ASH News Daily 2017 - Issue 2 - A-12

ASH NEWS DAILY

Page A-12

Sunday, December 10, 2017

®

LY M P H O M A S

Taming Aggressive Lymphomas: We Have Come a Long Way
By Mehdi haMadani, Md

O

n a cold Atlanta Saturday morning with snow
flurries, as I was walking
briskly toward the Georgia World
Congress Center to attend the
"Evolving Strategies in Aggressive
B-Cell Lymphoma" education program session, I wondered if Samuel
Wilks could ever have imagined
that the disease he described in his
1856 seminal paper "Cases of lardaceous diseases and some allied
affections with remarks" would
capture the imagination of many
brilliant minds for years to come.
Or if Christian Billroth, while reporting the first known case of nonHodgkin lymphoma in 1871, could
possibly have anticipated the biological complexity and heterogeneity of the aliment he chose to name
"malignant lymphoma."
Since those early days, our understanding of the biology of aggressive B cell lymphomas has
improved dramatically, leading
to the development of an everexpanding array of novel agents.
Yesterday's session, chaired by
Dr. Kieron Dunleavy of George
Washington University, aimed to
tackle the cutting-edge discoveries in managing aggressive B cell
lymphomas.
The first speaker, Dr. Andrew Davies of Southampton General Hospital, highlighted the controversies
in the frontline therapy of diffuse
large B cell lymphoma (DLBCL)
and eloquently argued that dose
intensity is unlikely to surpass the
current gold standard R-CHOP

(rituximab plus cyclophosphamide, doxorubicin, vincristine, and
prednisone) therapy. While summarizing trials incorporating the
cell-of-origin information in its
design, Dr. Davies cautioned that
such approaches are not yet ready
for prime time, especially considering the underwhelming data from
studies adding proteasome inhibitors to the R-CHOP backbone. Dr.
Davies also covered the challenging category of "double-hit lymphomas" where he argued that
results with R-CHOP alone have
been disappointing, and intensive inductions (e.g., DA-EPOCH
[dose-adjusted etoposide, doxorubicin, and cyclophosphamide
with vincristine, prednisone, and
rituximab]) with autologous transplantation reserved for patients not
achieving complete remission, is
a reasonable option for double-hit
lymphomas.
Next, Dr. Dunleavy presented
recent advances in deciphering the
biology of primary mediastinal B
cell lymphoma (PMBCL), including improved understanding of
genetic alterations in the JAK-STAT
and NF-КB pathways, as well as increased expression of programmed
death ligands bestowing "immune
evasion" abilities to this histology.
He noted that the optimal management of young patients with PMBCL is particularly controversial,
but highlighted a paradigm shift
away from consolidative radiation
to mitigate the risk of long-term
side effects by more widespread
use of DA-EPOCH plus rituximab
as frontline therapy. He also noted

Pictured (L to R): Drs. Peter Martin and Kieron Dunleavy, and Andrew Davies
present "Evolving Strategies in Aggressive B Cell Lymphoma."

that drugs targeting CD30 or the
PD1/PD-L1 axis have shown encouraging signal of activity in this
disease.
The last speaker of the session,
Dr. Peter Martin of Weill Cornell
Medical College focused on managing mantle cell lymphoma (MCL)
patients not well represented on
clinical trials. While acknowledging the striking diversity in MCL
biology, he noted that "differences
between IGHV-mutated, SOX11negative non-nodal MCL, and
IGHV-unmutated SOX11-positive
nodal MCL, as well as variation in
proliferation rates and mutations in
TP53 contribute to heterogeneous
presentations and clinical courses." He identified asymptomatic
patients with leukemic non-nodal
presentation and mutated IGHV

as suitable candidates for watchful
waiting. Dr. Martin also discussed
MCL patients with poor prognosis
including those with high MIPIc
score, TP53 mutation and post ibrutinib failure subjects where he recommended early consideration of
allogeneic transplantation or other
experimental approaches.
If you are experiencing any retroactive FOMO because you missed
this outstanding session, we've got
you covered. The same stimulating
discussion is scheduled to be repeated on Monday at 2:45 p.m. in
Hall C4 of the Georgia World Congress Center. Put it on your calendar - I guarantee you don't want
to miss it again!

be the standard of care, and reassesses patients every three months.
During every visit, she reviews the
signs and symptoms of VTE with
patients and reminds them to seek
urgent care in the event of VTErelated events.
Anticoagulant therapy can be
continued for high-risk factors including metastatic or progressive
disease, chemotherapy, or thrombogenic therapy, and discontinued
if there is active or recurrent serious bleeding, cancer in remission,
or a tumor type at low risk for recurrent VTE. She said that in the
event of major bleeding, the source
of bleeding must be addressed, in
addition to discontinuation of anticoagulation.

