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My Highlights from ASH 2019, December 7-10, 2019 in Orlando

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By Stefan Schönland, University Hospital of Heidelberg, Chair of the Plasma Cell Dyscrasia Subcommittee of the EBMT Chronic Malignancies Working Party

The 61st ASH annual meeting and exposition, held in Orlando, opened its doors to up to 30.000 attendees (5.000 more than expected), offering almost 3000 selected abstracts. Many physicians and researchers from EBMT also actively participated with more than 30 oral presentations or posters focused on stem cell transplantation.

In this year, new concepts in treatment of multiple myeloma (MM) and in the field of lymphomas were the focus of educational/scientific committee sessions.

Among non-malignant hematology, sickle cell disease (SKD) played a central role at ASH. Several oral abstracts highlight novel therapeutic agents for this disease and updates on ASH Clinical Practice Guidelines on SKD were given in a Special Education Session.

Overall the cutting-edge topics and new concepts that animated the scientific sessions were:

  • gene therapy, genome editing and single cell technology;
  • immune response and microenvironment in the context of effective immunotherapy.

Gene therapy was the main topic of Dr. Nathwani’s lecture, who was awarded with the Ham-Wasserman Lecture on Saturday. Dr. Nathwani presented the advancements in hemophilia gene therapy and suggested next steps for a further, broad improvement of this approach.

The cornerstone of discussion on immunotherapy was the E. Donnall Thomas Lecture, given by Dr. Greenberg on Monday. Dr. Greenberg presented progresses in developing antigen-specific adoptive T-cell immunotherapies, from CMV treatment to melanoma and mainly myeloid leukemia.

Immunotherapy is considered the most important innovation in MM after the “novel agents” of early 2000s. In the Educational “Immunotherapy and Myeloma” attendees were updated on various classes of immunotherapy, mechanism of action and new clinical and safety data. Particular interest raised on non-CAR-T approaches as anti-PD-1 axis checkpoint inhibitors, vaccine-based strategies, NK cells engineered with CAR technology and marrow-infiltrating lymphocytes. Interestingly, 2 oral abstracts with EBMT data were presented on results of upfront allogeneic transplantation, still one of the best evaluated immunotherapy in MM. The first one reported a meta-analysis of four prospective clinical trials and the second a large retrospective study comparing (tandem) autologous and allogeneic transplantation. Both showed an advantage of the auto-allo approach regarding progression free survival.

Most of the hot-topics were further highlighted in the Plenary session on Sunday.

Interesting data were presented by Dr. Broers, who reported the results of the HOVON-96 trial, a prospective randomized, multicenter, phase III study comparing post-transplant cyclophosphamide-based immunosuppressive regimen with conventional immunosuppression in patients with matched-related and matched-unrelated donors after allo-HSCT.  The authors showed that cyclophosphamide-based regimen results in lower rates of acute and chronic GVHD without negatively affecting relapse.

Two further presentations brought new insights on:

  • gene editing ELANE as a potential therapeutic strategy in severe congenital neutropenia;
  • effectiveness of mosunetuzumab, a T-cell engaging bispecific antibody, in patients with non-Hodgkin lymphoma after several lines of treatment, including CAR-T.

The meeting was concluded on Tuesday with the Late-breaking Abstracts session. Oral presentations reported the results of clinical trials on new therapeutic strategies involving monoclonal antibodies in acute lymphoblastic leukemia, acute myeloid leukemia, cold agglutinin disease and MM.

One of my personal highlight was the working dinner of Castleman Disease Collaborative Network on Saturday. The network was co-founded in 2012 by Dr. David Fajgenbaum who suffered from that disease while studying medicine. Bringing together a global team of other physicians, researchers, and patients he helped to change the diagnostic and therapeutic landscape of Castleman disease. Their current projects were presented at this evening.

In summary, ASH keeps feeding the discussion on the cutting-edge topics on research and clinical hematology. Further news is already eagerly awaited at the 62nd ASH meeting, hosted in San Diego, December 2020.