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
Selection of bispecific antibody therapies or CAR-T cell therapy in relapsed lymphomas
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):370-381. doi: 10.1182/hematology.2023000438.ABSTRACTPatients with relapsed and refractory (R/R) aggressive B-cell non-Hodgkin lymphomas have historically poor survival outcomes, with chimeric antigen receptor T-cell (CAR-T) therapy now presenting a curative option for a subset of those patients. However, with the approval of several novel bispecific monoclonal antibody (BsAb) therapies with considerable activity in R/R aggressive large B-cell lymphomas (LBCL), patients and oncologists will be faced with decisions regarding how to sequence CAR-T and BsAb therapies b...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Ajay Major Manali Kamdar Source Type: research
Management of aggressive lymphoma after CAR T-cell therapy failure
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):364-369. doi: 10.1182/hematology.2023000437.ABSTRACTSeveral recent advances have affected the treatment landscape of diffuse large B-cell lymphoma. Chimeric antigen receptor (CAR) T-cell therapy has transformed the management of chemorefractory disease. Two randomized studies in early relapse disease have expanded the label to provide access to CAR T-cell therapy as early as second line for some patients. Despite the durable remissions that have been achieved, many patients will experience relapse. There is a growing population of patients previously treated with C...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Loretta J Nastoupil Swetha Kambhampati Source Type: research
Acute leukemias and complicated lymphomas: pearls to optimize management when patients stay local
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):311-317. doi: 10.1182/hematology.2023000430.ABSTRACTHematologic malignancies often present acutely with a constellation of infectious complications, pancytopenia, tumor lysis, and renal dysfunction. Acute leukemias and aggressive lymphomas often require hospitalization for rapid diagnostic evaluation, urgent management of complicating presentations, and timely management of intensive systemic therapies. There is an emerging paradigm whereby complex cancer care can be safely and effectively provided in the community, where the majority of cancer is treated. A substa...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Dipti Patel-Donnelly Mitul Gandhi Source Type: research
How to manage splanchnic vein thrombosis in patients with liver disease
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):281-288. doi: 10.1182/hematology.2023000481.ABSTRACTLiver cirrhosis and splanchnic vein thrombosis (SVT) are strictly correlated. Portal vein thrombosis, the most common location of SVT, is frequently diagnosed in liver cirrhosis (pooled incidence 4.6 per 100 patient-years), and liver cirrhosis is a common risk factor for SVT (reported in 24%-28% of SVT patients). In cirrhosis-associated SVT, anticoagulant treatment reduces mortality rates, thrombosis extension, and major bleeding, and increases the rates of recanalization, compared to no treatment. Achieving vesse...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Nicoletta Riva Walter Ageno Source Type: research
Pyruvate kinase activators: targeting red cell metabolism in thalassemia
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):114-120. doi: 10.1182/hematology.2023000468.ABSTRACTThalassemia is an inherited red blood cell disorder whereby the qualitative and/or quantitative imbalance in α- to β-globin ratio results in hemolysis and ineffective erythropoiesis. Oxidative stress, from the precipitated excess globin and free iron, is a major factor that drives hemolysis and ineffective erythropoiesis. Pyruvate kinase activity and adenosine triphosphate availability are reduced due to the overwhelmed cellular antioxidant system from the excessive oxidative stress. Mitapivat, a pyruvate kinase...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Kevin H M Kuo Source Type: research
CAR T-cell therapy in aggressive lymphomas-identifying prognostic and predictive markers
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):357-363. doi: 10.1182/hematology.2023000436.ABSTRACTWe discuss different pre-infusion, post-infusion and post-CAR T-cell relapse prognostic factors influencing the outcomes of anti-CD19 CAR T-cell therapy in patients with relapsed or refractory large B-cell lymphomas. Despite the overall positive results of anti-CD19 CAR T-cell therapy, a significant percentage of patients relapse. We summarize the efforts made to identify predictive factors for response and durable remissions and survival. In the pre-infusion setting, the patient-related factors discussed include ...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Alberto Mussetti Nicole Fabbri Anna Sureda Source Type: research
Clonal hematopoiesis in frequent whole blood donors
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):299-304. doi: 10.1182/hematology.2023000483.ABSTRACTHealthy volunteer donors are committed to contributing key medical resources. Repeated, regular donation of whole blood represents a specific trigger of hematopoietic stress. Hematopoietic stem cells (HSCs) are known to respond to environmental triggers by altering their differentiation and/or proliferative behavior. This can manifest in long-term changes in the clonal dynamics of HSCs, such as the age-associated expansion of HSCs carrying somatic mutations in genes associated with hematologic cancers-that is, clo...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Darja Karpova Source Type: research
Clonal evolution in inherited marrow failure syndromes predicts disease progression
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):125-134. doi: 10.1182/hematology.2023000469.ABSTRACTProgression to myelodysplastic syndromes (MDS) and acute myeloid leukemia is one of the most serious complications of the inherited bone marrow failure and MDS-predisposition syndromes. Given the lack of predictive markers, this risk can also be a source of great uncertainty and anxiety to patients and their providers alike. Recent data show that some acquired mutations may provide a window into this risk. While maladaptive mechanisms, such as monosomy 7, are associated with a high risk of leukemogenesis, mutation...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Kristen E Schratz Source Type: research
Understanding differential technologies for detection of MRD and how to incorporate into clinical practice
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):682-690. doi: 10.1182/hematology.2023000454.ABSTRACTPatient- and leukemia-specific factors assessed at diagnosis classify patients with acute myeloid leukemia (AML) in risk categories that are prognostic for outcome. The induction phase with intensive chemotherapy in fit patients aims to reach a complete remission (CR) of less than 5% blasts in bone marrow by morphology. To deepen and sustain the response, induction is followed by consolidation treatment. This postremission treatment of patients with AML is graduated in intensity based on this favorable, intermedia...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Jacqueline Cloos Lok Lam Ngai Michael Heuser Source Type: research
Are transplant indications changing for myelofibrosis?
Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):676-681. doi: 10.1182/hematology.2023000453.ABSTRACTMyelofibrosis is a devastating myeloid malignancy characterized by dysregulation of the JAK-STAT pathway, resulting in splenomegaly, constitutional symptoms, anemia, thrombocytopenia, leukocytosis, and an increased likelihood of progression to acute leukemia. The only curative option is allogeneic stem cell transplantation. The numbers of transplants have been increasing every year, and although there have been improvements in survival, there remain many unanswered questions. In this review, we will evaluate patie...
Source: Hematology ASH Education Program - December 9, 2023 Category: Hematology Authors: Jeanne Palmer Source Type: research
