Recent Advances in the Treatment of Hematologic Malignancies
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February 2009 www.clinicaladvances.com Volume 7, Issue 2, Supplement 6 With Commentaries From: Shaji Kumar, MD Associate Professor of Medicine Mayo Clinc Rochester, Minn Recent Advances in the S. Vincent Rajkumar, MD Professor of Medicine Mayo Clinc Treatment of Hematologic Rochester, Minn Malignancies John P. Leonard, MD Richard T. Silver Distinguished Professor Hematology and Medical Oncology Weill Cornell Medical College New York Presbyterian Hospital New York, NY A Review of Selected Presentations from the Kanti R. Rai, MD 50th Annual American Society of Hematology Chief, Division of Hematology/Oncology Meeting and Exposition Long Island Jewish Medical Center December 6–9, 2008 New Hyde Park, NY San Francisco, California Guillermo Garcia-Manero, MD Associate Professor Chief, Section of Myelodysplastic Syndromes Guest Editor: Department of Leukemia Bruce D. Cheson, MD, FACP The University of Texas M.D. Anderson Cancer Center Head of Hematology Houston, Tex. Lombardi Comprehensive Cancer Center Georgetown University Hospital Washington, DC A CME Activity Approved for 1.25 AMA PRA Category 1 Credit(s) TM Release Date: February 2009 Expiration Date: February 15, 2010 Estimated time to complete activity: 1 hour 30 minutes Project ID: 6188 Sponsored by Postgraduate Institute for Medicine Supported through educational grants from Celgene Corporation and Cephalon Inc. Table of Contents CME Certification Information and Faculty Disclosure 3 Introduction by Dr. Bruce D. Cheson 4 Summaries of Selected Presentations on Myeloma and Expert Commentary from Drs. Shaji Kumar and S. Vincent Rajkumar 6 Summaries of Selected Presentations on Lymphoma and Expert Commentary by Dr. John P. Leonard 13 Summaries of Selected Presentations on Leukemia and Expert Commentary by Dr. Kanti R. Rai 17 Summaries of Selected Presentations on Myelodysplastic Syndromes and Expert Commentary by Dr. Guillermo Garcia-Manero 23 CME Post-Test 31 CME Evaluation Form 32 Disclaimer Funding for this Presentations Review has been provided through an educational grant from Celgene Corporation and Cephalon Inc. Support of this monograph does not imply the supporter’s agreement with the views expressed herein. Every effort has been made to ensure that drug usage and other information are presented accurately; however, the ultimate responsibility rests with the prescribing physician. Millennium Medical Publishing, Inc, the supporters, and the participants shall not be held responsible for errors or for any consequences arising from the use of information contained herein. Readers are strongly urged to consult any relevant primary literature. No claims or endorsements are made for any drug or compound at present under clinical investigation. ©2009 Millennium Medical Publishing, Inc. 611 Broadway, Suite 310, New York, NY 10012. Printed in the USA. All rights reserved, including the right of reproduction, in whole or in part, in any form. Target Audience Dr. Guillermo Garcia-Manero: No real or apparent conflicts of interest This activity has been designed to meet the educational needs of he- Dr. Kanti Rai—Royalties: UpToDate; Other Honoraria: Bayer, Celgene, matologist and oncologists involved in the management of patients Cephalon, Genentech. with hematologic malignancies. Dr. S. Vincent Rajkumar: No real or apparent conflicts of interest. Statement of Need/Program Overview The following planners and managers, Linda Graham, RN, BSN, Data are emerging on novel agents as well as new combination regi- BA, Jan Hixon, RN, BSN, MA, Trace Hutchison, PharmD, mens for the treatment of hematologic malignancies. This mono- Julia Kirkwood, RN, BSN and Jan Schultz, RN, MSN, CCMEP graph reviews some of the salient new data recently presented at hereby state that they or their spouse/life partner do not have any international meetings of hematologists/oncologists. financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any Educational Objectives amount during the past 12 months. After completing this activity, the participant should be better able to: Jessica Wapner: No real or apparent conflicts of interest. • Describe how to integrate prognostic factors into treatment Method of Participation decisions for patients with hematologic malignancies, including There are no fees for participating and receiving CME credit for this lymphoma, leukemia, myelodysplastic syndromes (MDS), and activity. During the period February 2009 through February 15, 2010, multiple myeloma participants must 1) read the learning objectives and faculty disclosures; • Identify factors influencing the choice