Accreditation/Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 8.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Physicians’ Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider No. 16669, for 8.0 Contact Hours.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, Jazz Pharmaceuticals, Inc, and Kite, a Gilead Company.

2nd Annual Live Medical Crossfire®: Hematologic Malignancies Online


Release Date: September 28, 2018
Expiration Date: September 28, 2019
Media: Internet - based

Activity Overview

The 2nd Annual Live Medical Crossfire®: Hematologic Malignancies was a live, full-day version of the renowned Medical Crossfire® format. This 1-day conference was developed to allow you to explore many of the most hotly debated clinical issues in the management of hematologic malignancies. Furthermore, this meeting was designed to facilitate the practical application of emerging data key to treating a broad range of hematologic malignancies, providing you with the information you need to confidently make personalized clinical decisions for your patients and apply novel strategies to real-world clinical case scenarios you routinely encounter in your practice.

For the Live Medical Crossfire®, we assembled renowned experts in the management of leukemias, lymphomas, and myeloma to facilitate discussion both among the faculty and with you in the audience. The program format for this meeting was unique. Each tumor’s section began with a brief evidence-based assessment of the evolving therapeutic space and transitioned quickly to the accompanying clinical questions that were the focus of the expert crossfire session. Each section concluded with a crossfire from the live audience at the meeting.

This online activity captures all the lectures presented at the 2018 2nd Annual Live Medical Crossfire®: Hematologic Malignancies and organizes them in a convenient modular format.
 

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca, Celgene Corporation, Jazz Pharmaceuticals, Inc, and Kite, a Gilead Company.

 

Instructions for This Activity and Receiving Credit

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a CME certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational activity is directed toward hematologists and medical oncologists. Nurse practitioners, nurses, physician assistants, pharmacists, investigators, and other health care professionals interested in the treatment of cancer will be invited to participate.

Learning Objectives

At the conclusion of this activity, participants should be better prepared to:

  • Appraise testing strategies that may inform clinical decision making in the management of hematologic malignancies
  • Apply clinical trial results to multiple lines of care in the management of hematologic malignancies
  • Analyze disparities in care for patients with hematologic malignancies
  • Outline strategies to monitor and proactively manage treatment-related toxicities in patients with leukemia, lymphoma, and multiple myeloma
  • Identify key emerging data pertaining to the diagnosis and management of patients with hematologic malignancies

Faculty, Staff, and Planners' Disclosures

 

CHAIR

Anas Younes
Anas Younes, MD
Professor of Medicine and Chief of Lymphoma Service
Department of Medicine
Division of Hematologic Oncology
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Grant Research Support: Novartis, Johnson & Johnson, Curis, Roche, Bristol-Myers Squibb Consultant: Bayer, Bristol-Myers Squibb, Celgene, Incyte, Janssen, Sanofi, Seattle Genetics, Takeda Millennium, Genentech, Merck

FACULTY

Jane Apperley
Jane Apperley, MBChB, MD, FRCP, FRCPath
Faculty of Medicine
Department of Medicine
Imperial College London
London, United Kingdom

Disclosures: Research Support: Ariad, Pfizer; Consultant: Incyte, Novartis, Pfizer, Takeda, Therakos; Speakers’ Bureau: Bristol-Myers Squibb, Incyte, Novartis, Pfizer, Therakos

Jacqueline Barrientos
Jacqueline Barrientos, MD, MS
Associate Professor
Division of Hematology and Medical Oncology
Department of Medicine
Hofstra/Northwell School of Medicine
Hempstead, NY

Disclosures: Grant Research Support: Gilead, Pharmacyclics/AbbVie, Acerta, American Society of Hematology/Harold Amos Medical Faculty Development Program; Consultant: Gilead, Pharmacyclics/AbbVie

Noa Biran
Noa Biran, MD
Multiple Myeloma Division
John Theurer Cancer Center at Hackensack University Medical Center
Hackensack, NJ

Disclosures: Grant Research Support: Merck, Bristol-Myers Squibb; Consultant: Takeda, Celgene, Amgen; Speakers’ Bureau: Takeda, Celgene, Amgen, Sanofi, Janssen

Danielle M. Brander
Danielle M. Brander, MD
Assistant Professor of Medicine
Duke Cancer Institute
Duke University Health System
Durham, NC

