Highlights from the British Society for Haematology Annual Meeting 2018
Last week, I spent three days at the BSH Annual Meeting in Liverpool along with another member of the Bloodwise research team. Below I’ve summed up the highlights of the Meeting, including news on the Bloodwise-funded DESTINY trial and an exciting study in Cardiff where chemotherapy is being taken nearer to people’s homes.
Successfully de-escalating and stopping treatment for chronic myeloid leukaemia
The Bloodwise-funded DESTINY trial, run by Professor Richard Clark at the Royal Liverpool University Hospital, is designed to test whether some people with chronic myeloid leukaemia (CML) can safely stop taking the drugs, tyrosine kinase inhibitors (TKIs), that keep the CML under control. People with CML have to take TKIs for life, and they can have unpleasant side effects such as nausea and fatigue, so being able to stop taking them will improve quality of life for many people.
Professor Clark reported some new findings from the 2-year point of the trial: at this point, those taking part had been on a lower dose of TKIs for a year and then stopped taking them entirely for the next year, unless the CML recurred. The team had looked at people with two different levels of remission, measured by detecting the level of a particular gene found in CML cells, and measured the number of people in each group who had recurrence-free survival (i.e. their cancer did not come back).
The new findings showed that 76% of people who were in deep remission (lower levels of the CML gene) and 39% of those with the higher levels of the CML gene were still disease free after stopping their TKIs for a year. This is exciting news – until now it was not known how people with higher levels of the CML gene would respond to de-escalating and stopping TKIs, and it means that a large group of people with higher levels of the CML gene may be able to stop taking TKIs and improve their quality of life. Please note, if you have CML, you should consult your healthcare team before stopping TKI treatment as it would need to be done under careful supervision from medical professionals.
Professor Clark’s team has continued to follow up people taking part in the trial. We should see the 3 year findings soon, so watch out for further news!
Developing new drug combinations for chronic myeloid leukaemia
Another CML research highlight was presented by Felix Warren, a PhD student at the University of Glasgow working on a Bloodwise-funded project. He is working on a potential new drug for CML, called idasanutlin. In contrast to TKIs, which work by stopping cancer cells from growing, idasanutlin works by restoring the function of a protein called p53. This protein usually helps prevent cancer from happening in healthy cells, but is often lost in cancer cells. By restoring the protective p53 protein, CML cells end up dying. In this project, the combination of idasanutlin and nilotinib (a TKI) is being tested on samples of CML cells and healthy cells. The results are very promising: the combination of drugs works better than either drug does alone, and selectively kills off CML cells but not healthy cells. These findings could help form the basis for a clinical trial.
Making stem cell transplants available to more people
When someone has a stem cell transplant (STC), one of the major considerations is whether the donor and recipient are a good genetic match. If this is not the case, it makes it more likely that the donor cells will attack recipient cells, causing graft-versus-host disease, which can be life-threatening. About a third of people who are eligible for an STC are unable to have one because no suitable matched donor can be found.
The Bloodwise-funded UK Haplo trial, led by Dr Kavita Raj at University College London, tested whether STCs from slightly less good genetic matches could be safely given in combination with cyclophosphamide (a chemotherapy drug). After one year, about 1 in 5 people taking part had developed graft-versus-host disease, but that this was not responsible for any deaths. Though further follow-up is needed, these results indicate that it would be safe to use Dr Raj’s procedure for people who might otherwise not be able to have a stem cell transplant.
Moving chemotherapy for lymphoma out of the hospital
Some people with lymphoma receive chemotherapy via injection, and some through an IV drip. The IV drip method can be very time-consuming and, so when the University Hospital of Wales in Cardiff switched from giving injections to giving IV chemotherapy, the outpatient chemotherapy unit did not have enough capacity to treat everyone. In response to this, lymphoma nurse specialist Charlotte Bloodworth and her team devised a way to give people treatment in places nearer their homes – either in a mobile unit, or in a local hospital (this project was not funded by Bloodwise).
While this meant some large changes for the team, including providing nurses with extra training so that they felt confident to administer chemotherapy away from the main hospital, the project was a resounding success. People receiving treatment were very pleased with the reduced travel times and waiting times that resulted. Charlotte and her team are now planning to expand capacity in the mobile unit and local hospital, to further free up capacity at the University Hospital of Wales that can be given over to clinical trials.
Other highlights in brief
CAR-T therapy was a hot topic, with Professor Peter Borchmann and Dr Stephen Robinson debating whether it would become the standard of care for relapsed high-grade B-cell lymphomas in the next five years. CAR-T works by isolating white blood cells called T-cells from the blood of someone with blood cancer, engineering them in the lab so that they are better able to recognise and kill cancer cells. Because it is highly tailored, it is effective, but also expensive and time-consuming, and it is so new that not much is known about the long-term safety of this therapy. Both speakers argued convincingly, with the result that Dr Robinson’s against position won very narrowly: 51% to 49%.
As well as blood cancers, haematologists deal with other diseases of the blood such as thrombosis and anaemia. Trainee haematologists working on a variety of diseases presented their answers to the question ‘How do haematologists do most harm to patients?’ in front of a packed room. Topics ranged from the stigmatism associated with having sickle cell anaemia (Dr Sonia Wolf, the eventual winner of the debate) to the psychological problems – such as anxiety and loneliness – of protective isolation for people who are susceptible to infections, for example those who have recently had a stem cell transplant (Dr Gerado Errico).