Alice Goodman

Current guidelines may be inadequate in at-risk African-American and Latino populations.

Standard therapy options are limited for patients with refractory chronic lymphocytic leukemia, with or without lymphadenopathy, and the results are generally poor. Ofatumumab (Arzerra), a novel human CD20 monoclonal antibody, could be the answer for improving outcomes in this patient population. Lead investigator William G. Wierda, MD, PhD, will share the final analysis of the results from this international study at ASH 2010.

Tests carry a significant price tag, but reduction in chemotherapy use is potentially cost-saving.

Parents and their children need to understand that advancing science does not always go hand-in-hand with a direct benefit to the patients.

There currently are no approved therapies for Waldenström macroglobulinemia, but everolimus (Afinitor) may be the answer. A collaborative phase II study showed encouraging single-agent activity with everolimus in relapsed and/or refractory disease.

Unlike conventional radiation, Yttrium-90-ibritumomab tiuxetan (Zevalin) induces cellular damage only in the targeted tumor cells and has demonstrated activity in follicular and diffuse large B-cell non-Hodgkin’s lymphoma.

In asymptomatic disease, overall survival is often the same with immediate treatment vs watch and wait. The deciding factor may be what patients are willing to tolerate.

Induction therapy with higher daily doses of daunorubicin improved complete response and boosted overall survival in younger patients with acute myelogenous leukemia, according to results of the phase III ECOG E1900 trial.

In a potentially practice-changing study, bendamustine plus rituximab improved PFS compared with CHOP plus rituximab as first-line therapy for indolent lymphoma.

More is better, at least when it comes to treatments for multiple myeloma. Studies from Spanish and Italian investigators showed that upfront use of four drugs improves durable responses and progression-free survival in elderly patients.

Patients with lower-risk myelodysplastic syndromes and anemia can derive long-term benefits from erythropoietin and myeloid growth factor hormones, according to a study in Blood.

From naked antibodies to arsenic-laced molecules to anti-survivin antibodies, three up-and-coming agents are potential standouts in the lymphoma treatment arsenal. SGN-35 is an immunoconjugate that could offer a novel approach to Hodgkin’s lymphoma therapy. Then there are darinaparsin, an organic arsenic molecule, and YM155, which may be able to restore normal apoptotic activity in advanced and aggressive lymphoma, respectively. Researchers working with these drugs discuss their studies and trials while hematologic experts offer some perspective on the future of these agents.

NEW ORLEANS-More is better, at least when it comes to treatments for multiple myeloma. Separate studies from a Spanish group and an Italian group showed that up-front use of four drugs improves durable responses and progression-free survival in elderly patients. Both studies also showed that a kinder, gentler weekly schedule of bortezomib (Velcade) instead of the standard twice-weekly schedule maintains efficacy and reduces toxicity.

NEW ORLEANS-There was good news at ASH 2009 on promising treatments for indolent lymphoma and aggressive non-Hodgkin’s lymphoma. Also, a separate poster presentation showed that even just one cycle of post-remission therapy extended survival in elderly patients with acute myeloid leukemia.

Researchers are exploring ways to manipulate rituximab (Rituxan) when added to the current standard therapy for diffuse large B-cell lymphoma, specifically shortening the number of treatment days. Preliminary results of a phase III trial showed that rituximab plus CHOP over a 14-day cycle achieved similar response rates and comparable toxicity compared to CHOP on a 21-day cycle in newly diagnosed patients.

Resistance to rituximab (Rituxan) has emerged as a considerable problem as the drug has become widely used to treat B-cell lymphomas, such as non-Hodgkin’s lymphoma, follicular lymphoma, and diffuse large B-cell lymphoma. A recent study in Blood suggested that resistance to rituximab is related to downregulation of CD20 expression via epigenetic mechanisms.

After almost a decade of research and two trials of a follicular lymphoma vaccine with negative results, a study of a personalized idiotype vaccine has achieved positive results. BiovaxID prolonged median disease-free survival by more than a year in a subset of patients who maintained complete remission after one year of chemotherapy and then received the vaccine.

With the availability of newer drugs for treating multiple myeloma, such as proteosome inhibitors and immunomodulatory drugs (IMiDs), outcomes and depth of response are steadily improving. These developments have led to a debate about whether high-dose chemotherapy and autologous stem cell transplant should still be considered first-line therapy or whether newer drug regimens should replace transplant.

A large, population-based study of the association between venous thromboembolism and mortality in hematologic malignancies found an increased risk of death in patients with acute lymphoblastic leukemia, but not in those with acute myelogenous leukemia. The authors had no explanation for the differential association between the two types of acute leukemia.

A phase III study by the Eastern Cooperative Oncology Group in patients with newly diagnosed multiple myeloma showed that induction therapy with low-dose dexamethasone plus lenalidomide (Revlimid) improved survival, compared with high-dose dexamethasone plus lenalidomide. Look for updates on treatment regimens that include dexamethasone in multiple myeloma at ASH 2010 from Sagar Lonial, MD, and S. Vincent Rajkumar, MD.

A triple therapy with fludarabine, cyclophosphamide, and rituximab (Rituxan) was hailed as the new standard of care for chronic lymphocytic leukemia at ASH 2008 in San Francisco. Now a new study has deemed low-dose fludarabine and cyclophosphamide combined with high-dose rituximab (FCR-Lite) as highly effective in untreated CLL patients.

An imatinib-based (Gleevec) regimen induced a similarly high rate of hematological complete response (CR) versus a more intensive imatinib-HyperCVAD regimen in younger adults with de novo Philadelphia-positive acute lymphoblastic leukemia (ALL). However, the rate of molecular response was somewhat lower with the imatinib-based regimen, according to preliminary results of the GRAAPH 2005 study.

Evidence from a large managed-care database suggests that sargramostim (Leukine) reduced the risk of infection-related hospitalization as well as associated costs compared with filgrastim (Neupogen) or pegfilgrastim (Neulasta) in patients with chemotherapy-induced neutropenia.

A simple, inexpensive, widely available serum lactate test had significant predictive value in identifying which patients with hematologic malignancies and febrile neutropenia are at risk for septic shock in a study presented at the ASH meeting this week.

Vorinostat (Zolinza) showed encouraging single-agent activity and was well tolerated over long durations of therapy in patients with two forms of indolent lymphoma, relapsed/refractory follicular and marginal zone lymphoma, according to results of a phase II study

Dexamethasone and prednisone were equally effective as induction therapy for children with newly diagnosed acute lymphocytic leukemia in terms of five-year event-free survival, according to a second interim analysis of EORTC Trial 58951.