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NCCN 8th Annual Congress: Hematologic Malignancies™

By Rashmi Kumar, PhD, Oncology Scientist/Senior Medical Writer

On Friday, September 20, and Saturday, September 21, 2013, the National Comprehensive Cancer Network® (NCCN®) hosted its 8th Annual Congress: Hematologic Malignancies™ at the Marriott Marquis in New York, NY.

Moderated by Andrew D. Zelenetz, MD, PhD, Memorial Sloan-Kettering Cancer Center, chair of the NCCN Guidelines panel for Non-Hodgkin's Lymphomas (NHL), this year's Congress focused on the new approaches to patient management and updates that have been incorporated into the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for hematologic malignancies and associated supportive care regimens. Nearly 700 oncology professional attended the event, which featured expert speakers representing the NCCN Member Institutions.

Friday's session commenced with a welcome reception for attendees, followed by opening remarks from Dr. Zelenetz.

In the opening presentation, "Genomics and the Era of Personalized Medicine", Ross Levine, MD, Memorial Sloan Kettering Cancer Center, presented data on genomic profiling of leukemias and talked about the implications of this genomic data in personalized medicine. Dr. Levine shared data from recent whole genome sequencing and gene array based studies that have identified novel commonly recurring disease alleles/mutations in acute myeloid leukemia. Clinical and biologic relevance of these novel disease alleles is yet to be determined.

The presentations following Dr. Levine's presentation focused on management and molecular monitoring of leukemias such as Chronic Myeloid Leukemia (CML) and Acute Lymphoblastic Leukemia (ALL). In the presentation, "TKI Therapy in CML: Practical Considerations," Michael Millenson, MD, Fox Chase Cancer Center, discussed the challenges related to management of patients with CML on tyrosine kinase inhibitor (TKI) therapy, such as selection of optimal agents, determining patient prognosis, and appropriate monitoring strategy while on therapy. Dr. Millenson also outlined strategies for maximizing adherence and management of side effects of TKI therapy.

Neil P. Shah, MD, PhD, UCSF Helen Diller Family Comprehensive Cancer Center, reviewed the data on the prognostic significance of monitoring molecular response to TKI therapy in patients with CML. Dr. Shah pointed out that, in both CML and ALL, rapid molecular response is associated with superior outcomes; however, standardization of molecular monitoring is essential to reliably interpret and apply molecular test results.

Friday's session concluded with a presentation by Patrick A. Brown, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, titled, "Management of Ph-positive ALL." Dr. Brown outlined the current standards of care for first-line treatment of Ph-positive ALL in the adolescent, young adult, and adult patients, pointing out that, although the optimal duration of TKI therapy is not defined, incorporation of TKIs has markedly improved outcomes of patients with Ph+ ALL.

Day two of the Congress included 14 presentations from the country's leading experts, including the latest advancements and best practices across the continuum of care for hematologic malignancies.

"Management of Relapsed/Refractory Multiple Myeloma," presented by Kenneth C. Anderson, MD, Dana-Farber/Brigham and Women's Cancer Center, included review of data leading to the approval of pomalidomide and carfilzomib as therapies for relapsed/refractory myeloma. Dr. Anderson also described the future landscape for treatment of Myeloma with the exciting potential of new classes of agents, including vaccine therapy, monoclonal antibodies, and new rationally based combination therapies to further improve and extend the lives of patients with Myeloma. Dr. Anderson concluded his talk, noting that genome sequencing efforts are underway to define the basis for the evolution of underlying relapse, identify new targets, molecularly classify a patient, and personalize therapy.

Following Dr. Anderson's presentation, Noopur Raje, MD, Massachusetts General Hospital Cancer Center, discussed the latest advancements in the management of bone health in Multiple Myeloma, which, she noted, remains a major source of morbidity and has an impact the quality of life in this patient population. After discussing how best to assess the skeletal–related events using the standard imaging techniques, Dr. Raje outlined the benefits and risks of bisphosphonates and surgical options for treatment of myeloma-related bone disease. She overviewed clinical trial data showing the equivalence of pamidronate versus zoledronic acid and the survival advantage with the use of zoledronic acid compared with clodronate, as well as the potential role of denosumab in this setting.

