VJHemOnc Podcast

Patient discussion at EHA 2018: CAR T-cells and MRD in CLL

CAR T-cells have demonstrated impressive efficacy in a variety of hematological malignancies, but their use in chronic lymphocytic leukemia (CLL) is still relatively new. In this podcast, Deborah Sims, CLL patient and advocate, and Brian Koffman, MD, CLL patient, and founder and medical director of the CLL society, discuss their experiences with the disease, and Brian’s recent treatment with CAR T-cells. They speak about their respective treatment routes, CAR T-cell toxicity and efficacy, the use of measurable residual disease (MRD) as an indicator of treatment success, and the future of CLL treatment. This discussion took place at the 23rd Congress of the European Hematology Association (EHA) 2018.

CLL therapies today: novel agents, combinations & the future of the field

Chronic lymphocytic leukemia (CLL) is experiencing a revolution in its treatment approaches. New therapies are constantly in development, and the past few years have seen an influx of highly effective novel therapies. In this podcast, Jennifer Woyach from the Ohio State University Comprehensive Cancer Center, Chris Fegan of Cardiff University, Anthony Mato from the Memorial Sloan Kettering Cancer Center, Michael Hallek from CECAD of Cologne, Peter Hillmen from Leeds Teaching Hospital NHS Trust, and William Wierda of the MD Anderson Cancer Center, discuss the current treatment landscape, as well as what the future holds for CLL therapies.

This podcast explores current challenges in CLL treatment, including the use of CAR T-cells, the variety of novel therapies on the market, and the huge potential benefits of novel agent combinations. The interviews included were recorded at the British Society for Hematology (BSH) 2018 Annual Meeting, the American Society of Oncology (ASCO) 2018 Annual Meeting, and the 23rd Congress of the European Hematology Association (EHA) 2018.

CAR T-cell therapy: where are we now and what’s in store for the future?

Over the last several years, CAR T-cell therapy has emerged as a revolution in immunotherapy, with incredible results to date. In this podcast, we look at the results of recent trials, the challenges being faced with the use of this novel therapy and advancements that we will be seeing in the future. This podcast features Tanya Siddiqi of the City of Hope National Medical Center, Faith Davies of UAMS Myeloma Institute, Rose Ellard from King’s College Hospital NHS Foundation Trust, Marion Subklewe of LMU Hospital Munich, Noelle Frey from the University of Pennsylvania, Stephen Robinson of University Hospitals Bristol NHS Foundation Trust, and Yi Lin from the Mayo Clinic.

The experts were speaking from the American Society of Clinical Oncology (ASCO) 2018, the American Society for Hematology (ASH) 2017, the 2018 European Society for Blood and Marrow Transplantation (EBMT) Annual Meeting, the British Society of Haematology (BSH) 2018 Annual Scientific Meeting and the European School of Hematology (ESH) Clinical Updates on Acute Leukemias 2018.

Focus on MRD: current landscape and future questions in hemonc

Measurable residual disease (MRD) has been a hot topic of interest due to its potential applications in the clinical setting. MRD measurement can help determine treatment efficacy, disease prognosis and guide disease management. In this podcast, Bijal Shah of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Richard Dillon from King’s College London, Todd Druley of Washington University School of Medicine in St. Louis and Ola Landgren of Memorial Sloan Kettering Cancer Center explore the exciting realm of MRD.

The role of MRD as a prognostic factor, the novel technologies that can be used to detect MRD, the next steps in utilizing this measure and MRD measurement as a strategy for treatment-free survival are among the stimulating areas considered. This footage was recorded at the International Workshop on Acute Leukemias (iwAL) 2018, the British Society for Haematology (BSH) 2018 Annual Meeting, the American Society for Hematology (ASH) Annual Meeting and Exposition 2016 and 2017, and the European Hematology Association (EHA) Congress 2018.

Acute leukemias discussion: what does genomics and epigenomics tell us about patient management?

A stimulating session on the implications of genomic data for the management of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients was hosted at the 1st International Workshop on Acute Leukemias (iwAL 2018), held in St. Pete Beach, FL. Here, the session speakers discuss the intriguing presentations from the session. Mark Levis, MD, PhD, of the Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, is joined by Ari Melnick, MD, of Weill Cornell Medicine, New York, NY, Klaus Metzeler, MD, of LMU-University Hospital Munich, Munich, Germany, and Torsten Haferlach, MD, of the MLL Munich Leukemia Laboratory, Munich, Germany. Firstly, the epigenome is discussed, with the fascinating topic of epigenetic alleles covered. The clinical implications of the genetic and molecular characterization of acute leukemia are then considered. The use of artificial intelligence in the analysis of the massive amounts of data that come from genetic and epigenetic sequencing is discussed by the experts. The intriguing nature of pre-leukemic clones, which are distinct from minimal residual disease, is also explored by the panel.

