ASH: American Society of Hematology

With the rise of targeted therapies, the days of letting doctors report informally on unexpected reactions to new cancer drugs are long gone. The change signals a larger role for phase IV, the post-marketing research step in the approval process.

One billion dollars. That can be the list price for bringing a new cancer-fighting agent from preclinical design through approval by the US Food and Drug Administration, according to Michael R. Grever, MD, of the Ohio State University.

Treating lymphoma today starts with an understanding of what is being treated, and the revolution in genetic profiling lets clinicians do that with more precision than ever.

Taking aim at relapse rates and overall poor outcomes among adult patients with acute lymphoblastic leukemia (ALL) demands both new therapies and new ways of thinking, according to Anjali S. Advani, MD, of the Cleveland Clinic. Antibodies, which have produced success in treating other blood cancers, offer promise because in some cases the same antigens are involved.

Treating newly diagnosed patients even older ones with a combination of lenalidomide, marketed by Celgene as Revlimid, and low-dose dexamethasone, a steroid, seems likely to become the new treatment standard for multiple melanoma, based on the presentation of a mass vascular endothelial growth factor inhibitor, ive, multinational Phase III study presented Sunday at the 55th American Society of Hematology Meeting and Exhibition in New Orleans.

In recent years, overall progress in treating acute lymphoblastic leukemia (ALL), in which malignant white cells multiply in the bone marrow, has been tempered by this fact: Survival rates among children far outstrip those of adults, with childhood rates reaching 85% and adults registering at 45%.

Progress in treating multiple myeloma, or cancer of the plasma cells in bone marrow, has advanced significantly over the past decade. Today, questions about the disease often involve finding a treatment that balances the goal of putting a patient into remission especially if stem cell transplantation is a possibility against the toxicity of the treatment itself.

With grants from government sources looking less certain, partnerships between academic research center and pharmaceutical companies are more important than ever to keep breakthrough hematology therapies in the pipeline, said Burt Adelman, MD, a hematologist who serves as executive vice president and chief medical officer for Dyax Inc.

New therapies to treat chronic lymphocytic leukemia (CLL) will receive plenty of attention this week at the 55th American Society of Hematology Annual Meeting and Exposition in New Orleans. At an education session that opened the meeting Saturday, a physician with the Mayo Clinic made it clear that cost considerations are a reality for many older patients.

At the 54th Annual Meeting of the American Society of Hematology, John Radford, MD, reported the results of the United Kingdom RAPID trial, in which PET-directed therapy provided an opportunity to avoid involved field radiotherapy, the current standard of care following abbreviated chemotherapy in early stage Hodgkin's lymphoma.

Ralph M. Meyer, MD, Director of Clinical Trials Group, National Cancer Institute of Canada, Queen's University, offers a counterpoint to the thoughts of Richard T. Hoppe, MD, on the role and utility of radiation therapy in patients with early stage Hodgkin's lymphoma.

Vorinostat added to standard chemotherapy before, during, and after hematopoietic stem cell transplantation reduced the cumulative incidence of graft-versus-host disease in a phase I/II trial reported at the 54th Annual Meeting of the American Society of Hematology.

Adrian Wiestner, MD, PhD, Investigator, Laboratory of Lymphoid Malignancies, National Heart Lung and Blood Institute, discusses the patient outcomes that clinical trials have demonstrated regarding the use of targeted kinase inhibitors for the management of chronic lymphocytic leukemia (CLL).

A unique targeted therapy, quizartinib, was able to clear leukemia cells from the bone marrow in more than 33% of patients with an aggressive form of acute myeloid leukemia marked by a mutation in the FLT3 gene.

Elisabeth M. Paietta, PhD, Professor, Department of Medicine (Oncology), Albert Einstein College of Medicine, defines minimum residual disease (MRD) and discusses its clinical significance. She then describes the methodological and therapeutic challenges that face clinical MRD implementation.

An investigational, weekly, oral proteosome inhibitor called MLN9708 achieved excellent response rates when combined with lenalidomide and dexamethasone as up-front treatment of newly diagnosed patients with multiple myeloma, according to results of a phase II trial presented at the 54th Annual Meeting of the American Society of Hematology.

Thomas P. Loughran, Jr, MD, Professor of Medicine, Penn State University, Director, Penn State Hershey Cancer Institute, describes the clinical sequelae of large granular lymphocyte (LGL) leukemia, particularly noting neutropenia and anemia, and discusses the pharmacotherapeutic approach.

Ibrutinib, an investigational Bruton's tyrosine kinase inhibitor, achieved excellent results in clinical trials of patients with chronic lymphocytic leukemia (CLL) presented at the 54th Annual Meeting of the American Society of Hematology.

Richard T. Hoppe, MD, Professor of Radiation Oncology - Radiation Therapy, Stanford School of Medicine, discussed the current role and utility of radiation therapy in patients with early stage Hodgkins Lymphoma when compared to conventional chemotherapy.

Extended anticoagulation with fixed doses of the oral Factor Xa inhibitor apixaban significantly reduced the incidence of symptomatic recurrent venous thromboembolism (VTE) or death without increasing the risk of major bleeding in patients with VTE who had already completed up to 12 months of anticoagulation.

Claire E. Dearden, MD, Consultant Hematologist, Head of CLL Clinic, Royal Marsden Hospital, London, UK, highlights the pharmacotherapeutic strategies for the management of B- and T-cell PLL, noting the clinical outcomes associated with the diseases, and briefly touches on the future of PLL therapy.