16-17 - ASH 2022 CONGRESS - bad blood but big advances

When Taylor Swift rocks up at a medical congress, you know that science is hitting the high notes. That was certainly the case at the American Society of Hematology’s 64th annual meeting in New Orleans in December 2022, where even the surprise appearance of the modern-day Queen of Pop couldn’t steal the headlines away from the breakthrough advances.

The message? Bad Blood isn’t just a Taylor Swift anthem, it’s the root cause of life-limiting diseases – liquid cancers and non-malignant blood disorders – that haven’t traditionally grabbed the headlines but are suddenly topping the billboard of science.

ASH 2022 showed a haematology category in great voice, strutting its stuff on the big stage, and wowing the audience with mic drop moments. What’s more, in its first in-person meeting since 2019, the hybrid event underlined the enduring attraction of face-to-face engagement, drawing massive crowds of more than 25,000 delegates – with not a Blank Space in sight.

The ASH annual meeting has always been considered one of the most important scientific congresses. However, outside the space, haematological diseases don’t enjoy the same profile as cancers covered at the likes of ASCO and ESMO. That’s understandable; the prevalence of major cancers like prostate cancer or lung significantly outnumbers haematological diseases. However, the complexity and burden of haematological disorders is huge; many are incurable and significantly diminish quality of life. Haematologists play a pivotal role in the treatment of patients, but as awareness of these individualised conditions is often low, congresses like ASH are key to medical education and patient care. Moreover, the difficulties associated with treating haematological diseases mean the category is dominated by substantial unmet needs. Encouragingly, ASH 2022 showed that innovation is advancing to help fulfil them.

The four-day congress spanned the full breadth of the haematology spectrum, with the programme diverse in every sense. The adjacent exposition was similarly colourful, showcasing a ubiquitous will to drive change and accelerate progress. As with all international congresses, it’s impossible to cover everything. Here’s our take on some of the key trends through the lens of both therapeutic advancement and health communications.

ASH remerged from its COVID-19 hibernation with a bang – and with patients and creativity at the centre of the experience. Throughout the conference, patients were at the forefront of the clinical presentations and discussions, arguably more than ever before. Data from studies was, of course, paramount. However, in most presentations, that data always hooked back to the impact on patients, underlining the value of novel innovations. Similarly, as we’ll explore later, panel discussions indicated a determination to ensure that real-world data capture is strengthened to provide perspectives through a patient-centred lens.

Experiences in the exhibition hall also majored on patient-centricity. Right across the stadium-sized arena, the patient experience was powerfully visualised in emotive campaigns and booth experiences that underscored the ‘why’ behind the need for novel or improved treatment options for patients. Creativity came to the fore, with the industry raising the bar to bring patient stories to life through immersive experiences and beautiful design. Some of it bordered on art.

Booths naturally maximised technology, but the real power was in the authenticity of the patient experiences at the heart of the storytelling. Did it work? The exhibition hall was jam-packed, with delegates engaging and interacting with content throughout. It was a great example of how creative communications can connect and drive change.

Much has been made of the need to bring through a new generation of classical haematologists, with therapeutic advances and a gradual drop-off in the number of experienced specialists making it ever more important to expand the workforce. Earlier this year ASH unveiled a $19m investment in attracting, training and upskilling the next generation of haematologists. This endeavour was a recurrent theme throughout the congress, with a primary objective to ensure the next generation is diverse and inclusive. While this is obviously a common goal everywhere, ASH is making tangible and visible efforts to shift the needle.

ASH’s own booth included a ‘Health Equity Studio’, a space designed to help recognise inequities in healthcare and provide tools to make change. All helping to highlight the need for clinical studies to represent real-world populations and facilitate clinical data that’s applicable and relevant in everyday practice. This trend was evident in sessions and discussions throughout the week. For example, the ASH-FDA Joint Symposium joined up with EU HARMONY to explore real-world evidence in haematologic malignancy research. The session drew on patient perspectives from the Leukemia Patient Advocates Foundation to advocate multicentre real-world data capture in haematologic malignancies in Europe.

In terms of DE&I across the profession, there were visible signs of progress as a new generation of female and ethnically diverse haematologists joined the ranks of rising stars presenting data and chairing scientific sessions. Notably, the Joint Symposium between ASH and the European Hematology Association (EHA) was led by the first all-female panel, with EHA President, Elizabeth Macintyre, telling ASH News TV: “We have reached female equality in certain spheres of haematological practice. Long may it continue. And may we extend that to all other forms of diversity, equity and inclusivity.”

