The tables have turned. Once barren, the therapeutic field for hematologic malignancies is now flourishing. Many patients who once faced the bleak prognosis of “no chance for a cure” now have access to curative options or the possibility of achieving long-term remission. Today’s Education Program sessions spotlight these promising advancements, offering a glimpse into future treatment and care.
Acute myeloid leukemia (AML) is a prime example of progress. Advances in next-generation sequencing have shifted the classification of AML from a purely morphologic system to one based on underlying genetic alterations. This change allows for better monitoring of treatment efficacy through measurable residual disease (MRD). The session AML M&Ms: How to Integrate Mutations and MRD Data (9:30 a.m. - 10:45 a.m., Manchester Grand Hyatt, Seaport Ballroom ABCD) dives deeper into this topic.
“Issues such as which patients should receive intensive versus lower-intensity combinations, which patients should be recommended to proceed with a stem cell transplant in first remission, when to stop therapy, and how to choose a treatment when there are now multiple approved treatment options will be discussed,” said session chair Courtney D. DiNardo, MD, MSc.
A key challenge in AML is the TP53 gene mutation, which significantly impacts prognosis. Patients with this mutation typically survive only five to 10 months, underscoring the urgent need for effective treatments. Handling Bad News: How to Best Manage TP53 Myeloid Disease? (4:00 p.m. - 5:15 p.m., Manchester Grand Hyatt, Grand Hall D), chaired by Daniel C. Link, MD, will provide an overview of non-transplant therapeutic approaches and allogeneic hematopoietic transplant options for treating TP53-mutated myeloid disease.
While AML presents unique challenges, the future for classic Hodgkin lymphoma (cHL) is here, with immunotherapy now integrated into frontline treatment for advanced disease. These advances will be covered in Moving the Needle in Hodgkin Lymphoma (9:30 a.m. - 10:45 a.m., Marriott Marquis, Pacific Ballroom Salons 15-17). Ryan C. Lynch, MD, will discuss a recent study in the New England Journal of Medicine1 that has established nivolumab plus doxorubicin, vinblastine, and dacarbazine (N+AVD) as the new standard of care, demonstrating superior progression-free survival compared to brentuximab vedotin plus AVD (BV+AVD).
So, where does brentuximab fit into this picture? “While expert guidelines are shifting to recommend [N+AVD] as the preferred initial treatment for advanced disease, [BV+AVD] remains important for patients who cannot receive nivolumab, such as those with autoimmune diseases, nivolumab intolerance, or lack of response,” said Ranjana H. Advani, MD. However, she added, "given the excellent outcomes and safety profile seen in elderly patients treated with [N+AVD], this regimen has undoubtedly moved the needle in cHL, improving cure rates.”
In the same session, Miguel-Angel Perales, MD, will discuss the role of allogeneic stem cell transplant for relapsed/refractory cHL, recommending it for patients who progress after checkpoint inhibitors.
Similarly, multiple myeloma is seeing rapid therapeutic advances. Newly Diagnosed Multiple Myeloma: Many Choices and More Questions (2:00 p.m. - 3:15 p.m., Marriott Marquis, Pacific Ballroom Salons 24-26), chaired by Shaji Kumar, MD, will focus on the evolving landscape of upfront treatment for multiple myeloma, highlighting quadruplet therapies and the increasing segmentation based on frailty, rather than the traditional, artificial definition of transplant eligibility. The key takeaway, according to Dr. Kumar, is that treatment intensity must align with a patient's frailty and functional status.
What is the position of autologous stem cell transplant (ASCT) in the era of chimeric antigen receptor T-cell (CAR-T) therapy moving up the ladder in treatment protocols? “ASCT remains a crucial initial treatment for multiple myeloma, supported by over three decades of phase III trials,” Dr. Kumar said. “Whether CAR-T can replace ASCT will depend on upcoming phase III trial results. However, CAR-T is no longer seen as a one-time solution but will likely be explored alongside maintenance treatments. Given the potential for significant toxicity with CAR-T, we need to tread carefully and explore its use in situations where ASCT does not yield good results, such as high-risk cases or lack of MRD negativity after ASCT."
As advances in multiple myeloma treatment continue, it is important to address the often-overlooked precursor condition monoclonal gammopathy of undetermined significance (MGUS). While typically benign, MGUS can sometimes cause significant symptoms affecting the skin, kidneys, and nervous system. Monoclonal Gammopathies: When the Clone Is More Than a Positive Laboratory Finding (4:00 p.m. - 5:15 p.m., Marriott Marquis, Pacific Ballroom Salons 21-22) will focus on diagnostic and follow-up strategies, renal disorders linked to MGUS (including monoclonal gammopathy of renal significance), and monoclonal gammopathy of neurological significance, with a focus on simplifying diagnosis and management.
These sessions are just the appetizers; there are also main-course sessions on other hematologic malignancies that will cater to your specific taste. Whether you are an early-career physician or a specialist focused on a single disease, staying abreast of the nuances of blood cancers is key to advocating for better patient care, driving research forward, and inspiring hope for those affected by these conditions.
1Herrera AF, LeBlanc M, Castellino SM, et al. Nivolumab+AVD in advanced-stage classic Hodgkin’s lymphoma. N Engl J Med. 2024;391(15):1379-1389.
