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Advances in multiple myeloma, lymphoma and other hematologic malignancies presented at ASH

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CLEVELAND: Researchers from University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine presented significant new research findings in multiple myeloma, lymphoma and other hematologic disorders at the 58th Annual Meeting of American Society of Hematology (ASH) in San Diego.

"The breadth and depth of this innovative cancer research presented at ASH is truly outstanding," says Stan Gerson, MD, Director of UH Seidman Cancer Center and Case Comprehensive Cancer Center at Case Western Reserve. "Our faculty members are making tremendous advances in multiple myeloma, lymphoma and other hematologic malignancies which is reflected in their being selected for oral and poster presentations."

Major advances have been made in treating multiple myeloma (MM) over the last 12 years and early phase clinical trials have played a key role in this progress according to an oral presentation (Abstract #1146) by Ehsan Malek, MD, of UH Seidman Cancer Center. Phase I trials, in addition to moving progress forward for new treatments, also have demonstrated therapeutic success for patients and are well tolerated.

Dr. Malek and a team of researchers analyzed data from 2,408 MM patients who participated in 74 phase I clinical trials from 2004-2015 to determine the overall benefit and risks for patients. The analysis indicated that "the therapeutic benefit for patients recruited onto MM phase I trials was significantly higher than that reported for phase I trials of all cancer types." The team further found that patients' response rates supported earlier patient entry onto these early phase trials.

"Multiple myeloma has seen tremendous progress over the past 12 years with the advent of new agents and survival rates have more than doubled," says Dr. Malek, Instructor at Case Western Reserve School of Medicine. "However in spite of advancements there still is an unmet need for drug discovery and phase I trials are critical to continued progress. Our research shows that these trials provide therapeutic benefit for patients who participate. Also these new therapies can be more beneficial the earlier patients enroll and no longer need to be thought of as a last resort."

A team of researchers also presented an oral abstract (Abstract #105) finding that obese and older patients with a common form of lymphoma are more likely to develop heart disease following treatment. The researchers conducted a retrospective analysis of more than 400 patients with Diffuse Large B Cell Lymphoma (DLBCL) to determine the incidence of heart failure, heart attack, stroke and other cardiovascular events. They linked patients over age 60 and those with body mass index (BMI) greater than 30 with poorer outcomes and an elevated incidence of cardiovascular events.

"Identification of patients at high risk for cardiovascular events is key to helping prevent complications after treatment and increasing long-term survival," says Paolo Caimi, MD, of UH Seidman Cancer Center and senior author of the study. "While further studies are needed, these findings provide important guidance on stratifying who is at risk and how to best tailor treatment. For patients who have advanced age or higher BMI, we can provide increased monitoring and identify ways to reduce their risk such as medications and other preventative measures."

Dr. Malek and a team also presented a poster session (Abstract #1862) on the efficacy of a newly identified prognostic tool for newly diagnosed multiple myeloma. The researchers analyzed a ratio of white blood cells in 337 MM patients and found that those with a higher ALC (absolute lymphocyte count) /AMC (absolute monocyte count) at diagnosis had longer survival.

"This biomarker is linked with the strength of a patient's immune system," says Dr. Malek. "Based on these new findings, we may be able to predict who will respond better and tailor immunologic therapies for patients for optimum response."

Dr. Caimi's team also had two other related posters which used the same patient cohort to further determine risk stratification in DBCL patients. In Abstract #3611, they showed that patients who experienced venous thrombotic events after diagnosis had poorer outcomes and also validated a method to identify patients at risk of venous thromboembolic events (VTEs). In Abstract #1863, the researchers found that DBCL patients older than 75 have a higher mortality risk following diagnosis. These patients respond equally well to treatment but have additional risk for complications such as heart attacks and blood clots.

"These studies in total provide us with important new information on how to modify treatments for certain patients," says Dr. Caimi, who is also Assistant Professor at the School of Medicine. "For lymphoma patients at risk for clotting and those over age 75, we are better able to provide targeted therapies to improve long-term outcomes."

