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On May 25, 2022, ivosidenib was approved for use in combination with azacitidine for newly diagnosed acute myeloid leukemia with a susceptible IDH1 mutation, as detected by a U.S. Food and Drug Administration–approved test, in patients aged 75 or older or in those who have comorbidities precluding...
Jennifer R. Brown, MD, PhD, of Dana-Farber Cancer Institute, discusses phase III findings of the ALPINE study, which showed that zanubrutinib is more efficacious and better tolerated than ibrutinib as a treatment for patients with relapsed or refractory chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). In this first head-to-head comparison of the two BTK inhibitors, the superior progression-free survival of zanubrutinib was observed across all major subgroups, including high-risk patients (Abstract LBA-6).
Mark R. Litzow, MD, of the Mayo Clinic, discusses phase III results from the ECOG-ACRIN E1910 Trial, which show that adding blinatumomab to consolidation chemotherapy resulted in a significantly better overall survival in adult patients aged 30 to 70 years with newly diagnosed B-lineage acute lymphocytic leukemia (ALL) who were measurable residual disease–negative after receiving intensification chemotherapy. The authors believe this may represent a new standard of care for this population (Abstract LBA-1).
Richter syndrome is an aggressive lymphoma that develops in up to 1% of patients with chronic lymphocytic leukemia (CLL) and it serves as an example of histologic transformation. While recent advances have transformed the treatment landscape of CLL, Richter syndrome remains associated with poor...
Zanubrutinib showed superior efficacy to ibrutinib—with fewer side effects—in the first head-to-head comparison between the Bruton’s tyrosine kinase (BTK) inhibitors among patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), according to data presented by Jennifer...
A novel study evaluating the addition of venetoclax to the intensive chemotherapy regimen of cladribine, idarubicin, and cytarabine as a front-line therapy demonstrated high rates of disease control and remissions in younger patients with newly diagnosed acute myeloid leukemia (AML) and high-risk...
A new phase II trial demonstrated that the chemotherapy-free regimen of ponatinib and blinatumomab may have achieved high response rates and reduced the need for an allogeneic stem cell transplant for patients with recently diagnosed Philadelphia chromosome–positive (Ph+) acute lymphoblastic...
Researchers observed encouraging response rates in older or high-risk patients with newly diagnosed acute myeloid leukemia (AML) when treated with the triplet combination therapy of azacitidine, venetoclax, and magrolimab in a phase I/II trial, according to new findings presented by Daver et al at...
The bispecific T-cell engager molecule blinatumomab was found to improve overall survival for patients with no measurable residual disease (MRD) after initial treatment for B-lineage acute lymphoblastic leukemia (ALL), according to the phase III ECOG-ACRIN E1910 trial presented by Litzow et al at...
The use of a simplified treatment regimen by oncologists—along with management recommendations and 24/7 support provided by a limited and dedicated group of academic disease experts—resulted in a decrease in early deaths from acute promyelocytic leukemia (APL). In the multicenter prospective trial...
A three-drug combination that showed success at sending patients with chronic lymphocytic leukemia (CLL) into deep remissions in a clinical trial may be effective at treating patients with high-risk types of the disease, according to new findings presented by Ryan et al at the 2022 American Society ...
The use of stem cell transplantation for acute myeloid leukemia increased by about 55% worldwide from 2009 to 2016, according to new findings presented by Niederweiser et al at the 64th American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 3638). Although the largest...
Irene Roberts, MD, of Oxford’s Weatherall Institute of Molecular Medicine, discusses children with Down syndrome, who have a more than 100-fold increased risk of developing acute myeloid leukemia before their fourth birthday compared to children without Down syndrome. Their risk of acute lymphoblastic leukemia is also increased by around 30-fold. Dr. Roberts details current knowledge about the biologic and molecular basis of this relationship between leukemia and Down syndrome, the role of trisomy 21 in leukemogenesis, and the clinical implications of these findings.