Disclosures: Consultant: AbbVie, Teva, Pharmacyclics, Genentech, TG Therapeutics; Other: Data and Safety Monitoring Board for Novartis

Robert W. Chen
Robert W. Chen, MD
Associate Professor of Medicine
City of Hope Medical Center
Duarte, CA

Disclosures: Grant Research Support: Seattle Genetics, Pharmacyclics, Bristol-Myers Squibb; Consultant: Seattle Genetics, Pharmacyclics, Bristol-Myers Squibb, Merck; Speakers’ Bureau: Seattle Genetics, Genentech, Merck

Graham Collins
Graham Collins, MD, DPhil
Consultant Hematologist
Oxford University Hospitals
Oxford, United Kingdom

Disclosures: Grant Research Support: Amgen, Celgene, MSD, Celleron; Consultant: Roche, Takeda, Bristol-Myers Squibb, MSD, Celeron, Gilead; Speakers’ Bureau: Roche, Takeda, Bristol-Myers Squibb

Naval G. Daver
Naval G. Daver, MD
Associate Professor
Department of Leukemia
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosures: Grant Research Support: Bristol-Myers Squibb, Pfizer, Merck, Incyte, Sunesis, Kiromic, Karyopharm, Daiichi-Sankyo; Consultant: Otsuka, Pfizer, Incyte, Alexion, Sunesis, Karyopharm, ImmunoGen, Bristol-Myers Squibb

Daniel J. DeAngelo
Daniel J. DeAngelo, MD, PhD
Associate Professor of Medicine
Harvard Medical School Institute
Institute Physician
Adult Leukemia Program
Dana-Farber Cancer Institute
Boston, MA

Disclosures: Grant Research Support: GlycoMimetics/Blueprint; Consultant: Amgen, Pfizer, Novartis, Incyte, Takeda, Shire

Gabriela Hobbs
Gabriela Hobbs, MD
Instructor in Medicine
Massachusetts General Hospital
Boston, MA

Disclosures: Grant Research Support: Incyte, Bayer support research trials; Consultant: Celgene Ad Board

Elias Jabbour
Elias Jabbour, MD
Associate Professor
Department of Leukemia
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosures: No relevant financial relationships with commercial interests to disclose.

Neil E. Kay
Neil E. Kay, MD
Professor of Medicine
Division of Hematology
Mayo Clinic
Rochester, MN

Disclosures: Grant Research Support: Pharmacyclics, Tolero, Acerta; Other: Data and Safety Monitoring Board for Gilead, MorphoSys, Infinity Pharm, Agios Pharm, Celgene and CytomX Therapeutics

Alexander M. Lesokhin
Alexander M. Lesokhin, MD
Assistant Attending Physician
Memorial Sloan Kettering Cancer Institute
New York, NY

Disclosures: No relevant financial relationships with commercial interests to disclose.

Selina Luger
Selina Luger, MD
Professor of Medicine
Director, Leukemia Program
Abramson Cancer Center
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA

Disclosures: Grant Research Support: Ariad, Cyclacel, Seattle Genetics, Onconova, Celgene; Consultant: Incyte, Pfizer, Astellas

Deepu Madduri
Deepu Madduri, MD
Assistant Professor of Medicine
Division of Hematology and Oncology
The Tisch Cancer Institute
New York, NY

Disclosures: No relevant financial relationships with commercial interests to disclose.

Sham Mailankody
Sham Mailankody, MBBS
Medical Oncologist
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Grant Research Support: Clinical investigator on trials supported by Juno Therapeutics, Janssen, and Takeda Oncology

David Maloney
David Maloney, MD, PhD
Member, Clinical Research Division
Medical Director, Cellular Immunotherapy
Leonard and Norma Klorfine Endowed Chair for Clinical Research
Fred Hutchinson Cancer Research Center
Professor of Medicine, Division of Oncology
University of Washington
Seattle, WA

Disclosures: Grant Research Support: Juno Therapeutics and Kite Pharma, paid to my institution; Consultant: Kite Pharma, Novartis, Eureka Therapeutics, Genentech; Other: Data and Safety Monitoring Board for BioLineRX and Celgene

