JSCO2016: International Session 19 Leukemia

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium


International Session 19: Leukemia


Treatment guideline for leukemia in Japan
Yasushi Miyazaki (Department of Hematology, Nagasaki University Atomic Bomb Disease Institute)

In Japan, the treatment guideline for leukemia was published as a part of the treatment guideline for hematological malignancy from the Japanese Society of Hematology in 2013. This leukemia guideline covers acute and chronic myeloid / lymphoid leukemias, myeloproliferative neoplasms, and myelodysplastic syndromes. For each disease, "summary" and "treatment algorithm" are presented followed by clinical questions (CQs) and their answers. All answers for CQ are graded with "recommendation grade" which was taken and modified from National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline in Oncology with the permission of NCCN. In this recommendation grade, a new category "grade 4" was added to that of NCCN to make the recommendation of denial clear for readers. References that were attached for each CQ were also graded with the evidence level proposed by National Cancer Institute in the Comprehensive Cancer Database Physician Data Query.
Since the evidences were collected from publications not only in Japanese but mostly in English, there were several drugs that were used in USA or European countries, but not approved in Japan. We described these drugs in the guideline with the notification in the approval status in Japan if the evidence level was high enough expecting the future situation in Japan.
Since there emerge new drugs and diagnostic methods in the field of hematology, it is necessary and important to continue renewing this guideline. We are now in the process of making the second edition of this guideline.


JSCO leukemia update USA/North America 2016
Timothy G. Call (Division of Hematology, Department of Medicine, Mayo Clinic, USA)

The incidence rates of adult leukemia appear stable. However, disease prevalence is increasing due to improvements in therapy resulting in improved survival and the aging population.
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in North America. It is often detected as an asymptomatic lymphocytosis or as a precursor state called monoclonal B-cell lymphocytosis (MBL). Recently there have been 2 large cooperative group studies comparing these classical treatments to ibrutinib +/- rituximab. Results from these studies are eagerly awaited. The treatment of relapsed CLL has been revolutionized by the introduction of ibrutinib, idelalisib and ventoclax.
Chronic myelogenous leukemia (CML) has a stable incidence rate, but a significantly improved survival rate over the past 15 years due to imatinib or related agents. Molecular response guidelines have been published advising efficacy of therapy based on the rate of bcr/abl falling. Resistance may occur and additional newer agents for this are in development. Clinical trials are looking at whether select patients on long-term imatinib can have the drug safely stopped.
Acute myelogenous leukemia (AML) is associated with increasing age and both survival and the ability to tolerate induction chemotherapy decreases with age. Induction chemotherapy with daunorubicin and cytarabine remain the essential backbone of therapy for younger patients. Newer molecular markers, such as FLT3, provide prognostic and therapeutic information. In older patients, decitabine or clinical trials with venetoclax show benefit.
Acute lymphocytic leukemia (ALL) continues to show very high response and cure rates in childhood, yet continues to show much inferior outcomes in adults. Treatment of ALL includes dose intense chemotherapy and in high risk patients stem cell transplantation. Newer therapies including the blinatumomab and cellular immune therapy using CAR-T cells are all showing promise.


Chronic myeloid leukemia; Year in review from Asia
Dong-Wook Kim (Department of Hematology, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Korea)

In 2001, the introduction of the first targeted BCR-ABL1 tyrosine kinase inhibitor (TKI), imatinib, revolutionized the therapeutic paradigm and dramatically improved outcomes. Since then, international guidelines recommend imatinib, nilotinib, dasatinib, and radotinib as first-line therapy for newly diagnosed CML patients, and have been followed in the Asia-Pacific region. However, the CML management algorithm is not uniform across the Asia-Pacific region. As second-generation TKIs are incorporated into clinical practice, the optimization of CML management for Asian patients has become an even higher priority. For these reasons, the Asia CML Study Alliance (ACSA) has developed Asia CML Registry (ACR) and conducted collaborative studies to identify unmet treatment needs.
By the analysis using DASISION subgroup population, imatinib and dasatinib showed favorable rates of complete cytogenetic response and major molecular response in Asian population. Also, the incidence of adverse events appeared to be higher in Asians regardless of treatment. Based on the results, several Asian investigators suggest an alternative body size-based dosing regimen to improve the safety of TKIs, providing a framework for a future dose-finding randomized clinical trial.
An increasingly important factor to consider in the context of chronic disease such as CML-CP is long duration of treatment. With the availability of multiple treatment options for CML, cost-effectiveness plays a significant role, especially in developing countries with limited resources and drug availability.
Currently, treatment free remission (TFR) trials showed that imatinib can be safely discontinued, at least in some patients with a persistent CMR and more patients with second generation TKI therapies may be safely discontinued. Therefore clinical studies for successful TKI discontinuation are actively conducting in Korea and Japan. This presentation will include Asian interests of several studies conducted in Asia.


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