The 61st American Society of Hematology Annual Meeting and Exposition

The annual meeting of the American Society of Hematology was held from Dec. 7 to 10 in Orlando, Florida, and attracted approximately 22,000 participants from around the world, including hematology specialists as well as clinical practitioners and other health care professionals. The conference featured presentations focusing on the diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic and vascular systems.

In one study, Karl M. Kilgore, Ph.D., of Avalere Health, an Inovalon Company, in Bowie, Maryland, and colleagues found that older patients with non-Hodgkin lymphoma who have multiple comorbidities may be treated successfully with chimeric antigen receptor T-Cell (CAR-T) therapy. CAR-T care was associated with fewer hospitalizations, shorter hospital stays, fewer emergency department visits, and lower total health care costs. The overall six-month survival rate was comparable to that observed in the clinical trials.

“This study provides the first real-world look at patients’ CAR-T experience, using the first Medicare fee-for-service claims subsequent to product FDA approvals,” Kilgore said. “Seventy-three percent of patients remained alive at the end of the six-month follow-up period. Patients spent 17 percent less time in the hospital six months after CAR-T than six months prior to CAR-T, and the number of patients requiring emergency room visits was reduced by one-third.”

The investigators also found that overall health care costs, exclusive of costs associated with the CAR-T procedure itself, were 39 percent less in the follow-up period compared with the six months prior to treatment.

“These results show that older patients and those with multiple comorbid conditions can be treated successfully with CAR-T,” Kilgore said. “Clinicians who may have been reluctant to use CAR-T in these types of patients may find these data useful in making treatment decisions going forward.”

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract No. 793

In another study, Jordan K. Schaefer, M.D., of the University of Michigan in Dexter, and colleagues found that adding aspirin to direct oral anticoagulant (DOAC) therapy increases bleeding events for some patients, without protecting patients from adverse thrombotic outcomes.

“We found that nearly one-third of patients on a DOAC for stroke prevention with nonvalvular atrial fibrillation or for the treatment or secondary prevention of venous thromboembolic disease were also taking aspirin,” Schaefer said.

The investigators demonstrated that patients on a DOAC with aspirin had a significantly higher rate of clinically relevant nonmajor bleeding events compared with patients on DOAC monotherapy.

“It is important that patients communicate to their clinicians if they are on aspirin in addition to DOAC therapy,” Schaefer said. “When patients are on antiplatelet therapy in combination with anticoagulant therapy, it is important that clinicians carefully consider each patient’s particular situation to advise whether the anticipated benefits of adding aspirin exceed the potential increase in bleeding risk.”

Several authors disclosed financial ties to pharmaceutical companies, including Bayer.

Abstract No. 787

Anita D’Souza, M.D., of the Medical College of Wisconsin in Milwaukee, and colleagues found that older adults (≥70 years) derived similar benefits from autologous hematopoietic cell transplantation for multiple myeloma as those of younger age groups.

“This is the largest study of older adults, 70 years of age or older, undergoing autologous hematopoietic stem cell transplantation in the United States with over 2,000 patients,” D’Souza explained.

The investigators used the Center for International Blood and Marrow Transplant Research database to conduct this study.

“Our study shows that there are fewer nonwhite patients in this category compared to younger age groups. While there are some important differences in the older patients (more comorbidities, less functional status, among others), the [group aged] 70 years of age or older … had no worse transplant-related mortality compared to the group aged 60 to 69 years,” D’Souza said. “We also found no difference in myeloma outcomes by age (relapse/progression and progression-free survival).”

Overall, D’Souza recommends that all myeloma patients be referred to transplant centers to assess eligibility for transplant, regardless of age.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

Abstract No. 782

Abby Statler, Ph.D., of the Cleveland Clinic in Shaker Heights, Ohio, and colleagues found that renal function eligibility criteria may be an important barrier to clinical trial enrollment for the African-American acute myeloid leukemia (AML) patient population.

“Within our cohort, a higher proportion of African-Americans had kidney dysfunction, when compared to whites, which suggests that African-Americans may be more likely to be excluded from clinical trials due to having kidney disease,” Statler said. “Fifty-six percent of our cohort presented with a kidney function abnormality; however, this proportion was greater among African-Americans, 63 percent of whom presented with a kidney function abnormality, which could have potentially excluded them from a clinical trial. However, our results indicate that minor kidney dysfunction is not associated with overall survival, suggesting it might not be appropriate to exclude patients from clinical trials for this reason alone.”

Statler suggests that kidney function eligibility criteria may be relaxed without necessarily increasing the risks to patients who present with such abnormalities, which in turn may promote the recruitment of African-Americans to AML clinical trials.

“We specifically recommend removing exclusion criteria relevant to minor creatinine and creatinine clearance abnormalities,” Statler said. “If renal function eligibility criteria are liberalized, this might reduce racial disparities in clinical trial enrollment, which may be a major step in improving the diversity of cancer clinical trial patient populations.”

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

Abstract No. 381

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