Leukemia

BETHESDA, Md-The Oncologic Drugs Advisory Committee (ODAC) has recommended that the FDA approve Targretin capsules (bexarotene, Ligand Pharmaceuticals) for the treatment of advanced cutaneous T cell lymphoma (CTCL) but not for early stage CTCL.

NEW ORLEANS-STI 571, an investigational drug for the treatment of chronic myelogenous leukemia (CML), produced complete hematologic responses in all patients receiving higher doses, according to preliminary analysis of phase I data presented at the 41st Annual Meeting of the American Society of Hematology (ASH) (see illustration ). All participants had failed interferon-alfa therapy.

High-dose therapy with hematopoietic progenitor-cell transplantation plays a key role in the treatment of Hodgkin’s disease and the non-Hodgkin’s lymphomas. First and foremost, transplantation is used as a salvage treatment for those who relapse or do not achieve a complete remission with first-line chemotherapy. Carefully selected patients with poor prognostic features may benefit from the incorporation of high-dose therapy and transplant into their initial treatment programs. Despite a myriad of trials, many pivotal questions regarding the appropriate application of high-dose therapy with transplantation to the lymphoid malignancies remain unsettled, including the role of allogeneic transplantation and the optimal timing of transplant for patients with poor prognostic indicators. Phase III studies are required to address these issues; these trials will demand the active commitment of concerned transplanters and referring hematologists and oncologists. Although autologous transplantation has been the preferred approach for the majority of patient subgroups, new approaches to allogeneic transplantation that have diminished toxicity may pave the way for a greater role for allogeneic grafting in the lymphoid diseases. [ONCOLOGY 13(12):1635-1645, 1999]

Data published in a recent issue of Blood suggest that valspodar (Amdray), a multidrug resistance modulator being developed by Novartis Pharmaceuticals Corporation, may show promise in treating certain patients with acute myelogenous leukemia

MIAMI BEACH, Florida-Cutaneous T-cell lymphomas (CTCL) often cause severe facial disfigurement that adversely affects a patient’s quality-of-life. A new fusion protein, DAB389IL-2 (denileukin diftitox, Ontak), has produced significant response rates in heavily pretreated relapsed CTCL patients and improved quality of life, Madeleine Duvic, MD, said at the American Society of Hematology (ASH) annual meeting.

The combination of fludarabine and mitoxantrone (FM) has been shown to be an effective regimen for indolent lymphoma (J

MIAMI BEACH-Long-term follow-up of 23 patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) in first complete remission showed a relatively low relapse rate at 3 years when treated with allogeneic bone marrow transplant from HLA-matched siblings, D.S. Snyder, MD, reported at the American Society of Hematology (ASH) annual meeting.

TUCSON-Cyclosporine (Sandimmune) significantly reduces resistance to daunorubicin (Cerubidine), prolongs the duration of remission, and improves overall survival of patients with high-risk acute myelogenous leukemia (AML), Alan F. List, MD, of the University of Arizona, said at the ASH meeting. Dr. List’s observations were based on a randomized trial conducted with the Southwest Oncology Group.

SEATTLE-Preliminary phase II data show that CMA-676, an engineered human anti-CD33 antibody linked to calicheamicin, a potent cytotoxic agent, produced an objective response in 10 of 23 patients (43%) with acute myelogenous leukemia in first relapse after initial chemotherapy. Six responders went on to allogeneic bone marrow transplant.

CHICAGO-A cost analysis of the use of G-CSF (Neupogen) in elderly patients undergoing intensive chemotherapy for acute myelogenous leukemia (AML) showed the agent to be almost cost neutral, Tammy J. Stinson, MS, said at a poster session of the American Society of Hematology annual meeting.

GOTEBORG, Sweden-A postconsolidation regimen of low-dose interleukin-2 (IL-2) and the investigational agent histamine dihydrochloride (Maxamine) appears to increase leukemia-free survival in acute myelogenous leukemia (AML) patients in remission, Bo I. Nilsson, MD, PhD, reported at an ASH poster session.

