With acquired resistance patterns emerging for nearly every agent, hematologic experts are looking closely at sequencing patterns, but more work needs to be done in aggressive malignancies in which mutations associated with resistance may be present before therapy even begins.
When treating patients with mantle cell lymphoma, early identification and appropriate frontline therapy remains critical, and therapies may vary for those 65 years and older compared with patients under the age of 65, with several additional factors also having a role in approaching treatment options for a new patient in the clinic.
Eunice Wang, MD, discusses reasons why some older patients with acute myeloid leukemia may not be eligible to receive hypomethylating therapy and highlights ongoing investigations within this older patient population
Jorge E. Cortes, MD, discusses important questions in acute lymphoblastic leukemia to address, such as improved understanding of the role of allogenic stem cell transplant and the use of tyrosine kinase inhibitor combinations.
Leveraging the advances made with liquid biopsies in pantumor assays and specific hematologic cancers has laid the groundwork for the shift in care by using single, or multifaceted approaches for identifying, predicting, and monitoring disease progression.
Targeted therapies, specifically those agents directed at mutated proteins and aberrant protein-to-protein interactions, have been shown to improve survival among patients with relapsed or refractory acute myeloid leukemia.
The emergence of novel agents, including CAR T-cell therapies and antibody-drug conjugates, plus existing options such as chemoimmunotherapy and bone-marrow transplant, have combined to raise questions about the sequencing of these treatments in patients with diffuse large B-cell lymphoma.
Genomic sequencing is a critical step in informing the prognosis of patients with acute lymphoblastic leukemia and more information regarding specific subgroups of ALL, such as lineage ambiguous ALL, could pave the way for more personalized therapies for patients.
Although it is too soon to tell whether the addition of a CD20-directed antibody to novel agents in relapsed/refractory follicular lymphoma should become standard practice, it is clear that immunotherapy could represent the next paradigm shift.
Minimal residual disease has helped to predict relapse in numerous leukemia subtypes, with novel testing methods helping to identify the biomarker at a higher sensitivity than ever before.
The treatment landscape of Waldenström macroglobulinemia is becoming increasingly complex with second-generation BTK inhibitors; however, the combination of bendamustine and rituximab remains the frontline standard of care for this patient population.
Targeted therapies have helped to improve responses in patients with relapsed chronic lymphocytic leukemia regardless of high-risk disease, although optimal sequencing and toxicity management need to be further explored to strengthen the utilization of these options.
Natural killer cells can offer several advantages over T cells for CAR therapy in that the former uses both a CAR dependent and independent mechanism for tumor eradication, has better safety, and off-the-shelf feasibility—all at a potentially lower cost.
Rituximab plus CHOP is not a suitable frontline treatment regimen for all patients with diffuse large B-cell lymphoma, explained Andre H. Goy, MD, who specified that patients with a high-risk International Prognostic Index, elderly patients, and patients with high-risk molecular subtypes require alternative treatment.
Since the publication of the pivotal ELIANA trial in pediatric patients with acute lymphoblastic leukemia, the field of CAR T-cell therapy has grown significantly and left providers better equipped to understand and manage treatment-related adverse effects, such as cytokine release syndrome.