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.
- ASH Newsletter Issue 3 - focus on CLL & SLL
- ASH Newsletter Issue 4 - focus on diffuse large B-cell lymphoma, Hodgkin lymphoma, primary central nervous system lymphoma, and CAR T-cell therapy.
- ASH Newsletter Issue 5 - a selection of interviews including follicular, chronic lymphocytic leukaemia (CLL) & small lymphocytic lymphoma (SLL), genetic testing for CLL/SLL, diffuse large B-cell lymphoma, CAR T-cell
therapy, DNA blood testing for lymphoma, and lymphoma patient supportive
All of the interviews are located on the Lymphoma Australia YouTube channel.
YouTube Playlist - ASH Meeting 2019
We greatly thank each of our clincians and experts for their time, knowledge and sharing of their expertise.
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 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.
Dr Stephen Schuste - 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. Dr Schuste discusses the ongoing phase I/Ib study (GO29781; NCT02500407) of mosunetuzumab in patients with B-cell non-Hodgkin lymphoma (NHL), who are relapsed/refractory (R/R) to CAR-T therapies or for whom a delay in effective therapy excludes this approach. Preliminary data support that mosunetuzumab has favorable tolerability and durable efficacy in heavily pre-treated R/R B-cell NHL.
Dr John Leonard - highlights from the meeting for lymphoma. Dr Leonard discussed his expert opinions from lymphoma presentations
during the meeting. He discussed a number of topics that included:
• Follicular lymphoma – chemo free regimens
• Diffuse Large B-cell Lymphoma – bone health in patients post R-CHOP
and CAR T-cell therapy
• Mantle Cell Lymphoma – new medicines in combination with chemotherapy
• DNA blood testing
• Lymphoma vaccines
Chronic Lymphocytic Leukaemia (CLL) & Small Lymphocytic Leukaemia (SLL)
Dr Brian Koffman - CLL updates & patient advocacy. Dr.
Koffman, a well-known doctor, educator and clinical professor turned CLL patient,
has dedicated himself to teaching and helping the CLL community since his
diagnosis in 2005. Dr. Koffman believes that his dual status as a physician and
patient provides a unique experience and understanding which allows him to
provide clear explanations of complex issues and to advocate for his fellow
patients and inform his fellow healthcare providers. This is especially
important in view of the rapidly changing therapeutic landscape. Dr
Koffman is the co-founder of the CLL Society, USA. Dr Koffman discussed
the CLL updates from the conference including updates about CAR T-cell therapy,
ibrutinib, acalabrutinib, sequencing of medications and different combination
therapy. He also discussed best
management of CLL, including genetic testing prior to treatment and those
patients with unmutated disease, 17p del should not have chemotherapy, rather
Prof John Gribben and Deborah Sims - Overview of CLL treatment. Prof Gribben discussed his view of the updates from the meeting where
many of the presentations reinforced that the treatments that are being
used are good as there have been longer follow up. With a longer follow
up also comes the knowledge of new toxicities that may appear. We can
then educate patients better with having a better idea of what to
He also discussed the new generation novel therapies that have been
introduced, not only in CLL, but other lymphomas such as Follicular
lymphoma & Mantle cell lymphoma. There are also many early phase
clinical trials with new medications that show promise. The next concern
is that with these novel therapies and combination therapies, comes an
expense for the health systems.
Prof Stephan Stilgenbauer and Deborah Sims- Updates on the management of CLL/SLL. Prof Stilgenbauer provided an overview of the treatment updates for patients with CLL/SLL from the ASH meeting. He discusses the use of novel therapies as single agents and in combinations that are having significant results for patients, especially those who have unmutated disease and therefore do not respond to traditional chemotherapy-based management.
Future therapy for CLL/SLL might be that chemotherapy may become a second or a third line treatment.
A/Prof Constantine Tam and Deborah Sims - CLL & Mantle Cell Lymphoma. A/Prof Constantine Tam, Peter MacCallum Cancer Centre, RMH & St Vincent’s Hospital spoke to Deborah Sims, from Lymphoma Australia. Dr Tam provides his insights from the highlights from the meeting on CLL and Mantle cell lymphoma.
He provided an overview of his 3 highly praised presentations for Chronic Lymphocytic Leukaemia (CLL) & Small Lymphocytic Lymphoma (SLL).
Dr George Follows - CLL updates. Dr George Follows from the UK spoke with Lymphoma Australia at the American Society of Hematology (ASH) meeting recently held in Orlando, USA. Dr 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.
He discussed the updates on the latest research and study results presented at the ASH meeting on CLL.
Dr Nitin Jain and Deborah Sims - Ibrutinib & Venetoclax in patients with CLL. Dr Nitan Jain is an Associate Professor in the Department of Leukaemia at the University of Texas MD Anderson Cancer Center in Houston, Texas, USA.
