ASCO 2017 Report — Malignant Hematology

Meeting Report |
July 17, 2017

ASCO 2017 Report — Malignant Hematology

  1. Michael E. Williams, MD, ScM

Highlights of new treatments for myeloma, leukemia, and lymphoma

  1. Michael E. Williams, MD, ScM

At this year's annual meeting of the American Society of Clinical Oncology (ASCO 2017), held June 3 to 7 in Chicago, investigators discussed the latest findings in cancer research. The editors of NEJM Journal Watch Oncology and Hematology were on hand to report highlights of the conference. Here, Michael E. Williams, MD, ScM, reviews key presentations on new treatments for myeloma, leukemia, and lymphoma patients. All meeting abstracts can be viewed in the ASCO meeting library.

CAR-T-Cell Therapy for Relapsed or Refractory Myeloma

Chimeric antigen receptor T-cell (CAR-T) immunotherapy is highly active in acute lymphoblastic leukemia, chronic lymphocytic leukemia (CLL), and B-cell non-Hodgkin lymphoma (NHL). Fan and colleagues have now developed a CAR-T-cell therapy targeting the B-cell maturation antigen (BCMA) that is expressed on myeloma cells and have used it to treat patients with relapsed or refractory myeloma (abstract LBA3001).

Of 19 patients, 18 responded with complete or near-complete remission, including minimal residual disease–negative responses in some patients more than 6 months after treatment. A total of 14 patients developed the cytokine release syndrome commonly observed with CAR-T therapy, but only 2 cases were grade 3 or 4. No patient has developed disease progression, although follow-up was short. CAR-T-cell therapy targeting BCMA is a highly promising new treatment for patients with relapsed or refractory myeloma.

Long-Term Outcomes of Bendamustine plus Rituximab for NHL

Flynn and colleagues reported long-term results of the BRIGHT trial (abstract 7500) of bendamustine plus rituximab (BR) versus R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone) or R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) in 447 previously untreated patients with indolent NHL or mantle-cell lymphoma. At a follow-up of 65 months, progression-free survival (PFS) was significantly improved with BR versus R-CVP or R-CHOP (65.5% vs. 55.8%; P=0.0025), and overall survival (OS) was similar (82% and 85%, respectively); 43%–45% of patients received maintenance R.

In the StiL NHL1 study (abstract 7501), Rummel and colleagues compared BR versus R-CHOP in indolent NHL and MCL and, at follow-up of 117 months, likewise found improved PFS benefit and similar OS with BR. However, they also identified a significant benefit for time to next treatment with BR.

Long-Term Follow-Up of Ibrutinib for CLL

In the prior RESONATE trial, N Engl J Med 2014; 371:213), Byrd and colleagues compared the use of ibrutinib versus ofatumumab in CLL patients who progressed after one or more prior therapies and found that, at a median follow-up of 9.4 months, ibrutinib improved PFS, OS, and response rate. Now, these investigators report durable responses with ibrutinib at a median follow-up of 44 months (abstract 7510) even in patients with high-risk cytogenetics: del(17p) or del(11q).

The overall response rate with ibrutinib was 91%, and 3-year OS was 74%. Grade 3 or higher serious adverse events with ibrutinib included major hemorrhage in 6% of patients, atrial fibrillation in 6%, and hypertension in 8%. Overall, ibrutinib was discontinued in 27% owing to disease progression and in 12% owing to adverse events.

Stem-Cell Transplantation for Poor-Risk Follicular Lymphoma

Patients with follicular lymphoma (FL) who experience early chemoimmunotherapy failure have poorer outcomes compared with those who achieve more durable responses. To investigate the potential role of hematopoietic stem-cell transplantation (SCT) for such patients, Godfrey and colleagues conducted a retrospective analysis of 440 FL patients who had disease progression within 2 years of induction treatment with rituximab plus chemotherapy and underwent SCT (abstract 7508). Of these patients, 240 received autologous SCT, 105 received matched sibling donor (MSD) allogeneic SCT, and 95 received matched unrelated donor (MUD) allogeneic SCT.

Five-year nonrelapse mortality was significantly lower following autologous SCT (5%) versus MSD allogeneic SCT (17%) or MUD allogeneic SCT (33%; P<0.0001). Five-year OS was significantly higher following autologous SCT (70%) or MSD allogeneic SCT (74%) versus MUD allogeneic SCT (49%; P=0.004). The authors note that prior data show a 5-year OS of 50% in early-progressing patients who do not undergo SCT, which suggests that a prospective analysis of SCT in early-progressing FL is warranted.

Editor Disclosures at Time of Publication

  • Disclosures for Michael E. Williams, MD, ScM at time of publication Consultant / Advisory board Celgene; Gilead; Takeda; TG Therapeutics Speaker's bureau Research to Practice Grant / Research support Celgene; Janssen; Allos; Pharmacyclics; Gilead; Novartis; Takeda Editorial boards Annals of Lymphoma; Journal of Clinical Oncology; Blood; British Journal of Haematology; Haematologica; American Journal of Hematology Leadership positions in professional societies Lymphoma Research Foundation (Scientific Advisory Board); American Board of Internal Medicine (Chair, Hematology Subspecialty Board; Member, Council)

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