of treatment for patients 2) study the educational activity; 3) complete the posttest by recording with MDS and leukemia the best answer to each question in the answer key on the evaluation • Outline the most recent data on treatment options for both newly form; 4) complete the evaluation form; and 5) mail or fax the evalua- diagnosed and recurrent multiple myeloma. tion form with answer key to Postgraduate Institute for Medicine. You may also complete the post-test online at www.cmeuniversity.com. On Accreditation Statement the navigation menu, click on “Find Post-tests by Course” and search This activity has been planned and implemented in accordance by project ID 6188. Upon successfully completing the post-test and with the Essential Areas and policies of the Accreditation Council evaluation, your certificate will be made available immediately. for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and A statement of credit will be issued only upon receipt of a complet- Millennium Medical Publishing, Inc. PIM is accredited by the AC- ed activity evaluation form and a completed posttest with a score of CME to provide continuing medical education for physicians. 70% or better. Your statement of credit will be mailed to you within three weeks. Credit Designation PIM designates this educational activity for a maximum of Media 1.25 /AMA PRA Category 1 Credit(s)TM/. Physicians should only Monograph claim credit commensurate with the extent of their participation in the activity. Disclosure of Unlabeled Use This educational activity may contain discussion of published and/or Disclosure of Conflicts of Interest investigational uses of agents that are not indicated by the FDA. PIM, PIM assesses conflict of interest with its instructors, planners, man- Millennium Medical Publishing, Inc., Cephalon, Inc., and Celgene agers and other individuals who are in a position to control the con- Corporation do not recommend the use of any agent outside of the tent of continuing medical education (CME) activities. All relevant labeled indications. conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activ- The opinions expressed in the educational activity are those of the fac- ity, and patient care recommendations. PIM is committed to provid- ulty and do not necessarily represent the views of PIM, Millennium ing its learners with high quality CME activities and related materi- Medical Publishing, Inc., Cephalon, Inc., or Celgene Corporation. als that promote improvements or quality in healthcare and not a Please refer to the official prescribing information for each product for specific proprietary business interest of a commercial interest. discussion of approved indications, contraindications, and warnings. The faculty reported the following financial relationships or re- Disclaimer lationships to products or devices they or their spouse/life part- Participants have an implied responsibility to use the newly acquired ner have with commercial interests related to the content of this information to enhance patient outcomes and their own professional CME activity: development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medica- Dr. Bruce Cheson—Consulting fees: Celgene, Cephalon, Genentech, tions, or other courses of diagnosis or treatment discussed or suggested Millennium; Speakers’ Bureau: Genentech, Millennium in this activity should not be used by clinicians without evaluation of Dr. Shaji Kumar—Research support: Bayer, Celgene, Genzyme, their patient’s conditions and possible contraindications on dangers in Millennium use, review of any applicable manufacturer’s product information, and Dr. John Leonard—Consulting fees: Biogen IDEC, Celgene, Cepha- comparison with recommendations of other authorities. lon, Genentech, GlaxoSmithKline, Immunomedics, Johnson & Johnson, Millennium, Wyeth p R e S e n tatio n S R e vi e w Introduction eaders perusing the 2008 American Society tions with histone deacety- of Hematology (ASH) abstracts selected for lase inhibitors may further the accompanying review cannot help but be improve patient outcome. Rimpressed by not only how far we have come in the last Unfortunately, improvements few years in the treatment of patients with leukemias, in the therapy of acute mye- lymphomas and myeloma, but also how far there is to logenous leukemia have been go. The days of empiric mixing and matching of con- slow in coming. ventional cytotoxics, once the subject of many ASH The ASH meetings provided important data on the presentations, has been replaced by studies reporting role of both relatively standard agents as well as novel on a series of novel agents which, when demonstrated compounds in the non-Hodgkin