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Highlights in haematologic malignancy from ASH 2018

The ASH congress is the most comprehensive haematology event of the year, over 5000 abstracts covering new developments in malignant and non-malignant haematology were presented. Here we focus on two areas of personalised medicine from the oncology setting.

Earlier this month, Porterhouse Medical attended the 60th American Society of Hematology (ASH) Annual Meeting (http://www.hematology.org/Annual-Meeting/). The ASH congress is the most comprehensive haematology event of the year, attracting 25,000 to 30,000 professionals from every haematology subspecialty. Over 5000 abstracts covering new developments in malignant and non-malignant haematology were presented. Here we focus on two areas of personalised medicine from the oncology setting.

Immunologic treatments – new options for durable response in aggressive malignancies

The spotlight shone on Chimeric Antigen Receptor (CAR) T-cell therapy; a transformative approach where the patient’s T cells are harvested and re-engineered to recognise antigens expressed by the patient’s cancer cells, enabling them to target and eliminate the cancer. Longer-term outcomes were presented for tisagenlecleucel, a therapy directed against the CD19 antigen and now approved in the USA and Europe. High rates of durable remission or response were demonstrated 18 months after a single tisagenlecleucel infusion in children and adolescents with relapsed/refractory acute lymphoblastic leukaemia (ALL), and adults with relapsed/refractory diffuse large B-cell lymphoma.

However, CAR T-cell therapies stop working in some patients and severe toxicity can also occur. Therefore, the next wave of studies is assessing how this may be overcome. Initial findings from small groups of patients suggest CD19-directed CAR T-cell therapy, plus ibrutinib or a checkpoint inhibitor, can enhance responses and/or reduce toxicity in difficult-to-treat chronic lymphocytic leukaemia and relapsed B-cell ALL. A reduced risk of relapse was also seen when CD19-directed CAR T-cell therapy was followed by a first-time stem cell transplant in children with ALL.

Other abstracts reported on CAR T-cell therapies for multiple myeloma directed against the B-cell maturation antigen (BCMA). None is yet approved; however, the data appear to be very promising.

Precision medicine – using technology to support treatment decisions in MDS and AML

US-based researchers reported on a new machine learning-based model to predict prognosis in patients with myelodysplastic syndromes (MDS). The course of MDS is highly variable, and around one-third of patients develop acute myeloid leukaemia (AML). The new algorithm uses patients’ genomic and clinical data to determine prognosis, outperforming the current gold standard tool for predicting survival and development of AML. The team is working to further enhance the new model, which may offer a more personalised tool for assessing risk and informing treatment choice (e.g. stem cell transplant for higher risk patients and less aggressive treatments for others).

The first findings from Beat AML®, a multi-site trial testing precision medicine approaches for previously untreated AML, showed the feasibility of using rapid genetic screening to determine a patient’s AML subtype and thereby select an appropriate treatment. The study will include new experimental therapies as they are developed, with 11 treatment arms to date and 365 patients aged over 60 years. Evidence shows that patients can benefit from treatments tailored to their disease subtype.

If you would like to discuss insights from ASH 2018 or have any questions about our strong heritage in haematology, please get in touch: mark.walker@porterhousemedical.com

20th December 2018

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