Anthony Mato
Anthony Mato, MD, MSCE
Director, CLL Program
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Grant Research Support: TG Therapeutics, Gilead, Pharmacyclics, Regeneron, AbbVie, Portola, Acerta; Consultant: Celgene, Gilead, AbbVie, TG Therapeutics

Michael J. Mauro
Michael J. Mauro, MD
Leader, Myeloproliferative Neoplasms Program
Attending Physician, Leukemia Service Member, Memorial Sloan Kettering Cancer Center
Professor of Medicine, Weill Cornell Medical College
New York, NY

Disclosures: Grant Research Support: Novartis Oncology; Consultant: Novartis Oncology, Bristol-Myers Squibb, Pfizer, Ariad

Bruno C. Medeiros
Bruno C. Medeiros, MD
Associate Professor of Medicine (Hematology)
Stanford University Medical Center
Stanford, CA

Disclosures: Grant Research Support: Jazz, Novartis, Celgene, Astellas; Consultant: Jazz, Novartis, Celgene, Astellas

Sattva S. Neelapu
Sattva S. Neelapu, MD
Professor and Deputy Chair ad interim
Department of Lymphoma and Myeloma
The University of Texas MD Anderson Cancer Center
Houston, TX

Disclosures: Grant Research Support: Kite Pharma, Merck, Bristol-Myers Squibb, Cellectis, Poseida; Consultant: Kite/Gilead, Novartis, Merck, Celgene, Unum Therapeutics; Other: Participation in advisory or review activities (Kite Pharma, Merck, Celgene)

Ruben Niesvizky
Ruben Niesvizky, MD
Professor of Medicine
Director, Oncology Operations
Weill Cornell Medical Center/NewYork-Presbyterian Hospital
Director, Multiple Myeloma Center
New York, NY

Disclosures: Consultant: Celgene, Amgen, Takeda Pharmaceuticals, Janssen, Bristol-Myers Squibb

Javier Pinilla-Ibarz
Javier Pinilla-Ibarz, MD, PhD
Senior Member
Lymphoma Section Head and Director of Immunotherapy
Malignant Hematology Department
H. Lee Moffitt Cancer Center & Research Institute
Tampa, FL

Disclosures: Consultant: Janssen, Pharmacyclics, Gilead, AbbVie, Novartis, Pfizer; Speakers’ Bureau: AbbVie, Gilead, Pharmacyclics, Takeda

Daniel A. Pollyea
Daniel A. Pollyea, MD, MS
Associate Professor
Clinical Director, Leukemia Services
Division of Hematology
University of Colorado Cancer Center
University of Colorado School of Medicine
Aurora, CO

Disclosures: Grant Research Support: Pfizer, Agios; Consultant: Celgene, Pfizer, Argenx, Agios, AbbVie, Celyad

Stephen J. Schuster
Stephen J. Schuster, MD
Director, Lymphoma Program
Robert and Margarita Louis-Dreyfus Professor of Chronic Lymphocytic Leukemia and Lymphoma
Abramson Cancer Center, University of Pennsylvania
Philadelphia, PA

Disclosures: Grant Research Support: Novartis, Celgene, Merck, Incyte, Pharmacyclics, Bristol-Myers Squibb; Consultant: Merck, Celgene, Gilead, Novartis, Pfizer

Neil Shah
Neil Shah, MD, PhD
Professor, Department of Medicine (Hematology/Oncology)
Program Leader, Hematopoietic Malignancies Program
Helen Diller Family Comprehensive Cancer Center
University of California, San Francisco
San Francisco, CA

Disclosures: Grant Research Support: Bristol-Myers Squibb, Ariad

David J. Straus
David J. Straus, MD
Medical Oncologist
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Consultant: Seattle Genetics, Onco tracker 2016, Millennium (Takeda), Dava, Juno Therapeutics, Bayer 2017; Speakers’ Bureau: Roche China

The staff of Physicians’ Education Resource®, LLC, have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recaps

1 of 3
2nd Annual Live Medical Crossfire®: Hematologic Malignancies

The live continuing medical education activity 2nd Annual Live Medical Crossfire®: Hematologic Malignancies, held July 14, 2018, in New York, New York, was cochaired by C. Ola Landgren, MD, PhD; S. Martin Tallman, MD; and Anas Younes, MD. This program featured renowned experts who led 8 exciting Medical Crossfire® discussions on important topics in acute and chronic leukemias, lymphoma, and multiple myeloma. This meeting addressed some of the most controversial and cutting-edge clinical issues in the management of hematologic malignancies, facilitating the practical application of emerging clinical data so that participants could return to their practices more confident in employing personalized and evidence-based treatment approaches for their patients. This first of 3 PER Pulse Recaps reviews novel therapies for diffuse large B-cell lymphoma (DLBCL).