Dr Nitan discussed his 2 presentations during the ASH meeting of the 2 studies conducted at MD Anderson Cancer Centre using combined Ibrutinib and venetoclax with patients with chronic lymphocytic leukaemia (CLL) in both first-line treatment and those with relapsed/refractory disease. Results showed that in both groups the combined treatment using ibrutinib and venetoclax is an effective chemotherapy-free oral regimen for patients with CLL and further studies will be ongoing.
Dr Tanya Siddiqi - CAR T-cell in relapsed/refractory CLL. Dr Tanya Siddiqi is the Director, Chronic Lymphocytic Leukaemia Program, Toni Stephenson Lymphoma Centre and A/Prof Department of Hematology & Hematopoietic Transplantation at the City of Hope National Medical Centre, Duarte, USA.
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.
Prof John Seymour - Overview of the Murano study – CLL/SLL. Prof Seymour presented the four-year analysis of the Murano study that confirms sustained benefit of time limited Venetoclax & rituximab in relapsed or refractory chronic lymphocytic leukaemia (CLL).
Venetoclax (Ven) is a highly selective oral inhibitor of key apoptosis regulator BCL-2, which is overexpressed in CLL. MURANO (a randomized Phase III study) compared fixed-duration VenR with standard bendamustine-rituximab (BR) in R/R CLL. The superior progression-free survival (PFS) of VenR versus BR was established in the first pre-planned analysis (Seymour et al. N Engl J Med 2018); continued PFS benefit was seen with longer follow-up and after all patients had completed therapy.
Prof Peter Hillmen - CLL updates from ASH 2019. Prof Hillmen discussed some of the most significant highlights from the meeting on novel therapy trials used in the frontline setting that were presented that showed good results with the use of ibrutinib (BTK inhibitor), acalabrutinib (new generation BTK inhibitor), venetoclax (BCL2 inhibitor) and the use of combination therapies. He also discussed clinical trials in the relapsed setting showing good results that included CAR T-cell therapy. Thank you to Leukaemia Care for sharing the interview with Lymphoma Australia.
Prof Miles Prince – Genetic testing (CLL/SLL) & CAR T-cell therapy. Prof Prince discussed his opinions of the main topics of interest for lymphoma from the meeting.
He discussed that the best way to treat a patient’s lymphoma, their diagnosis needs to be understood and fully known. It has been
demonstrated that patients who are diagnosed with CLL/SLL need to have genetic testing prior to receiving treatment. Patients who have
unmutated and a TP53 mutated CLL/SLL, chemotherapy has been shown to not be as effective for this patient group. In the USA and the UK (and some European countries) patients are funded
to receive Ibrutinib front-line, however this is still not the case in
Australia, where patients receive chemo-immunotherapy and ibrutinib in
second line treatment.
Diffuse Large B-cell Lymphoma (DLBCL)
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
A/Prof Chan Cheah - Follicular lymphoma clinical trial update. Dr Cheah discussed a presentation provided by Dr Loretta Nastoupil from MD Anderson Cancer Centre, Texas during the ASH 2019 meeting.
The phase II study looked at treating previously untreated Follicular lymphoma patients with Obintuzumab (type II anti-CD20 monoclonal antibody) and Lenalidamide (immunomodulatory agent), with a high tumour burden. This combination of therapies was seen to be well tolerated and effective in a previous study for patients treated in relapsed or refractory FL conducted at MD Anderson Cancer Centre by Prof Nathan Fowler (RELEVANCE study).
Dr Allison Barraclough -Nivolumab + Rituximab in First-line Follicular Lymphoma. Dr Barraclough discussed the interim results of a first in world phase II study, that is led by Dr Eliza Hawkes, front-line management of patients with stage 1-3A follicular lymphoma. The study uses a combination immune therapy only approach, that had only been previously tried in the relapsed setting.
Patients receive nivolumab only for the first 8 weeks and if they achieve a complete response, will continue with single agent nivolumab. For those who only achieved a partial response would go onto having a combination on nivolumab and rituximab.
Results were good with on overall response rate (ORR) of 80% and over a half of these patients achieved a complete response (CR). There was a low toxicity profile, where many patients were still able to work and continue normal life activities
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
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.
Dr Jessica Hochberg - Chemotherapy, Young Adults & Hodgkin Lymphoma. Cure rates for newly diagnosed Hodgkin Lymphoma is high with combined use of chemoradiotherapy. However, this often results in significant adverse physical and psychosocial function that can significantly impact the quality of life among survivors. The addition of Brentuximab vedotin and Rituximab to combination risk adapted chemotherapy (without cyclophosphamide, etoposide or bleomycin) for newly diagnosed Hodgkin Lymphoma appears to be safe in children, adolescents and young adults. Our results show significant promise with a CR rate of 100%, 58% rapid early response and significant reduction in the use of toxic chemotherapy and radiation. The EFS/OS to date is 100% with a median follow up time of greater than 3.5 years.
