T. Feys MBA, MSc

New haematology reimbursements in Belgium

OVERVIEW OF BELGIAN REIMBURSEMENT NEWS

(BELG J HEMATOL 2024;15(3):130)

Fixed-duration therapies for CLL

Chemoimmunotherapy (CIT) has been the long-standing cornerstone of the first line treatment for patients with chronic lymphocytic leukaemia (CLL). More recently, however, continuous treatment with Bruton’s tyrosine kinase inhibitors (BTKis) emerged as a new standard of care frontline treatment for the majority of CLL patients. However, the continuous nature of this treatment modality is associated with a considerable treatment burden, long-term toxicity and potential clonal selection. Therefore, research efforts have focused on the development of new, time-limited and chemotherapy-free first line treatment regimens for patients with CLL.¹ In this mini review, the main clinical trial results with these different fixed-duration regimens are summarised.

Medical need for patients with resistance to covalent Bruton tyrosine kinase inhibitors

Bruton tyrosine kinase inhibitors (BTKis) have revolutionised the treatment landscape for patients with chronic lymphocytic leukaemia (CLL) and several non-Hodgkin lymphoma (NHL) subtypes, including mantle cell lymphoma (MCL). Despite the efficacy of covalent BTKis (cBTKis), the development of resistance mutations leads to poor outcomes in patients who relapse after a cBTKi-based therapy. Non-covalent BTKis (ncBTKis), such as pirtobrutinib, have a different mode of action than cBTKis allowing them to overcome this acquired resistance. In recent years, several clinical trials have yielded promising results with pirtobrutinib and other ncBTKis in patients progressing on a cBTKi. This article zooms in on the unmet clinical needs of cBTKi-resistant patients, exploring pivotal findings from clinical trials assessing pirtobrutinib in this context, alongside other prospective strategies.

Expanding the therapeutic armamentarium in relapsed/refractory Diffuse Large B-cell Lymphoma

In recent years, the treatment landscape of patients with relapsed or refractory diffuse-large B-cell lymphoma (R/R DLBCL) has changed dramatically. This mini review will briefly discuss the clinical trial data that were obtained with these different options.

Towards a chemotherapy-free future for patients with follicular lymphoma

Follicular lymphoma (FL) is the most common B-cell non-Hodgkin lymphoma (NHL) and typically follows an indolent disease course. While some patients do not require treatment until certain criteria are met, others may progress to an aggressive lymphoma phenotype requiring a different treatment approach. The current standard initial treatment for FL consists of chemo-immunotherapy in which cytotoxic chemotherapy is combined with an anti-CD20 antibody. In general, this treatment strategy is highly effective, significantly delaying disease progression and postponing the need for additional therapy for many years. However, a proportion of patients may experience chemotherapy-related toxicities, while others prove to be chemotherapy-refractory. For these patients, an effective chemotherapy-free treatment approach is sought. This article provides a concise overview of the mechanisms of action of potential targeted therapies for FL and briefly discusses the available clinical trial data.¹

Haematological highlights from ESMO 2023

SUMMARY

Once more, the European Society for Medical Oncology (ESMO) dedicated a session to haematological malignancies during its last meeting in October 2023. This session revealed novel immunotherapeutic strategies, such as activating γ9δ2 T cells to treat haematological cancers and using trifunctional natural killer (NK) cell engagers to eliminate CD123+ tumour cells. Additionally, promising results were observed with the combination of toripalimab and radiotherapy in treating extranodal NK/T cell lymphoma. Furthermore, genetic analyses identified genetic alterations with prognostic value for anti-PD-1 therapy in peripheral T-cell lymphomas (PTCL). Finally, a large cohort study examined treatment outcomes in primary ocular adnexal MALT lymphoma (POAML) patients.

(BELG J HEMATOL 2024;15(2):62–5)

Highlights in acute myeloid leukaemia

SUMMARY

The 2023 annual meeting of the American Society of Hematology (ASH) again featured some interesting studies related to acute myeloid leukaemia (AML). In newly diagnosed patients, the FLT3 inhibitor quizartinib and the combination of ivosidenib and a hypomethylating agent (HMA) yielded promising results in patients harbouring a FLT3-internal tandem duplication (ITD) or IDH1 mutation, respectively. Additionally, the nuclear export inhibitor selinexor, combined with azacitidine and venetoclax (SAV), resulted in encouraging responses in unfit AML patients. In the relapsed/refractory (R/R) setting, the menin inhibitor revumenib and CD33 CART cells emerged as promising regimens for paediatric and adult patients with KMT2A rearranged AML. Finally, vaccination using host-derived leukaemia cells and donor-derived dendritic cells represents a promising strategy to reduce the relapse risk for AML patients following an allogeneic transplant.

(BELG J HEMATOL 2024;15(1):22–6)