ASH News Daily - Sunday, December 11, 2011 - (Page A-2)
Page A–2
®
ASH News Daily
2011 Editorial Board
Editor
Joseph Mikhael,
MD, MEd
Mayo Clinic Arizona
Authors
Michael R. Bishop, MD
Medical College
of Wisconsin
Amanda M. Brandow,
DO, MS
Medical College of
Wisconsin
David Garcia, MD
University of New
Mexico Cancer Center
Shari A. Ghanny, MD
McMaster University
Heather Landau, MD
Memorial
Sloan-Kettering
Cancer Center
Julie A. Panepinto,
MD, MSPH
Medical College of
Wisconsin
Barbara Pro, MD
Fox Chase Cancer
Center
ASH NEWS DAILY
HODGKIN LYMPHOMA
How Little is Too Much and How Much is
Too Little in Hodgkin Lymphoma?
By BaRBaRa PRo, Md
W
hat a journey it has been
for Hodgkin lymphoma
since the first report by
Thomas Hodgkin, “On Some Morbid
Appearances of the Absorbent
Glands and Spleen,” in 1832. The
histological origin of the neoplastic
cells was a mystery for years, until
analysis of immunoglobulin genes
revealed that these cells were abnormal
but clonal B cells. Hence,
the disease described by Hodgkin
became a true lymphoma and has
been renamed as such. In parallel,
with a better understanding of the
biology of the disease, significant
progress has been achieved in the
combination treatment that has
translated into a dramatic increase
in cure rate. So, the major dilemma
of this modern time is how little
is too much for patients who will
survive Hodgkin lymphoma (HL),
and how much is too little for those
patients who will not do well. Dr.
Ranjana Advani, Stanford University,
chairs the Education Program
session on Hodgkin Lymphoma
outlining recent advances in the
treatment of the disease. This session
will be repeated this morning
at 9:30 a.m. in Room 20AB, of the
Choices
«« From Page A-1
Michael A.
Rosenzweig, MD
City of Hope
The information contained in ASH News
Daily is provided solely for educational
purposes. A diversity of opinions exists in
the field of hematology, and the articles
in this publication are often intended to
inform readers about more than one point of
view. These articles are not comprehensive
and should not be used as a substitute
for traditional sources of hematology
information, traditional diagnostic and
treatment information, or the individual
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views expressed in ASH News Daily do not
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or advertised within.
©2011 by the American Society of Hematology
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in any manner without the express prior
permission of ASH News Daily.
Contributing authors have declared
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of the dollar amount. Any such financial
interest is noted with the author byline.
Kettering Cancer Center, discussed
the current role for autologous SCT
in multiple myeloma and acknowledged
that the benefits of transplant
were demonstrated prior to the availability
of regimens containing novel
therapies. He reviewed the studies
that have the potential to change
treatment standards in the future,
and highlighted the need to consider
the burden of therapy when evaluating
all approaches. While Dr. Giralt
remains a believer in the value
of SCT, he acknowledges the need
for more data with respect to both
autologous and allogeneic SCT.
While he admitted his enthusiasm
for reduced-intensity allogeneic
SCT in myeloma has waned based
on the results of the BMT-CTN 0102
trial, novel approaches including
T cell depleted myeloablative allogeneic
SCT still hold promise, and
preliminary results of this approach
were presented later in the day
by Dr. Guenther Koehne (abstract
#1992). Certainly, there is a subset
of patients with short remissions in
need of aggressive therapy.
In the last part of the session, Dr.
Kenneth C. Anderson, Dana-Farber
San Diego Convention
Center.
Dr. Advani will
open the session
with a review of
the current clinical
management of
patients with advanced
HL. With
current treatments,
advanced- s tage
HL is curable in
65 to 89 percent
of cases and the
five-year survival
rate is 90 percent.
“Challenges are
how to individualize
treatment choices and what
is the optimal chemotherapy,” Dr.
Advani said. While the combination
of doxorubicin, bleomycin, vinblastine,
and dacarbazine (ABVD)
has been considered the “gold-standard”
treatment for advanced HL,
20 to 30 percent of patients fail to
achieve durable remissions. Recent
studies that have shown the superiority
of more aggressive chemotherapy
regimens such as BEACOPP escalated.
However, these results are
achieved at a cost of increased early
and late toxicity. Moreover, there is
a risk of over-treating patients who
Sunday, December 11, 2011
Dr. Joseph M. Connors presents his findings during the
Education session on Hodgkin Lymphoma.
otherwise would have responded
to a less intensive chemotherapy
regimen.“Are there adequate data
showing that BEACOPP escalated
is better than ABVD to justify toxicity?”
Dr. Advani asked. “When we
look at the data of trials of ABVD we
need to look at the modern ABVD,
as the most current results look better.
Progression-free survival is better
with BEACOPP escalated across
all prognostics sub-group, but a benefit
in overall survival is challenging
to establish,” she added. This has
»» HODGKIN Page A-19
Cancer Institute, showed that there
may be even more than 31 flavors
when it comes to targeting pathologic
plasma cells and their niches.
He began the session with immunebased
strategies and showed the
success of elotuzumab, the humanized
monoclonal antibody directed
against CS1 in combination with
lenalidomide and dexamethasone,
which will be presented by Dr.
Sagar Lonial in Monday’s Oral session
(abstract #303) and is currently
being studied in the phase III setting.
He went on to describe two
innovative vaccine approaches, one
using the combination of a dendritic
cell fused to a myeloma cell with the
latter serving as the antigen and another
utilizing a series of myelomaspecific
antigens (XBP1,CD138, and
CS1) in an HLA-A2 specific manner,
which is a true attempt to personalize
myeloma therapy. The importance
of targeting both multiple
myeloma cells directly and the bone
marrow microenvironment was
stressed throughout his presentation,
which may be responsible for
the success of the first-generation
proteasome inhibitor bortezomib
and the second-generation immunomodulatory
drug lenalidomide,
which are two of the better-known
“novel” medicines. Other agents to
look out for include the AKT inhibitor
perifosine and the more selective
HDAC 6 inhibitor ACY-1215,
as well as mTOR inhibitors. He
highlighted the multiple genomic
strategies that are available to assess
individual tumors and showed
how multiple levels of analysis can
be used over time, which will be
further discussed by Dr. Nikhil C.
Munshi in an oral session on Monday
(abstract #297). He ended with
encouraging words: “Through personalized
treatment and novel approaches,
multiple myeloma will
become a chronic disease,” and he
dared to say “cured.”
So physicians and patients may
be left dizzied but inspired with
many options for upfront, consolidation,
maintenance, and salvage
therapies that were not available
even just a few years ago. Yet, until
science informs rational combinations
and sequences of agents, we
may continue to agonize over chocolate
chip, cookie dough, or even
cookies and cream!
Dr. Rosenzweig indicated no relevant
conflicts of interest. Dr. Landau served
on the advisory board and receives research
support from Millennium.
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