Science and data that have fueled the rapidly evolving field of hematology figure prominently in the program for the 2019 American Society of Hematology (ASH) meeting, which begins here today.
The largest hematology conference in the world, ASH will host more than 25,000 attendees from 115 countries. The program includes almost 5,000 research abstracts, 1,000 of which were selected for presentation at oral sessions.
“This really is just a great, grand meeting of the minds,” said chair of the ASH communications committee, Aaron Gerds, MD, of the Cleveland Clinic.
The meeting begins with a day of continuing education programming, covering all aspects of hematology. Industry-sponsored satellite symposia feature some of the leaders in their respective fields, offering insights into key clinical issues and ongoing research and development. Afternoon scientific workshops introduce attendees to current science and emerging scientific concepts that will provide the basis for future clinical advances.
Abstract presentations begin early Saturday and continue through mid-day Tuesday.
Developments in the field of CAR T-cell therapy will continue to figure prominently in the key scientific presentations.
“CAR T-cells have captured the imagination of physicians, scientists, and patients, mainly for their incredible efficacy in treating B-cell malignancies,” said ASH secretary Robert Brodsky, MD, of Johns Hopkins School of Medicine in Baltimore. “But there have been a number of drawbacks. One is the time and expense required to generate patient-specific CAR T cells. Only about two thirds of patients enrolled in clinical trials of CAR T cells will actually receive the treatment, as many times the disease will progress during the time it takes to produce the cells. Toxicity has been another issue.”
Several abstracts at ASH will feature strategies to overcome some of the limitations of CAR T-cell therapy. Examples of the research that will be presented include an off-the-shelf CAR NK cell for B-cell malignancies, clinical data from a trial of CAR T-cell therapy directed against B-cell maturation antigen (BCMA) in relapsed/refractory multiple myeloma, and a bispecific CAR T cell therapy targeting BCMA and CD38 in relapsed/refractory myeloma.
The Presidential Plenary Session will include data on mosunetuzumab, a monoclonal antibody that has induced complete remission in patients with poor-prognosis non-Hodgkin’s lymphoma that is resistant to or has relapsed after CAR T-cell therapy. A high response rate and persistence were observed in a difficult-to-treat population, including patients whose disease was refractory to CAR T-cell therapy, said Brodsky.
In the area of venous thromboembolism (VTE), the program includes several potentially practice-changing studies, said ASH president Roy Silverstein, MD, of Medical College of Wisconsin in Milwaukee. A trial of an oral formulation of rivaroxaban for VTE prevention in children demonstrated equivalent efficacy with low molecular weight heparin. The oral formulation facilitated administration and acceptance and will likely become a new standard of care for children with VTE, said Silverstein.
Another study evaluated the common practice of adding aspirin without an apparent indication to a direct oral anticoagulant (DOAC) for patients with atrial fibrillation or VTE. The results showed similar rates of recurrent thrombosis or stroke in patients who received DOACs alone or with aspirin, but aspirin-treated patients had more clinically relevant, nonmajor bleeding events.
“This is an example of less is more,” said Silverstein. “It will provide good evidence to our community practitioners that when starting a DOAC for nonvalvular atrial fibrillation or venous thrombosis, patients should not also receive aspirin unless there is a clear indication, such as a recent stenting or coronary disease.”
A number of sessions will address the issue of inclusiveness in medicine. Examples include a comprehensive evaluation of data on stem-cell transplantation for multiple myeloma, showing that older and younger patients derive similar benefit. Older patients who did worse tended to receive less-than-optimal dosing of melphalan, a pretransplant conditioner.
“The results suggest we are under-referring patients for bone marrow transplant on the basis of age alone and perhaps undertreating the ones who are referred,” said Silverstein. “This is a very important abstract that gets to the point that age as a number is probably not adequate as an exclusion or inclusion in clinical trials.”
A study of “real-world” experience with CAR T-cell therapy showed that older patients did well on the therapy and had a lower rate of healthcare resource utilization.
The late-breaking abstract session on Tuesday will include an entire lineup of potentially practice-changing studies, said Brodsky. The studies include a randomized phase III trial showing the superiority of blinatumomab (Blincyto) versus chemotherapy as post-induction therapy for children, adolescents, and young adults in first relapse of B-acute lymphoblastic leukemia; inhibition of C1s with monoclonal antibody sutimlimab in patients with cold agglutinin disease; a randomized, placebo-controlled phase III trial of an oral formulation of azacitidine for patients with acute myeloid leukemia in first remission; and a randomized trial demonstrating the superiority of adding daratumumab (Darzalex) to carfilzomib (Kyprolis) and dexamethasone versus carfilzomib and dexamethasone in relapsed/refractory myeloma.
The 2019 ASH meeting will continue until Tuesday afternoon.
