The sum of the parts: what we can and cannot learn from comorbidity scores in allogeneic transplantation
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):715-722. doi: 10.1182/hematology.2023000458.ABSTRACTAllogeneic hematopoietic cell transplantation (alloHCT) requires the comprehensive evaluation of patients across multiple dimensions. Among the factors considered, comorbidities hold great significance in the pretransplant assessment. As many as 40% of alloHCT recipients will have a high burden of comorbidities in contemporary cohorts. To ensure a standardized evaluation, several comorbidity scores have been developed; however, they exhibit variations in properties and performance. This review examines the strengt...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Roni Shouval Joshua A Fein Source Type: research

How old is too old? Frailty and geriatric assessments of older patients undergoing allogeneic HCT
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):709-714. doi: 10.1182/hematology.2023000457.ABSTRACTAllogeneic hematopoietic cell transplantation (HCT) is a curative-intent treatment for many hematologic malignancies but carries a significant risk of morbidity and mortality. An increasing number of older adults are receiving HCT, but current pretransplant evaluations overlook the unique vulnerabilities that older adults face. Oncology-specific geriatric and frailty assessments provide a comprehensive evaluation of older adults, help better weigh the risks of HCT with patients, and guide personalized optimization...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Reena V Jayani Source Type: research

The range of haploidentical transplant protocols in sickle cell disease: all haplos are not created equally
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):532-541. doi: 10.1182/hematology.2023000486.ABSTRACTThe ideal curative therapy for sickle cell disease (SCD) must be applicable across all ages and include individuals with strokes and preexisting heart, lung, and kidney disease. Myeloablative, matched sibling donor hematopoietic stem cell transplant (HCT) for children with SCD has shown excellent outcomes over the past 3 decades but has been restricted due to the limited availability of a human leukocyte antigen-matched sibling donor (10%-15%) and increased treatment-related death in adults with myeloablative cond...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Adetola A Kassim Michael R DeBaun Source Type: research

How to classify risk based on clinical and molecular modeling: integrating molecular markers in the risk assessment of myelodysplastic syndrome
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):51-58. doi: 10.1182/hematology.2023000420.ABSTRACTMyelodysplastic syndrome (MDS), also known as "myelodysplastic neoplasm," is a heterogeneous group of clonal myeloid neoplasms that typically affects older adults. The clinical phenotype, symptoms, and complications relate to the depth of cytopenia and progression to acute myeloid leukemia (AML). The diagnosis of MDS relies on morphologic criteria, such as evidence of dysplasia, disordered maturation, and increasing blast counts, which separate the disease into histologic subtypes with different probabilities for pr...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Rena R Xian Source Type: research

A rational approach to functional high-risk myeloma
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):433-442. doi: 10.1182/hematology.2023000443.ABSTRACTMultiple myeloma is a clinically and biologically highly heterogeneous disease, as the overall survival can vary from more than a decade in patients with standard risk disease treated with intensive chemotherapy to 2-3 years in patients with high-risk features. The current staging systems, which rely on baseline biological risk factors to stratify patients into groups with differing risks of progression or death, are sometimes suboptimal tools for identifying high-risk patients. This is particularly evident when c...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Francesca Gay Giuseppe Bertuglia Roberto Mina Source Type: research

Richter transformation-is there light at the end of this tunnel?
This article reviews recent therapeutic developments, focusing on inhibitors of BTK, BCL2, the PD1-PDL1 axis, and T-cell-activating/engaging therapies. Herein, I discuss the importance of randomized clinical trials in a disease where small single-arm studies dominate; industry engagement, including the role of registrational studies; and the need to integrate prospectively planned correlative biological studies embedded within future clinical trials to help discover which patient benefits most from each class or combination of novel targets.PMID:38066897 | PMC:PMC10727096 | DOI:10.1182/hematology.2023000442 (Source: Hemato...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Toby A Eyre Source Type: research

Managing side effects: guidance for use of immunotherapies in multiple myeloma
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):348-356. doi: 10.1182/hematology.2023000435.ABSTRACTChimeric antigen receptor T-cell therapy and bispecific T-cell recruiting antibodies have transformed the treatment landscape for relapsed/refractory multiple myeloma, with B-cell maturation antigen being the most common target and other targets in clinical development. However, these therapies are associated with unique and severe toxicities, including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), delayed neurotoxicity, cytopenias, and infection. In addition, imm...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Emily C Liang Surbhi Sidana Source Type: research