Additional information on UH Seidman Cancer Center/ School of Medicine Presentations:

Abstract #1146 Rethinking Risk-Benefit Assessment for Phase I Multiple Myeloma Trials
Monday, December 5, 2016: 5:45 PM
https://ash.confex.com/ash/2016/webprogram/Paper96301.html
Authors: Dr. Malek, Caner Saygin, MD, Rebecca Ye, Byung-gyu Kim, DVM, Fahrettin Covut, MD, Marcos De Lima, MD, and James J. Driscoll, MD, PhD.

Abstract #105 Cardiovascular Toxicity after Therapy for Diffuse Large B Cell Lymphoma Occurs Early and Results in Decreased Overall Survival.
Saturday, December 3, 2016: 10:00 AM
https://ash.confex.com/ash/2016/webprogram/Paper97849.html
Authors: Sabarish Ram Ayyappan, MBBS, Akiva Diamond, MD, Vinita Gupta, MD, Brenda Cooper, MD, Ben Tomlinson, MD, Ehsan Malek, MD, Leland Metheny, MD, Hillard Lazarus, MD, Stanton Gerson, MD, Marcos De Lima, MD and Dr. Caimi.

Abstract #1862 Immunologic Status Evaluated By the Absolute Lymphocyte/Monocyte Ratio Provides a Powerful Prognostic Tool for Newly Diagnosed Multiple Myeloma
Saturday, December 3, 2016, 5:30 PM-7:30 PM https://ash.confex.com/ash/2016/webprogram/Paper90474.html
Authors: Dr. Malek,Talib Dosani, MD, Raisa Pinto, MD, Fahrettin Covut, MD, Hugo Akabane, MD, James J. Driscoll, MD, PhD, and Marcos De Lima, MD.

Abstract #3611 Venous Thromboembolic Events in Diffuse Large B Cell Lymphoma Patients: Risk Factors and Outcomes
Sunday, December 4, 2016, 6:00 – 8:00 PM
https://ash.confex.com/ash/2016/webprogram/Paper98118.html
Authors: Sabarish Ram Ayyappan, MBBS, Vinita Gupta, MD, Akiva Diamond, MD, Brenda Cooper, MD, Ben K. Tomlinson, MD, Ehsan Malek, MD, Leland Metheny, MD, Hillard Lazarus, MD, Stanton Gerson, MD, Marcos De Lima, MD, and Paolo F. Caimi, MD.

Abstract #1863 Treatment of Diffuse Large Cell Lymphoma (DLBCL) Patients Older Than 75 Years: Higher Mortality and Risk of Complications without Increased Risk of Relapse after Treatment
Saturday, December 3, 2016, 5:30 – 7:30 PM
https://ash.confex.com/ash/2016/webprogram/Paper97666.html
Authors: Akiva Diamond, MD, Sabarish Ram Ayyappan, MBBS, Raisa Pinto, MD, Ehsan Malek, MD, Ben K. Tomlinson, MD, Leland Metheny, MD, Brenda Cooper, MD, Stanton Gerson, MD, Hillard Lazarus, MD, Marcos De Lima, MD and Paolo F. Caimi, MD.

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About University Hospitals

Founded in 1866, University Hospitals serves the needs of over 1 million patients per year through an integrated network of 18 hospitals, more than 40 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. The system's flagship academic medical center, University Hospitals Cleveland Medical Center, located on a 35-acre campus in Cleveland's University Circle, is affiliated with Case Western Reserve University School of Medicine. The main campus also includes University Hospitals Rainbow Babies & Children's Hospital, ranked among the top children's hospitals in the nation; University Hospitals MacDonald Women's Hospital, Ohio's only hospital for women; and University Hospitals Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, including cancer, pediatrics, women's health, orthopedics, radiology, neuroscience, cardiology and cardiovascular surgery, digestive health, dermatology, transplantation and urology. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including "America's Best Hospitals" from U.S. News & World Report. UH is also home to Harrington Discovery Institute at University Hospitals – part of The Harrington Project for Discovery & Development. UH is the second largest employer in northern Ohio with 26,000 employees. For more information, go to UHhospitals.org.

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