Acute leukemias: is MRD already a surrogate for survival?

The use of minimal residual disease (MRD) in the management of acute leukemias is a hotly debated topic. Despite the potential of MRD status as a prognostic marker and measure of disease, there are a number of controversies surrounding its use. These were discussed in a thought-provoking session at the 1st International Workshop on Acute Leukemias (iwAL), held in St. Pete Beach, FL. Chairing the discussion, Farhad Ravandi, MD, of the University of Texas MD Anderson Cancer Center, Houston, TX, is joined by Marion Subklewe, MD, of LMU-University Hospital Munich, Munich, Germany, and Adriano Venditti, MD, University of Rome Tor Vergata, Rome, Italy. Dr Subklewe covers the use of MRD in acute myeloid leukemia (AML), which is lagging behind that in acute lymphoblastic leukemia (ALL).

A pioneer in the early use of flow cytometry for MRD measurement, Dr Venditti gives us his thoughts on the use of flow cytometry vs. other techniques for MRD assessment. The panel also discuss the preferred techniques for MRD measurement in the US and Europe in both AML and ALL. The possibility of combining flow cytometry and next-generation sequencing for MRD assessment is then explored by the experts, with strong points made for both techniques in terms of limitations and strengths. The group finally turn to the question of eradicating MRD; how useful is its measurement if we cannot combat what we discover? This podcast was recorded at the iwAL 2018.

 

Revolutionary immunotherapies for lymphoma

Immunotherapy has emerged in recent years as an effective novel treatment for lymphoma, with studies constantly striving to identify new molecules that could help patients. Here, Graham Collins, MA, MBBS, MRCP, FRCPath, DPhil, of Oxford University Hospitals NHS Foundation Trust, Oxford, UK, discusses the current state of lymphoma immunotherapy research, including follow-up data on the efficacy of rituximab, and information on several newer treatments, such as ADCC-activating monoclonal antibodies and antibody-drug conjugates. Dr Collins also discusses some of the most exciting data yet to be released in the field, such as that from the ECHELON-1 trial and the use of CAR T-cells in lymphoma. This feature was recorded at the 2017 National Cancer Research Institute (NCRI) Conference, held in Liverpool, UK.

Latest advances and current challenges in immunotherapies for lymphoma

In this lively discussion, Catherine Bollard, MBChB, MD, FRACP, FRCPA, from the Children’s National Health System and George Washington University, Washington, DC, chairs on the hot topic of immunotherapy in lymphoma. Joined by Stephan Ansell, MD, PhD, of the Mayo Clinic, MN, and Steve Gottschalk, MD, from Bayor College of Medicine, Houston, TX, they discuss the immunotherapy session at the 2017 International Workshop on Non-Hodgkin Lymphoma (iwNHL) in Vancouver, BC, Canada. The panel debate various topics, including toxicity and finding the best combinations for therapies, including the likes of CAR T-cells and immune checkpoint inhibitors.

The circle of CLL: from gene discovery to targeted treatment

In this exciting feature, Carlo Croce, MD, from Ohio State University, Columbus, OH, provides an overview of the history of advancements in chronic lymphocytic leukemia (CLL) research. Prof. Croce delivers insights into the discovery of the genetic mechanisms and targets of CLL, including his group’s identification of BCL2 and the role of two microRNAs in the pathogenesis of CLL. He explains the advances in CLL in terms of drug therapies that have been able to target the BCL2 gene, which have revolutionized the treatment of CLL patients. This feature was recorded at the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2017, held in New York, NY.

Debate on the use of MRD for multiple myeloma management

The highly anticipated panel discussion on the hot topic of MRD at the Myeloma 2017 meeting in Edinburgh, UK produced thought-provoking debate. In this video the main points of debate are discussed by Jeffrey Wolf, MD from the University of California, San Francisco, CA, Roger Owen, MD, MRCP, MRCPath of Leeds Teaching Hospitals NHS Trust, Leeds, UK, Bruno Paiva, PhD from the University of Navarra, Pamplona, Spain, Nina Shah, MD of UCSF Medical Center, San Francisco, CA and Joaquin Martinez-Lopez, MD, PhD from the Hospital Universitario, Madrid, Spain.

Questions asked in the discussion included: Should MRD be the primary endpoint for clinical trials? Should MRD negativity be the goal of myeloma treatment, and are we yet at the point to use it in the clinic? Where is MRD research going moving forward? Furthermore, the pros and cons of flow cytometry vs. next generation sequencing to determine MRD are discussed, as well as the quality control in this process.