Hematologic Malignancies

With the accelerated FDA approval in December 2015 of the anti-CD38 monoclonal antibody daratumumab (Darzalex) for patients with multiple myeloma who received ≥3 previous therapies, studies of the drug presented at ASH 2015 were of great interest.
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The immunostimulatory monoclonal antibody elotuzumab (Empliciti), which was approved by the FDA in December 2015, is being studied in combination with immunomodulatory drugs and proteasome inhibitors in patients with relapsed or refractory multiple myeloma. Results presented at ASH 2015 show continued benefit from these regimens.
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With the recent FDA approval of the first oral proteasome inhibitor ixazomib (Ninlaro), patients with relapsed or refractory multiple myeloma who have received previous treatment now have access to an all-oral regimen. The FDA-indicated triplet regimen of ixazomib, lenalidomide (Revlimid), and dexamethasone (Decadron) significantly improved progression-free survival (PFS) compared with the doublet of lenalidomide and dexamethasone, reported Philippe Moreau, MD, University of Nantes, France, at ASH 2015.
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The year 2015 saw an explosion of new drugs approved by the FDA and new indications for drugs already on the market for multiple myeloma. Overall, 4 new drugs from 2 new classes were approved in 2015, changing the standard of care for patients with this disease.
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Traditional myeloablative conditioning remains the standard of care for preparing patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) for transplant, according to a randomized trial from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN). The study, presented as a late-breaker at ASH 2015, was halted after a reduced-­intensity conditioning (RIC) regimen proved less effective.
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In patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL), the addition of rituximab (Rituxan) to chemotherapy significantly improved event-free survival in a large European study.
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Monoclonal antibodies targeting PD-1 may be effective in multiple myeloma, according to early data from 2 clinical trials on pembrolizumab (Keytruda) presented at ASH 2015.
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Chimeric antigen receptor (CAR) T-cell therapy has been striking in various hematologic malignancies, and for the first time this treatment approach is being evaluated in multiple myeloma.
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Although the cost of treating newly diagnosed patients with multiple myeloma is greatly increased with the use of 3 drugs, 2-drug regimens should no longer be considered adequate, according to new data presented at ASH 2015.
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At the Fifth Annual Conference of the Association for Value-Based Cancer Care in Washington, DC, Grant Lawless, RPh, MD, FACP, of the University of Southern California, Los Angeles, moderated a multidisciplinary panel on value-based care for patients with multiple myeloma.
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