The European Hematology Association (EHA) Congress is one of the highlights of the haematology year and the EHA 2022 Hybrid Congress saw a return to in-person attendance in Vienna between 9-12 June, as well as a virtual platform. Australian clinician researchers featured prominently at the meeting and here we highlight some of their presentations made as part of the e-posters sessions at EHA 2022.
Trends in CLL therapy revealed
The evolving landscape of treatment for Australian patients with chronic lymphocytic leukemia (CLL) in the era of Bruton’s tyrosine kinase inhibitors (BTKis) was highlighted in a study led by Professor Con Tam of the Peter MacCallum Cancer Centre, Melbourne.
A review of PBS dispensing data for 803 patients with CLL treated between 2011-2021 showed that the use of fludarabine-cyclophosphamide-rituximab (FCR) in first line treatment has decreased (from 78% to 10%).
Conversely, the use of novel therapies such as ibrutinib, acalabrutinib has increased since the BTKi became available from 2016 onwards, with overall use increasing from 0-26% of patients. The agents were used predominantly in relapsed/refractory CLL, in whom usage reached at around 60% of patients within three years. There was also an increase in the use of venetoclax with or without CD20 targeted therapy, which were used by 26% of patients. Over the same period the use of CD20 monotherapy for R/R disease decreased from 60% to 17%, the study showed.
CAR T-cell efficacy and safety compared in r/r FL
An Australian-led study comparing the CAR T-cell therapies, tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel) in the treatment of relapsed/refractory follicular lymphoma (r/r FL) showed that were comparable in response rates and PFS, while tisa-cel was associated with better safety outcomes than axi-cel.
Professor Michael Dickinson of the Peter Mac Cancer Centre, Melbourne reported results from an international matching adjusted indirect comparison (MAIC) study that compared patient-level data for 53 evaluable participants in the ELARA trial of tisa-cel; and 50 patients in ZUMA-5 study of axi-cel; the patients were from a subgroup not exposed to bridging chemotherapy.
After adjusting for differences in baseline characteristics, the overall response rate, complete response rate and progression free survival rates were comparable between tisa-cel and axi-cel treated patients.
In the primary analysis, the hazard ratio for PFS was 0.90 (95% confidence interval: 0.39, 2.06; p=0.81) (Figure 1B).
When safety outcomes were compared, patients infused with tisa-cel had lower adverse event rates for cytokine release syndrome (CRS) and lower rates of corticosteroid and toclilizumab use for CRS compared to those infused with axi-cel. They also had lower rates of neurotoxicity events.
Fully vaccinated patients have low risk of severe covid
Vaccination has helped ensure a very low mortality for Australian blood cancer patients infected with COVID-19, a study from Monash Health has shown.
A review of outcomes for 75 patients with immunocompromising haematological cancers who tested positive for COVID19 between January 2020- February 2022 found that while almost half were hsoitalised, the mortality rate was 4%.
The patients had a median age of 70 years and had conditions such as indolent lymphoma (26), myeloma (25), aggressive lymphoma (7), myelodysplastic syndrome (6), chronic myeloid leukaemia (4) and acute myeloid leukaemia (3).
Ten of the patients were unvaccinated for COVID19, while 43 had received two doses and 19 had received 3 doses.
Almost half (48%) patients were admitted to hospital with a median length of stay of eight days Four patients were admitted to ICU, of whom three were unvaccinated. The patients received therapies such as dexamethasone, the antivirals sotrovimab and remdesivir and the JAK inhibitor baricitinib.
Of the four deaths, three (4%) were directly attributed to COVID19 infection
The study found that severe disease and hospitalisation was more likely in older patients, those who were unvaccinated or partially vaccinated and more common in those with Delta compared to Omicron strains. The underlying haematological condition, prior anti-CD20 therapy, presence of recent neutropenia and use of sotrovimab was not found to impact on the likelihood of severe disease or hospital admission.