Ten ASH Stories You Shouldn't Miss

Several studies were presented at the 51st American Hematology Society (ASH) Annual Meeting and Expository that have the potential to change practice now or in the future. These include advances in the treatment of leukemias, lymphomas, myelodysplastic syndromes and other hematologic malignancies. Here are 10 we covered that you do not want to miss.

• Dr Mathias Rummel said the combination of bendamustine (Treanda) and rituximab (Rituxan) demonstrated significantly superior progress-free survival and proved less toxic in patients with indolent lymphoma than CHOP-R and may become the new standard of care for first-line treatment of this disease. Abstract 405.

http://hcplive.com/oncology/ash/ash_rituximab

• Our list includes two studies highlighting new drugs that proved effective in patients with chronic myeloid leukemia who have BCR-ABL and T315I mutations, which confer resistance to currently approved tyrosine kinase inhibitors (TKIs). Omacetaxine (Omapro) achieved durable hematologic and cytogenetic response (CyR) in patients who failed treatment with imatinib said Dr Jorge Cortes, who presented the data. In total, 86% of patients had complete hematologic response, and 41% had a CyR. Dr Cortes said a phase I trial of AP24534 in 20 evaluable patients with CML induced a CyR in 60% of patients, with 45% demonstrating major CyR.

http://hcplive.com/oncology/ash/ash_omacetaxine_cml

http://www.hcplive.com/oncology/ash/ash_refractory_cml

• Second-generation TKI nilotinib (Tasigna) demonstrated superior effectiveness compared with imatinib (Gleevec) as a first-line treatment for patients with CML in the chronic phase. Experts said more research is needed before recommending initial treatment with nilotinib, but Dr Saglio Giuseppe, the study’s lead author, said if results hold out, nilotinib might someday replace imatinib as first-line therapy for CML. One-year major molecular response (MMR) was 43%-44% in the nilotinib arms compared with 22% for the imatinib arm.

http://hcplive.com/oncology/ash/ash_nilotinib

• A study of younger patients with aggressive B-cell non-Hodgkin lymphoma (NHL) found that a conventional CHOEP-R regimen resulted in higher rates of complete response (CR), overall survival, and progression-free survival (PFS) compared with an intensified regimen. The conventional regimen was also associated with fewer discontinuations due to toxicities and fewer lymphoma-associated deaths. The study originally included chemotherapy-only arms but these were discontinued when the rituximab-arm demonstrated clearly superior effectiveness, with a 21% difference in 3-year event-free survival favoring rituximab.

http://hcplive.com/oncology/ash/ash_choep

• Patients with cancer are at high risk of venous thromboembolism (VTE). Warfarin is sometimes used but requires regular monitoring and is associated with bleeding complications. A study found the investigational anticoagulant dabigatran was similar to warfarin in efficacy but did not require regular monitoring due to better predictability and had a significantly reduced rate of bleeding events (16.1% vs 21.9%).

http://hcplive.com/oncology/ash/ash_dabigatran

• Adding alemtuzumab to fludarabine (FluCam) is superior to fludarabine alone as a second-line therapy for patients with relapsed or refractory chronic lymphocytic leukemia (CLL), including those with advanced disease. FluCam produced significantly longer PFS, higher rates of overall response and CR. It also has an acceptable safety profile and is convenient to administer. Researchers concluded it may be an additional second-line treatment option for patients with relapsed or refractory CLL.

http://hcplive.com/oncology/ash/ash_cll

•As many as 50% of patients with myelofibrosis have the JAK2V617F mutation. An early stage study found that the experimental drug INCB018424 demonstrated activity in this disease, shrinking spleens, reducing pain, and improving quality of life. Patients without the mutation also responded to the drug said Dr Srdan Verstovsek. Trial information is available at www.comfortstudy.com.

http://hcplive.com/oncology/ash/ash_jak2

• Physicians who talk to patients about advanced care planning should focus on the practical importance of a plan and de-emphasize the emotional aspects. Patients with advanced care plans were more likely to use problem-focused coping methods rather than emotional ones that might include substance abuse and social withdrawal.

http://hcplive.com/oncology/ash/ash_advanced_care_planning

• Patients with follicular lymphoma who received Bexxar had an overall response rate of 97%, and the median duration of CR was 9.1 years. In addition, patients remained responsive to treatment for 6 years. Nearly 5% of patients developed grade 4 neutropenia, however.

http://hcplive.com/oncology/ash/ash_bexxar

• Patients with aggressive B-cell lymphoma responded well to lenalidomide (Revlimid) in an international phase II study according to Mayo Clinic investigators. Patients with relapsed or refractory NHL had a 35% response rate to lenalidomide, with reversible myelosuppression as the most common adverse effect.

http://hcplive.com/oncology/ash/ash_lenalidomide

Visit our Conference 360 coverage of the conference at: www.hcplive.com/oncology/ash