall Survival With Measurable Residual Disease Negativity in AML
In a systematic review and meta-analysis reported in JAMA Oncology, Nicholas J. Short, MD, of The University of Texas MD Anderson Cancer Center, and colleagues, found that measurable residual disease (MRD) negativity is associated with superior disease-free and overall survival in patients with...
Front-Line Nonchemotherapy Regimens May Improve Long-Term Outcomes in CLL
An assortment of agents has been approved in the United States for the first-line treatment of chronic lymphocytic leukemia (CLL), and all of them are effective, explained Richard Furman, MD, of Weill-Cornell Medical College, NewYork-Presbyterian Hospital, New York. In the modern era, most patients ...
Matthew S. Davids, MD, on CLL/SLL: New Data on Ibrutinib, Venetoclax, and Rituximab Therapies
Matthew S. Davids, MD, of Dana-Farber Cancer Institute, summarizes three key studies from a session he co-moderated on ibrutinib plus venetoclax for first-line treatment of patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), long-term responses to these agents for relapsed and refractory CLL, and undetectable minimal residual disease following fixed-duration treatment with venetoclax and rituximab for CLL (Abstracts 123, 124, and 125).
David T. Teachey, MD, on Pediatric Leukemia and Lymphoma: New Findings on Cranial Radiation and Bortezomib
David T. Teachey, MD, of the University of Pennsylvania and Children’s Hospital of Philadelphia, discusses data showing that cranial radiation might be eliminated in most children with T-cell acute lymphoblastic leukemia and that bortezomib may improve survival in children with T-cell lymphoblastic lymphoma (Abstract 266).
ASH 2020: Chemotherapy Plus Blinatumomab for Philadelphia Chromosome–Negative B-Cell ALL
Results from a phase II study presented by Nicholas J. Short, MD, and colleagues at the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 464) showed that first-line treatment with a regimen of chemotherapy combined with the monoclonal antibody blinatumomab...
Expert Point of View: David Snyder, MD
David Snyder, MD, Acting Chair, City of Hope Department of Hematology & Hematopoietic Cell Transplantation, Duarte, California, who was not involved in the ASCEMBL study, commented on the promise of asciminib: “The hope is this drug would be able to overcome resistance to other tyrosine kinase...
ASH 2020: Study Finds Asciminib Safer, More Effective Than Bosutinib in Chronic Phase CML
Since the introduction of imatinib almost 18 years ago, similar next-generation tyrosine kinase inhibitors have been approved for chronic myeloid leukemia (CML), including dasatinib, nilotinib, bosutinib, and ponatinib. These drugs attack a similar target, making it more likely that resistance to...
ASH 2020: Role of Venetoclax in High-Risk Myeloid Malignancies
The BCL2 inhibitor venetoclax can be safely added to standard therapies for some high-risk myeloid blood cancers, and in early studies, the combination showed improved outcomes, according to two reports presented by Jacqueline S. Garcia, MD, and colleagues at the 2020 American Society of Hematology ...
Curtis Lachowiez, MD, on AML: Venetoclax in Combination With Standard Intensive Induction/Consolidation Therapy
Curtis Lachowiez, MD, of The University of Texas MD Anderson Cancer Center, discusses an interim analysis of a phase Ib/II study showing that venetoclax plus chemotherapy represents an effective regimen, particularly in patients with newly diagnosed and relapsed or refractory acute myeloid leukemia. The regimen appears to be an effective bridge to hematopoietic stem cell transplantation (Abstract 332).
ASH 2020: Novel Antibody-Drug Conjugate Shows Activity in Rare, Aggressive Form of Leukemia
A phase I/II study found that IMGN632, a novel CD123-targeting antibody-drug conjugate, was tolerable and resulted in a 29% overall response rate in patients with relapsed or refractory blastic plasmacytoid dendritic cell neoplasm (BPDCN), a rare but aggressive form of leukemia. Treatment with the...
Ann-Kathrin Eisfeld, MD, on AML in Black Patients: Racial Disparities in Survival Outcomes
Ann-Kathrin Eisfeld, MD, of The Ohio State University Comprehensive Cancer Center, discusses SEER data showing that patients with acute myeloid leukemia who are Black and younger than age 60 may have poor survival outcomes, a disparity that should be addressed and further studied to establish molecular risk profiles (Abstract 6).
ASH 2020: Does Race Contribute to Poor Outcomes in Younger Black Patients Diagnosed With AML?
It has been well documented that, collectively, Black individuals have the highest death rate and shortest survival of any racial/ethnic group in the United States for most cancers. Black men also have the highest cancer incidence. Although the causes of these inequities are complex, a study by...
ASH 2020: Study Examines Impact of Neighborhood Socioeconomic Status on Outcomes in Minority Patients With AML
Studies show that non-Hispanic Black and Hispanic patients with acute myeloid leukemia (AML) have higher mortality rates than non-Hispanic White patients diagnosed with the disease, despite lower rates of incidence, more favorable genetics, and a younger age at disease onset. A study by Abraham et...
FDA Pipeline: Agents in DLBCL, SCLC, AML, and More
Recently, the U.S. Food and Drug Administration (FDA) has issued regulatory decisions for agents to treat diffuse large B-cell lymphoma (DLBCL), small cell lung cancer (SCLC), acute myeloid leukemia (AML), biliary tract cancer, and graft-vs-host disease. Priority Review for Loncastuximab Tesirine...
