ASH News Daily 2012 - Monday, December 10, 2012 - (Page A-14)
Page A–14
®
ASH NEWS DAILY
Monday, December 10, 2012
CliffsNotes From American Society of Clinical Oncology
ASH/ASCO
BY MICHAEL R. BISHOP, MD
I
f one had accidentally walked
into Room B405 of the Georgia
World Congress Center yesterday
and started listening to the presentations
without knowing exactly
what session it was, they may have
thought they inadvertently ended
up at a “Best of ASCO” symposium.
They would not have been far off,
as that was the specific intent of the
ASH/ASCO Joint Symposium titled
“Clinical Oncology Update: Studies
from the 2012 ASCO Annual Meeting.”
The overlapping interests of
both societies lend themselves to a
mutually beneficial relationship that
is supremely useful to clinicians and
researchers alike.
In
planning
this symposium,
Sandra Swain, MD, president of
the American Society of Clinical
Oncology (ASCO), shared the following:
“Dr. Keating and I had
several discussions about exciting
developments at ASCO. With so
many excellent abstracts to choose
from, we narrowed it down to several
of which were felt to be important
for all practicing hematologists
and oncologists to be aware.” After
hearing these outstanding and interesting
presentations, I believe
TRANSPLANTATION
Whoever Wishes to Foresee the Future
Must Consult the Past (in Transplantation)
BY MATTHEW HSIEH, MD
doubt that Machiavelli was referring
to hematopoietic stem
cell transplantation (HSCT)
when he wrote this, but it does
seem prudent. Myeloablative allogeneic
HSCT originated with the
idea of giving large doses of chemotherapy
and/or radiation, in the
hopes of eradicating the underlying
tumor and making “space” for the
incoming cells. This approach, however,
has an attendant high risk of
non-relapse mortality (NRM) and
has excluded many older patients
or younger patients with complex
medical illnesses. We have come a
long way since then, but is a history
lesson in transplantation helpful for
the future? This and several other
questions were addressed yesterday
in the Education Program session,
“Hematopoietic Stem Cell Transplantation
II – Toward Safer Allogeneic
Transplantation.”
I
Didier Blaise, MD, Institut PaoliCalmettes
of Marseille, was placed
in charge of reviewing how the conditioning
regimens have changed
over the past decades. He took us
on a wonderful tour of moving
from myeloablative to reduced intensity
and non-myeloablative regimens.
These changes have allowed
transplantation for older patients
and using unrelated donors. He
also emphasized the importance of
T-cell depletion using rabbit ATG,
and there is probably an optimal
dose to preserve anti-malignant
effect and minimize GVHD. Moving
forward, he suggested that randomized
studies comparing two
or more conditioning regimens are
needed to assess the survival benefit.
He ended with an interesting
thought: Perhaps reduced-intensity
and non-myeloablative approaches
should really be renamed to “reduced
toxicity.”
Steven Z. Pavletic, MD, Nation-
al Cancer Institute, continued the
history lesson through the lens of
GVHD. With the changes in conditioning
regimen, the timing of
GVHD has moved from the classical,
before or after day 100, to a
much more blended time course.
Many GVHD prophylaxis combi-
nations have been tested over the
past decades, but calcineurin inhibitor
and methotrexate remain the
most widely used. He showed that
corticosteroids remain the frontline
treatment for acute or chronic
GVHD, but clear efficacious second-line
treatments are yet to be
defined. Much recent progress in
chronic GVHD has built upon the
NIH Consensus staging system
and how to integrate the severity of
organ involvement (mild, moderate,
and severe, each with a scoring
of 1-3) and quality of life, and can
serve as the basis to evaluate future
response rates.
Kieren A. Marr, MD, Johns Hopkins
University in Baltimore, took a
“glass-half-full” perspective when
she talked about opportunistic infections.
The pattern has expanded
from gram-negative organisms in
the early 1980s to other bacteria, viruses,
and fungi. Reduced-intensity
conditioning regimens, antimicrobial
prophylaxis, and protracted
periods of chronic GVHD have delayed
the at-risk period. She highlighted
the progress in anti-fungal
coverage with the availabilities of
new azoles, confirmed the benefit of
monitoring and pre-emptive treatment
for CMV, and underscored
that vaccinations, especially against
pneumococcus,
are
under-utilized.
