CARE™ at ASH 2022 Conference Report

[Le contenu qui suit est présenté dans sa langue originale : Anglais]

 

The CARE™ at ASH 2022 event was held on December 9th 2022, both virtually and in-person at the NOPSI Hotel in New Orleans, Louisiana. Canadian hematologists contextualized recent international news and data in hematology framing the news from a Canadian perspective.

Acute Myeloid Leukemia

Dr. Kareem Jamani — University of Calgary, Tom Baker Cancer
Recap of Presentation

Newly Diagnosed AML: Diagnostic and Treatment Algorithm

  • Eligible for intensive induction
  • Ineligible for intensive induction
    • Focus on both patient and AML; current treatments, and ASH updates that might impact treatment options
Access Presentation Video, SlidesAML Guidance

Benign: Hemostasis

Dr. Michelle Sholzberg — St. Michael’s Hospital
Recap of Presentation

Provide a snapshot of non-malignant heme at ASH 2022

  • Von Willebrand Disease – most prevalent inherited bleeding disorder
  • Addressing Iron Deficiency 
  • Reproductive health needs in patients with bleeding disorders
  • Immuno hematology

Von Willebrand disease (VWD)

  • Learnings about the lived experiences with Von Willebrand disease (VWD)
  • Barriers to care
  • Multifaceted negative impact of structural sexism in bleeding disorders’ management 
  • Review constructive directions
Access Presentation Video, Slides, Q&A

Benign: VTE

Dr. Wendy Lim — McMaster University
Recap of Presentation
  • Advances in our understanding of LMWH dosing for pregnancy prophylaxis and lack of benefit for anticoagulant prophylaxis for preventing pregnancy loss in women with recurrent miscarriage and thrombophilia
  • COVID-19 in patients with cancer is associated with ~3% risk of thrombosis at 30 days and elevated biomarkers (VWF, FVIII) can associated with increased risk; no increase in VTE risk with COVID vaccination compared with influenza vaccination
  • VEXAS syndrome is associated with increased thrombotic risk
Access Presentation Video, Slides, Q&A

Chronic Lymphocytic Leukemia

Dr. Carolyn Owen — University of Calgary
Recap of Presentation
  • Key News This Year: approval VO
  • How we approach therapy for CLL in 2022
  • Where is the “unmet need” in CLL today?
    • Is FCR still appropriate for young fit and good risk?  (CLL13/GAIA)
    • VO vs BTKi frontline in unmutated IgHV, any survival difference depending on sequencing?
    • Can we do even better with BTKi/BCL2i combos frontline?
    • What to do about patients who fail both BTKi AND BCL2i (particularly those who fail both covalent and non-covalent BTKi)?
    • How do we treat Richter’s Transformation?
  • Considerations for CLL Treatment During COVID-19 
    • Take into account local infection rates and risk to the patient of contracting COVID-19. 
    • Encourage patients to be current with approved COVID-19 vaccinations. 
    • Therapeutic decisions should remain to be based on individual factors such as symptom burden and comorbidities, along with molecular and cytogenetics abnormalities. 
    • If patients are currently on OTT without complications, they should maintain on the same therapy 
    • If a patient acquires COVID while on treatment, interrupt therapy when feasible, delay until symptoms resolve and tests are negative. Continuing with treatment may be warranted. 
    • Healthcare professionals should be aware of their local variant proportions, discuss risk of contracting COVID-19 with immunocompromised individuals, and advise them to seek immediate medical attention if they develop COVID-19 symptoms. 
      • EVUSHELD™, a monoclonal antibody, is authorized as pre-exposure prophylaxis to prevent COVID-19 in people who have moderate to severe immune compromise. EVUSHELD™ can also be used by those for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) or its component(s).
Access Presentation Video, Slides, Q&ACLL Guidance

Lymphoma (CAR T)

Dr. Michael Jain — Moffitt Centre, Tampa
Recap of Presentation

In DLBCL:

  • Second line DLBCL – Three RCTs of CAR T cells (ZUMA-7, BELINDA, TRANSFORM)
  • Axi-cel and tisa-cel are available in the 3+ line setting
  • Patients relapsing within 12 months of R-CHOP have poor outcomes with standard second line therapy followed by auto-SCT
  • High tumor burden, and high CAR-HEMATOTOX scores lead to poorer outcomes after CAR T. Do not let systems factors worsen these!
  • Retrospective (registry) and 2L trial data suggest axi-cel more effective than tisa-cel

In MCL:

  • Brexu-cel soon to be available for BTK-resistant MCL
  • Tumor intrinsic factors (p53, complex karyotype affect outcome)

In FL:

  • CAR T cell therapy not available (outside of trial)

In Myeloma:

  • CAR T cell therapy not available (outside of trial)
Access Presentation Video, Slides, Q&A

Lymphoma (Non-CAR T)

Dr. John Kuruvilla — Princess Margaret Cancer Centre
Dr. John Kuruvilla
Recap of Presentation

Novel therapy comes of age!

  • Novel therapy demonstrates significant benefit in the primary treatment setting
    • DLBCL (PFS: Polarix)
    • cHL (OS: ECHELON-1)
  • CAR-T cell therapy increasingly established in DLBCL with strong data in MCL (FL)
  • Anti-PD1 antibodies confirm benefit in RR-cHL and move into frontline
    • S1826/HDC1 completes accrual (Nivo or BV with AVD in stage III/IV cHL)
  • Bispecific antibodies (CD3/CD20) show significant single agent activity in RR-DBCL and RR-FL
    • Glofitamab, Mosunetuzumab, Epcoritamab, Odronextamab
  • BTKi trials (frontline MCL; RCTs in WM) deliver favourable results for new treatments
Access Presentation Video, Slides, Q&AHL Guidance

Plasma Cell Dyscraisas

Dr. Hira Mian — McMaster University
Recap of Presentation
  • What do our outcomes currently look like? Mian et al. CLML 2022
  • Precursor to MM Disease stages
  • Current Landscape of Treatment in Multiple Myeloma in Canada
    • Drugs coming down the pipeline
    • We need to catch up from access end
      • RVD to quadruplet therapy / Bispecifics / CART therapy
      • How will we sequence? How will we pay?
Access Presentation Video, Slides, Q&A

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