This ASH meeting was filled with great oral abstract presentations. Facing an audience thirsty for blood (research), our gladiators traveled from faraway lands to the San Diego “Conference Colosseum.” They came clad in business attire, armed with laser pointers, intimidating their opponents through the length of their ribbons. They have already triumphed over great odds, as thousands of abstracts are regularly submitted to the premier event in our field, but only a few are selected. Bravely taking to the podium, the lead authors faced their fears, displayed their scientific skills, and stood their ground, despite the occasional “more of a comment than a question.”
Now that #ASH24 has ended, like emperors Geta and Caracalla in Gladiator II, these ASH News Daily authors have become drunk with power, as we decide which of the oral abstracts will receive the coveted “Golden Globule” awards and which will remain in the dark corners of the online meeting supplement. At our pleasure, through totally arbitrary criteria, we have again chosen to focus on patient-centered, clinically actionable efforts that can be implemented in a wide range of practice settings. This time we have focused on patients with mature lymphoid disorders (yes, that also includes plasma cells), with a dash of hematopoietic cell transplant and cell therapy.
Starting with mature lymphoid neoplasms, a Golden Globule is awarded to Abstract 397, which has shown us the prevalence, genetic predispositions, and clinical consequences of non-chronic lymphocytic leukemia (CLL)-type monoclonal B-cell lymphocytosis in more than 10,330 individuals, a condition that affects millions of people worldwide. In Hodgkin lymphoma, the use of pembrolizumab maintenance instead of autologous transplant for patients with relapsed or refractory disease who received pembrolizuab plus gemcitabine, vinorelbine, and liposomal doxorubicin was eagerly awaited. Abstract 569 demonstrated a two-year progression-free survival (PFS) of 51%, with questions regarding the optimal sequencing of treatment. Abstract 652 argued that you get more bang for your buck using polatuzumab vedotin in relapsed/refractory non-germinal center type diffuse large B-cell lymphoma determined by the Hans algorithm — a finding originally described in newly diagnosed patients with the pola-R-CHP backbone (polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone). Abstract 588, displaying the bold title “Curing CLL,” was favored by fortune with a Golden Globule, as all patients who received CD19 chimeric antigen receptor (CAR) T cells and achieved one year without disease progression remained progression-free for more than five years of follow-up. Finally, we recognize the efforts in conducting randomized clinical trials with older chemotherapy agents in this era for patients with a large granular lymphocyte leukemia. Abstract 979 favored the use of cyclophosphamide over methotrexate as a first-line therapy, adding valuable data to this under-represented disease.
In the plasma cell neoplasm category, we have given a Golden Globule to the updated results of the Andromeda study, which has proven that, in patients with light chain amyloidosis, the use of daratumumab in addition to bortezomib, cyclophosphamide and dexamethasone improves overall survival (Abstract 891). The IFM2017-03 trial also deserves recognition for studying a dexamethasone-free regimen in frail patients with newly diagnosed multiple myeloma, yielding better outcomes using the alternative daratumumab and lenalidomide (Abstract 774). Finally, we award a Golden Globule to the investigators who have liberated patients with multiple myeloma from constant 24-hour urine collections (Abstract 81), where no relevant impact in responses or PFS was observed in 636 patients.
In transplant and cell therapy, we have awarded a Golden Globule for the Blood and Marrow Transplant Clinical Trials Network 1702 study, which proved that survival of transplant candidates is similar regardless of their likelihood of finding an 8/8 human leukocyte antigen-matched unrelated donor in the era of alternative donors (Abstract 695). The Composite Health Risk Assessment Model (CHARM) is also recognized for being able not only to predict non-relapse mortality but also to predict risk of functional and cognitive decline in survivors of allogeneic transplantation (Abstract 685). For prevention of graft-versus-host disease, a Golden Globule is also awarded to the investigators who developed a positive phase III randomized controlled trial studying low-dose ruxolitinib in patients who receive haploidentical hematopoietic cell transplantation using anti-thymocyte globulin without post-transplant cyclophosphamide (Abstract 1044). Finally, a Golden Globule is awarded to Abstract 608, which showed comparable outcomes using point-of-care versus commercial CD19 CAR-T cell therapies in large-B cell lymphoma, shining a light on an alternative manufacturing strategy that will be key for the implementation of this technology throughout the world.
Thus, the Golden Globules come to an end. The reader may find the comparison of abstract presenters to gladiators dramatic, but we must remember that unlike the gladiators of old, it is not our survival that is at stake, but the lives of others. To improve them, there are an infinite number of clinical questions that we can ask, but only a small number that can be answered. And so, we should do well to remember the words of Maximus Decimus Meridius: “What we do in life, echoes in eternity.” Here, investigators who have asked the important questions are recognized.
