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17th Annual International Congress on Hematologic Malignancies®: Focus on Leukemias, Lymphomas and Myeloma

17th Annual International Congress on Hematologic Malignancies®: Focus on Leukemias, Lymphomas and Myeloma


Resources

Community Practice Connections: 17th Annual International Congress on Hematologic Malignancies®: Focus on Leukemias, Lymphomas and Myeloma
Earn up to 3.0 AMA PRA Category 1 Credits™
A series of short, interactive video interviews with leading experts in the treatment of hematologic malignancies address a variety of questions commonly faced in the community oncology practice setting.

17th Annual International Congress on Hematologic Malignancies®: Meeting-in-a-Box

PER Pulse™ Recap



PER Meeting in a Box

17th Annual International Congress on Hematologic Malignancies®: Meeting-in-a-Box

The Meeting-in-a-Box components below are designed for you to download and share the information with colleagues, fellows, and other health care professionals.

Included in the Meeting-in-a-Box:



PER Pulse™ Recap

PER Pulse™ Recap

Three PER Pulse™ Recaps summarize a number of the key leukemia, lymphoma, and myeloma lectures from the 17th Annual International Congress on Hematologic Malignancies®, which was held February 15-17, 2013

Medical Writer: Jennifer Klem, PhD



1 of 3
17th Annual International Congress on Hematologic Malignancies®
Multiple Myeloma


The 17th Annual International Congress on Hematologic Malignancies® was held February 15-17, 2013, to discuss and debate the cutting-edge management of patients with leukemias, lymphomas, and myeloma. This PER Pulse™ Recap, the first of three presenting key topics from the International Congress on Hematologic Malignancies®, is focused on new agents for the treatment of relapsed or refractory multiple myeloma.

Dr. Sundar Jagannath presented information on the optimal use of novel proteasome inhibitors and immunomodulatory drugs (IMiDs) in multiple myeloma. The oral IMiD pomalidomide and the IV proteasome inhibitor carfilzomib are newly approved agents that have demonstrated activity in patients previously treated with drugs of the same class (ie, lenalidomide or thalidomide for patients receiving pomalidomide, and bortezomib for patients receiving carfilzomib). Pomalidomide and carfilzomib are each indicated for patients who have had at least two prior therapies (including an IMiD and bortezomib), whose disease has relapsed within 60 days of the last treatment. Both drugs are well tolerated, can be easily combined with other agents, and appear to extend survival in patients with relapsed/refractory myeloma.
  • What Can We Learn From Multiple Myeloma Genomic Analysis? - Nikhil Munshi, MD
  • High Risk Smoldering Myeloma—Should We Intervene Early?  - Ola Landgren, PhD
  • Current Trends: Treatment Strategies for Newly Diagnosed Elderly Patients With Myeloma  - James Berenson, MD
  • Debate: Role of Transplant in the Management of Multiple Myeloma - Nikhil Munshi, MD, and James Berenson, MD
  • Maintenance Therapy—Is It for Everyone?  - Nikhil Munshi, MD
Click here to download PDF version



2 of 3
17th Annual International Congress on Hematologic Malignancies®
Chronic Lymphocytic Leukemia and Lymphoma

The 17th Annual International Congress on Hematologic Malignancies®, which was held February 15-17, 2013, was convened to share the latest information on the management of patients with leukemias, lymphomas, and myeloma. This second of three PER Pulse™ Recaps from the International Congress on Hematologic Malignancies® is centered on the management of elderly patients with chronic lymphocytic leukemia (CLL) and the treatment of relapsed or refractory lymphoma.
  • Dr. Alessandra Ferrajoli discussed the treatment of elderly patients with CLL. Although CLL is often described as an indolent disease, SEER data show that elderly patients with CLL have a shortened survival time relative to age-matched controls, illustrating the need for active therapy in these patients. Elderly patients can be functionally divided into distinct treatment groups based on their frailty. Those who have no significant comorbidities and excellent renal function can be treated with standard chemoimmunotherapy (fludarabine + cyclophosphamide + rituximab), regardless of age. Those patients who are less healthy but are still fit enough for active therapy can receive reduced-intensity regimens; good response rates can be achieved with this type of therapy, but the depth of response is typically suboptimal, with few complete responses. Several such regimens have been used successfully in these patients, including rituximab plus chlorambucil, rituximab plus granulocyte-macrophage colony-stimulating factor (GM-CSF), and single-agent lenalidomide, but there is currently no standard of care for these patients.
  • Dr. Anas Younes presented data on the treatment of patients with relapsed diffuse large B-cell lymphoma (DLBCL), beginning with the acknowledgment that rituximab plus CHOP (R-CHOP) produces a clear survival advantage over CHOP alone, but the addition of rituximab does not cure everyone. In the first randomized trial of patients with relapsed disease following rituximab-based therapy, patients were randomized to either R-DHAP (rituximab + dexamethasone + cytarabine + cisplatin; popular in Europe) or R-ICE (rituximab + ifosfamide  + carboplatin + etoposide; popular in the US), after which all responding patients received autologous stem cell transplant (ASCT). Progression-free survival and overall survival results were similar between the R-DHAP and R-ICE arms, suggesting that R-ICE followed by ASCT remains the standard in the US. However, patients who were refractory to or relapsed within 1 year of initial rituximab therapy responded poorly to salvage rituximab therapy and transplantation, highlighting the need for better therapies in this patient population. Clinical trials are investigating novel combination regimens for patients not eligible for transplant, and they are also using biomarker-driven trials to test new targeted agents in this relapsed/refractory setting.
Click here to download PDF version

