Stephen M. Ansell, MD, PhD, chair, faculty development and recruitment, consultant, Division of Hematology, Department of Internal Medicine, Mayo Clinic, discusses the updated analysis of the phase 3 ECHELON-1 (NCT01712490) in classical Hodgkin lymphoma.

The trial compared brentuximab vedotin (Adcetris) plus doxorubicin, vinblastine, and dacarbazine (AVD) with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the frontline treatment of classical Hodgkin lymphoma.

When adding new drugs to treatment, there is the concern about long-term toxicities, Ansell says. Findings of the ECHELON-1 trial showed that the development of secondary solid tumor and hematologic malignancies were approximately the same in both arms, Ansell adds.

What was different in the arms were the type of secondary hematological malignancies observed, with T- and B-cell lymphomas being common among patients who received ABVD and less common in those who received brentuximab videoton plus ABVD chemotherapy, Ansell explains. This suggests that the CD30-targeted antibody-drug conjugate may hit a precursor cell that prevents subsequent lymphomas from developing, Ansell says. Overall, these data demonstrate the advantage of adding a novel targeted agent to an AVD backbone, Ansell concludes.

Videos

Stephen M. Ansell, MD, PhD, discusses the updated analysis of the phase 3 ECHELON-1 in classical Hodgkin lymphoma.

Dr. Ansell on the Updated Analysis of ECHELON-1 in Classical Hodgkin Lymphoma

Stephen M. Ansell, MD, PhD, chair, Lymphoma Group, Mayo Clinic, discusses the utility of non–CAR T-cell therapy options in non-Hodgkin lymphoma (NHL).

Historically, patients with NHL, particularly large B-cell lymphoma (LBCL), who progressed following autologous stem cell transplant had poor prognoses with limited treatment options, Ansell says. As such, palliative chemotherapy was often the only available option for this patient population. 

However, several novel therapeutic approaches have emerged that have changed the treatment course for these patients, Ansell explains. Antibody-drug conjugates, such as polatuzumab vedotin-piiq (Polivy), can be used as single agents or in combination with chemotherapy. The monoclonal antibody tafasitamab-cxix (Monjuvi) is FDA approved for use in combination with lenalidomide (Revlimid) in patients with relapsed/refractory diffuse LBCL. Additionally, bispecific antibodies, as well as the XPO1 antagonist selinexor (Xpovio), are approved for use in LBCL, Ansell says. 

These non–CAR T-cell therapies can be utilized in various sequences, Ansell explains. In the context of CAR T-cell therapy, some of these approaches can be used as bridging treatment to CAR T-cell therapy, after progression on CAR T-cell therapy, or instead of CAR T-cell therapy in patients who are ineligible for CAR T-cell therapy or whose disease histology limits the utility of CAR T-cell therapy, concludes Ansell.

Stephen M. Ansell, MD, PhD, discusses the utility of non–CAR T-cell therapy options in non-Hodgkin lymphoma. 


Dr. Ansell on the Utility of Non–CAR T-Cell Therapies in Non-Hodgkin Lymphoma 

Stephen M. Ansell, MD, PhD, of Mayo Clinic, discusses the use of PD-1 inhibitors for patients with Hodgkin lymphoma.

 The use of PD-1 blockade drugs, such as nivolumab (Opdivo) or pembrolizumab (Keytruda), have proven to be promising in patients who have failed multiple prior therapies. There is an overexpression of PD-L1, which allows these patients to benefit from PD-1 treatment.   

The CheckMate-039 study focused on using nivolumab to treat patients who had failed on prior lines of therapy. There were many different cohorts in this study, but the Hodgkin lymphoma cohort did particularly well, Ansell explains.

Dr. Ansell on PD-1 Inhibitors in Hodgkin Lymphoma

Stephen Ansell, MD, PhD, professor of medicine at the Mayo Clinic in Minnesota, discusses using rituximab (Rituxan) to treat subgroups of patients with Waldenström Macroglobulinemia (WM), a rare type of slow-growing non-Hodgkin lymphoma.

WM patients with modest amounts of disease can be treated with rituximab as a monotherapy. However, giving this agent alone increases the risk of developing a flare phenomenon, in which the protein IgM increases causing hyperviscosity in the blood, a leading cause of the symptoms associated with WM.

Management of hyperviscosity may include plasmapheresis before and after the administration of rituximab. Additionally, rituximab may be combined with chemotherapy. This combination has shown promise at reducing the incidence of the flare phenomenon.

Dr. Stephen Ansell, from the Mayo Clinic, on Treating Patients With WaldenstrÃ¶m Macroglobulinemia 

Dr. Ansell on WaldenstrÃ¶m Macroglobulinemia Treatments

Stephen Ansell, MD, PhD, professor of medicine at the Mayo Clinic in Minnesota, describes the symptoms associated with Waldenström Macroglobulinemia (WM), an indolent non-Hodgkin lymphoma caused when lymphoplasmacytic cells multiply abnormally.

The symptoms of WM include a palpable enlargement or swelling in the liver, lymph nodes, or spleen caused by the disease's origin in the immune system. The direct cause of the immune system overproduction is unknown, but a possible link to hereditary genetics has been made.

A common side effect of WM is hyperviscosity syndrome that is caused by high serum levels of the protein immunoglobulin M (IgM), produced by the overactive lymphoplasmacytic cells. Excess of this large protein causes the blood to be thicker and prevents oxygen from reaching organs, fingertips, eyes, and the brain, causing organ dysfunction.

Dr. Stephen Ansell from the Mayo Clinic in Minnesota Describes Waldenstrom Macroglobulinemia Symptoms

Dr. Ansell on Waldenstrom Macroglobulinemia Symptoms

Stephen Ansell, MD, PhD, professor of medicine at the Mayo Clinic in Minnesota, explains the 2 main types of patients with Waldenström Macroglobulinemia (WM), a rare type of slow-growing, non-Hodgkin lymphoma.

Some types of WM present with very few symptoms and are generally only detected because the monoclonal immunoglobulin M antibody, or macroglobulin, protein that is overproduced in WM is detected. This type is generally referred to as indolent WM and may not require therapy, these patients are generally monitored without being treated and will not require treatment for many years.

Patients with WM that present symptoms, which includes weakness, swollen lymph nodes, severe fatigue, nose bleeds, weight loss, and visual and neurological problems, require treatment. Treatment will begin with plasmapheresis followed by chemotherapy plus rituximab.

Dr. Stephen Ansell from the Mayo Clinic Describes WaldenstrÃ¶m Macroglobulinemia

Stephen Ansell, MD, PhD

Articles

Dr. Ansell on the Updated Analysis of ECHELON-1 in Classical Hodgkin Lymphoma

Dr. Ansell on the Utility of Non–CAR T-Cell Therapies in Non-Hodgkin Lymphoma

Dr. Ansell on PD-1 Inhibitors in Hodgkin Lymphoma

Dr. Ansell on WaldenstrÃ¶m Macroglobulinemia Treatments

Dr. Ansell on Waldenstrom Macroglobulinemia Symptoms

Dr. Ansell on Waldenstrom Macroglobulinemia Types