ASH News Daily - Sunday, December 11, 2011 - (Page A-14)
Page A–14
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NON-HODGKIN
ALL
What’s New in Aggressive Non-Hodgkin Lymphomas?
Efficacy and Toxicity — Is There a Sweet Spot in ALL?
By BaRBaRa PRo, Md
By BarBara pro, Md
New Agents and Current Management,”
attend the repeat session today
at 7:30 a.m. in Room 20AB, San
Diego Convention Center, to learn
about the latest developments in the
diagnosis and treatment of aggressive
lymphomas. Dr. Elaine Jaffe,
National Cancer Institute, will open
this session with a review that will
highlight the most recent updates in
lymphoma classification. As the list
of lymphoma subtypes gets longer,
I
T
Meth Lab
«« From Page A-12
Education Program session titled
“Updates on Treatment Strategies
in
Myelodysplastic
Syndromes,”
which emphasized the advances
that had been made in our understanding
of the biology of MDS,
that survival has increased dramati
particularly
has
cused on how this
ing
changed
hypomethylating
our
approaches with the approval of
health issues,
agents
treatment
such
potion. Thus, moving away from
standard “kill-all” drugs to “spareme”
targeted agents have been most
of the focus of cancer research in the
last few decades. Also, as patients
live longer, we struggle with a number
of issues due to treatment-related
short- and long-term toxicities
and look back and ask ourselves:
How can we make it better? Is there
a sweet spot of increased efficacy
and minimal toxicity? This morning
at 7:30 a.m. and again at 2:00 p.m.
in Elizabeth Ballroom EFGH, Manchester
Grand Hyatt San Diego, Dr.
Adele Fielding, University College
London, will chair an Education Program
session titled “Current Management
Issues in Acute Lymphocytic
Leukemia,” outlining the most
current and pressing issues in the
treatment of ALL.
For pediatric ALL the good news is
methylation, and fo-
f you missed yesterday’s Education
Program session, “Update
on Aggressive Lymphomas –
cally with five-year rates exceeding understand90
percent. The bad news is that success
has come with a price. Chronic
secondary cancers,
as
and significant emotional hurdles
othy Graubert, Washington University,
St. Louis, shared with the
audience some recently discovered
genetic abnormalities in MDS, with
a particular emphasis on genes coding
for proteins involved in epigenetic
modifications, as many of them
may have prognostic value, including
in response to hypomethylating
agents. During his presentation, Dr.
Graubert reviewed the hot topic
of RNA splicing, highlighting the
SF3B1 mutations and their relations
to What about adult ALL? The good
refractory anemia with ringed
sideroblasts. Dr. Steven Gore, Johns
Hopkins University, then reviewed
the AZA001 study and how it has
JAK2
plantation
news is that there are many new
therapies; the bad news is that none
of them are fully effective at controlfirmly
established azacitidine as the
treatment of choice for patients with
high-risk MDS who are not allogeneic
hematopoietic stem cell transcandidates.
«« From Page A-12
Dr.
Gore
emphasized that it is important to be
patient in the administration of this
agent, as it may take several cycles
before evidence of hematologic responses.
Dr. Pierre Fenaux’s portion
of the session focused primarily on
results obtained with lenalidomide
in low-risk MDS with 5q deletion.
He also shared some new data on
the use of lenalidomide in lower-risk
MDS without 5q deletion.
the eosinophilic disorders, molecularly
defined as PDGFRA, PDGFRB,
and FGFR1-associated neoplasms.
Dr. James W. Vardiman from the
University of Chicago, indicates
that the promise of future targeted
therapies akin to imatinib played a
role in devising the 2008 WHO Classification
system. While JAK2 mutations
were at once enlightening,
they likely represent just the first
piece of a very elaborate mosaic.
Dr. Bishop indicated no relevant
conflicts of interest.
Dr. Landau indicated no relevant
conflicts of interest.
003192_sgn35_adc_and_fa2.indd 1
azacitidine and decitabine. Dr. Timfor
both patients and caregivers are
only a few of the many issues we are
left to deal with. Dr. Leslie Robinson,
St. Jude Children’s Research Hospital,
will present the most current in
formation on key issues associated
with early morbidity and mortality
in childhood ALL survivors.
Most importantly, based on recent
findings, she will provide recommendations
for screening and new
directions for interventions to improve
long-term outcomes.
he goal of our fight against
cancer is finding the MELTing
(most-effective-least-toxic)
it is a must for the practicing clinician
to become familiar with some
of the new challenges in the classification
of these neoplasms and get
to know the new kids on the block.
Be prepared, as some of these new
ones can “double hit.” Dr. Jaffe
will summarize what is new in the
WHO classification regarding aggressive
B-cell lymphoma and in
particular how we subdivide this
heterogeneous group based on cell
of origin, clinical and etiologic factors,
and pathogenesis. An entity
ling this challenging disease. The development
of monoclonal antibodies
represents one of the greatest success
stories in the treatment of hematologic
malignancies as it is the ideal
targeted therapy. Dr. Dieter Hoelzer,
University of Frankfurt, will discuss
how the introduction of antibodybased
therapies is changing the
outcome for patients with ALL. In
addition to providing the most current
data on the use of traditional
antibodies, Dr. Hoelzer will discuss
the use of the newer humanized
anti-CD20 and bi-specific an-
that is particularly challenging for
both pathologists and clinicians is
double hit B-cell lymphoma, which
has features intermediate between
diffuse large B-cell lymphoma (DLBCL)
and Burkitt lymphoma (BL).
Patients with this disease have a
poor prognosis when treated with
conventional therapy and most cases
carry a Myc translocation. Dr. Jaffe
will also address important questions
regarding the impact of c-Myc
translocation in other subtypes of aggressive
B-cell lymphoma.
tibodies in the treatment of ALL.
Some of the challenges related to
the use of antibody-based therapies
in different clinical settings
will also be addressed.
Dr. Fielding will conclude the ses-
sion with an update on the treatment
of Philadelphia-positive (Ph+) ALL.
The Philadelphia chromosome is the
most common cytogenetic abnormality
associated with adult ALL. Before
the introduction of tyrosine kinase
inhibitors (TKIs), Ph+ ALL carried a
poor prognosis with poor response
to chemotherapy and short survival
Following Dr. Jaffe, Dr. Jonathan
Friedberg, University of Rochester,
will present the most recent data on
treatment of relapsed disease. He
will address the importance of using
prognostic markers to identify
newly diagnosed patients at highest
risk of relapse and who therefore
may be offered more aggressive
therapies. The majority of patients
with relapsed DLBCL have primary
refractory disease but late relapses
flicts of interest.
»» NON-HODGKIN Page A-19
rates. Treatment with BCR-ABLspecific
TKIs has resulted not only in
higher complete remission rate and
better long-term outcome but also in
minimal toxicity. Dr. Fielding will
review a number of important issues
such as the role of monotherapy with
TKIs in select patients, the role of allogeneic
stem cell transplantation,
and mechanisms of resistance. Results
of ongoing studies with novel
agents will also be presented.
Dr. Pro indicated no relevant conASH
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