Dr. Ingrid Pabinger with the
Medical University of Vienna discussed the potential for using direct
oral anticoagulants (DOACs) for
prevention and treatment of cancer-associated VTE. DOACs seem
to be comparable in efficacy and
safety to vitamin K antagonists in
studies in patients with cancer. DOACs can be considered an alternative to LMWH to treat VTE in the
acute phase in patients with cancer.
Dr. Pabinger noted ongoing studies assessing the use of DOACs for
VTE prophylaxis versus placebo or
LMWH in acute cancer-associated
VTE and for the prophylactic use
of DOACs in patients with cancer.

Dr. Hamadani indicated no potential conflicts of interest.

VENOUS THROMBOEMBOLISM

The Clot Thickens
By lynne lederMan, Phd

C

ancer-associated thrombosis, one of many complications faced by patients with
malignancies, is quite challenging
to manage. Questions yet to be answered include what type of anticoagulation to use and how long
to use it. The education session
covering these topics, "Common
Clinical Questions in Cancer-Associated Venous Thromboembolism
(VTE)" was presented twice yesterday.
Dr. Marc Carrier of the University of Ottawa at The Ottawa
Hospital replaced Dr. Marcello Di
Nisio, who was unable to get to
Atlanta. Dr. Carrier said that in

general, incidental VTE should be
treated. For patients with incidental proximal deep-vein thrombosis
or multiple subsegmental or more
proximal pulmonary embolism,
therapeutic anticoagulation for at
least six months is recommended,
using low-molecular-weight heparin (LMWH) or warfarin as an
alternative if LMWH is not available, affordable, or acceptable.
Dr. Agnes Y.Y. Lee from the University of British Columbia discussed how to determine when to
stop anticoagulation in patients
with cancer-associated thrombosis
in the absence of clinical trial data.
Dr. Lee treats her patients with
cancer with LMWH for three to
six months, which she considers to