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder that follows a characteristic clinical course in which a chronic phase of variable duration precedes an accelerated, and ultimately blastic, phase,

Chronic myelogenous leukemia (CML) is an intriguing disease for reasons that point to important biological differences between this and other types of leukemia:

WASHINGTON--Despite questions about dose levels and number of treatment courses, the FDA’s Oncology Drugs Advisory Committee (ODAC) gave a vote of confidence to Seragen’s Ontak (denileukin diftitox or DAB389IL-2) for its approval for use in cutaneous T-cell lymphoma (CTCL) that persists or recurs despite prior therapy. Ontak is an interleukin-2 (IL-2) fusion protein that delivers a diphtheria toxin fragment to lesions via IL-2 receptor binding. The panel was not asked to formally recommend the agent to the FDA.

Individualizing the dosage of cancer chemotherapy can increase survival rates for children with acute lymphoblastic leukemia (ALL) without causing excessive toxicity, according to a recent study published in The New England Journal of Medicine.

The management of patients with the less aggressive subtypes of non-Hodgkin’s lymphoma remains a clinical challenge. As pointed out by Webster and Cella, this challenge relates, at least in part, to the comparatively long median survival that can be achieved in such patients with a wide variety of treatment approaches. However, it is very important to realize that not all patients with the indolent varieties of non-Hodgkin’s lymphoma are the same.

Cancer treatment often has debilitating effects on the patients who receive it. Chemotherapy regimens can produce toxicities, such as gastrointestinal disturbances, hematologic deficiencies, fatigue, and neurotoxicity. Patients typically undergo these chemotherapy regimens to increase their disease-free survival time. Given that these therapies can negatively affect a patient’s quality of life (QOL), treatments need to provide clear curative potential and/or survival benefits to offset detrimental effects on QOL.

SAN DIEGO-Up to 80% of newly diagnosed elderly acute myelogenous leukemia (AML) patients overexpress P-glycoprotein (P-gp), leading to multidrug resistance and a poor prognosis, said Dr. P. Sonneveld, University Hospital, Rotterdam, in a presentation at the American Society of Hematology (ASH) annual meeting.

ASH-Long-term treatment with alfa-interferon has continued advantages over conventional chemotherapy with hydroxyurea in patients with chronic myeloid leukemia (CML), according to updated findings from the Italian Cooperative Study Group on CML. Prolonged survival in the alfa-interferon-treated patients closely correlated with cytogenetic response, Sante Tura, MD, reported at the annual meeting of the American Society of Hematology in San Diego.

Researchers found that men who use cocaine are twice as likely as abstainers to develop intermediate- or high-grade non-Hodgkin’s lymphoma (NHL). For those who use cocaine more frequently, ie, on at least nine occasions, the risk is more than triple what nonusers face, says Rebecca Nelson, a doctoral student in the preventive medicine department at the University of Southern California (USC) School of Medicine, in an article published recently in the British Journal of Cancer.

ASH-Patients with chronic myelogenous leukemia (CML) who are eligible for transplant but lack a matched sibling donor should begin their search for an unrelated donor as soon as possible after diagnosis, A. James Morton, MD, said at the plenary session of the annual meeting of the American Society of Hematology (ASH) in San Diego.

Drs. Enright and McGlave succinctly review the biology of chronic myelogenous leukemia (CML) and highlight the therapeutic role of allogeneic stem-cell transplantation. Two points, however, warrant further discussion. The first is that a regimen containing interferon-alfa (Intron A, Roferon-A) is optimal front-line therapy for the great majority of CML patients.[1] The second is that use of an interferon-alfa-based regimen prior to allogeneic stem-cell transplantation does not adversely affect post-transplant mortality, morbidity, or anti-CML efficacy.

ASCO--Treatment with an investigational immunoconjugate, CMA-676, safely induced remissions in some patients with refractory or relapsed acute myelogenous leukemia (AML), Eric L. Sievers, MD, said in his poster presentation of the preliminary results at the American Society of Clinical Oncology annual meeting.

ORLANDO--Combination therapy utilizing interferon alfa-2b (Intron A) and cytarabine is associated with improved cytogenetic response and survival over interferon alone in patients with chronic myelogenous leukemia (CML), a French study, presented at the 38th Annual Meeting of the American Society of Hematology (ASH), has shown.

ORLANDO--A preparative regimen employing a radiolabeled monoclonal antibody (MoAb), coupled with busulfan (Myleran) and cyclophosphamide (Cytoxan, Neosar), yielded a low relapse rate in patients with acute myelogenous leukemia (AML) undergoing bone marrow transplantation (BMT) while in first remission.