Abdul Rahman Al Armashi, MD, of Seidman Cancer Center, Case Western University, University Hospitals Cleveland Medical Center, discusses a retrospective analysis, using a CDC database, in one of the largest subgroup-based racial population studies analyzing mortality trends in patients with acute myeloid leukemia (AML). Between 2000 and 2019, AML mortality was the highest in Whites and the lowest in American Indians or Alaska Natives. The highest rate of increase in mortality was seen in Asians or Pacific Islanders. Dr. Al Armashi talks about the many variables that might contribute to these inequalities (Abstract 600).
Anand P. Jillella, MD, of Georgia Cancer Center at Augusta University, discusses results from the ECOG-ACRIN EA9131 Trial, which showed that using a simplified treatment algorithm and management recommendations made by a group of specialists, resulted in a dramatic improvement in 1-year survival of patients with acute promyelocytic leukemia (Abstract 421).
Andrew Matthews, MD, of the Abramson Cancer Center, University of Pennsylvania, discusses findings from a large, multicenter study that showed superior outcomes with 7 + 3 chemotherapy (cytarabine continuously for 7 days, along with short infusions of an anthracycline on each of the first 3 days) vs venetoclax in patients with acute myeloid leukemia (AML). In this real-world data set, the 7 + 3 cohort outperformed historical benchmarks in overall survival and early mortality, perhaps reflecting improved later lines of therapy and patient selection. Prospective studies (such as NCT04801797) must confirm the superiority of intensive chemotherapy (Abstract 426).
Researchers from the University of Pennsylvania’s Abramson Cancer Center presented preliminary results of an ongoing phase I clinical trial demonstrating successful retreatment with chimeric antigen receptor (CAR) T-cell therapy for patients whose cancers relapsed after previous CAR T-cell therapy. ...
Researchers from The University of Texas MD Anderson Cancer Center showed that inhibiting menin with an oral small-molecule inhibitor of the menin-KMT2A interaction, SNDX-5613—now named revumenib—yielded encouraging responses for patients with advanced acute leukemias and KMT2A rearrangements or...
Jorge E. Cortes, MD, of Georgia Cancer Center at Augusta University, discusses new findings on vodobatinib, which was administered to patients with chronic-phase Philadelphia chromosome–positive chronic myeloid leukemia (CML) and appeared to be efficacious and safe in people who had received therapy with two or three prior tyrosine kinase inhibitors (TKIs). Vodobatinib remains a potential option for these highly refractory patients. A phase II study (NCT02629692) of vodobatinib is ongoing in CML patients whose disease has failed to respond to three or more TKIs, including ponatinib (Abstract 84).
Elias Jabbour, MD, of The University of Texas MD Anderson Cancer Center, discusses an analysis confirming that olverembatinib is a potentially viable treatment option for patients with chronic myeloid leukemia (CML) and Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL), including those with CML whose disease did not respond to ponatinib or asciminib, or who had a T315I mutation (Abstract 82).
Eunice S. Wang, MD, of Roswell Park Comprehensive Cancer Center, discusses the outcomes of patients newly diagnosed with acute myeloid leukemia (AML) who were treated with cytarabine plus daunorubicin plus gemtuzumab ozogamicin (GO). These patients experienced higher rates of measurable residual disease–negative complete remission and complete remission with incomplete count recovery, compared to those treated with cytarabine plus idarubicin daunorubicin alone. Although adding GO was not associated with improved overall survival, longer follow-up is warranted to determine an absolute survival advantage of this regimen (Abstract 58).
The results of a new study answer some questions and raise new ones about the optimal treatment strategy for children and young adults living with acute lymphoblastic leukemia (ALL) or lymphoblastic leukemia (LBL). The randomized study is the first to test whether the use of a shorter, higher-dose...
Patients with acute myeloid leukemia (AML) whose disease relapsed or did not respond to initial chemotherapy had similar outcomes when they proceeded directly to allogeneic stem cell transplantation compared with those who underwent intensive salvage chemotherapy to achieve complete remission...