While the task of prevention seems
so daunting, she reassured the audience
that infections are manageable,
considering the progress that
we have made. This sentiment is
reflected with her words, “a surmountable
challenge.”
With newer conditioning regimen
approaches, standardized classification
and treatment of acute and
chronic GVHD, and better infection
monitoring and treatment, alloHSCT
indeed has become much safer for a
wider range of patients – those who
are older and those with complicated
co-morbid conditions.
It is often said that if you don’t
know where you’ve been, you won’t
know where you are going. So a history
lesson in alloHSCT is certainly
essential.
Dr. Hsieh indicated no relevant conflicts
of interest.
that she and Dr. Keating, ASH president,
achieved their goal.
Two of the abstracts presented
were related to supportive care. The
first, by Rudolph Navari, MD, PhD,
associate dean of Indiana University
School of Medicine - South Bend, University
of Notre Dame, was focused
on the use of olanzapine, which is approved
for the treatment of bipolar
disorder and schizophrenia, to control
breakthrough chemotherapy-induced
nausea and vomiting. Breakthrough
nausea and vomiting occurs in about
30 percent of patients who are being
treated with maximal anti-emetic therapy.
This includes patients being treated
with drugs such as anthracyclines
and cyclophosphamide, which are
commonly used for the treatment of
hematologic malignancies. In a randomized
study, no vomiting was observed
in 71 percent of patients with
olanzapine compared with 32 percent
on metoclopramide. The second presentation
related to supportive care
was given by Ellen Lavoie Smith,
PhD, of the University of Michigan,
School of Nursing, who reported on
a study on the use of duloxetine for
chemotherapy-induced peripheral
neuropathy, which affects 20 to 30
percent of patients receiving taxanes
or vincristine. Previously there have
been very limited effective treatments
for chemotherapy-induced neuropathy;
however, duloxetine resulted in
a significant decrease in pain secondary
to the neuropathy compared with
placebo.
Yael Mosse, PhD, from the Chil-
dren’s Hospital of Philadelphia
spoke on the use of crizotinib in
a subset of children with anaplastic
large cell lymphoma (ALCL).
Crizotinib is FDA-approved for
the treatment of locally advanced
or metastatic non-small cell lung
cancer that is anaplastic lymphoma
kinase (ALK)-positive. Dr. Mosse
and colleagues identified several
children with ALK-positive malignancies,
including ALCL, who they
treated with crizotinib; approximately
80 to 95 percent of ALCL
patients have ALK abnormalities.
Eighty-eight percent of children
had complete responses to crizotinib,
which lasted for one to two
years or more. Responses were also
seen in patients with inflammatory
myofibroblastic tumors and neuroblastomas,
both of which may have
ALK abnormalities.
Finally, Chaya Moskowitz, PhD,
from Memorial Sloan-Kettering Cancer
Center, focused on long-term
complications related to radiation
therapy, which is highly relevant as
children, adolescents, and young
adults are living longer and longer
after primary cancer treatments. Dr.
Moskowitz and collaborators found
that lower levels of radiation therapy
can lead to secondary risk of breast
cancer in patients treated for childhood
cancer. The study cohort included
6,000 patients on the Childhood
Cancer Survivor Study. The
incidence of breast cancer by age 50
ranged from 24 to 31 percent in patients
who received from 10 to 19 Gy
of radiation therapy, which is comparable
to women who are BRCA1/2
carriers. This has tremendous implications
for earlier screening in these
patients and suggests that magnetic
resonance imaging (MRI) should be
used in some cases due to fibrotic
breasts. There are currently 50,000
women in the United States who
were treated with less than 20 Gy of
radiation therapy who should receive
annual screening, as recommended
by Children’s Oncology Group.
This outstanding session demonstrated
the complementary research
that occurs between these two great
societies.
Dr. Bishop indicated no relevant conflicts
of interest.
Table of Contents for the Digital Edition of ASH News Daily 2012 - Monday, December 10, 2012
ASH News Daily 2012 - Monday, December 10, 2012
https://www.nxtbookmedia.com