Experts Discuss Progress in Leukemia, Lymphoma and Low Blood Platelet Therapies

Copenhagen, 13 June 2008 – The burden of hematological disease is often underestimated: The third most common killer among all cancers is hematological malignancies. Thus it is appropriate that progress in therapies in this area is given prominence at the 13th Congress of the European Hematology Association (EHA). More than 6,500 participants from around 100 European and non-European countries are gathering in Copenhagen to share the latest developments in hematological research and improvements in care.

Novel treatment mechanisms prove very effective in low blood platelet count

As an example of important recent progress, Prof. James Bussel, (New York, USA), in Copenhagen reports on new approaches in the treatment of thrombocytopenia. This decrease of platelets in the blood may result from a wide variety of causes, including chemotherapy treatment for malignancies, hepatitis C or ITP, an autoimmune disorder caused by antibodies against platelets. “Recent studies in ITP have shown that these antibodies not only destroy platelets at an accelerated rate but also damage the cells that produce new platelets or else prevent them from releasing platelets into the blood. Novel therapies have been developed to take advantage of these findings,” Prof. Bussel says. “So-called thrombopoietic agents stimulate the receptor for thrombopoietin on the relevant cells and thus dramatically increase platelet production. This is a novel mechanism of treatment effect.” According to Prof. Bussel, these new treatments have thus far been used mainly in ITP therapies and have been highly effective. There are also ongoing studies investigating the effectiveness of thrombopoietic agents in thrombocytopenia induced by other diseases.

Hodgkin’s lymphoma: towards more individualized therapies through PET scans

New possibilities for individualized therapies that could spare some Hodgkin’s lymphoma patients unnecessarily aggressive chemotherapy are presented in Copenhagen by Prof. Andrea Gallamini (Cuneo, Italy). Hodgkin’s lymphoma, a malignant enlargement of the lymph nodes, is considered a curable disease. Standard treatment, involving ABVD chemotherapy with four cytostatic drugs, induces remission in the disease in about 75% of patients. In those patients where primary treatment fails, around half respond to a second course of treatment and achieve complete remission. However, alternative more radical therapies have demonstrated greater efficacy, with cure rates of 85%, but at a cost to the patient of very high toxicity.

Experts therefore aim to identify those patients who would profit from the more aggressive therapies, while sparing those who would respond to less toxic treatments their burdensome side effects. Prognostic factors used until now have been only partially successful in predicting treatment response and outcome in individual patients. Modern imaging techniques are an important corrective here, Prof. Gallamini says: “An interim PET scan, performed very early during treatment after the second course of ABVD chemotherapy, is able to identify the chemosensitivity of the tumour in individual patients,” he says. In a joint Italian-Danish study, Prof. Gallamini and his colleagues found that patients with a negative interim-PET showed a probability of survival at 2 years of 95%. However, one fifth of the patients showed a positive interim-PET. For these patients, the probability of survival was only 10%. “Based on these results, new trials are ongoing worldwide with risk-adapted therapy tailored to individual patients, based on interim PET results and sparing 4/5 of patients the unacceptable toxicity of more aggressive chemotherapy regimens,” Prof. Gallamini explains.

New trial shows improved outcome in chronic myeloid leukemia

The most recent, previously unpublished data on potential optimisation of therapies for chronic myeloid leukemia (CML) is presented in Copenhagen by Prof. Jorge Cortes (Houston, TX, USA). CML is a cancer of the blood and bone marrow, in which the body produces cancerous white blood cells. Almost all patients with CML have what is known as the Philadelphia chromosome. This chromosome stimulates the production of a special protein, called Bcr-Abl, which causes malignant white blood cells to proliferate. The reduction of Bcr-Abl to a low level, called major molecular response (MMR), results in a very favorable long term response to therapy. “Imatinib, the first therapy to inhibit the activity of Bcr-Abl, revolutionized the treatment of Philadelphia chromosome-positive CML and is now the standard of care for this disease,” Prof. Cortes says. “Improving upon the molecular response rates is the next logical step toward optimizing therapy.”

Research is being conducted to establish best approaches in optimizing therapies. The landmark IRIS study established 400 mg/day imatinib as the standard dose for patients with CML. A new trial, the Tyrosine Kinase Inhibitor Optimization and Selectivity (TOPS) study, is an open-label, randomized, multicenter clinical trial including 476 newly diagnosed, previously untreated patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML) from 19 countries worldwide. TOPS is evaluating whether a higher initial dose of the substance (800 mg/day) will boost patients’ likelihood of achieving a major molecular response to treatment in the early chronic phase of CML. Previously reported data from smaller studies have suggested that high-dose imatinib increases the rapidity of achieving MMR and may improve long-term progression-free survival.

Prof. Cortes: “The TOPS study is expected to provide important new insights into how we might more effectively treat patients with newly diagnosed CML, to improve long-term outcome for the disease.” Data presented at the EHA Congress are the first analysis of a large data set, says Prof. Cortes. “They provide us with clear indications that use of early higher doses of imatinib results in more patients achieving molecular response sooner after treatment begins,” he says.

Interviews with study authors and the press briefing moderator will be possible directly after the briefing.

Contact

B&K Medien- und Kommunikationsberatung GmbH
Dr. Birgit Kofler; Daniela Pedross, MA.
Porzellangasse 35/Top 3, A-1090 Vienna
Press Office: Phone during the Congress: 0045-32 47 21 03
Phone after the Congress: 0043-1-319 43 78-11
E-Mail: kofler@bkkommunikation.com , pedross@bkkommunikation.com

About EHA

The European Hematology Association (EHA) aims to promote excellence in clinical practice, research and education in European hematology.

Today, EHA – with over 2700 active members from 95 countries – directs a large and growing number of projects and programs. An Executive Board and Councilors elected by the membership form the governmental body responsible for the strategy and organization of the Association.

About the EHA Annual Congress

The EHA annual congress is held every June in a major European city. Over the years the congress has become the meeting place for hematologists in all fields of the specialty. The congress program has sessions on clinical and laboratory hematology and covers all the major hematological subspecialties, including hemato-oncology, red cell disorders, hemostasis, thrombosis, pediatric hematology and transfusion medicine.