(Nicola Simonetti) From American University of Hematology (ASH) from San Diego (USA) gathered for the "most important scientific event of the year on the subject", says that, thanks to the new therapies, the mortality for blood neoplasias is reduced .
Currently, most of these pathologies present a poor diagnosis but, in the last decades, giant steps have been taken in lengthening the life expectancy and improving the quality of the latter, thanks above all to the introduction of first therapies. line that see the use of combinations of classic treatments (chemo) with immunotherapy. And now progress is being made, on a biological and therapeutic level, in terms of lymphomas, CAR-T cell, acute leukemia, chronic lymphatic leukemia, myelodysplasia and multiple myeloma.
Italian and foreign oncoematologists of international fame in the post-ASH of Bologna are also the spokespersons.
Even for the over 33 thousand Italians who, every year, are affected by a haematological tumor, certainties and hopes at hand.
Numerous studies have validated the use of monoclonal antibodies in association with classic chemotherapy drugs. The use of the technique called CAR-T, still on a low number of patients, has opened the way - says Pier Luigi Zinzani, professor of hematology, University of Bologna who was one of the first users at the ist. Seràgnoli ”of the University of Bologna - to a promising treatment strategy that could revolutionize the course and prognosis of these malignant neoplasms. The global and complete answers are satisfactory.
"The CAR-T, acronym from the English Chimeric Antigen Receptor T-cell, refers to a procedure that involves the withdrawal from the patient of some cells of the immune system (T lymphocytes), to their genetic modification in the laboratory to train them to recognize the tumor cells and then the reinfusion of the cells, so instructed, in the same patient. These cells activate the immune response and destroy the tumor. The CAR-T activity has also been confirmed in high-grade lymphomas, whose control lasts even after two years of follow-up without the need for further treatment.
Signs of efficacy in multiple myeloma with relapsed and refractory disease, and ongoing studies for use in Hodgkin's lymphoma, anaplastic lymphoma and chronic lymphatic leukemia. CAR-T in association with other drugs that enhance its activity and sometimes reduce side effects "(Prof. Paolo Corradini, Milan University and president of the Italian Hematology Society).
In lymphomas (diagnosis that includes over 30 different diseases), which are the most frequent oncohematological diseases, we have passed - says Zinzani - from conventional chemotherapy to that combined with the introduction of chemotherapy. "In this context, the anti-CD20 antibody has certainly played a fundamental role ... Monoclonal antibodies have also given good results in Hodgkin's lymphoma, in lymphomas of T-lymphocyte derivation, in primary mediastinal lymphoma, in mantle cell lymphoma and in follicular lymphomas. The new therapeutic approach represented by CAR-T has given a fundamental change in the field of diffuse large cell lymphomas. The results of Hodgkin's lymphoma therapies with a drug conjugate antibody [linked to a biologically active drug] anti-CD25 and the three-drug combination with monoclonal antibodies were also presented at the San Diego congress. Also in the context of other lymphomas, the combinations of chemo therapies and immunotherapy with monoclonal antibodies have proved effective ".
Acute leukemia and lymphoblastic - says prof. Fabrizio Pane, university, Naples Federico II and president of the Society - constitute the latest group of neoplastic blood pathologies that have begun to benefit from the introduction of biological drugs into the therapy ... The news presented at ASH concern, for myeloid leukemia, drugs with intracellular molecular target. For lymphoid leukemia, on the other hand, immunotherapies dominate.
“They are therapies based on monoclonal antibodies recently modified compared to those already used in the past in order to increase their efficiency. Numerous studies - continues Pane - on active immunotherapy techniques that use patient lymphocytes that are modified in their antigenic specificity and able to recognize antigens expressed on leukemic cells (CAR-T). They have a very high efficacy even in multi-refractory patients to all other therapies. The survival expectancy with intensive care and monoclonal antibodies is over 50% ".
Myeloma, a disease still considered incurable, has recorded, in the last 20 years, an increase in survival from just over 2 years to averages close to 7, even in advanced age groups.
"Presented at ASH, very interesting results, in terms of improvement of disease-free survival, of therapy with a monoclonal antibody in association with classical drugs tested in the first line of therapy in patients not candidates for transplantation. The results of many new combinations of innovative drugs of 2 ° and 3 ° generation, used both in the first line and in relapsed or refractory patients, have allowed to steal valuable information to identify the molecular profiles associated with the disappearance of the minimal residual disease, from which then depends on the prognosis of each patient. Even the treatments with the CAR-T technique were surprisingly effective in multi-treated patients and no longer controllable with other drugs "(Prof. Giovanni Pizzolo, University of Verona).
The novelties of ASH also concern clonal diseases that develop in hematopoietic stem cells such as polycythemia vera (PV), essential thrombocythaemia (TE), myelofibrosis (PMF). "For these diseases studies were presented on new methods and criteria for diagnosis and prognosis - says Prof. Angelo Michele Carella (San Martino University Hospital of Genoa). the treatments, in particular for myelofibrosis, involve the use of inhibitors to block those mutating proteins at the base of the diseases ".