Below are some highlights from the Medical Crossfire® panel discussion led by Dr Younes.

  • When asked how chimeric antigen receptor (CAR) T-cell therapy will be incorporated into the treatment landscape for patients with DLBCL, Sattva S. Neelapu, MD, suggested that it will move into earlier lines of therapy, even up front, although he suspected that this approach would likely be tested in a select group of patients because the majority of patients with newly diagnosed disease are already cured with standard rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone therapy.
    • David G. Maloney, MD, PhD, spoke positively about providing CAR T-cell therapy early in the course of disease or in patients with lower disease burden. He suggested that because a randomized head-to-head trial of CAR T-cell therapies might be prohibitive, these agents are more likely to be tested in combination regimens.
    • Stephen J. Schuster, MD, shared his belief that this approach will be investigated in patients for whom rituximab-based induction therapy is inadequate or in those with poorly prognostic molecular markers.
  • The panel then spent some time debating the relative clinical utility of the 2 approved and 1 investigational CAR T-cell therapies for non-Hodgkin lymphoma, talking about appropriate patient populations, efficacy, inpatient versus outpatient treatment, and the frequency of adverse events, including cytokine release syndrome.
  • Dr Younes asked the panelists how long a patient who receives CAR T-cell therapy can go without achieving a complete response (CR) before they get nervous. Dr Neelapu said 3 months, because a CR at 3 months correlates very strongly with a durable response, and at that point he considers adding lenalidomide or some other therapy.
    • Dr Maloney countered that he gets nervous as early as 1 month, because most patients respond so quickly to CAR T-cell therapy. In his experience, patients who have a poor partial response at 1 month are unlikely to achieve a CR at all.

2 of 3

The live continuing medical education activity 2nd Annual Live Medical Crossfire®: Hematologic Malignancies, held July 14, 2018, in New York, New York, was cochaired by C. Ola Landgren, MD, PhD; S. Martin Tallman, MD; and Anas Younes, MD. This program featured renowned experts who led 8 exciting Medical Crossfire® discussions on important topics in acute and chronic leukemias, lymphoma, and multiple myeloma. This meeting addressed some of the most controversial and cutting-edge clinical issues in the management of hematologic malignancies, facilitating the practical application of emerging clinical data so that participants could return to their practices more confident in employing personalized and evidence-based treatment approaches for their patients. This second of 3 PER Pulse Recaps discusses the changing treatment landscape in multiple myeloma.

Below are some highlights from the Medical Crossfire® panel discussion led by Sham Mailankody, MBBS.

