What are your top takeaways in Hematologic Malignancies from ASCO 2022?

Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce how I approach adult patients with advanced classical Hodgkin’s lymphoma, reconsider what I do for those with newly diagnosed multiple myeloma, and question a potential “practice-changing development” for elderly patients with newly diagnosed mantle cell lymphoma.

1. I will continue to use the A + AVD (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) regimen as first-line therapy for patients with classical Hodgkin’s lymphoma (cHL).

A...

1. The rusfertide presentation by Ron Hoffman was interesting as it’s the first PV drug to essentially eliminate phlebotomy need immediately.

2. The study by Ong looking at the impact of conditioning in transplant outcomes was also very interesting as it challenges the standard of care that fits patients who should undergo intensive induction pre-transplant along with intensive conditioning. The outcomes of the venetoclax treated patients were similar and those patients were more likely to receive reduced intensity induction, I look forward to the day when we don’t have to give intensive induction again!

3. The study by Hourigan about MRD stratified outcomes in AML was also thought-provoking, how do we help more patients achieve MRD negativi...

1. The LBA4 (DETERMINATION) trial obviously generated a lot of discussion, given no apparent survival benefit and the low use of salvage transplant. There were 3 bispecific presentations, each of which had merits.

2. Abstract 8007 was a further update for teclistamab, which is likely going to be approved this year and will offer another “off the shelf” BCMA targeted, T cell redirecting therapy but we need to pay attention to the COVID issues with these drugs.

3. Abstract 8057 was a CIBMTR study looking at second malignancies—the years the analysis covered means there aren’t any patients included who received antibodies, by and large, but the signal of second primary malignancies is there, but seems relatively stable. However, sobering results...

1. SHINE Study - BR + ibrutinib improves PFS without OS benefit. Lack of OS benefit is not necessarily surprising given salvage regimens. Of concern would be the non-disease-related deaths in the experimental arm and the lack of benefit in high risk patient populations. Not currently practice-changing given the potential for sequencing agents which might produce similar PFS with less toxicity but without formal study, this comparison is speculation.

2. ECHELON-1: AVD + A vs. ABVD. This study revealed that the experimental arm had an OS benefit compared to ABVD. Had no impact on fertility or any new long term safety signals. A+AVD is likely the new SOC for advanced stage HL pending current cooperative group study. (Previous publication)

3. Glo...