What are your top takeaways from ASH 2022?

1. Late Breaking Abstract (LBA-1): Consolidation Therapy with Blinatumomab Improves Overall Survival in Newly Diagnosed Adult Patients with B-Lineage Acute Lymphoblastic Leukemia in Measurable Residual Disease Negative Remission: Results from the ECOG-ACRIN E1910 Randomized Phase III National Cooperative Clinical Trials Network Trial

- This, some would argue, is a practice changing presentation as the date from E1910 would suggest that in Ph- ALL patients, Blina can be utilized in patients who achieve a CR as a consolidation leading to a significant improvement in overall survival (median NR vs 71.4 months). However, the question now remains as to the exact role of AlloSCT as only a small number from each group in this trial proceeded to an...

Since there is no mention of “non-cancer blood disorders”, I wanted to point out the late breaking abstract for oral Iptacopan in PNH. Data looks promising. This is the conclusion of the abstract PNH-Apply authors wrote: Conclusions: "In this Phase III trial in PNH patients with residual anemia on IV anti‑C5 SoC therapy, single-agent, oral iptacopan resulted in a significant majority of patients achieving clinically meaningful Hb increases and Hb ≥12 g/dL, via resolution of extravascular hemolysis and maintenance of intravascular hemolysis control. These hematological benefits were associated with transfusion independence in almost all patients and clinically meaningful improvements in patient-reported fatigue. Iptacopan monotherapy was wel...

1. The plenary paper of the trail from the European MCL network that demonstrated non inferiority of ibrutinib when compared with autologous transplant.
2. The 2 Bite trials for 1. Myeloma with a GPRC5D target and 2. The CD20 bite for lymphoma after failure of CD19 Car T cells.

1. REMoDL-B - Improved OS with the addition of bortezomib to first like RCHOP in sequencing-defined ABC-DLBCL (and MHG although comparator was RCHOP, not REPOCH as many prefer in HGL).
2. TRIANGLE - the ability to add Ibr to Nordic-style induction and 2y of maintenance in lieu of auto transplant consolidation. Need to see if there are subsets of patients who still derive greater benefit from auto (biology, MRD, etc).
3. Paired studies looking at MATRix and auto in PCNSL in younger and older patients - more firmly establishes a standard of care in this disease.

1. TRIANGLE study – looked at adding ibrutinib to induction chemotherapy and whether using it in maintenance could allow for omission of ASCT.

At this point, the study is too immature to say it is practice changing. We do not know if the early events are from high-risk patients that were rescued by ibrutinib and leading to the early drop in FFS/OS in the SOC arm. Also, maintenance R was not initially given in the SOC arm. Another point will be to see if the 5-year/long term FFS of the two experimental arms remains superior to the SOC arm or if, as the high-risk patients eventually continue to fail treatment with these modalities if all the arms eventually merge. Given the cost of ibrutinib and the long-term consequence of combination vs. se...

1. Stephen Oh et al. Bone marrow fibrosis changes and clinical correlations, or lack thereof, from the SIMPLIFY-1 trial. (Saturday, 12/10/22 oral session).

Commentary: Although a hallmark of the disease (barring some cases of pre-fibrotic primary myelofibrosis), the importance of bone marrow fibrosis in myelofibrosis remains a somewhat contentious issue. Originally thought to be a reactive phenomenon, bone marrow fibrosis in primary myelofibrosis (PMF) has been shown to be driven by neoplastic fibrocytes that carry the MPN driver mutation; furthermore, the grade of bone marrow fibrosis has been demonstrated to impact prognosis and features in the popular MIPSS70 prognostic model. Intuitively, it is assumed that improvement in bone marrow fib...

For the second consecutive year, I attended ASH virtually. Now a veteran of such video experiences, I found the ASH home page very easy to navigate. I was grateful to avoid airline flights and the long walks between sessions but missed the random and serendipitous interactions with friends while racing from one talk to another. At least I was able to be more efficient and probably accomplished more learning objectives this year than I would in a typical ASH meeting.

As always, there were several sessions that prompted me to reconsider how I currently do things and to modify my approach to patient care. Here are 3 examples:

1. Abstract No. 169 One of the biggest complaints I hear from my hospitalized patients with neutropenia revolves around t...

I was asked by theMednet what I considered to be the "top 3" presentations from the 2022 ASH meeting, my thoughts on their impact, and what questions did these studies raise in my clinical practice?

Since my practice focuses on the myeloproliferative neoplasms (MPN), I wasn’t certain whether they were being an optimist or pessimist. Also, with respect to full disclosure, I have been a consultant to PharmaEssentia (ropeginterferona2a) and GSK (momelotiniib). With respect to the MPN, I considered only the abstracts from the oral presentations.

My first choice was easy since it was one of the six plenary oral abstracts. Entitled “Discovery of INCA033989, a Monoclonal Antibody That Selectively Antagonizes Mutant Calreticulin Oncogenic Function ...