Liz Burtally
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What’s been happening at the European Hematology Association Congress 2018

Liz Burtally
Posted by
15 Jun 2018

One of the biggest haematology events of the year has kicked off in Stockholm. Highlights so far include new research on CAR-T therapy and folllicular lymphoma

A banner on display at European Haemotology Association Congress. The banner reads EHA

Greetings from Stockholm, Sweden – the land of the midnight sun! I’ve been at the European Hematology Association (EHA) congress in Stockholm just over 24 hours, but so much has happened already.

What’s all the fuss about immunotherapy?

One of blood cancer’s hottest topics at the moment has been reflected in EHA’s theme this year: ‘immunotherapy, frontiers in hematology’.

A close-up of a T cell

Immunotherapy – drugs that direct the body’s own immune response to kill cancer cells – is certainly making waves.

CAR-T therapy has been big on the agenda, and I was lucky hear lots of discussion around this exciting new development.

Prof Borchmann from the University Hospital of Cologne told us that now, around 80% of people with diffuse large B cell lymphoma (DLBCL) respond well to standard first line treatment. This is made up of rituximab (a type of immunotherapy that targets CD20 on the surface of lymphoma cells) and chemotherapy. But when people relapse after this treatment, it gets harder and harder, and chances of survival are radically cut as different treatments are tried and fail. This is where CAR-T therapy makes an appearance.

CAR-T therapy is a new type of immunotherapy, where a patient's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells.

How CAR-T therapy works

How CAR-T therapy works

In many people with DLBCL who were not responding to treatments, CAR-T therapy has had remarkable effects, and has taken patients who only had months to live into remission. Because of this, two new CAR-T therapies (Kymriah and Yescarta) were approved in the US, and we are now on the cusp of these being approved in the UK this year.

But there are still issues that we need to address with CAR-T therapy.

Doctors say safety can be a concern, with side effects called ‘cytokine storms’ and neurological (confusion, loss of memory etc) happening within the first 30 days. Cytokine storms are where CAR-T cells unleash massive amounts of proteins called cytokines, which stimulate other elements of the immune system to attack the cancer cells. This can cause flu like symptoms, such as high fevers and extreme fatigue, but also difficulty breathing, and a sharp drop in blood pressure. Cytokine storms luckily can be dealt with by giving the patient an antibody to counteract the affects, and steroids can be given to stop the neurological issues. And thankfully, doctors are also beginning to understand what patients are more likely to get these effects, and are starting to think of ways to deal with this.

Other issues discussed in the session were cost, logistics of providing the therapy and will everyone be able to administer CAR-T? Prof Borchmann hopes the price will come down once the competition hots up from the pharmaceutical companies, and as CAR-T gets rolled out into the health care system, upscaling and future innovations are sure to happen.

With all this to take in, there has also been talk on where CAR-T therapy may sit in the future treatment line for DLBCL. Should we be thinking about treating people that we know are high risk of relapsing (based on the genetic and biological make-up of their lymphoma)? Only time will tell.

A presentation slide explaning how CAR-T therapy works

Prof Neelapu’s presentation on where CAR-T treatment could sit in the future treatment line of DLBCL (MD Anderson Cancer Center, US).

Follicular lymphoma current perspectives and future directions

Follicular lymphoma is a slow growing blood cancer, but it remains incurable despite advances in understanding the biology of the disease, and there being more targeted treatments available.

Wanting to find out what was holding things up, I headed a session where experts discussed the barriers to improvements in follicular lymphoma, and what was being done to overcome these.

A presentation slide exploring follicular lymphoma

It turns out that the outlook for follicular lymphoma has really improved thanks to establishing the standard treatment of rituximab and chemotherapy. Young patients can now expert to survive for years. Trials are still going on which want to see if replacing standard chemotherapy with more targeted treatments like lenalidomide improves things further.

There’s also the question of when you start therapy. Many patients are placed on ‘watch and wait’ if they have no symptoms or signs of progression. Doctors think that giving rituximab on its own may be an alternative for these patients. For people with more advanced disease, there is talk of giving three therapies at once (triplet therapy), which has shown promise in other blood cancers like myeloma (see our ASCO round up blog). Triplets tried have been combinations of targeted drugs: rituximab, ibrutinib, lenalidomide and idelalisib. But unfortunately, in follicular lymphoma the side effects like rash and stress to the liver are too severe.

For the future treatment of follicular lymphoma, experts say we need to find distinct treatment strategies based on the biology and risk of each individual because there are so many effective treatments now available. With this, there is promise that doctors are moving away from chemotherapy-based treatment as more targeted drugs become available. This is also becoming apparent for other slow growing blood cancers like chronic leukaemia.

Pick a winner – the LI-1 AML trial

Dr Mike Dennis from Cardiff University presented some results from the Bloodwise LI-1 trial. This trial is looking at adding tosedostat to standard low dose chemotherapy helps elderly people with AML and high risk MDS. Tosedostat is a targeted drug that prevents cancer cells from reproducing.

Professor Mike Dennis presents at the European Hematology Association Congress

LI-1 has a ‘pick a winner’ trial design, which means that you can evaluate very quickly in a trial what treatments are beneficial, and you can rule out and stop the drugs that don’t work early in the process.

Sadly, despite promising early results, adding tosedostat to chemotherapy didn’t improve survival in this group of patients. Even though negative results are disappointing in clinical trials, they are really important in guiding next steps, making sure doctors do not pursue treatment avenues that won’t improve the current outlook for patients.

Find out more about this trial and the other treatments that were tested.

EHA continues until 17 June. I'm tweeting live from EHA, so if you want to keep up to date with what is happening, follow Bloodwise Research on Twitter. If you are lucky enough to be at EHA wave and say hello!

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