Lymphoma Highlights from the 2022 American Society of Hematology Annual Meeting, with Christopher Flowers, MD

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In this podcast, Cancer.Net Associate Editor Dr. Christopher Flowers covers new research in non-Hodgkin lymphoma presented at the 2022 American Society of Hematology Annual Meeting, held December 10-13 in New Orleans, Louisiana. Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interim of Cancer Medicine in August 2020. View Dr. Flowers’ disclosures at Cancer.Net. Dr. Flowers: Hello and welcome to this Cancer.Net podcast. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma at the University of Texas MD Anderson Cancer Center. And it's my great pleasure to talk to you today about updates in lymphoma from this year's American Society of Hematology meeting in December of 2022. I have a number of disclosures related to my work as a consultant for companies in the development of therapies for lymphoma. I will not talk about agents specifically related to those companies, but 2 companies that overlap with some of the areas that I'll talk about in bispecific antibodies includes Genentech, Roche, and Genmab, as well as research support from those companies for research that is performed at MD Anderson. So this year's American Society of Hematology meeting had a number of highlights. I was very fortunate to be the introducer for one of those key highlights, and that was the abstract presented at this year's plenary session. This was actually the first abstract presented in the plenary session where I introduced the abstract and set the context, and Dr. Martin Dreyling from the German group described the TRIANGLE study. So the TRIANGLE study was a randomized controlled clinical trial, meaning that the trial was performed in a randomized fashion to be able to test 3 particular strategies for patients with mantle cell lymphoma. Mantle cell lymphoma, as many of you may know, is a relatively uncommon form of non-Hodgkin lymphoma. It's a kind of lymphoma that can be quite aggressive, and particularly for younger patients who are suitable for aggressive therapy, the role of autologous stem cell transplantation has been something that's been important for the first-line therapy for mantle cell lymphoma. This study evaluated the use of a standard regimen of giving R-CHOP chemotherapy alternating with R-DHAP chemotherapy. So a chemotherapy regimen that includes Ara-C as their component followed by autologous stem cell transplantation. And it compared using that same regimen to giving it with ibrutinib added to the R-CHOP portion of the chemotherapy, followed by ibrutinib maintenance after the stem cell transplant or another experimental arm that added ibrutinib to the R-CHOP portion of the chemotherapy and gave 2 years of ibrutinib maintenance without stem cell transplantation. I think, importantly, this arm compared to each of those 2 experimental arms versus the standard of care and showed graphically that both of the arms that contained ibrutinib, the BTK inhibitor, looked to have improved failure-free survival compared to the standard stem cell transplant arm. Formal statistical tests were performed to compare the arm that included transplant plus ibrutinib showing that that was superior to transplant alone. And it remains to be seen whether that arm is superior to the arm that used ibrutinib alone. But those 2 arms look fairly similar in terms of their outcomes, and also the toxicity associated with the transplant obviously was substantially more than performing the therapy without transplant. This suggested perhaps autologous stem cell transplantation can be removed from frontline therapy for patients with aggressive mantle cell lymphoma and provides provocative data that may help to change practice, both in Europe and in the United States, as well as the rest of the world. A few other abstracts that were presented at this year's ASH meeting presented provocative data about ways to be able to improve the ways that we predict outcomes for patients. Matt Maurer presented the results of the Follicular Lymphoma International Prognostic Index 24, or the FLIPI24, as a risk factor to try and predict patients who might have early progression of disease with follicular lymphoma. One of the things that we know is that when you look at patients with follicular lymphoma, those patients who have progression of their disease within 24 months of the start of chemoimmunotherapy are patients that have markedly worse outcomes. And Dr. Maurer and our colleagues led an international study showing that a new prognostic factor model that included age, hemoglobin, white blood cell count, normalized lactate dehydrogenase, and beta-2-microglobulin, so all laboratory values that are connected within routine clinical practice, along with age, were a better predictor of this early progression of disease. This may serve as a useful model moving forward to help patients and their providers to understand who are the patients who are at higher risk of having aggressive behaving follicular lymphoma, and eventually, we can make strategies that help to address that for those patients. A second provocative model for using integrated genomics helps to identify patients who also have early progression of disease, and those are for patients with diffuse large B-cell lymphoma. This was presented by Kirsten Wenzel from the Mayo group, where Anne Novak was the senior author for this publication. What they did was they integrated the genomics into the clinical prognostic factors and found that there was a particular RNA-seq profile that helped to identify those patients who had early progression of disease with diffuse large B-cell lymphoma. They compared this approach to other prognostic models and suggested that these approaches may be able to improve upon the prediction of outcomes and be incorporated into the ways that we predict treatment strategies for patients with diffuse large B-cell lymphoma in the future. While these are still early on in their development, I think this holds promise for the future management of patients. And then the other class of agents that I'll mention from this year's ASH meeting are the bispecific antibodies. There were several abstracts that addressed this, both in patients with relapsing, refractory, diffuse large B-cell lymphoma, and in patient populations with relapsing refractory follicular lymphoma. One of those highlighted came from Nancy Bartlett, who discussed the role of a specific bispecific antibody for patients with relapsed follicular lymphoma. And I think these agents hold broad promise. So I appreciate your time and attention and hope you enjoyed this podcast and look forward to talking to you in the future about new developments in lymphomas broadly. ASCO: Thank you, Dr. Flowers. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. 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