Advances in technology help improve safety and access to blood cancer therapies 

Four clinical trials presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition illustrate how advancements in technology are contributing to an improved outlook for many patients with blood cancers.

“These studies tie together different approaches bringing technological improvements to bear on therapeutic innovation and improving patient safety,” said Prof Wendy Stock, Anjuli Seth Nayak Professor of Medicine, University of Chicago Medicine, US, who moderated the press briefing ‘The next wave of innovation: Breakthrough blood cancer trial findings’.

“They also show how new drugs and technologies can reduce toxicity and make curative therapies feasible and accessible to a broader population of patients.”

The first study suggests that patients with chronic lymphocytic leukaemia do not necessarily need to remain on therapy indefinitely, as fixed-duration combination treatments resulted in outcomes that were non-inferior to continuous treatment with a single agent. The study compared continuous ibrutinib alone versus an approximately one-year course of either venetoclax and ibrutinib or venetoclax and obinotuzumab.

The second and third studies point to the power of using sensitive tests for detection of measurable residual disease (MRD) as an early predictor of outcomes and to inform treatment decisions in patients with acute leukaemias.

In the second study, MRD positivity following two cycles of intense chemotherapy was found to be strongly associated with worse outcomes among patients with acute myeloid leukaemia (AML), regardless of MRD assessment method. The results could help guide the adoption of MRD as a biomarker to inform patient care, and the study also provides evidence for the use of MRD as an early surrogate endpoint of survival for clinical trials in AML.

The third study used MRD testing to identify patients at very low risk of relapse after initial treatment for B-cell acute lymphoblastic leukaemia and then assessed outcomes from different conditioning regimens before hematopoietic cell transplantation. Patients had similar outcomes with chemotherapy-based conditioning versus total body irradiation, suggesting that patients who are low-risk can safely avoid the long-term side-effects of total body irradiation with a chemotherapy-based regimen.

In the final study, researchers found that receiving a post-transplant cyclophosphamide-based graft-versus-host disease prevention strategy can overcome the negative effects previously associated with receiving a bone marrow transplant from an unrelated and genetically mismatched donor. Based on the findings, researchers say many patients could safely receive transplants from a much broader pool of potential donors, improving access to this curative therapy.