This ASH 2018 annual meeting held here in San Diego is actually the 60th anniversary and I would say it’s a true turning point in our field. Because, first of all, we are dissecting on a molecular basis more and more the different disease entities, that is allowing to go into more targeted and personalised therapies. In a disease where I’m much interested, multiple myeloma, actually this is fascinating – more than 900 abstracts are presented in this meeting, several highly effective combinations especially combinations based on daratumumab and the monoclonal antibodies. The value of minimal residual disease assessment is becoming very clear and this is now part of the algorithm for therapy. We have many combinations that are proving effective so a lot of choice; it can make it quite difficult actually for the physicians to choose but this is definitely good news for the patient. The more options you have the better it is. For example, I can highlight the study that will be presented in the late breaking abstract looking into the front-line setting into the combination of daratumumab plus lenalidomide/dexamethasone. Actually, according to what we hear, the results are quite impressive compared to the standard lenalidomide/dexamethasone.
Of course, we do have an update about the different daratumumab trials in the relapsed setting, also further confirming the efficacy and extended progression free survival with these combinations. We’ve seen many new options being developed, for example, selinexor in the penta-refractory population and, of course, one cannot escape the famous cellular therapies and CAR T-cells. Again, when it comes to CAR T-cells, they are the superstars of this meeting. We have them all over the place – in ALL, in lymphoma, in myeloma but also in AML now. When it comes to multiple myeloma we have extended follow-up of some trials and it looks like now that the results are quite reproducible from one trial and one product to another. We are talking roughly about 15 months of progression free survival in a heavily pre-treated population. We are talking also about an impressive level of negative minimal residual disease in heavily pre-treated patients. So these CAR T-cells are really proving to be the next major step. Actually there are also communications now trying to move these CAR T-cells earlier into the course of the disease.
I think the excitement about the CAR T-cells should not make us ignore the other cellular therapies that are being developed. We have seen in this meeting communications about other cell subsets and I would like to highlight, for example, the CTLs directed against EBV in the context of haematopoietic stem cell transplantation. Solid organ transplantation we know that EBV PTLD is really a dismal complication and having an effective and safe cellular therapy is really very exciting.
Besides the new drugs, besides the cellular therapies, what we can see in this meeting is the start of the emergence of the role of the microbiota in haematology. There are some fascinating communications; we presented ourselves our results – a phase I/II trial looking into microbiota transfer in acute myeloid leukaemia.
So I think the future is really brilliant in the field of haematology and it’s really an exciting time to be a haematologist these days because we are clearly seeing a sort of clear improvement of the natural history of all of these hematologic diseases.