Mathias Castonguay, MD

Approach to autologous stem cell transplantation in a patient with severe cold agglutinin disease, a case report Background Cold agglutinin disease (CAD) or syndrome (CAS) can be particularly challenging when autologous stem cell transplant (ASCT) is needed. Standard peripheral blood stem cell (PBSC) collectio.....

ASCT remains the standard treatment for chemosensitive relapsing LBCL. Here, we report the first case of a patient with severe cold agglutinin disease, transfusion-dependent and under anti-complement therapy, who required ASCT for LBCL. @m-drinkwater.bsky.social #lymsm

doi.org/10.1111/trf....

Brentuximab Vedotin Combination for Relapsed Diffuse Large B-Cell Lymphoma PURPOSEIn patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), brentuximab vedotin (BV) as monotherapy or combined with either lenalidomide (Len) or rituximab (R) has demo...

ECHELON-3 is out !
Another option for multiple r/r DLBCL, however doesn’t seem to be a curative. Interestingly, efficacy was not affected by CD30 status.
Specific congrats to Isabelle Fleury, an amazing lymphoma doctor here in Montreal ! #lymsm

doi.org/10.1200/JCO-...

Siltuximab for chimeric antigen receptor T-cell therapy–related CRS and ICANS: a multicenter retrospective analysis Key PointsIn this retrospective analysis, siltuximab effectively treated CRS and ICANS with an objective response rate of 75% and 60%, respectively.Siltuxi

Siltuximab, a new therapeutic option for ICANS and tocilizumab-refractory CRS associated with CAR-T? Great work by Bajwa et al. We need to incorporate new corticosteroid-sparing agents for severe ICANS into treatment algorithms (Anakinra, siltuximab, others?). #lymsm

doi.org/10.1182/bloo...

CAR-T cell therapies for T cell malignancies: does cellular immunotherapy represent the best chance of cure? Chimeric antigen receptor T cell (CAR-T) therapy has proven successful for B cell lymphomas and leukaemias. This success has inspired the development of CA

Excellent review of current knowledge, challenges and clinical trials regarding immunotherapies (CAR-T) for T-cell malignancies by Maciocia and al. Very exciting time ahead for lymphoma doctors #lymsm

doi.org/10.1182/bloo...

Tafa +/- R² RCT #ASH24 LBA
- 548 pts, 32% POD24, 55% 1 prior LOT
- superior PFS w/ tafa, including POD24
- look at that tafa TTNT curve!
- slightly more tafa & len d/c in tafa arm
- more PD deaths in pbo arm
OS analysis planned at 5 yrs, trend towards tafa. #lymsm

3-yr F/U fixed-duration glofi @mike_dickinson1 #ASH24
- 53% of pts w/ CR had ongoing CR
- ctDNA: 3/4 of pts with EOT CR had ongoing uMRD
- B-cell fxn & IgG recover ~12-18 mos after ETO
- 2 new G5 AEs: COVID & AML
Important updated data for 40% of pts who get into CR. #lymsm

Great work! Will be interesting to see the real-world evidence of re-exposure in pts who had a CR1 and the duration of CR2. Also raising the question if allo transplant should be considered among patients r/r to CAR and in CR with a BsAbs.
Can’t wait for more data and real-world evidence !

Neelapu: long term Zuma5 FU (Axi-cel FL)
- 127 efficacy pts, R/R FL 2+ prior lines
- at >5y FU, >50% alive, no further Rx
- PFS at 5y approx 50%
- NRM approx 15%
- only 1 PD event after 4y
- Apply to high risk incl POD24
Does support curative potential in FL
#ASH24 #lymsm

Lewis et al: ENRICH study in 1L MCL
- Ibr+ritux vs R-chemo (RCHOP or R-benda)
- 400 pts, >60y
-PFS: prolonged with IR
- Largely driven by benefit over R-CHOP
- Blastoid did not benefit from IR
- OS the same
- 22% cardiac AEs with IR
1st trial to show benefit chemo-free in 1L MCL.
#ASH24 #lymsm

Jerkeman - acala+ritux in older MCL
• MRD guided - 56% of low risk stopped due to MRD neg
• safe, although 2 deaths due to aplastic anaemia (v odd?)
• low risk had excellent outcomes (less so if p53, blastic / high Ki67)
#ASH24 #lymsm

Le Gouill - OASIS II
• IBR + R v I-Ven-R 1L MCL
• DDPCR for MRD at 6mo
• MRD- rate 82% with IVR, higher than any other regimen incl immunochemo
• some excess AE: diarrhoea, neutrop, arrhyth
IVR clearly a hugely active triplet
#ASH24 #lymsm

Low VAF TP53 CLL #ASH24:
- 961 pts, 1/3 had low VAF TP53mut (<10%)
- OS similar for low VAF TP53 & WT
- TP53mut associated with worse TT1T
- if 1L tx targeted agents: low VAF group did not have worse TT2T (v WT)
No diff in OS between high VAF & WT in targeted agent era! #leusm

Overall response rate (ORR) of 100%! Now with long term data showing 5-yr-Progression Free Survival (PFS) of 91%.

Neither Pembro nor GVD alone is as efficacious, begging the mechanistic question of “synergy” - that is, how do immunotherapy and chemotherapy combine to become more than either alone?

Excellent presentation by Dr. Dreyling at #ASH2024. A trend in favor of A+I vs. I for high-risk MCL (including highP53), which contrasts with previous data suggesting no benefice of ASCT in TP53mut MCLs. I believe we should not (yet?) abandon consolidation ASCT in MCL pts with poor pronostic. #lymsm

I’m surprised to see the mPFS of R2 at 13.9 months, whereas it was 39 months in the AUGMENT trial. Looking forward to learning more!

Looking forward to attending this presentation at #ASH24.
MRD is neither standardized nor universally accessible for the treatment of MCL, but now it might have decision making impact! #lymsm

ASCT in CR1 MCL MRD-adapted #ASH24 @timfenske:
650 pts, 73% AraC induction, mFU 2.7 yr
- A: uMRD6 ASCT + MR x 3 yr
- B: uMRD6 MR x 3 yr
3-yr PFS/OS:
- A: 76.6%/82.1%
- B: 77.4%/82.7%
No difference in OS based on futility analysis. CR1 with MRD-neg at 10-6 do not need ASCT! #lymsm

Important paper: Comparing axi-cel and liso-cel in patients receiving 3L+ therapy for relapsed large b-cell lymphoma. Outcomes similar to trials, but liso-cel takes longer and when matched, axi-cel improved PFS. @oncoalert.bsky.social
#lymsm #medsky #oncsky