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American Society of Hematology, Dec. 5-8, 2009

51st American Society of Hematology Annual Meeting and Exposition

The 51st American Society of Hematology Annual Meeting and Exposition was held Dec. 5 to 8 in New Orleans. Over 20,000 attendees were expected at this year's meeting, including international participants. Attendees included physicians, clinicians, researchers, health professionals, and other blood specialists. Research presented featured emerging trends in the diagnosis, treatment, and understanding of many blood disorders and hematologic cancers. Furthermore, a special focus was made on other issues affecting physicians and patients, including health care costs and changes to U.S. health care policies.

Stef P. Kaandorp, M.D., of the Academic Medical Center in Amsterdam, Netherlands, presented findings from the ALIFE study, a randomized controlled multicenter trial evaluating aspirin, and aspirin combined with low-molecular-weight heparin, in females with unexplained recurrent miscarriage.

The rationale for this trial was based on the theory that many of these unexplained miscarriages may be due to the formation of clots in the blood vessels which support the placenta. Both aspirin and low-molecular-weight heparin are often prescribed to prevent miscarriage, although there is no data to support their use in this setting.

The study included 364 females between 18 and 42 years of age, all who were either attempting to conceive or who were less than six weeks pregnant. All participants had previously experienced at least two unexplained miscarriages by the 20th week of pregnancy, and women with a prior history of clotting disorders were excluded from the study. Participants were randomized to receive aspirin alone, aspirin plus nadroparin (a low-molecular-weight heparin), or placebo. In an analysis of the intent-to-treat population, the rate of live births was not found to be significantly different among the three treatment groups (50.8, 54.5, and 57 percent of women treated with aspirin alone, aspirin plus nadroparin, or placebo, respectively).

In a statement, Kaandorp concluded "the study clearly demonstrates that aspirin combined with heparin and aspirin alone do not prevent recurrent, unexplained miscarriages, and that we should not needlessly put these women through the inconvenience and risks associated with these blood-thinning medications." Kaandorp further commented on the importance of these findings, adding that "they will likely change the way some women at high risk for another miscarriage have been treated."

Several study authors reported financial relationships with the pharmaceutical industry.

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Mathias J. Rummel, M.D., of the University Hospital in Giessen, Germany, reported the final results of the Study Group Indolent Lymphomas' multicenter, randomized phase III study. This trial was conducted to evaluate the efficacy and safety of a new combination regimen (bendamustine plus rituximab) compared to standard therapy (CHOP plus rituximab) as first-line treatment for patients with follicular, indolent, or mantle cell lymphoma.

The study randomized 549 patients to either treatment regimen. Compared with CHOP plus rituximab, the bendamustine plus rituximab combination resulted in a significantly improved rate of progression-free survival, the primary end point of the study (median progression-free survival, 54.8 versus 34.8 months). The complete remission rate was also significantly improved in the bendamustine plus rituximab group (40.1 versus 30.8 percent). Furthermore, patients in the CHOP plus rituximab group experienced higher rates of serious adverse events, including neutropenia and leukocytopenia.

Rummel concluded in a statement that, "while the CHOP and rituximab combination is the current standard of care, it is frequently associated with serious adverse events and more side effects, as was further shown in this study. These promising results suggest that the combination of bendamustine and rituximab has the potential to become the new standard first-line treatment option for patients with these non-Hodgkin lymphoma entities."

Several study authors reported financial relationships with the pharmaceutical industry.

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Jorge Cortes-Franco, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, reported the results of a phase II clinical study evaluating a novel drug under investigation for the treatment of chronic myeloid leukemia (CML) that does not respond to currently available therapies. Omacetaxine is an injectable drug which has previously shown activity in CML patients who harbor the T315I mutation in the BCR-ABL kinase gene; this mutation renders the BCR-ABL kinase unaffected by imatinib and other currently available drugs.