  • The panel first discussed circumstances in which doublet therapy might still be appropriate in the relapsed/refractory setting, with Deepu Madduri, MD, stating that nearly all her patients receive triplet therapy. However, she said, she would consider doublet therapy in an elderly or frail patient or one with an asymptomatic biochemical relapse.
    • Alexander M. Lesokhin, MD, and Noa Biran, MD, both countered by saying that even in those patients, triplet therapy may be feasible, by either by adding a well-tolerated monoclonal antibody like elotuzumab or dose-reducing the agents in the triplet regimen.
    • Ruben Niesvizky, MD, shared a different perspective, suggesting that the doublet regimen of carfilzomib plus dexamethasone compares favorably with many of the triplet regimens.
  • Dr Niesvizky asked the panelists whether they prefer chimeric antigen receptor (CAR) T-cell therapy or allogenic transplant. Dr Biran said that at her institution, transplantations in patients with myeloma have decreased as CAR T-cell therapy has gained popularity. She thought the overall safety profiles of these 2 approaches were similar.
    • Dr Lesokhin mentioned that there are insufficient long-term data with CAR T-cell therapy and not everyone who wants to receive CAR T-cell therapy can find an open clinical trial.
    • Dr Madduri pointed out that she reserves allogenic transplants for younger and high-risk patients. She said her belief is that CAR T-cell therapy may be safer than transplantation but acknowledged the anecdotal nature of the evidence.
  • Dr Mailankody asked how and when the panelists refer patients to clinical trials. Dr Madduri confirmed that she also has patients frequently asking about CAR T-cell therapy clinical trials but stated that specific clinical trial eligibility criteria, in addition to the limited number of spots available, often make it impossible for patients to enroll in these trials.
    • Dr Lesokhin reminded everyone to think of clinical trials early and often, because decreased performance status and decreased blood counts caused by multiple lines of therapy may make patients ineligible for trials later in their disease. He encouraged everyone to consider clinical trials at second relapse and possibly even at first relapse.
  • An audience member asked the panel how they would treat one of his patients with preexisting renal failure who has poor performance status and florid progression after 1 month of treatment with bortezomib plus dexamethasone. The patient has no circulating plasma cells.
    • Dr Niesvizky cautioned against giving lenalidomide to this patient because of his renal insufficiency, saying that carfilzomib/pomalidomide/dexamethasone combined with daratumumab might be a better option.
    • Dr Lesokhin suggested considering infusion chemotherapy in combination with a proteasome inhibitor and an immunomodulatory agent if the patient has a plasmablastic histology. He also recommended considering moving rapidly to a stem cell transplant if patient performance status permitted it. Dr Mailankody agreed with that approach, specifying that he often treats his patients with aggressive disease with 1 or 2 cycles of inpatient infusion chemotherapy to cytoreduce before moving to transplant.

3 of 3

The live continuing medical education activity 2nd Annual Live Medical Crossfire®: Hematologic Malignancies, held July 14, 2018, in New York, New York, was cochaired by C. Ola Landgren, MD, PhD; S. Martin Tallman, MD; and Anas Younes, MD. This program featured renowned experts who led 8 exciting Medical Crossfire® discussions on important topics in acute and chronic leukemias, lymphoma, and multiple myeloma. This meeting addressed some of the most controversial and cutting-edge clinical issues in the management of hematologic malignancies, facilitating the practical application of emerging clinical data so that participants could return to their practices more confident in employing personalized and evidence-based treatment approaches for their patients. This third of 3 PER Pulse Recaps describes treatment strategies for the treatment of acute myeloid leukemia (AML).

Below are some highlights from the Medical Crossfire® panel discussion, led by Naval G. Daver, MD:

  • Dr Daver posed a question to the panel about what tests are performed in patients with newly diagnosed AML and how these test results are used to select treatment. Selina M. Luger, MD, outlined in detail the algorithm at her institution, saying that she orders karyotype and next-generation sequencing (NGS) but typically doesn’t get those results before beginning therapy. She does, however, do flow cytometry and fluorescence in situ hybridization, which, combined with age, allows the identification of patients over age 60 with secondary AML who don’t have core-binding factor (CBF), and these patients receive daunorubicin/cytarabine as induction therapy. Those younger than 70 with CBF receive gemtuzumab.
    • Daniel J. DeAngelo, MD, PhD, reported that at his institution, he gets NGS results back in 3 days, which not only is helpful for patients who want to enroll in a clinical trial but also stratifies patients by P53, IDH1/2, FLT3, and secondary AML status.
    • Dr Daver mentioned that he also receives most results in 72 hours. He said that all CBF-positive patients are treated with gemtuzumab.
  • The panel also discussed whether FLT3 inhibitors should be used in the frontline setting in patients without FLT3 mutations. Daniel Pollyea, MD, MS, suggested that many FLT3 inhibitors actually target multiple kinases and thus may have efficacy because of off-target activity. He pointed out that in the FLT3–wild type population, these drugs are simply multikinase inhibitors rather than FLT3 inhibitors.
    • Dr DeAngelo shared that data have been presented in support of off-target effects of midostaurin.
    • Dr Daver said that he has never used a FLT3 inhibitor in a FLT3–wild type patient.
    • When Dr DeAngelo asked whether anyone had used sorafenib in all-comers for the same reason, Bruno C. Medeiros, MD, commented that he had done this at his institution (using 7 + 3 with sorafenib as induction therapy) prior to the approval of several AML agents with survival advantages in the past year.

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