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Report of the Chronic Malignancies Working Party Educational Meeting – 20-21 January 2023 - Virtual

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Chronic Malignancies Working Party (CMWP)

Summary report written by Donal McLornan (CMWP Chair), Joanna Drozd-Sokołowska and Kavita Raj (CMWP Co-Secretaries)

We were delighted that the CMWP Scientific and Educational virtual meeting took place on 20th and 21st January 2023.

On the Friday, we had a very successful scientific business meeting focusing on our research project portfolio. We have made even further progress across all of our subcommittees and refining the portfolio of active studies. We were pleased to highlight during the meeting that we had a total of 22 publications in 2022 and a further 3 publications in the first week of January 2023 with a marked increase in our cumulative impact factor.

On the Saturday, we started our education meeting with a focus on MDS, CMML and VEXAS.

First, we had an overview of the CMWP structure and activities given by Dr Donal McLornan (CMWP Chair). The next session was entitled ‘A dynamic landscape: An update on classification and prognostication in MDS in 2023’ chaired by Dr. Marie Robin (Paris), chair of the MDS subcommittee, and Donal McLornan. First, Dr Robin gave a very comprehensive overview of the rapidly dynamic changes we have observed within MDS classification systems, how these have developed and the practical challenges that need to be overcome with so many rapid modifications. Next, we had an update from Professor Matteo della Porta (Milan) on the IPSS-molecular (IPSS-M), from the origin of the score through to validation and predictive power in the transplant and non-transplant cohorts. In addition, a minimum gene set was designed that retained prognostic power. Dr. Nico Gagelmann (Hamburg), gave his views on how utilisation of IPSS-M could guide the decision-making process in MDS allo-HCT but always within the context of donor, patient and transplant conditioning specific variables.

After a short break, the next session focused on improvements in allo-HCT outcomes in MDS and CMML commenced, chaired by Professor Francesco Onida (Milan) and Dr. Joanna Drozd-Sokolowska (Warsaw). The two chairs kicked off the meeting debating the question if every transplant eligible CMML patient be offered an allo-HCT? Within each excellent pitch, we got detailed updates on CMML prognostic scores, chemotherapy alone versus allo-HCT outcomes and how the mutational landscape may influence treatment decisions and outcomes. Suggestions for strategies to improve allo-HCT outcomes were discussed and a very useful transplant algorithm for CMML was provided. The Hamburg team (Dr Nico Gagelmann and Professor Nicolaus Kröger) subsequently gave a comprehensive update on conditioning approaches in MDS – ‘a European view’ – with a focus on results from the multicentre, open-label, randomized phase III EBMT RIC MAC trial that compared a busulfan-based RIC with MAC in patients with MDS or secondary acute myeloid leukemia. Next, we had a lively debate on the eternal burning question on whether pre-transplant chemotherapy/HMA is required prior to moving forward with MDS allo-HCT. Dr. Katja Sockel (Dresden) gave a fantastic overview on outcomes following ‘up front’ allo-HCT strategies and discussed the importance of the kinetics of the disease and donor availability in influencing this approach. Outcomes were admirable from the provided data, and she discussed the rate of patients who undergo pre-transplant therapy with an intent to transplant who do not get to allo-HCT due to disease progression or evolving morbidities that exclude transplant. We were delighted to have the alternative view from Professor Pierre Fenaux (Paris), giving a fascinating update on recent advances and more novel agents in the MDS therapeutic armamentarium and how these may be used pre allo-HCT to optimise outcomes.

After lunch, Professor Ibrahim Yakoub-Agha (Lille) tackled the difficult subject of post-transplant intervention to optimise outcomes in MDS, chaired by Dr. Patrick Hayden (Dublin) and Professor Yves Chalandon (Geneva). He provided an insightful and expert summary of the available heterogeneous data focussed on immunotherapeutic intervention with DLI (alone or in combination), use of HMA maintenance and how more novel agents may fit into post-transplant algorithms.

This was followed by the last session of the day focused on our emerging understanding of VEXAS, a fascinating autoinflammatory disease that may be accompanied by MDS or other haematological neoplasm. This session was chaired by Dr. Christof Scheid (Köln) and Professor Meral Beksac (Ankara, Turkey). Professor Arsene Mekinian (Paris) gave a state-of-the-art update on therapeutic approaches to VEXAS including the most recent data on JAK inhibitors.  Dr. Carmelo Gurnari (Rome), who leads on VEXAS within the CMWP, gave an update on the role of allo-HCT for VEXAS with MDS, and Dr. Raffaella Greco (Milan), current chair of the ADWP, on approaches to allo-HCT in VEXAS alone, alongside an update on the role of allo-HCT in AID. To conclude the session, Dr. Moniek de Witte (Utrecht), presented her experience of transplant approaches to VEXAS. All talks led to a thought-provoking discussion on how the field of therapeutic approaches to VEXAS may develop as we learn more about this fascinating disease.

Dr. Donal McLornan thanked all the participants, the speakers and chairs and the Events and Education team and ended a very stimulating day of focused discussion on MDS, CMML and VEXAS.

We look forward to meeting again in person at the next Annual Meeting of the EBMT in Paris in April, and afterwards in Hamburg (local host Nico Gagelmann) on 6-8th October 2023, during a 3-day meeting dedicated to plasma cell disorders and CAR-T in PC disorders alongside the Cellular Therapy and Immunobiology working party (CTIWP).