ASH 2022: Longstanding new assumptions about the clinical data challenge

ASH 2022: Longstanding new assumptions about the clinical data challenge

NEW ORLEANS – In addition to news about the latest in clinical care and drug development, some startling discoveries that challenge long-held but untested assumptions are promised at the annual meeting of the American Society of Hematology.

The conference begins in New Orleans on Saturday, but a sample of what’s to come was given last week during a preview press conference, hosted by Mikkael A. Sekeres, MD, of the University from Miami Miller School of Medicine. Sekeres, who recently wrote a book about the FDA and how it regulates drug approvals, is also chairman of the ASH Committee on Communications.

“Feeding our patients with porridge”

Sekeres said he was particularly excited about a multicenter randomized trial showing that patients with neutropenia after stem cell transplants don’t have to be put on a bland diet (Abstract 169).

“For years we have basically fed our patients oatmeal in the hospital, and these are people who need to be hospitalized for a stem cell transplant or in my case – I am a leukemia specialist – for leukemia acute, for 4 to 6 weeks. . The neutropenic diet is the blandest food you can imagine, with nothing to really spice it up.”

He noted that a neutropenic diet is so unpleasant that family members often introduce food into patient rooms, and “for years we have never seen any adverse results in any of these people who, instead of having mashed potatoes and oatmeal, ate a corned beef sandwich for dinner.”

Now, the results of this trial “actually allow us to allow patients to eat whatever they want,” he said.

Data that changes practice

Two other presentations have the potential to change clinical practice, ASH experts say, including the finding that high-dose methotrexate does not reduce the risk of central nervous system (CNS) relapse in children with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (Abstract 214), and a study defying common wisdom showing that intensive chemotherapy aimed at achieving remission before stem cell transplantation in adults with relapsed or refractory acute myeloid leukemia (AML) did not provide better results compared to sequential conditioning and immediate grafting (Summary 4).

Premature aging in HL survivors

ASH President Jane N. Winter, MD, of the Feinberg School of Medicine at Northwestern University in Chicago, who also spoke at the briefing, highlighted a study that followed survivors adults with pediatric Hodgkin lymphoma. This study, from St. Jude Children’s Research Hospital in Memphis and the Wilmot Cancer Institute at the University of Rochester, New York, found that these adult survivors are at significantly elevated risk for epigenetic age acceleration accompanied by neurocognitive deficits. compared to witnesses. (Abstract 902)

“It’s an area very close to my heart,” she said. “Much of my career has focused on reducing therapy to reduce the long-term consequences of treatments. Pediatricians have been very fond of very intensive therapies and tend to incorporate radiation therapy more frequently into their treatment for children than we do for adults.”

Winter noted that although clinicians primarily focus on the link between mediastinal radiation and long-term adverse events such as breast cancer, “we are now shedding light on neurocognitive deficits, which I think are under-reported. Being able to track this impact of our treatment and then perhaps develop strategies to deal with it or prevent it will have a very broad impact.”

Hereditary thrombophilia and miscarriage

Cynthia E. Dunbar, MD, chief of the translational branch of stem cell biology at the National Heart, Lung and Blood Institute in Bethesda, Maryland, who also spoke at the briefing, said one of the abstracts most important to her practice is a study concerning pregnancy. It showed that low molecular weight heparin did not prevent miscarriages in pregnant women with confirmed hereditary thrombophilia who had at least two previous miscarriages compared to standard surveillance. (Abstract LBA-5).

“That’s not my field at all; on the other hand, as a hematologist and a woman, that’s often what my middle of the night emails and panicked phone calls are for. Once that someone is having a miscarriage especially if it feels like they are already over 30 and time is running out there is a huge emphasis and huge pressure on obstetricians to be prepared for anything , a kind of shotgun [approach],” she says.

These tests can reveal genetic mutations associated with a slight increase in the risk of clotting and, therefore, some pregnant women are subjected to anticoagulant treatment, which can lead to complications in pregnancy and childbirth. The results of this study don’t solve the problem of spontaneous miscarriage, but they do at least rule out hereditary thrombophilia as a preventable cause of miscarriages, Dunbar said.

Another potentially practice-changing summary is a study showing that in young adults with mantle cell lymphoma, the addition of ibrutinib (Imbruvica), a Bruton’s tyrosine kinase inhibitor, to induction therapy and as maintenance treatment with or without autologous stem cell transplantation had high efficacy and acceptable toxicity. .(Summary 1)

“The results show that the ibrutinib-containing regimen without grafting is at least as good as the current standard of care with grafting.” said winter. “Further follow-up will be needed to definitively show that an autograft is not necessary if ibrutinib is included in this treatment regimen.”

Health Equity Challenges

In addition to more clinical abstracts, ASH 2022 will feature sessions on health equity challenges, including an abstract on social determinants of health and pulmonary embolism treatment and mortality (Abstract 140 ); the impact of laboratory eligibility criteria by race/ethnicity in clinical trials for diffuse large B-cell lymphoma (Abstract 850); associations between non-European ancestry and low socioeconomic status with receipt of disparate HLA allografts (Abstract 127); and an analysis of the worldwide use of hematopoietic stem cell transplantation for patients with acute myeloid leukemia (Abstract 3638).

Hybrid meeting

In total, ASH 2022 will feature nearly 5,000 abstracts presented in a hybrid live and virtual format. On-site attendees will be required to provide proof of vaccination against COVID-19 and will also be required to wear masks in all public areas.

American Society of Hematology (ASH) 2022 Annual Meeting and Expo: December 10-13, 2022.

Neil Osterweil, award-winning medical journalist, is a longtime and frequent contributor to Medscape.

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