Dasatinib/Blinatumomab Produces High Rates of Molecular Response and Survival in Philadelphia Chromosome–Positive ALL
In an Italian phase II trial (GIMEMA LAL2116) reported in The New England Journal of Medicine, Robin Foà, MD, of Sapienza University of Rome, and colleagues, found that first-line induction and consolidation treatment with dasatinib and blinatumomab produced a high rates of molecular response as...
Venetoclax in Combination Therapy for Untreated Acute Myeloid Leukemia
On October 16, 2020, venetoclax was granted regular approval for use in combination with azacitidine, decitabine, or low-dose cytarabine for the treatment of newly diagnosed acute myeloid leukemia (AML) in adults aged 75 years or older or those with comorbidities precluding intensive induction...
4-Year Findings From MURANO Trial: Venetoclax Plus Rituximab for Relapsed Chronic Lymphocytic Leukemia
As reported in the Journal of Clinical Oncology by Arnon P. Kater, MD, PhD, of Amsterdam University Medical Centers, and colleagues,1 the 4-year progression-free and overall survival rates were significantly higher with venetoclax plus rituximab vs bendamustine plus rituximab in the phase III...
Final ASCEND Results Confirm Acalabrutinib as a Standard for Relapsed CLL
The Bruton’s tyrosine kinase (BTK) inhibitors have been one of the most exciting advances in the treatment of patients with chronic lymphocytic leukemia (CLL) and have led to the development of chemotherapy-free treatments for both treatment-naive as well as relapsed or refractory CLL based on...
Acalabrutinib Improves Progression-Free Survival vs Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed or Refractory CLL
As reported in the Journal of Clinical Oncology by Paolo Ghia, MD, PhD, of the Università Vita-Salute San Raffaele, Milan, Italy, and colleagues, the phase III ASCEND trial showed significantly prolonged progression-free survival with acalabrutinib monotherapy vs investigator’s choice of either...
Novel Therapies and New Indications for Use in Treatment of Hematologic Malignancies
Daratumumab and hyaluronidase-fihj: On May 1, 2020, the FDA approved daratumumab and hyaluronidase-fihj (Darzalex) for adult patients with newly diagnosed or relapsed or refractory multiple myeloma. Ibrutinib: On April 21, 2020, the FDA expanded the indication of ibrutinib (Imbruvica) to include...
Novel Therapies and New Indications for Use in Treatment of Hematologic Malignancies
Venetoclax: On October 16, 2020, the U.S. Food and Drug Administration (FDA) approved venetoclax (Venclexta) in combination with azacitidine, decitabine, or low-dose cytarabine for newly diagnosed acute myeloid leukemia (AML) in adults aged 75 or older. See page 32 for more on this approval....
Hematologic Oncology Highlights 2019–2020 Almanac
The past year has seen remarkable advances in the treatment of leukemia, lymphoma, and multiple myeloma, which combined account for 9.9% of the estimated 1,806,590 new cases of cancer diagnosed in the United States and an estimated 56,840 cancer-related deaths.1 Novel therapies are providing...
Venetoclax Combination in Newly Diagnosed AML
On October 16, 2020, the U.S. Food and Drug Administration (FDA) granted regular approval to venetoclax (Venclexta) in combination with azacitidine, decitabine, or low-dose cytarabine for newly diagnosed acute myeloid leukemia (AML) in adults aged 75 or older or who have comorbidities precluding...
ASH Releases New Clinical Practice Guidelines on Treatment of Older Adults With Newly Diagnosed Acute Myeloid Leukemia
The American Society of Hematology (ASH) has published new guidelines to help older adults with acute myeloid leukemia (AML) and their health-care providers make critical care decisions, including if and how to proceed with cancer treatment and the need for blood transfusions for those in hospice...
Optimizing the Treatment of Adults With Acute Lymphoblastic Leukemia
In the treatment of adults with acute lymphoblastic leukemia (ALL), use of newer antibodies and de-intensification of chemotherapy have greatly improved outcomes, according to Hagop Kantarjian, MD, FASCO, who has been very involved in much of the research in ALL treatment. Dr. Kantarjian, Professor ...
Effects of Stopping Tyrosine Kinase Inhibitor Treatment for Chronic Myeloid Leukemia
In a study (Life After Stopping TKIs; LAST) reported in JAMA Oncology, Atallah et al found that stopping tyrosine kinase inhibitor (TKI) therapy in patients with controlled chronic myeloid leukemia (CML) was associated with maintenance of major molecular response and achievement of treatment-free...
Addition of Venetoclax to Bortezomib/Dexamethasone in Relapsed or Refractory Multiple Myeloma: BELLINI Trial
As reported in The Lancet Oncology by Shaji K. Kumar, MD, and colleagues, the phase III BELLINI trial has shown that the addition of venetoclax to bortezomib/dexamethasone significantly prolonged progression-free survival in patients with relapsed or refractory multiple myeloma but was associated...
Ivosidenib Plus Azacitidine in Newly Diagnosed IDH1-Mutant Acute Myeloid Leukemia
In a phase Ib study reported in the Journal of Clinical Oncology, Courtney D. DiNardo, MD, and colleagues found that the combination of ivosidenib and azacitidine produced a high response rate in patients with newly diagnosed isocitrate dehydrogenase 1 (IDH1)-mutant acute myeloid leukemia...
Comanagement of Induction Therapy for Acute Promyelocytic Leukemia by Experts and Community Practices
In a study reported in JCO Oncology Practice, Anand P. Jillella, MD, and colleagues found that physician education on the main causes of death during induction treatment for acute promyelocytic leukemia (APL)—and comanagement of cases with expert physicians—resulted in a low early mortality rate...