The next two talks focused on Myeloid Leukemias. Martin S. Tallman, MD, Memorial Sloan Kettering Cancer Center, discussed the current treatment approaches in acute promyelocytic leukemia (APL). In the presentation, "Clinical Genomics in Myeloid Malignancies (AML)," Richard M. Stone, MD, Dana-Farber/Brigham and Women's Cancer Center, summarized the importance of genetic analyses in assessing prognosis of patients with de novo AML and in choosing post-remission therapy. Dr. Stone added that it may also help enroll patients in appropriate clinical trials since there are many ongoing and planned trials centered on patients with certain molecular features.

Steven P. Treon, MD, PhD, Dana-Farber/Brigham and Women's Cancer Center, in his presentation, "Diagnosis and Management of Waldenström's Macroglobulinemia/Lymphoplasmacytic Lymphoma," introduced the audience to the treatment approach and new findings in management of this B-cell-related disease. He discussed clinical data on currently available combination therapies and presented emerging data on the new treatment options potentially approved in the near future for the management of this disease, including ibrutinib and carfilzomib-based regimens. In closing, Dr. Treon shared new molecular findings of a commonly recurring mutation in patients with Waldenström's Macroglobulinemia, called MYD88 L265P, that now represents a novel pathway for differential diagnosis and targeted therapy for this disease.

In the presentation,  "Current Practices in NHL Therapy: Focus on Marginal Zone Lymphomas," Leo I. Gordan, MD,  Robert H. Lurie Comprehensive Cancer Center of Northwestern University, explained that the subtypes of various marginal zone lymphomas (MZLs), such as gastric MALT, nodal MZL, and splenic MZL, are all related clinical entities and their differential diagnosis is not straightforward. Dr. Gordan also outlined the diagnosis and treatment options for the major subtypes of MZLs.

In addition to treatment of various hematological malignancies, attendees learned the latest practices in supportive care, management of patient symptoms, and palliative care. In the presentation "Supportive Care Considerations in the Treatment of NHL," Dr. Zelenetz pointed out that there are several important areas for supportive care considerations in patients with NHL including, but not limited to, management of tumor lysis syndrome (TLS), viral reactivation, febrile neutropenia, chemotherapy-induced thrombocytopenia, and role of erythropoiesis-stimulating agents and growth factors.

Kim Noonan, MS, RN, ANP, AOCN, Dana-Farber/Brigham and Women's Cancer Center, summarized the risk factors for development of cancer therapy-induced nausea and vomiting (CINV) and the current standards in anti-emesis management. Ms. Noonan outlined the risk factors for CINV, particularly the relationship to the specific therapy used to treat cancer patients, and discussed the importance of providing anti-emetic prophylaxis to prevent or control CINV.

Susan G. Urba, MD, University of Michigan Comprehensive Cancer Center, began her presentation, "Palliative Care for Hematologic Malignancies," by highlighting that newly diagnosed patients with hematological malignancies have numerous distressing symptoms and controlling these is of paramount importance to improve symptoms, quality of life, and patient satisfaction, with reduced caregiver burden. Dr. Urba shared data indicating patients with hematological malignancies are often referred to palliative care much later during the course of treatment than those with solid tumors; and she stressed the importance of integrating supportive care measures with curative treatment for the management of patients with hematological malignancies.

The final presentation of the day, "Alternative Stem Cell Sources in Transplantation," delivered by Richard J. Jones, MD, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, included discussion on the haploidentical stem cell transplantation (SCT), a technique that involves use of hematopoietic stem cells from relatives who are partially matched. Dr. Jones noted that the biggest advantage of this technique is of rapid and near universal donor availability; however, he noted its association with high rates of graft rejection, severe graft-versus-host disease (GVHD), and infectious complications. Dr. Jones shared exciting new data on how the use of high-dose cyclophosphamide post-transplant significantly inhibits GVHD associated with haploidentical SCT, potentially making this an excellent therapeutic alternative for patients lacking HLA-matched sibling donors or fully matched unrelated donors.

The Congress concluded with closing remarks from Dr. Zelenetz.

For more information about the NCCN 8th Annual Congress: Hematologic Malignancies™ visit NCCN.org.

Look for further announcements in upcoming editions of NCCN eBulletin regarding continuing education opportunities, based off of the presentations from this year's Congress, which will be available in the coming months.