From 9th to 17st June, the Acute Leukemia Advocates Network (ALAN) attended the 27th European Hematology Association (EHA) congress, held for the hybrid, with a F2F part from 9th to 12th June and a virtual part from 15th to 17th June. We had the chance to be in Vienna for the F2F component as well as attending online when we came back.
Here is what we took away from the various sessions. The report was written by Rian.
Focus on AML
Novel treatment options and prognostic markers in AML
Hernandez-Sanchez, confirmed his finding on the NPM1 Mutated AML and its impact on patients, admitting it was linked to a higher chance of relapse and/or loss of life, although found to only effect a lower percentage of overall AML patients, whilst admitting more work would need to be done in these fields to conclude further the NPM1 mutation and its behaviours.
Following from this session Kuojui Sun, presented their findings on ST mutations. Confirming the ST mutation of de novo AML was present in 32.8% of patients, arguably though, this was more common in older patients (45%) in comparison to younger patients (24%). The mutation had an association with a lower white blood cell and blast count. The mutation is associated with a lower overall survival rate in most cases. It is suggesting that a Allo-HSCT could improve the outcome for older patients with the ST mutation.
Ruihao Huang, confirmed the promising discovery and continued research into CAR NK cell therapy, confirming its positive tolerability for relapsed and refactory AML patients, with positive anti-tumour efficacy aswell. It is also suggested an Allo-HCST could be a beneficial and promising consolidation treatment for this also.
Precision medicine in AML
Over the last 12 months there has been extensive research into the protocols around the current treatments for AML. The consensus is that a majority would like to seek more effective treatment options.
Harmut Dohner has admitted that there have been major advances in our knowledge of AML this year. Which is allowing us to update classification protocols and treatments.
A revised criteria is appearing from the European Leukemia Network (ELN) and it is expected more work and discovery is hopeful within these treatments to allow for further development of treatment. The speakers continued to discuss the likelihood of some new treatments and the hope that these treatments may give to those affected by AML in the future. It is a promising time for many, hope is the key word we took from these talks. Hope of further discoveries to compliment the current options and knowledge available.
Novel insights into AML treatments
Much research is being done into the improvement of life expectancy for those affected by AML. It is no secret that AML still holds a disappointing survival and relapse rate.
In new research a trial was conducted to test the other treatment plans in conjunction with the novel 3+7. Decitabine was found to be more or less similar in its results with the current 3+7 plan. Although it was found to have slightly more effective results with those over the age of 70 years.
Much work is being carried out to support the change of treatment protocols. Many are giving similar results with slights of hope dazzled into them. Below is a clinical trial result that was presented by Nigel Russell at EHA.
AML in elderly patients
It is clear from the findings that are more commonly emerging these days that understanding and knowledge of the biology of the disease is increasing massively. We are aware that the elderly are struggling more, and now understanding that this is because age leads to other biologies within the genes that has led to epigenomes. However, whilst boosting research we have found one major change help this research the most, and that is uniting within Europe has helped us understand the changes in the disease and identify the changes in outcomes and what impacts that.
We want to now move and focus on the micro factors of AML to help us cure AML in elder patients. This appears to be a clear focus for many at this time in research and development.
CD123-CD33 Compound Car-T Cells with novel antigen binding domains provide a new hope for the treatment of AML.
Work has been researched into in a hope of attempting to improve the outcome of relapsed and refectory AML via Car-T therapy. AML has a notoriously bad reputation for its 5-year non-relapse/ survival rate. The AML antigens that were found most affected by this form of treatment (CD123 & CD33) are present in around 95% of AML patients. Testing therapies have almost doubled the survival rates in preclinical trials.
Patients with AML belong to the highest risk group for developing invasive fungal disease (IFD) at diagnosis or during treatment course. Relevant entities of IFD in this population include invasive candidiasis and candidemia mostly acquired through fungal translocation of commensal yeasts from the lumen of the gastrointestinal tract via the mucosal barrier, whereas invasive mold infections are acquired through airborne inhalation of fungal conidia, airway germination, and subsequent dissemination. These entities affect profoundly neutropenic patients.
To address those questions, EHA gathered an expert group in 2019 to give recommendations for clinical management in cooperation with the Cochrane Haematology Group. For the resulting guideline, studies including all relevant novel-targeted agents and antifungal agents were reviewed, summarized and—depending on available studies—evidence-based or consensus-based recommendations were phrased.
Summary of Recommendations Regarding Antifungal Prophylaxis for Clinically Relevant Antileukemic Drugs can be found here: summary of recommendations
Focus on ALL
Novel Treatment Insights into ALL
Peihua Lu presented a novel and successful CD7 gene knockout CAR-T therapy, with particular focus for relapsed or refractory T-Cell hematologic malignancies. This is known for having a higher level of relapse. It demonstrated a success in KO7CAR-T therapy having a high efficacy for CD7+ T-cell malignancies, I feel the most positive news from this would be the success it had in those who had relapsed even post transplant, something that can be a great fear for many patients. It was confirmed, however, that when CD7 was lost in relapse, patients often had a poorer outcome.
Following on from this Nicholas Short extended the results found in a research trial that was conducted to discuss and research the use of Ponatinib and Blinatumomab for patients with Philadelphia chromosome positive acute lymphoblastic leukaemia. These were updated results from a second phase study. Concluding it’s safety and efficacy. Most interestingly they only transplanted one of the patients from within the trial and no patients had since relapsed. This shows more hope on the future of treatment.
MRD use in adult ALL
This interesting talk showed and took us through the reality and current use and understanding of MRD in Adult ALL cases:
- MRD’s main use currently is the positional use of post consolidation therapies.
- Use of immunology therapies in MRD positive and B-cell positive cases is likely to decrease chances of relapse and be a positive force for overall survival in these cases.
- Ph positive ALL targeted and immune therapy has shown clear decreases on the MRD levels.
Quality of life and health economics in hematological patients
We were so happy to see the support and talk being raised for those who are not able to be put forward for transplant. It is important we are able to offer options to all and Mattia D’Agostino concluded this with the below.
During the acute leukemia day, we uncovered the hope for many new treatments and ideas around acute leukemia and the hope to improve the likelihood of non-relapse and also the mortality for the diseases around it.
It became apparent that CAR-T cell therapy was becoming quite favourable within the industry. Particularly for those who are in the higher risks. Though it was heavily reminded that this is not a ‘cure all’ it is merely more hope when accompanied by other treatments also.
Immuno-therapy has become a very popular choice of research around combination of immunotherapy and chemotherapy to help reduce the risk of relapse in some forms of acute leukemia. It will be an interesting future, and only research will give us answers to what we ask, but we as I am sure many others, have come away from the EHA conference with hope and intrigue.
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Additional resources to check
Recommendations for the top abstracts to look out for in AML. See post here: https://aml-hub.com/medical-information/eha2022-abstracts-what-s-hot-in-aml
Recommendations for the top abstracts to look out for in ALL. See post here: https://lymphoblastic-hub.com/medical-information/eha-2022-abstracts-what-s-hot-in-all