Significant Updates in Hematology Include New Options for DLBCL, MM, and GVHD

The annual conference of the Hematology/Oncology Pharmacy Association offered a session titled “Significant Updates in Hematology,” which covered the latest advancements in the treatment of several conditions, including B-cell lymphoma, multiple myeloma (MM), and graft-versus-host disease (GVHD).

Matthew J. Newman, PharmD, MEHP, BCOP, clinical pharmacist practitioner in hematologic malignancies at Johns Hopkins Hospital in Baltimore, MD, described loncastuximab tesirine, the newest option available to fight B-cell lymphoma. The LOTIS-2 trial showed that “loncastuximab tesirine has substantial single-agent anti-tumor activity and produces durable responses with an acceptable safety profile, potentially offering a new therapeutic option for heavily pretreated patients with relapsed or refractory [diffuse large B-cell lymphoma],” according to the study published in Lancet Oncology.

Dr. Newman offered several insights into treatment with loncastuximab tesirine. It’s used after two or more lines of systemic therapy, he said, and it’s a potential option for patients unable to receive or who have already received chimeric antigen receptor (CAR) T-cell therapies. The treatment requires premedication with dexamethasone, Dr. Newman said, adding that that patients should avoid sun exposure and healthcare providers should be aware of the possibility of extravasation.

In multiple myeloma, Dr. Newman reviewed new options of isatuximab-irfc and idecabtagene vicleucel. Adding isatuximab-irfc to carfilzomib plus dexamethasone has resulted in improved progression-free survival compared with carfilzomib alone dexamethasone alone, Dr. Newman explained. He cautioned healthcare providers to be aware of potential toxicities, such as pulmonary complications, infusion-related reactions, neutropenia, and skin cancer as a secondary primary malignancy. Idecabtagene vicleucel, Dr. Newman explained, leads to a high rate of response in heavily pre-treated patients with relapsed or refractory MM. Efficacy and toxicity increase with CAR+ T-cell dose, he said, and practitioners should be aware of potential cytokine release syndrome, neurotoxicity, and prolonged cytopenia.

Dr. Newman then explained new options in GVHD: ruxolitinib, an oral JAK1/JAK2 inhibitor, and belumosudil, a serine/threonine kinase inhibitor. Ruxolitinib is approved for steroid-refractory acute GVHD. It has been shown to improve overall response, response duration, and reduce symptom burden, he said, with potential adverse events of thrombocytopenia, anemia, and infections. Belumosudil also has proven effective against chronic, steroid-refractory GVHD, improving response rate and duration of response, lessening symptoms, and reducing steroid doses, Dr. Newman said, adding that healthcare providers should check aspartate aminotransferase, alanine aminotransferase, and bilirubin monthly in patients receiving this treatment.