In the context of newly diagnosed multiple myeloma, recent advances in risk assessment have influenced treatment decisions and paved the way for more individualized approaches. The current NCCN Guidelines for Multiple Myeloma outline the updated staging system, highlight various high-risk features for disease progression/relapse, and provide evidence-based recommendations for myeloma therapy. Although the therapeutic landscape continues to shift toward increased risk adaptability, ongoing efforts should place an emphasis on tackling modifiable risks.
Management of Newly Diagnosed Multiple Myeloma Based on Risk Stratification
Presented by: Natalie S. Callander
Management of Toxicities of BTK Inhibitors in B-Cell Malignancies
Presented by: Muhammad Saad Hamid and Kirollos S. Hanna
Brüton’s tyrosine kinase (BTK) inhibitors have significantly advanced treatment options for patients with B-cell malignancies; however, side effects with these agents are not uncommon, and a multidisciplinary approach is necessary for monitoring and managing adverse events such as bleeding, hypertension, and atrial fibrillation. In the treatment of patients on BTK inhibitors, maintaining communication between patients and all providers is essential, particularly concerning the use of any concurrent medications or supplements, as is educating patients on identifying early risk factors and reporting any signs or symptoms of toxicities. Ongoing clinical studies with both covalent and noncovalent BTK inhibitors are expected to further increase the understanding of these toxicities while improving the efficacy and safety of this class of medications.
Navigating the Challenges: Effective Management of Toxicities in CAR T-Cell Therapies
Presented by: Olalekan O. Oluwole and Salyka Sengsayadeth
CAR T-cell therapy has dramatically changed the treatment landscape of many hematologic cancers, but it carries some risk. Cytokine-release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome can be life-threatening acute toxicities that require prompt identification, severity grading, and intervention. Appropriate use of tocilizumab and steroids may mitigate the side effects of CRS. Some of the chronic toxicities, such as cytopenias and hypogammaglobulinemia, should be differentiated from other possible causes; they also may respond to well-informed management.
The NCCN 2023 Annual Congress: Hematologic Malignancies
Crystal S. Denlinger
Perioperative Management of Anticoagulation and Antithrombotic Therapy
Presented by: Michael B. Streiff
The latest updates to the NCCN Guidelines for perioperative management of anticoagulation and antithrombotic therapies reflect significant changes in the use of bridging anticoagulation. For patients with low- to intermediate-risk atrial fibrillation, the standard of care has shifted toward reduced reliance on bridging anticoagulation. The rationale for this shift is based on the BRIDGE trial, which revealed a 3-fold greater risk of major bleeding without significant reduction in thrombotic outcomes in patients receiving bridging therapy. In patients with mechanical heart valves, findings from the PERIOP2 study led to similar conclusions. Both of these studies have contributed to a paradigm shift in perioperative anticoagulation management, pivoting toward personalized therapy based on patient-specific bleeding and thrombotic risks. For emergent or elective surgeries, the NCCN Guidelines provide a framework for more individualized decision-making, emphasizing the need for ongoing cooperation among physicians, surgeons, and patients.
Relapsed/Refractory CLL/SLL: Overcoming Resistance to Covalent BTKi and/or BCL2 Inhibitors
Presented by: Brian T. Hill
We are now in the era of targeted therapy for frontline chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), with current treatments demonstrating favorable long-term outcomes. However, patients with double-refractory CLL whose disease has relapsed or been refractory to treatment with both a BTK and BCL-2 inhibitor present a unique challenge; although the number of patients experiencing relapse after first-line chemoimmunotherapy is likely to decrease, the number of those with double-refractory CLL is expected to increase. Various treatment strategies have been explored and noncovalent Bruton’s tyrosine kinase inhibitors, such as pirtobrutinib, show activity in the double-refractory CLL population. Further research and prospective trials are needed to refine these approaches and improve outcomes for patients with relapsed/refractory CLL/SLL.
Revolutionizing Hematologic Cancer Treatment: The Promise of Bispecific T-Cell Engagers
Presented by: Lihua E. Budde, Stacy Pak, and Lauren R. Seipel
The advent of bispecific T-cell engager (TCE) therapies has marked a turning point in the management of hematologic malignancies. Several clinical trials of these agents have led to approvals from the FDA, resulting in their subsequent incorporation into standard patient care. Although ongoing efforts are being made to optimize bispecific TCE therapies, a focus on their equitable distribution is needed. At the NCCN 2023 Annual Congress: Hematologic Malignancies, panelists presented clinical trial data, 2 case studies, and updates from NCCN Guidelines to develop an evidence-based approach for the use of these immunotherapies in various clinical contexts.
Updates in the Management of Myelofibrosis
Presented by: Andrew T. Kuykendall
The JAK inhibitors ruxolitinib, fedratinib, and pacritinib have demonstrated significant activity in improving symptoms and spleen size, as well as quality of life, in patients with myelofibrosis. Additionally, the recent approval of another JAK inhibitor, momelotinib, for patients with myelofibrosis and anemia has further expanded the available treatment options for this malignancy. As research continues to reveal the best treatment strategies, clinical trials will remain an essential avenue for improving outcomes in this patient population.
Volume 21 (2023): Issue 11 (Nov 2023)
Acute and Chronic Complications After Treatment of Locoregional Anal Cancer: Prevention and Management Strategies
Leah Katz, David P. Horowitz, and Lisa A. Kachnic
Definitive chemoradiotherapy (CRT) for anal cancer spares patients the morbidity of a colostomy surgery and optimizes cancer outcomes. CRT, however, has introduced a unique acute and chronic toxicity profile, which has greatly improved over the years with the introduction of advanced radiotherapy techniques. This article provides the multidisciplinary care team with practical tools to mitigate and manage acute and chronic complications from definitive treatment of anal cancer.