As reported in the Journal of Clinical Oncology by Laetsch et al, the 3-year update of the phase II ELIANA trial showed durable responses and a manageable safety profile with tisagenlecleucel for the treatment of pediatric and young adult patients with relapsed or refractory B-cell acute...
On December 1, the U.S. Food and Drug Administration (FDA) approved olutasidenib (Rezlidhia) capsules for adult patients with relapsed or refractory acute myeloid leukemia (AML) with a susceptible IDH1 mutation as detected by an FDA-approved test. The FDA also approved the Abbott RealTime IDH1...
In an interim analysis of the phase III ALPINE trial reported in the Journal of Clinical Oncology, Peter Hillmen, MBChB, PhD, and colleagues found that zanubrutinib produced a significantly higher objective response rate vs ibrutinib in patients with relapsed or refractory chronic lymphocytic...
The ASCO Post is pleased to present Hematology Expert Review, an ongoing feature that quizzes readers on issues in hematology. In this installment, Drs. Syed Ali Abutalib and Mrinal M. Patnaik explore the current treatment and prognosis of chronic myelomonocytic leukemia. For each quiz question...
On November 18, the U.S. Food and Drug Administration (FDA) approved a new Monday/Wednesday/Friday dosing regimen for asparaginase erwinia chrysanthemi (recombinant)-rywn (Rylaze). Under the new regimen, patients should receive 25 mg/m2 intramuscularly on Monday and Wednesday mornings and 50 mg/m2...
In a Chinese phase II study reported in the Journal of Clinical Oncology, Wang et al found that the coadministration of CD19- and CD22-directed chimeric antigen receptor (CAR) T cells produced promising initial outcomes in pediatric patients with B-cell acute lymphoblastic leukemia (ALL) with...
Although socioeconomic status often influences survival outcomes, pediatric patients with relapsed or refractory acute lymphoblastic leukemia (ALL) who were living in poverty and were treated with CAR T-cell therapy achieved similar overall survival and were equally likely to achieve a complete...
In a single-institution analysis reported in the Journal of Clinical Oncology, Benjamin L. Lampson, MD, and colleagues found a higher prevalence of rare germline ATM variants in chronic lymphocytic leukemia (CLL) vs other lymphoid and myeloid disorders. They also determined that patients with CLL...
In a single-institution study reported in the Journal of Clinical Oncology, Jacola et al found that survivors of childhood acute lymphoblastic leukemia (ALL) who received central nervous system (CNS)-directed therapy excluding cranial irradiation had poorer outcomes in numerous neurocognitive...
The treatment paradigm for chronic lymphocytic leukemia (CLL) continues to evolve in the first-line setting and beyond, with the availability of Bruton’s tyrosine kinase (BTK) inhibitors, the BCL2 inhibitor venetoclax, and novel combinations of these agents with anti-CD20 monoclonal antibodies....
For many years, treatment options for acute myeloid leukemia (AML) were limited mainly to the 7 + 3 regimen. However, more recently, a mini-explosion of AML therapies aimed at newly identified genetic targets makes discussions about treatment of this disease much more complicated. In fact, these...
When it is dark enough, you can see the stars.” —Ralph Waldo Emerson Low-intensity therapy for older or unfit patients with acute myeloid leukemia (AML) was introduced in the early 2000s in the form of low-dose cytarabine or hypomethylation therapy (azacitidine or decitabine). Recent studies...
In a study reported in the Journal of Clinical Oncology, Grob et al found that next-generation sequencing detection of FLT3-internal tandem duplication (FLT3-ITD) measurable residual disease (MRD) in complete remission was associated with markedly increased risk of relapse and poorer overall...
In a retrospective study reported in the Journal of Clinical Oncology, Attarbaschi et al described outcomes in patients with noninfant childhood acute lymphoblastic leukemia (ALL) and 11q23/KMT2A rearrangements treated with chemotherapy regimens between 1995 and 2010. Study Details The study...
