What’s New in Blood Cancer Research and Treatment?
Article Summary
- The world’s foremost hematology researchers met earlier this month in San Diego at the American Society for Hematology’s annual meeting.
- Sylvester’s Dr. Mikkael Sekeres shared his reflections on new findings and trends for patients with blood cancers.
- He sees an increasing focus on targeted therapies with fewer side effects, as well as a better understanding of pre-cancerous conditions and how or whether to treat them.
Mikkael Sekeres, M.D., M.S., remembers his medical school teachers telling the class that 50% of what they were learning would be obsolete in 10 years. They just couldn’t predict which 50%.
“Where we are now is night and day from where I started in this field,” said Dr. Sekeres, who is chief of the Division of Hematology at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.
When Dr. Sekeres first started treating blood cancer patients 20 years ago, it was the dawn of the field’s focus on individual tumor genetics, he said. Understanding how mutations in a patient’s cancer cells drive tumors’ behavior and responses to treatment was key to unlocking today’s field of precision oncology, where targeted therapies are matched to patients’ individual cancers.
“Now, every single patient who walks through the door at Sylvester gets genetic screening to see what mutations their blood or bone marrow cancer has and, therefore, how we can optimize therapy for that patient,” Dr. Sekeres said.
Coming off the heels of 2024’s American Society for Hematology (ASH) meeting, held earlier this month in San Diego, Dr. Sekeres shared his reflections on several exciting advances in blood cancer treatment and research. Sylvester researchers have been involved in many studies related to new findings for blood cancer patients. Along with added targeted therapies becoming available, physician-scientists are also testing out other new drugs in combination, providing even more powerful options for patients. And they’re also learning more about pre-cancerous conditions—when it’s important to treat them, how they progress to cancer and which patients can benefit from active surveillance instead of treatment.
Uncovering New Biology of Pre-cancers
Dr. Sekeres was involved in two important studies presented at ASH focused on pre-cancerous conditions that can develop into blood cancers:
• One study, led by Sylvester’s Sangeetha Venugopal, M.D., showed that smoking has a previously unrecognized role in myelodysplastic syndromes (MDS), a kind of blood cancer that can itself develop into acute myeloid leukemia (AML). This study was the first to show that smoking can worsen outcomes in these cancers if a patient continues to smoke after diagnosis, meaning smoking cessation is important to focus on to improve these patients’ overall prognoses.
• Another study looked at a precursor condition to MDS and acute myeloid leukemia, which is known as clonal cytopenia of undetermined significance, or CCUS. That study, a collaboration between Sylvester, Moffitt Cancer Center and other centers, was able to divide CCUS into high- and low-risk groups, and showed that those with high-risk CCUS have similar outcomes to patients with low-risk MDS. That means patients with high-risk CCUS would likely benefit from treatment and should be enrolled in clinical trials. This study provides important knowledge for understanding which patients with this pre-cancerous condition should be treated. Sylvester has recently opened a CCUS clinic and is starting clinical trials for patients with this condition.
Cancer doesn’t happen at the flip of a switch. It’s an unfolding of accumulated mutations and other biological changes over time, sometimes quite a long time. Experts at Sylvester and elsewhere are working to understand when in the course of a cancer’s or pre-cancer’s development interventions would be most beneficial to patients. Not all pre-cancers will develop into cancer, so better understanding when to intervene and when to stand by and monitor the patient is crucial for the best outcomes, Dr. Sekeres said, to catch cancers early but avoid unnecessary treatments.
“There’s this kind of ironic saying in medicine: Don’t just do something, stand there,” he said. “Sometimes in medicine the hardest thing is to not do something.”
Dr. Sekeres also collaborated on a study conducted by several cancer centers across the U.S. that found that, although people with AML who live in areas with lower socioeconomic status are less likely to receive transplants for their disease, those that do receive transplants fare just as well as those from higher socioeconomic neighborhoods. That finding implies that there are no biological reasons (such as additional co-morbidities) people from these regions are less likely to receive transplants. The disparity is likely due to social health inequities.
New Therapies on the Scene
Several Sylvester teams are leading or collaborating on studies testing new types of treatments for blood cancers. Besides improving patient outcomes, many of these new therapies reduce the harsh side effects of more traditional treatments.
“For lymphoid cancers, it turns out that many of the therapies we’re using are so effective that, in some cases, we’re able to avoid bone marrow transplants,” Dr. Sekeres said. “And that’s a big deal, because that can be a very aggressive procedure.”
In one study, researchers showed that the antibody pembrolizumab can replace transplantation in patients with relapsed or refractory Hodgkin lymphoma. Another study showed that the drug combination venetoclax with azacitidine, which had been approved for older or more medically vulnerable patients with AML to replace aggressive induction chemotherapy before transplantation, also works in younger patients to avoid this grueling chemotherapy process. Another study showed that the antibody drug loncastuximab tesirine yields good response rates in patients with high-risk follicular lymphoma or marginal zone lymphoma.
In the coming years, Dr. Sekeres predicts even more availability of targeted therapies and combination therapies that could treat more patients with fewer side effects.
“I see us increasingly pivoting away from our traditional, aggressive therapies and need for aggressive transplantation,” he said. “I also see us increasingly meeting the needs of vulnerable populations, including older adults and the populations we serve here in South Florida.”
Tags: Acute Myeloid Leukemia, ASH 2024, blood cancers, cancer research, Dr. Mikkael Sekeres, myelodysplastic syndromes, Sylvester Comprehensive Cancer Center