Backgrounds: Targeted and Immunotherapy have changed treatment practices for many haematological malignancies. Even in the current era of targeted, immunotherapies and check point inhibitors, chemotherapy remains the backbone of treatment for many haematological malignancies. Application of novel immunotherapies in haematology attempts to harness the killing power of the immune system against leaukaemias and lymphomas, plasma cell myelomas. Cellular immunotherapy is evolving rapidly for high-risk haematological disorders. Recent advances include chimeric antigen-receptor T cells (CAR T Cells), mesenchymal stromal/stem cells, dendritic cell tumour vaccines, cytokine-induced killer cells, and virus-specific T cells. The advantages of non-transplantation cellular immunotherapy include suitability of patients for whom transplantation has failed or is contraindicated, and potentially less-toxic treatment alternative to transplantation for relapsed/refractory conditions are available. In my talk, I will be discussing about emerging cellular immunotherapies that are changing treatment paradigms for patients with haematological malignancies including CAR Cell therapies in 2019 and the future directions.
Stem cell transplantation and immunotherapy: In the era of targeted and immunotherapy stem cell transplantations and indications of the procedure has been reducing globally. For example, in CLL/SLL we use to believe stem cell transplantation is a curative option in high risk cytogenetic groups but increasingly we are moving away from transplantation and is not considered as curative any longer. Newer and emerging noble therapies are being added almost on a yearly basis and changing the treatments landscapes rapidly. Despite this, we still consider allogeneic stem cell transplantation is the only hope of cure in many haematological malignancies and used as consolidation therapy. I will be talking the patients’ selection criteria and indications we use in the United Kingdom.
Maintenance immunotherapies: Maintenance with immunotherapies and targeted therapies has transformed the way we treat patients not only with haematological malignancies but also with other solid cancers. There are number of conditions we use maintenance therapies with overall (OS) and progression free survival (PFS) benefit. Rituximab, Ibrutinib Idelalisib, Venetoclax, Obinutuzumab and so on in lymphomas, Lenalidomide, Valcade in myelomas and many more adding almost each year.
Relapsed haematological cancers: Despite the huge advancement and potential curative therapies, many patients with haematological malignancies relapse invariably. There are patients who have primary refractory diseases. The treatment in this group of patients can be challenging due to many factors. The choice of a treatment regimen at relapse is complicated and is affected by many factors including the timing of the relapse, response to prior therapy, aggressiveness of the relapse, and performance status (TRAP). Patients who are eligible for transplantation should be considered for the procedure if they have never had one before or if they have had excellent remission duration with the first transplantation either with autologous or allogeneic. There are various salvage regimens have been developed with very good response rate prior to the consideration of stem cell transplantation. In relapsed setting clinical trial should be encouraged if available. Many modalities of targeted and immunotherapies are emerging rapidly and the future is very promising. CAR T cell therapies are being engineered and have attracted many developed national and international authorities. Check point inhibitors, antibody drug conjugates are also under investigations with variable success rates
Acknowledgement: My oral presentation in 4th Bangladesh HaematoCon 2019, has been sponsored by the Haematology Society of Bangladesh.
Correspondence: Dr. Amin Islam, Queen Mary University, London, United Kingdom, Consultant Haematologist and Stem Cells Transplantation, Mid and South Essex University Hospitals NHS foundation Trust & University College London Hospital NHS Foundation Trust, United Kingdom. Email: [email protected], [email protected].