Best Practices in Hematologic Malignancies – December 2017 Vol 8

Oncology navigation has made great strides in improving cancer care, including access to quality care, for nearly 3 decades. Navigation programs are well established for most patient populations with solid organ tumors, but less so within the patient populations with liquid cancers. I am pleased to report that this is changing, and it is wonderful to see.
A recent survey of patients with myeloproliferative neoplasms (MPNs), including myelofibrosis, polycythemia vera, and essential thrombocythemia, has identified a strong association between symptom burden and medical disability leave.
Recent advances in the treatment of multiple myeloma have dramatically altered the trajectory of disease, as providers now have several efficacious agents in various drug classes at their disposal.
Despite major and continuing treatment interventions, myeloma remains incurable for most patients, and relapse is an expected part of the disease course. At the National Comprehensive Cancer Network 12th Annual Congress: Hematologic Malignancies, Natalie S. Callander, MD, outlined issues in the management of relapsed/refractory multiple myeloma (RRMM).
Daratumumab (Darzalex), in combination with pomalidomide (Pomalyst) and dexamethasone, for the treatment of patients with multiple myeloma who have received at least 2 previous therapies, including lenalidomide (Revlimid) and a proteasome inhibitor, was approved by the FDA on June 16, 2017.
With 5-year survival rates for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) at 86% and 71%, respectively, the number of lymphoma survivors is on the rise, but achieving long-term quality of life after treatment is completed remains an ongoing challenge.
Treatments targeting immune responses against solid tumors have led to dramatic improvements in patient outcomes, but the role for immunotherapy in the treatment of acute leukemia is still being defined.
After nearly 40 years of negligible drug development, 2017 saw the approval of 4 drugs by the FDA for the treatment of acute myeloid leukemia (AML).
On August 1, 2017, the FDA approved enasidenib (Idhifa), an isocitrate dehydrogenase-2 inhibitor, for the treatment of adults with relapsed or refractory acute myeloid leukemia (AML) who have the IDH2 genetic mutation.
The FDA, on August 3, 2017, approved a fixed combination daunorubicin plus cytarabine (Vyxeos) injection for the treatment of adults with 2 types of acute myeloid leukemia (AML)—newly diagnosed, therapy-related AML (t-AML) and AML with myelodysplasia-related changes (AML-MRC).
Tisagenlecleucel (Kymriah), a genetically modified chimeric antigen receptor (CAR) T-cell immunotherapy, was approved by the FDA on August 30, 2017, for the treatment of pediatric patients and young adults aged ≤25 years with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL).
On September 1, 2017, the FDA approved gemtuzumab ozogamicin (Mylotarg) for the treatment of adults with newly diagnosed CD33-positive acute myeloid leukemia (AML), as well as patients aged ≥2 years with relapsed or refractory CD33-positive AML.

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