Study results included data for 81 patients at different phases of CML, all who had previously failed the standard imatinib treatment. Among 49 individuals with chronic phase CML, omacetaxine treatment resulted in a complete hematologic response in 42 patients (85 percent), and a cytogenetic response was achieved by another 27.5 percent. Over half (57 percent) of patients in chronic phase experienced a reduction in the baseline levels of the T315I clone. The median survival time was not reached among patients with chronic phase CML at the time of this analysis.

For the 17 patients in accelerated phase CML, a hematologic response was achieved by six patients (35 percent), with five patients achieving a complete response and one patient downgraded to chronic phase disease. The median survival for this group was 18.8 months. For the 15 patients in blast crisis CML, seven patients (47 percent) achieved a hematologic response, three of which were complete. The median survival among patients with blast crisis CML was 2.1 months. Grade 3/4 adverse events were experienced by approximately two-thirds of patients (68 percent); most of these were hematologic toxicities, including thrombocytopenia (58 percent), anemia (36 percent), and neutropenia (33 percent). A delay in treatment (median 12 days) was required by approximately half of patients.

According to a statement by Cortes, "this treatment appears to be overall well-tolerated for the majority of patients." Cortes also noted that "the drug can be self-administered, which makes it convenient."

The study was funded by ChemGenex Pharmaceuticals and several authors reported relationships with the company.

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Steven B. Deitelzweig, M.D., of Ochsner Hospital in New Orleans, presented the results of a study evaluating the prevalence of venous thromboembolism (VTE) across ethnic groups in the United States. A Medicaid database was used to generate patient data; data, collected between January 2002 and December 2005, was restricted to individuals who were 18 years of age or older.

Overall, the prevalence of VTE grew by 30 percent between 2002 and 2005, increasing from 276 to 358 cases per 100,000 individuals. Each year, African-American males had the highest prevalence of VTE, increasing from 584 cases in 2002 to 785 cases in 2005 per 100,000 individuals.

"VTE prevalence increased during the study period for the overall U.S. Medicaid population," the authors wrote. "African-Americans had the highest rate of VTE, followed by Caucasians and Hispanics. There is a need for improved VTE awareness and prevention across all ethnic groups."

The authors reported financial relationships with the pharmaceutical industry, including receiving editorial and writing support in the preparation of this abstract, employment, and research funding.

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ASH: Second-Line Drugs Target Chronic Myeloid Leukemia

TUESDAY, Dec. 8 (HealthDay News) -- In patients with drug-resistant chronic myeloid leukemia, two second-line drugs -- nilotinib and dasatinib -- may be at least as effective as the front-line drug imatinib, according to research presented this week at the annual meeting of the American Society of Hematology, held from Dec. 5 to 8 in New Orleans.

Abstract - Nilotinib
Abstract - Dasatinib
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ASH: Novel Drug Beneficial in Multiple Myeloma

TUESDAY, Dec. 8 (HealthDay News) -- In patients with relapsed or resistant multiple myeloma who have received up to three prior therapies excluding the first-generation proteasome inhibitor bortezomib, treatment with the second-generation proteasome inhibitor carfilzomib is associated a high response rate and a low incidence of side effects, according to research presented at the annual meeting of the American Society of Hematology, held from Dec. 5 to 8 in New Orleans.

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ASH: Gene Findings May Benefit Infants With Leukemia

MONDAY, Dec. 7 (HealthDay News) -- In infants with acute lymphoblastic leukemia, newly discovered translocations of the MLL gene on chromosome 11 may help guide treatment decisions, according to research presented this week at the annual meeting of the American Society of Hematology, held from Dec. 5 to 8 in New Orleans.

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ASH: Dabigatran, Warfarin Compared for VTE Prevention

MONDAY, Dec. 7 (HealthDay News) -- The oral thrombin inhibitor dabigatran performed similarly to the anticoagulant warfarin to prevent the recurrence of venous thromboembolism (VTE) without the need for constant laboratory monitoring, according to research published online Dec. 6 in the New England Journal of Medicine to coincide with the annual meeting of the American Society of Hematology, held from Dec. 5 to 8 in New Orleans.

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