Roswell Park Presentations at TCT 2019 Focus on Tools for Predicting Patient Outcomes

HOUSTON, Texas — Particularly in the realm of cancer care, which can mean years of treatment and follow-up for patients, clinicians look to a number of tools and metrics to guide their decision-making regarding what, if any, treatment options and care approaches may be most effective for a particular patient. Roswell Park Comprehensive Cancer Center experts were invited to highlight ways to optimize these predictive strategies to improve both treatment and rehabilitation of patients undergoing hematopoietic stem cell transplantation, also known as bone marrow transplant, during the TCT/Transplantation and Cellular Therapy Meetings now underway in Houston, Texas.

Theresa Hahn, PhD, earned a Best Abstract Award from the meeting organizers for her work to better predict the long-term risk of disease progression or death in multiple myeloma patients treated with hematopoietic cell transplant followed by long-term, “maintenance” doses of the immunomodulating drug lenalidomide. Dr. Hahn led a multicenter team of collaborators from Roswell Park, the Center for International Blood and Marrow Transplant Research, the Medical College of Wisconsin and the Blood and the Marrow Transplant Clinical Trials Network in this effort to determine whether a patient’s status as either positive or negative for minimal residual disease, or MRD, in the bone marrow at key junctures during the course of treatment could accurately predict how long their disease would remain well-controlled.

There are several unique aspects of the team’s approach to determining prognosis for patients with multiple myeloma. Their study, called Prognostic Immunophenotyping for Myeloma Response (PRIMeR), was the first major effort in the U.S. to look at this metric of MRD as an indicator of prognosis for newly diagnosed multiple myeloma patients undergoing autologous stem cell transplant as part of primary therapy. It’s also the first U.S. study to measure MRD in patients with multiple myeloma at three key junctures, using next-generation flow cytometry: before transplant (baseline), after transplant but before maintenance therapy is initiated (pre-maintenance) and one year following hematopoietic cell transplant (at one year).

The team found that MRD status is prognostic for progression-free survival (PFS) at all measured timepoints, and for overall survival at one year, performing better than other existing predictive tools for newly diagnosed multiple myeloma patients. But their findings also point to an opportunity to improve treatment for some patients who have minimal residual disease upon bone marrow testing. Also, while maintenance therapy with lenalidomide has significantly improved survival for patients with multiple myeloma, about 1 in 5 patients who showed no evidence of residual disease at one year still went on to experience disease progression.

“Multiple myeloma remains an incurable disease, but we have more and better treatment options than ever before,” notes Dr. Hahn, a Professor of Oncology with the Department of Medicine at Roswell Park. “What’s most exciting about this approach is that it may help us figure out sooner which patients may benefit from a change in their treatment regimen.”

The study, “Minimal Residual Disease (MRD) assessment before and after autologous hematopoietic cell transplantation (AutoHCT) and maintenance for Multiple Myeloma: Results of the Prognostic Immunophenotyping for Myeloma Response (PRIMeR) Study,” is TCT 2019 abstract no. 6. Dr. Hahn’s talk is scheduled for Friday, Feb. 22 from 4:35 to 4:50 p.m. CST during the Best Abstracts Session, to be held in the George R. Brown Convention Center, GRB-Grand Ballroom ABC.

Other highlights of Roswell Park’s participation in TCT 2019:

• Jordan Pleskow, PharmD, from Roswell Park’s Clinical Pharmacy Service will give a talk entitled “BMT 101: Reimmunization in Post-Hematopoietic Stem Cell Transplant Patients,” discussing considerations around the  vaccinations that are given to patients following transplant in order to prevent infectious diseases from developing.
  
  “I will highlight the importance of vaccination for patients undergoing transplant and cell therapy, but also the need to hold off on giving some of these vaccinations in some cases,” notes Dr. Pleskow. “Vaccinations are especially important for patients who are receiving immunosuppressive therapy, but the type and timing of administration can vary considerably from therapy to therapy and patient to patient. We’re just beginning to understand the role of vaccines for patients receiving immune effector therapy treatments such as chimeric antigen receptor T cell or CAR-T therapy, so there’s a lot of new information to discuss.”
  
  Dr. Pleskow will give his presentation today, Thursday, Feb. 21, from 4 to 4:45 p.m. CST in the Hilton Americas Houston, Ballroom of the Americas A.
   
• Hillary Jacobson, DPT, a physical therapist with Roswell Park’s Transplant and Cellular Therapy Center, will discuss the importance of accurately assessing a patient’s performance status in advance of transplant and cellular therapies. Dr. Jacobson will present evidence-based tips and best practices to help guide other clinicians on how to decide which patients may benefit from rehabilitation and physical therapy, underscoring how accurate assessments can impact patient outcomes.
  
  “The Karnofsky Performance Scale is used throughout the cancer field to help clinical professionals appropriately assess their patients’ abilities, limitations and overall health, but it’s really just the beginning,” says Dr. Jacobson. “There are still a lot of factors and variables that physical therapists and other professionals need to look at to design a program that will support optimal recovery, safety and wellness for each individual. So I will talk about how we work through some of those challenges for our patients at Roswell Park and some of the approaches that have helped us to improve our patients’ long-term outcomes and quality of life.”
  
  Dr. Jacobson’s talk, which will be part of the Clinical Education Conference session Performance Status and Rehabilitation, will be presented Saturday, February 23, beginning at 2 p.m. CST at the Hilton Americas Houston, Ballroom of the Americas AB.

The TCT/Transplantation and Cellular Therapy Meetings (formerly the BMT Tandem Meetings) are the combined annual meetings of the American Society of Blood and Marrow Transplantation (ASBMT) and the Center for International Blood and Marrow Transplant Research (CIBMTR), and continue through Feb. 24 in Houston. Researchers from a broad range of fields and disciplines gather to share knowledge through a scientific program addressing the most timely issues in hematopoietic cell transplantation.

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Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at www.roswellpark.org, or contact us at 1-800-ROSWELL (1-800-767-9355) or ASKRoswell@RoswellPark.org.