Prof Andrew Evens - HoLISTIC Hodgkin Lymphoma International Study. Prof Evens is an active member of the HoLISTIC (Hodgkin Lymphoma International Study for Individual Care) - an international consortium coalescing a team of diverse experts from across the world to study the salient aspects of Hodgkin lymphoma prognosis, epidemiology, treatment, survivorship and health outcomes across all age groups. They are harmonizing individual patient data from more than 20
contemporary clinical trials from North America and Europe of all ages
as well as 6 institutional and regional Hodgkin lymphoma registries, and
a large community oncology practice. Their goal is to enhance
decision-making for pediatric and adult Hodgkin lymphoma patients and
providers, given expanding treatment options and in the absence of
complete acute and long-term prognostic data.
Dr Stephen Ansell and Deborah Sims - Hodgkin Lymphoma. Dr Ansell is a leading specialist in non-Hodgkin lymphoma and Hodgkin
lymphoma at the Mayo Clinic, USA.
Dr Ansell spoke about the Hodgkin lymphoma – front line therapy session
at ASH that he had just attended.
The session highlighted a clinical trial whereby there were further use
in novel therapies in the front-line setting, whereby adding Brentuximab
Vedotin & a PD-1 inhibitor and reducing some of the standard
chemotherapy that was bleomycin, showed outstanding results. The
outcomes also reduced the toxicity for patients receiving this treatment
in comparison to standard therapy. Standard therapy in Hodgkin lymphoma
have high over all response rates where around 90% patient reach a
complete metabolic response. Many trials in Hodgkin lymphoma are
currently aimed at reducing the toxicity profile and late effects for
Marginal Zone Lymphoma
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.
Central Nervous System Lymphoma
Dr Katherine Lewis - Primary Central Nervous System Lymphoma (PCNSL). Dr Lewis discussed a poster presentation at ASH 2019 that looked at the outcomes for patients with primary or secondary central nervous system (brain and spine) lymphoma treated with Ibrutinib (BTK inhibitor).
This is a rare and aggressive lymphoma where this patient group has a poor prognosis with often treated with intensive combination chemotherapy regimens. This was a retrospective study that collected information from across Australia and New Zealand of 16 patients who were treated with monotherapy Ibrutinib in the relapsed/refractory setting. Although a small number of patients, the results were promising, with response rates of up to 81%.
T Cell Lymphoma
Peripheral T-cell Lymphoma
Dr Timothy Illidge, explains the purpose of targeting PTCL. (Thanks to OBRoncology).
Dr. Illidge, Professor of Targeted Therapy and Oncology, Division of Cancer Sciences, The Christie Hospital, University of Manchester, explains the purpose of targeting peripheral t-cell lymphoma (PTCL).
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.
Dr Collin Chin – CAR T-cell therapy in aggressive lymphomas. Dr Chin chaired one of the aggressive lymphoma sessions that looked at prospective clinical trials and CAR T-cell therapy during the meeting.
Dr Chin provided an overview of the session that discussed the outcomes of various trials that included the outcomes of CAR T-cell therapy in relapsed/refractory DLBCL.
Prof John Gribben - precision medicine & genetic testing. Prof John Gribben from the UK discusses the use of FISH (Fluorescent in situ hybridization) testing for patients with chronic lymphocytic leukaemia (CLL) prior to receiving treatment.
FISH testing is recognised as important for patients with CLL to have prior to having treatment to see whether they have either what is known as mutated disease or unmutated disease, by detecting common chromosome abnormalities can be seen in CLL.
Prof Peter Hillmen - Treatment – patient choice. Prof Hillmen discusses the importance of patients knowing what treatments are available to them in their country and what clinical trials are available. Patient organisations are a great resource to help advocate for new treatments and to help patients to become connected to clinical trials, even if they need to travel.
Patient Advocacy at ASH 2019. Lymphoma Australia hosted a round table discussion that covered a number
of key issues that patient advocate groups such as Lymphoma Australia and Leukeamia Care face to achieve in the work they do to advocate on behalf of lymphoma and leukaemia patients in their respective countries. Participants: Deborah Sims, CLL patient & advocate, Lymphoma Australia (facilitator);
Sharon Millman, CEO, Lymphoma Australia;
Zach Pemberton-Whitely, Patient Advocacy Director, Leukaemia Care, UK
Dr Nada Hamad – Electronic Record to Connect City-Rural Health Teams and The Rural Patient.
Dr Hamad provided a poster presentation during the meeting highlighted a
pilot study that was conducted between St Vincent’s Hospital in Sydney
and Griffith Hospital in rural Australia. The study looked at improving
patient outcomes and experience by introducing technology that would
allow health professionals from both sites to access patient
information, including test results easier via a computer program in
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