The DE&I challenge extends beyond the workforce and into patient populations, where health inequities remain widespread. Management of these haematological diseases often comes with a high-cost burden to both health systems and patients, creating access challenges and inequities of care.

This issue was evident in many posters, underlining the need to elevate the patient voice to make the case for continued innovation. Informed haematologists are crucial to this battle, once again illustrating the importance of empathetic communications to help clinicians understand the everyday realities of these complex diseases. ASH 2022 did a great job in progressing that journey.

The scale and pace of therapeutic advances in haematology is accelerating rapidly. Special interest sessions during the ASH-FDA Joint Symposium picked out advances in disease states as diverse as multiple myeloma, B-cell lymphoma and AML, while in non-malignant haematology it noted novel approvals in pyruvate kinase deficiency, cold agglutinin disease and histiocytic disorders. But these examples only scratch the surface of a burgeoning array of innovation in both haematologic oncology and non-malignant disorders.

This evolution has seen haematologic innovation progress through precision medicine to a crop of new agents like CAR-T and immunotherapy. CAR-T is offering an improvement on invasive stem cell therapy, manipulating cells to hunt down and kill cancer cells. In solid tumours, immunotherapies often harness checkpoint inhibitors to stimulate the immune system to fight cancers – but this has so far showed limited returns in haematologic malignancies. As a result, a different approach is being taken. Data showed how new modalities of immunotherapy are being used to signal the innate immune system to ingest liquid tumours, producing encouraging results in conditions like AML. It’s hoped that, in time, this may have a wider application across other disease states.

In some cases, therapeutic advances have been so rapid that clinical studies cannot keep pace. For example, one clinical trial investigator described a comparator study conducted against the standard of care – but by the time the trial had concluded, that standard of care had changed, rendering its data outdated. With innovation accelerating so quickly, haematologists are finding it hard to keep up, further underlining why ASH is investing in the next generation to equip haematologists for success. This reinforces the importance of medical communications to support learning and close the knowledge gap.

One of the most groundbreaking announcements came in mantle cell lymphoma (MCL), where – as with many haematologic malignancies – patients often require stem cell therapy. Autologous stem cell transplantation (ASCT) is an aggressive procedure that some patients struggle to tolerate. But alongside immunochemotherapy, it’s the standard of care in many disease states. Data presented at ASH 2022 suggests that could soon change.

Results from the TRIANGLE trial of younger patients with MCL show failure-free survival rates were higher in patients receiving ibrutinib either alone or with ASCT, compared with ASCT alone. The findings suggest ibrutinib could replace ASCT as a standard first-line treatment. This was described by a plenary panelist – to great ovation – as ‘milestone progress in MCL’. It’s a huge advancement for patients that will likely lead to better outcomes. Moreover, there’s hope it can be applied in other disease states, redefining pathways and transforming care.

Multiple myeloma was a major focus, with data presentations on emerging and approved bispecific antibodies and CAR-T therapies showcasing promising approaches for heavily pre-treated patients. One particular session on bispecific antibodies attracted huge interest, requiring multiple separate overflow areas to accommodate the crowds. In the session, phase 1/2 results from the MonumenTAL-1 study confirmed G Protein-Coupled Receptor Class C Group 5 Member D (GPRC5D) as a new target to treat refractory/relapsed multiple myeloma with talquetamab – a GPRC5D x CD3 bispecific antibody.

A proportion of the 280 patients involved in the study had been treated with several prior lines of therapy – including BCMA-targeted therapy such as CAR-T or bispecifics – but hadn’t shown a response. Of the 280 patients, over 70% responded to talquetamab, with their cancers diminishing significantly or entirely. One haematology oncologist said the findings were “the biggest thing to come out of ASH this year”, adding: “It’s actually huge that we’ve got a new target. You can’t help but be impressed with a response rate of over 70%. That’s like… whoa, okay!”

ASH 2022:
bad blood but big advances

1. Patients are at the centre, driving change in haematology

2. The next generation of haematology will be transformative… and inclusive

3. Advances in haematology are rapid, with immunotherapy poised to make its mark

4. Milestone advance in MCL could displace ASCT and create new standards of care

5. Novel treatment strategies are generating excitement – and hope – in multiple myeloma

Maximising the mood music