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The American Society of Hematology (ASH) meeting was held December 7th-10th 2019 in Orlando, USA. 

This meeting is the premier and largest annual international haematology conference that was attended by over 30,000 experts in haematology. 

Lymphoma Australia was successful in receiving a global grant from AbbVie to conduct interviews with Australian and international experts in lymphoma and chronic lymphocytic leukaemia (CLL). The interviews will report the latest information about lymphoma/CLL clinical trials and studies from around the world and were presented during the ASH meeting. These interviews will be shared around the world through patient advocacy groups.  

Lymphoma Australia conducted almost 40 interviews during the 4 days of the meeting, and we will highlight and break down what you need to know.

  • ASH Newsletter Issue 1 - This edition highlights interviews from experts discussing updates from their presentations during the ASH meeting on Follicular lymphoma, Mantle Cell lymphoma and Waldenstrom’s Macroglobulinaemia
  • ASH Newsletter Issue 2 - a selection of interviews covering CAR T-cell Therapy and B Cell Lymphomas.  

All of the interviews are located on the Lymphoma Australia YouTube channel.

YouTube Playlist - ASH Meeting 2019 

Follicular Lymphoma

Dr Loretta Nastoupil – Follicular lymphoma study – Part 1. Dr Nastoupil discussing the results of her phase II study of Obintuzumab (type II anti-CD20 monoclonal antibody) and Lenalidamide (immunomodulatory agent) in previously untreated, high tumour burden FL. This combination of therapies was seen to be well tolerated and effective in a previous study for patients treated in relapsed or refractory FL.

Dr Loretta Nastoupil – Follicular lymphoma study – Part 2. Dr Nastoupil discussed the results of her phase II study of Obintuzumab (type II anti-CD20 monoclonal antibody) and Lenalidamide (immunomodulatory agent) in previously untreated, high tumour burden FL. Further study of this effective, immune therapy approach in untreated FL is warranted. Dr Nastoupil discusses the reasons for this effective and well tolerated approach for any population of patients with Follicular lymphoma.

Mantle Cell Lymphoma

Dr Sasanka Handunetti – Mantle Cell Lymphoma (Update of the AIM study). Dr Handunetti discussed her presentation about the three-year update of the phase II AIM study (TAM, et al, NEJM 2018) conducted at Peter MacCallum Cancer Centre in Melbourne, using combination BTK inhibitor ibrutinib and BCL-2 inhibitor venetoclax therapy in patients with poor prognosis mantle cell lymphoma (MCL).   Results showed a median progression free survival of 29 months. It raised the question that there is a possibility of limited duration  targeted-agent therapy in the management of relapsed or refractory MCL.

Prof Steven Le Gouill - Mantle Cell Lymphoma study. Prof Le Gouill discussed his phase I study for newly diagnosed MCL using Ibrutinib, Venetoclax and Obintuzumab that have all been previously shown to have efficacy in the relapsed/refractory setting as single agents and in combination in the relapsed/refractory (R/R) MCL. He also provided an overview of standard of care for patients with MCL for the younger patient and the older patient in both the front line and R/R management.

 

Prof Simon Rule - Mantle Cell Lymphoma Update. Prof Simon Rule discussed his poster presentation at the meeting looking at a 7.5 year follow up of patients with relapsed or refractory MCL who patients on ibrutinib (BTK inhibitor) that showed a significant number of patients still in remission greater than 5 years. It also showed that the patients who received Ibrutinib in earlier lines of therapy had a better durable response, than those who received it lateistique.

KTE-X19: A CAR T-Cell Option for Mantle Cell Lymphoma?
Ninety-three percent of patients with relapsed/refractory mantle cell lymphoma (MCL) responded to treatment with KTE-X19, an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, according to results from the ZUMA-2 trial presented at the 2019 ASH Annual Meeting.

Waldenstrom’s Macroglobulinaemia

Prof Mathias Rummel - Waldenstrom’s Macroglobulinaemia & the StiL trial. Covers the 2-year results post the StiL study looking at maintenance Rituximab vs observation post bendamustine-rituximab. Results show that maintenance rituximab does not improve overall survival. Prof Rummel also provides an overview of current management of WM. 

 

 

Chimeric Antigen Receptor (CAR) T-cell Therapy 

Dr Loretta Nastoupil – CAR T-cell Therapy Updates, USA. Dr Nastoupil is an international leader focusing on research improving the outcomes for high-risk patients, particularly with those with Follicular lymphoma (FL) and Diffuse Large B-cell lymphoma (DLBCL). Dr Nastoupil discusses the work that she has participated in with CAR T-cell therapy at MD Anderson Cancer Centre and centres across the USA, particularly in the relapsed or refractory large cell lymphoma. She provides an update of what has been presented at ASH 2019 on CAR T-cell therapy.