Other important lectures covering additional practical issues included:
  • Prognostic Factors: How to Use in Clinical Practice
  • William Wierda, MD
  • Targeted Therapy for CLL: Focusing on the B Cell Receptor Pathway
  • Jennifer Brown, MD, PhD
  • Targeting BCL-2 to Treat CLL
  • Tom Kipps, MD, PhD
  • IMiDs and Combinations: How to Integrate Standard Therapy
  • Alessandra Ferrajoli, MD
  • How I Manage Early-Stage DLBCL
  • Daniel Persky, MD
  • Advanced-Stage DLBCL
  • Craig Moskowitz, MD
  • New Directions in Follicular Lymphoma
  • Bruce Cheson, MD
  • Stem Cell Transplantation in Indolent Lymphoma
  • Andre Goy, MD



3 of 3
17th Annual International Congress on Hematologic Malignancies®
Chronic Myeloid Leukemia

The 17th Annual International Congress on Hematologic Malignancies®, which was held February 15-17, 2013, was convened to share the latest information on the management of patients with leukemias, lymphomas, and myeloma. This is the final of 3 PER Pulse™ Recaps from the International Congress on Hematologic Malignancies®, and it reviews the debate over the optimal first-line treatment for patients with chronic myeloid leukemia (CML).
 
Dr. Harry Erba presented data in support of the continued use of imatinib as the preferred first-line treatment for CML. He pointed out that there is currently no evidence of any second-generation tyrosine kinase inhibitor (TKI) showing a survival advantage over imatinib as first-line therapy. At early time points, both nilotinib and dasatinib produced more major molecular responses (MMRs) and more complete cytogenetic responses (CCyRs) than imatinib, but by 24 months the CCyR gap appeared to have diminished. A 2011 study suggested that CcyR, not MMR, is the most important factor related to event-free survival, supporting the idea that outcomes with imatinib and with second-generation TKIs may be similar. Dr. Erba acknowledged that there may be a higher rate of patients progressing to accelerated or blast phase with first-line imatinib, but he said that these data have not yet been published.
 
Dr. Michael Mauro countered Dr. Erba’s stance, arguing for the use of second-generation TKIs as optimal first-line therapy. He suggested that early reduction of disease burden may reduce or eliminate unstable clones, halt tumor cell proliferation, and reduce relapse. He noted that nilotinib maintains a significant improvement in CCyR rate at 24 months compared with imatinib. Moreover, both second-generation TKIs produce a significant improvement in MMR and complete molecular response (CMR) at 24 months, although the clinical importance of these measures remains unknown. Perhaps the most striking argument is the evidence showing that the BCR-ABL/ABL ratios at 3 months are predictive of survival at 8 years, with BCR-ABL/ABL ratios <10% associated with an improved survival rate compared with those having higher ratios (93% vs 57% 8-year survival). Patients taking second-generation TKIs as first-line therapy have a much greater chance of achieving these favorably low BCR-ABL/ABL ratios than patients taking imatinib, suggesting that second-generation TKIs may be associated with improved survival, despite the fact that no randomized trial has yet demonstrated this result.
 
Other important topics discussed in the session on CML included:
  • Can Therapy With TKIs Ever Be Stopped?
  • Should This Be the Primary Goal of Treatment? 
  • Moshe Talpaz, MD
  • How to Monitor Patients Receiving TKIs for CML
  • Harry Erba, MD, PhD
  • The Management of Accelerated and Myeloid Blast Phase CML
  • Richard Stone, MD
Click here to download PDF version



 
Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
 
This activity is not approved for AMA PRA Category 1 Credit™.
 
Supported by educational grants from Celgene Corporation, Genentech, Lilly USA, LLC, and Onyx Pharmaceuticals.







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