Hematologic Oncology

To define the differences between the subtypes of myeloma patients, not only prospective collection of clinical and laboratory data are needed, but also cytogenetics and molecular profiling.

Myelomas that “lack” a monoclonal protein can be divided further into those that produce some protein and yet do not secrete it or whose serum concentration is so low that it cannot be measured, and those that truly produce no monoclonal protein at all.

In this article we briefly review the labeled indications for new agents for cutaneous and peripheral T-cell lymphoma, focus on data from the last 1 to 2 years, and on data from ongoing clinical trials, with the hope that in doing so we can help elucidate difficult treatment decisions.

Numerous small series of patients suggest that the prognosis for non-secretory myeloma patients is likely no worse than the prognosis for patients with traditional secretory myeloma, and in some settings may be superior.

A phase I study of dasatinib in children and adolescents with chronic myeloid leukemia (CML) and other malignancies determined dosing for further studies and suggested the drug is well tolerated and effective in these patients.

Patients with multiple myeloma who underwent autologous stem cell transplantation may have a continued response to the treatment even after the traditional disease assessment at 100 days. A new study indicates that this continued response maintained prognostic value and should be taken into account when considering post-transplant therapies.

Maintenance therapy with rituximab showed some improvement over observation, though it did not reach significance, among older patients with advanced follicular lymphoma who responded to a brief chemoimmunotherapy induction regimen followed by rituximab consolidation therapy.

A phase I study showed that azacitidine priming followed by standard chemotherapy could be an effective approach to resistance in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).

Researchers in London have identified a number of new genetic variants that are linked to myeloma, and one specifically linked to a telomerase RNA component gene called TERC, that helps to control the aging process by acting as a cell’s internal clock.

The real promise of improving patient outcomes in IgD and IgE multiple myeloma lies in multi-drug combinations, next-generation agents, and immunotherapy.

The use of newer methods of disease assessment that focus on minimal residual disease may facilitate the long-term evaluation of IgD and IgE myeloma patients, even if the rare Ig subtype is not identified at diagnosis.

How often do we choose the “second best” treatment as initial therapy for our patients with cancer? The management of chronic myeloid leukemia should be no different.

I am very comfortable in using imatinib as initial therapy in most patients who present in chronic phase, with the possible exception of patients with more advanced disease and higher Sokal scores.

In a new series, beginning this month and running into early 2014, experts on five “unusual dysproteinemias” will share their insights into diagnosis and management.

Although survival of patients with IgD or IgE multiple myeloma is shorter in comparison to those with IgG or IgA multiple myeloma, the outcome for patients with IgD and IgE subtypes is improving with the use of novel agents and autologous transplantation.

The present guidelines review epidemiology, pathology, presentation, workup, staging, prognostic factors, and treatment options for patients with localized nodal indolent lymphoma, with an emphasis on radiation guidelines, including radiation dose, field design, and radiation techniques.

Early treatment with lenalidomide and dexamethasone in patients with high-risk smoldering myeloma significantly delayed progression to symptomatic disease and prolonged survival with a good safety profile.

A study from the Mayo Clinic/University of Iowa assessing the use of surveillance CT scans to detect DLBCL relapses found that the majority of relapses occurred outside of regularly scheduled visits and concluded that it is important to educate patients to be more alert to signs and symptoms of relapse.

Dr. Brian Link discusses challenges in managing very elderly patients with diffuse large B-cell lymphoma and looks ahead to future management of DLBCL in general.

Dr. Brian Link discusses clinical implications of the large Mayo Clinic/ University of Iowa study (ASCO abstract 8504) showing patient symptoms rather than scheduled surveillance imaging drove detection of relapses in patients with diffuse large B-cell lymphoma (DLBCL).

In this interview, we discuss the current state of therapies available in treating CML patients and the role of newer agents.

The phase II portion of the GAUGUIN study found promising activity with the anti-CD20 antibody obinutuzumab in patients with relapsed or refractory indolent NHL.

Older multiple myeloma patients exposed to novel agents prior to autologous peripheral blood stem cell transplantation were at increased risk for engraftment syndrome.

A phase I/II study found that radioimmunotherapy with 177Lu and the anti-CD20 antibody rituximab along with the chelator DOTA is safe and feasible for treatment of relapsed follicular, mantle cell, or other indolent lymphomas.

Palliation is a laudable concept and an important goal in the therapy of all patients with malignant disease. Unfortunately, in the current day and age, the adjective “palliative” is being used in a derogatory manner that suggests palliation of suffering somehow lessens the importance or impact that such a therapy has upon individuals with the disease.

By inhibiting inflammatory cytokines and controlling the signs and symptoms of myelofibrosis, the patient’s body condition improves as the disease is kept under good control. Ultimately, prolonged exposure of a patient with myelofibrosis to ruxolitinib at a clinically effective dose results in prolongation of the his or her life.

A new study validates a simple prognostic score, the EUTOS score, as a useful tool in predicting the therapeutic effects of TKIs for chronic myeloid leukemia.

ARIAD has received marketing authorization from the European Commission for ponatinib (Iclusig) in chronic myeloid leukemia and acute lymphoblastic leukemia.

In this interview we discuss acute myeloid leukemia therapy approaches and new molecular targets based on genetic analyses of the disease with a leukemia expert.

The International Myeloma Working Group recently released new recommendations to aid physicians in the treatment of bone disease related to multiple myeloma.