Dr Loretta Nastoupil – CAR T-cell Therapy – ASH Meeting Updates. Dr Nastoupil is an international leader focusing on research improving the outcomes for high-risk patients, particularly with those with Follicular lymphoma (FL) and Diffuse Large B-cell lymphoma (DLBCL). Dr Nastoupil discusses current clinical trials in the USA for CAR T-cell therapy and update from ASH 2019.

Dr Tanya Siddiqi – CAR T-cell Therapy in Chronic Lymphocytic Leukaemia (CLL). Dr Siddiqi discussed her presentation during the meeting of the phase I study treating relapsed or refractory patients with CLL. All patients had previously received at least 3 standard treatments, including ibrutinib and half of patients had also received venetoclax. The study treated 23 patients with CAR T-cell therapy where over 80% achieved durable responses over 6 months. Follow up continues.

Dr Max Topp – Improving CAR T-cell Therapy Toxicities. Dr Topp discussed his presentation during the meeting about the phase II study looking at improving the risk benefit profile for patients when having CAR T-cell therapy. In the ZUMA 1 study (phase 1 of 2), CAR T-cell therapy can produce concerning side effects such as grade 3 cytokine release syndrome (CRS) and neurological events (NEs) in 11% and 32% of patients respectively, the objective response rate (ORR) was 83% and complete response (CR) rate was 58% of patients. This study looked at whether adding steroids earlier may help reduce the incidence of severe CRS and NEs without affecting response rates or CAR T-cell expansion.

Mosunetuzumab induces durable complete remissions in patients with B-cell non-Hodgkin lymphoma. The bispecific monoclonal antibody Mosunetuzumab, which targets CD3 and CD20, led to durable responses in patients with B-cell non-Hodgkin lymphoma (NHL), even in those who had disease that was relapsed or refractory to chimeric antigen receptor (CAR) T-cell therapy. Stephen J. Schuster, MD, from the University of Pennsylvania, presented these results as a plenary abstract at the 2019 ASH Annual Meeting.

 

 

B Cell Lymphomas 

Dr Laurie Sehn – ASH Lymphoma Updates. Dr Laurie Sehn from British Columbia Cancer Centre from Vancouver, Canada is Chair of the medical advisory board for the International Lymphoma Coalition. Dr Sehn discussed some of the highlights in novel therapies that were presented during the ASH meeting for lymphoma. These included Polatuzumab (antibody drug conjugate) for diffuse large B-cell lymphoma (DLBCL) and Mosunetuzumab – (bispecific antibody) used for B-cell non-Hodgkin lymphomas.

Dr Chan Cheah – Phase I Study TG-1701 Relapsed or Refractory B-cell Lymphoma. A/Prof Chan Cheah, Consultant Haematologist, Sir Charles Gairdner Hospital, Hollywood Private Hospital & Blood Cancer Research WA, in Perth, Western Australia, discussed a poster presentation at ASH of a trial that was conducted in Australia using a new generation Bruton’s Tyrosine Kinase (BTK) inhibitor called TG-1701 used in patients with relapsed/refractor B-cell malignancies. This oral medication is given as a single agent in combination with umbralisib (PI3K inhibitor) and ubiltuximab (glycoengineered anti-CD20 monoclonal antibody).

Dr Sasanka Handunetti – Phase II Study in Relapsed or Refractory Marginal Zone Lymphoma. Dr Handunetti discussed a poster presentation from the team at Peter MacCallum Cancer Centre during the meeting of the use of ibrutinib in combination with venetoclax for patients with relapsed or refractory Marginal Zone Lymphoma (MZL). MZL is an incurable disorder that there is no standard of care treatment in the relapsed or refractory setting. Both of these medications were seen to have evidence of activity and tolerability as monotherapies (single agents) and this study aimed to evaluate the response as a combination therapy.

Dr George Follows – Lymphoma Updates. Dr George Follows is the Lymphoma/CLL Clinical Lead for Cambridge and he also holds a number of appointments including the chair of the UK CLL forum. Dr Follows discussed updates for lymphoma that have been presented during the ASH meeting of interest. These included the phase I trial using a new medicine called Monunetuzumab that is a bispecific monoclonal antibody that targets CD3 and CD20 and has led to durable responses in patients with relapsed or refractory B-cell non-Hodgkin lymphoma, including patients who relapsed from CAR T-cell therapy.