Richter transformation, usually a diffuse large B-cell lymphoma developing in a person with CLL, remains a challenging entity, but novel regimens look promising, as described at the 2022 Pan Pacific Lymphoma Conference by Matthew S. Davids, MD, MMSc, Associate Professor of Medicine at Harvard...
In a study reported in JCO Oncology Practice, Lucie M. Turcotte, MD, MPH, and colleagues found that real-world costs for care for commercially insured U.S. pediatric patients with acute lymphoblastic leukemia (ALL) were higher in those diagnosed at age 10 or older and have increased substantially...
Christopher E. Jensen, MD, of the University of North Carolina School of Medicine, talks about older adults with acute myeloid leukemia who receive high-intensity chemotherapy. Although they may live longer, much of their survival gains may be spent engaged in oncology care (Abstract 376).
Barbara Eichhorst, MD, of the German CLL Study Group and the University of Cologne, discusses phase III findings from the GAIA/CLL13 trial, which showed that time-limited treatment with venetoclax, obinutzumab, and ibrutinib or venetoclax plus obinutzumab improved progression-free survival compared with standard chemoimmunotherapy in fit, previously untreated patients with chronic lymphocytic leukemia (Abstract LBA2365).
In a retrospective study reported in the Journal of Clinical Oncology, Schultz et al found poor survival among children and young adults with lack of response to tisagenlecleucel for B-cell acute lymphoblastic leukemia (ALL). Salvage therapy after relapse was capable of inducing responses, but...
In a Chinese phase III trial reported in the Journal of Clinical Oncology, Zhang et al found that conditioning with busulfan plus cyclophosphamide (BuCy) was noninferior to total-body irradiation plus cyclophosphamide (TBI-Cy) in 2-year overall survival among adult patients with standard-risk...
Nearly one in four families of pediatric patients with acute lymphoblastic leukemia (ALL) enrolled in a clinical trial experienced food insecurity, and almost half of the families eligible for the Supplemental Nutrition Assistance Program (SNAP) did not receive benefits. In addition, receiving SNAP ...
On August 26, the U.S. Food and Drug Administration (FDA) approved pemigatinib (Pemazyre), a selective fibroblast growth factor receptor (FGFR) inhibitor, for the treatment of adults with relapsed or refractory myeloid/lymphoid neoplasms with FGFR1 rearrangement. Myeloid/lymphoid neoplasms with...
In a study reported in the Journal of Clinical Oncology, Casey et al found that most U.S. minority populations were underrepresented in clinical trials leading to U.S. Food and Drug Administration approval of drugs for treating leukemias and multiple myeloma. Study Details The investigators...
On May 20, 2022, azacitidine for injection was approved by the U.S. Food and Drug Administration for pediatric patients with newly diagnosed juvenile myelomonocytic leukemia.1 Supporting Efficacy Data Approval was based on findings in the multicenter AZA-JMML-001 trial (ClinicalTrials.gov...
Harry P. Erba, MD, PhD, of Duke Cancer Institute, discusses potentially practice-changing phase III results from the QuANTUM-First trial, which showed that adding quizartinib to standard chemotherapy and up to 3 years of continuation therapy led to improvement in overall survival for adults aged 18 to 75 with newly diagnosed FLT3-ITD–positive acute myeloid leukemia. The manageable safety profile further supports the use of quizartinib in combination with standard therapy, including allogeneic hematopoietic stem cell transplantation, in this setting (Abstract S100).
Children in Pennsylvania living near unconventional oil and gas developments at birth were two to three times more likely to be diagnosed with leukemia between the ages of 2 and 7 years than children who did not live near this oil and gas activity, after accounting for other factors that could...
A newly constructed map of the landscape of genetic changes in chronic lymphocytic leukemia (CLL) may provide a better understanding of this complex malignancy, which could lead to more accurate prognoses for patients, improved diagnostics, and novel treatments. These research findings were...