How to avoid early mortality in acute promyelocytic leukemia
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):248-253. doi: 10.1182/hematology.2023000477.ABSTRACTAcute promyelocytic leukemia (APL), a phenotypically and genotypically unique subtype of acute myeloid leukemia, has seen unprecedented advances in its management since the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide. However, the phenomenal pharmacologic conversion of this once highly fatal disease to one with a long-term survival exceeding 90% among patients who survive induction remains impaired by the significant incidence of early death (ED) reaching 30% in some real-world studies. The...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Oluwatobi Odetola Martin S Tallman Source Type: research

Minimal intensity conditioning strategies for bone marrow failure: is it time for "preventative" transplants?
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):135-140. doi: 10.1182/hematology.2023000470.ABSTRACTHematopoietic cell transplantation (HCT) can cure blood dyscrasias and reduce the risk of hematologic cancers in patients with inherited bone marrow failure syndromes (IBMFS). However, because of its high mortality rate, HCT is generally reserved until patients with IBMFS manifest life-threatening cytopenias or myeloid malignancy, at which point outcomes are poor. Screening tests that accurately predict transformation and enable timely intervention are lacking. These unknowns and risks limit the use of HCT in pati...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Suneet Agarwal Source Type: research

Stem cell transplantation for ALL: you've always got a donor, why not always use it?
This article reviews critical current evidence and debates the potential of HSCT as a more universal treatment for ALL, reevaluating traditional treatment stratification in light of the constant availability of stem cell donors.PMID:38066901 | PMC:PMC10726989 | DOI:10.1182/hematology.2023000423 (Source: Hematology ASH Education Program)
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: David Shyr Kara L Davis Alice Bertaina Source Type: research

Long-term follow-up of CD19-CAR T-cell therapy in children and young adults with B-ALL
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):77-83. doi: 10.1182/hematology.2023000422.ABSTRACTThe tremendous successes of CD19-directed CAR T cells in children and young adults with B-cell acute lymphoblastic leukemia (B-ALL) has led to the more widespread use of this important treatment modality. With an ability to induce remission and potentially lead to long-term survival in patients with multiply relapsed/chemotherapy refractory disease, more children are now receiving this therapy with the hope of inducing a long-term durable remission (with or without consolidative hematopoietic cell transplantation). ...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Rebecca Epperly Nirali N Shah Source Type: research

Should older patients with low weight and CKD receive full-dose DOACs for treatment of acute proximal DVT?
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):614-616. doi: 10.1182/hematology.2023000515.NO ABSTRACTPMID:38066903 | PMC:PMC10727011 | DOI:10.1182/hematology.2023000515 (Source: Hematology ASH Education Program)
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Nicolas Gallastegui Camila Masias Source Type: research

How to diagnose and manage antiphospholipid syndrome
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):606-613. doi: 10.1182/hematology.2023000493.ABSTRACTAntiphospholipid antibodies (aPL) are autoimmune antibodies directed toward phospholipids or phospholipid-protein complexes, particularly those containing β2-glycoprotein I (β2GPI). Persistently positive aPL accompanied by arterial or venous thrombosis, or recurrent pregnancy loss, constitutes the antiphospholipid syndrome (APS). Several types of aPL with different specificities have been defined and may be detected in the clinical lab, including lupus anticoagulants (detected using clotting assays) and anticard...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Anne Hubben Keith R McCrae Source Type: research

Using disease-modifying therapies in sickle cell disease
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):519-531. doi: 10.1182/hematology.2023000485.ABSTRACTAs curative therapy using allogeneic hematopoietic stem cell transplantation as well as gene therapy and gene editing remains inaccessible to most patients with sickle cell disease, the availability of drug therapies that are safe, efficacious, and affordable is highly desirable. Increasing progress is being made in developing drug therapies based on our understanding of disease pathophysiology. Four drugs, hydroxyurea, L-glutamine, crizanlizumab, and voxelotor, are currently approved by the US Food and Drug Admin...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Parul Rai Kenneth I Ataga Source Type: research

The optimal management of relapsed and refractory Hodgkin lymphoma: post-brentuximab and checkpoint inhibitor failure
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):510-518. doi: 10.1182/hematology.2023000450.ABSTRACTThe treatment landscape of classical Hodgkin lymphoma has changed dramatically over the past decade. Relapsed and refractory mainstay therapeutics such as brentuximab vedotin (BV) and checkpoint inhibitors (CPIs) are being moved to earlier lines of therapy. However, the treatment of patients who progress after BV and CPI remains a challenge. Allogeneic stem cell transplantation still plays an important role in this patient population as the only current treatment approach with curative potential. Unfortunately, no...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Natalie S Grover Christopher Dittus Astha Thakkar Anne W Beaven Source Type: research