»» VTE Page A-20



Table of Contents for the Digital Edition of ASH News Daily 2017 - Issue 2

ASH News Daily 2017 - Issue 2 - A-1
ASH News Daily 2017 - Issue 2 - A-2
ASH News Daily 2017 - Issue 2 - A-3
ASH News Daily 2017 - Issue 2 - A-4
ASH News Daily 2017 - Issue 2 - A-5
ASH News Daily 2017 - Issue 2 - A-6
ASH News Daily 2017 - Issue 2 - A-7
ASH News Daily 2017 - Issue 2 - A-8
ASH News Daily 2017 - Issue 2 - A-9
ASH News Daily 2017 - Issue 2 - A-10
ASH News Daily 2017 - Issue 2 - A-11
ASH News Daily 2017 - Issue 2 - A-12
ASH News Daily 2017 - Issue 2 - A-13
ASH News Daily 2017 - Issue 2 - A-14
ASH News Daily 2017 - Issue 2 - A-15
ASH News Daily 2017 - Issue 2 - A-16
ASH News Daily 2017 - Issue 2 - A-17
ASH News Daily 2017 - Issue 2 - A-18
ASH News Daily 2017 - Issue 2 - A-19
ASH News Daily 2017 - Issue 2 - A-20
ASH News Daily 2017 - Issue 2 - A-21
ASH News Daily 2017 - Issue 2 - A-22
ASH News Daily 2017 - Issue 2 - A-23
ASH News Daily 2017 - Issue 2 - A-24
ASH News Daily 2017 - Issue 2 - A-25
ASH News Daily 2017 - Issue 2 - A-26
ASH News Daily 2017 - Issue 2 - A-27
ASH News Daily 2017 - Issue 2 - A-28
ASH News Daily 2017 - Issue 2 - B-1
ASH News Daily 2017 - Issue 2 - B-2
ASH News Daily 2017 - Issue 2 - B-3
ASH News Daily 2017 - Issue 2 - B-4
ASH News Daily 2017 - Issue 2 - B-5
ASH News Daily 2017 - Issue 2 - B-6
ASH News Daily 2017 - Issue 2 - B-7
ASH News Daily 2017 - Issue 2 - B-8
ASH News Daily 2017 - Issue 2 - B-9
ASH News Daily 2017 - Issue 2 - B-10
ASH News Daily 2017 - Issue 2 - B-11
ASH News Daily 2017 - Issue 2 - B-12
ASH News Daily 2017 - Issue 2 - B-13
ASH News Daily 2017 - Issue 2 - B-14
ASH News Daily 2017 - Issue 2 - B-15
ASH News Daily 2017 - Issue 2 - B-16
ASH News Daily 2017 - Issue 2 - B-17
ASH News Daily 2017 - Issue 2 - B-18
ASH News Daily 2017 - Issue 2 - B-19
ASH News Daily 2017 - Issue 2 - B-20
ASH News Daily 2017 - Issue 2 - B-21
ASH News Daily 2017 - Issue 2 - B-22
ASH News Daily 2017 - Issue 2 - B-23
ASH News Daily 2017 - Issue 2 - B-24
ASH News Daily 2017 - Issue 2 - B-25
ASH News Daily 2017 - Issue 2 - B-26
ASH News Daily 2017 - Issue 2 - B-27
ASH News Daily 2017 - Issue 2 - B-28
ASH News Daily 2017 - Issue 2 - B-29
ASH News Daily 2017 - Issue 2 - B-30
ASH News Daily 2017 - Issue 2 - B-31
ASH News Daily 2017 - Issue 2 - B-32
ASH News Daily 2017 - Issue 2 - B-33
ASH News Daily 2017 - Issue 2 - B-34
ASH News Daily 2017 - Issue 2 - B-35
ASH News Daily 2017 - Issue 2 - B-36
ASH News Daily 2017 - Issue 2 - B-37
ASH News Daily 2017 - Issue 2 - B-38
ASH News Daily 2017 - Issue 2 - B-39
ASH News Daily 2017 - Issue 2 - B-40
ASH News Daily 2017 - Issue 2 - B-41
ASH News Daily 2017 - Issue 2 - B-42
ASH News Daily 2017 - Issue 2 - B-43
ASH News Daily 2017 - Issue 2 - B-44
ASH News Daily 2017 - Issue 2 - B-45
ASH News Daily 2017 - Issue 2 - B-46
ASH News Daily 2017 - Issue 2 - B-47
ASH News Daily 2017 - Issue 2 - B-48
ASH News Daily 2017 - Issue 2 - B-49
ASH News Daily 2017 - Issue 2 - B-50
ASH News Daily 2017 - Issue 2 - B-51
ASH News Daily 2017 - Issue 2 - B-52
ASH News Daily 2017 - Issue 2 - B-53
ASH News Daily 2017 - Issue 2 - B-54
ASH News Daily 2017 - Issue 2 - B-55
ASH News Daily 2017 - Issue 2 - B-56
ASH News Daily 2017 - Issue 2 - C-1
ASH News Daily 2017 - Issue 2 - C-2
ASH News Daily 2017 - Issue 2 - C-3
ASH News Daily 2017 - Issue 2 - C-4
ASH News Daily 2017 - Issue 2 - C-5
ASH News Daily 2017 - Issue 2 - C-6
ASH News Daily 2017 - Issue 2 - C-7
ASH News Daily 2017 - Issue 2 - C-8
ASH News Daily 2017 - Issue 2 - C-9
ASH News Daily 2017 - Issue 2 - C-10
ASH News Daily 2017 - Issue 2 - C-11
ASH News Daily 2017 - Issue 2 - C-12
ASH News Daily 2017 - Issue 2 - C-13
ASH News Daily 2017 - Issue 2 - C-14
ASH News Daily 2017 - Issue 2 - C-15
ASH News Daily 2017 - Issue 2 - C-16
ASH News Daily 2017 - Issue 2 - C-17
ASH News Daily 2017 - Issue 2 - C-18
ASH News Daily 2017 - Issue 2 - C-19
ASH News Daily 2017 - Issue 2 - C-20
ASH News Daily 2017 - Issue 2 - C-21
ASH News Daily 2017 - Issue 2 - C-22
ASH News Daily 2017 - Issue 2 - C-23
ASH News Daily 2017 - Issue 2 - C-24
ASH News Daily 2017 - Issue 2 - C-25
ASH News Daily 2017 - Issue 2 - C-26
ASH News Daily 2017 - Issue 2 - C-27
ASH News Daily 2017 - Issue 2 - C-28
ASH News Daily 2017 - Issue 2 - C-29
ASH News Daily 2017 - Issue 2 - C-30
ASH News Daily 2017 - Issue 2 - C-31
ASH News Daily 2017 - Issue 2 - C-32
https://www.nxtbookmedia.com