On Location
Breakthrough Research,
Practice-Changing Data at the
2014 ASH Annual Meeting
or the more than 20,000 attendees who converged
in San Francisco for the 2014 ASH Annual Meeting,
there was no shortage of compelling research across
the full spectrum of hematology – with nearly 5,000
scientific abstract presentations and numerous special
sessions highlighting important areas of clinical progress.
This year’s Education and Scientific Programs showcased
cutting-edge research and clinical updates in a variety of
fields – from refining and expanding immunotherapy, to
individualizing therapy based on genetic profiles, to exploring
novel combination therapies in lymphoma and myeloma.
Special sessions also looked beyond the trials data, to issues affecting patient outcomes and access to these emerging therapies - such as the financial toxicity associated with
expensive therapies.
Here, we present a sampling of the most compelling
hematology research presented at this year’s annual meeting. Stay tuned for more news and coverage in our upcoming
issues – including a look at hematologic drugs soon entering
the marketplace.
And don’t forget to save the date for next year’s 57th Annual Meeting: December 5-8 in Orlando, Florida.
Late But Certainly Not Least....
This year’s six late-breaking abstracts feature innovative research in preventing bleeding risk, better prediction tools in Hodgkin lymphoma, and
new approaches for high-risk, difficult-to-treat malignancies.
LBA-1
Targeting Factor XI: Preventing VTE Without
Increasing Bleeding Risk
FXI-ASO, a novel factor XI inhibitor, significantly reduced the risk of
post-operative venous thromboembolism (VTE) in patients undergoing
knee surgery, according to results presented by Harry Roger Büller, MD,
PhD. Three hundred patients were randomized to receive either 200 or
300 mg FXI-ASO (a second-generation antisense oligonucleotide) or
the anticoagulant enoxaparin. Higher-dose FXI-ASO led to the lowest
rates of VTE (4.2%, 3 of 71 patients), followed by lower-dose FXI-ASO
(26.9%, 36 of 134 patients) and enoxaparin (30.4%, 21 of 69 patients).
“Only three clots were present in the 300 mg group,” Dr. Büller said during his presentation of the results. “This rate, 4.2 percent, has never been
seen in the setting of knee surgery, where the best evidence is around
10 or 15 percent.” Notably, the new agent exerted this effect without
increasing bleeding rates: 2.6 and 2.8 percent in the high- and low-dose
FXI-ASO groups, versus 8.3 percent in the enoxaparin group.
LBA-2
CATCH-ing Recurrent VTE in Cancer Patients with
Tinzaparin
Tinzaparin, a low-molecular-weight heparin (LMWH), was more
effective than warfarin in preventing recurrent VTE in cancer patients with symptomatic VTE, according to long-term results from
the phase 3 CATCH study. During the six-month treatment period,
recurrent VTE was less common in the 449 patients who were treated
with 175 IU/kg once-daily with tinzaparin than in the 451 warfarintreated patients (6.9% vs. 10.0%; p=0.07), amounting to a 35 percent
relative risk reduction with tinzaparin. Tinzaparin was also safe, with
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ASH Clinical News
approximately 90 percent of patients completing
the study protocol and no differences in major
bleeding events or mortality between the two
study arms. Agnes Y.Y. Lee, MD, the study’s
lead investigator, added, “This study reinforces
clinical guidelines supporting the use of lowmolecular-weight heparins instead of warfarin
to prevent recurrent blood clots.” Another
factor working in tinzaparin’s favor: ease of use.
Although it is self-injectable, it does not require
extensive monitoring like warfarin.
LBA-3
More is Better in Terms of Anticoagulation and Pulmonary Embolism
In patients with previous unprovoked pulmonary embolism (another population at high risk
for recurrent VTE), extended anticoagulation
proved more effective in reducing VTE risk and
major bleeding compared with shorter-term
anticoagulation. In a study that included 371
patients who received 6 months of initial treatment with warfarin, patients were randomly
assigned to an additional 18 months of warfarin (n=184) or placebo (n=187). Patients who
received the additional 18 months of warfarin
were significantly less likely to experience a primary endpoint event (recurrent VTE or major
bleeding) compared to those randomized to the
placebo arm (3.3% vs. 13.5%, HR=0.23; 95% CI
0.09-0.55). “Extending anticoagulation for 18
months was associated with a risk reduction of
77 percent of recurrent VTE or major bleed-
ing during the treatment period,” lead author
Francis Couturaud, MD, PhD, said during his
presentation of the results, “but during followup after stopping treatment, the curves catch up
and there is no significant difference at the end
of the study.”
LBA-4
Circulating Cell-Free DNA Sequencing
Opens Up New Possibilities in
Hodgkin Lymphoma
Using massive parallel sequencing of circulating cell-free DNA (ccfDNA) derived from
Hodgkin/Reed-Sternberg (HRS) cells – the
malignant cells in classic Hodgkin lymphoma
(HL) – investigators have discovered a corre