There are many weapons against lymphomas and myeloma, even ‘amazing’ such as Car-T cell therapies, therefore diagnosis and recurrence must be faced with optimism knowing that there are many tools available. This is the summary of the message of the specialists of the Italian Society of Hematology (SIE) who spoke today in Bologna, at the second national event ‘Sie meets patients’, the latter being represented in particular by the Italian Association against leukemia, lymphoma and myeloma ( ail).
“The survival of patients with lymphoma is increasing thanks to the emergence of new therapeutic approaches in which monoclonal antibodies are worth a large share – says Marco Ladetto, associate professor of the Eastern Piedmont University and director of the Complex Structure of Hematology of the SS Antonio e Biagio hospital and Cesare Arrigo of Alessandria – The new biological therapies, with single agents or in combination, are increasing the possibility of treatment and are enabling the development of chemo-free therapies. The new bispecific antibodies” that bring the patient’s T lymphocytes closer to the tumor cell “represent one of the most important classes of new agents likely to dramatically change the therapeutic scenario”.
“For multiple myeloma there is optimism, even of a cure, due to the many new things that are coming – adds Maria Teresa Petrucci, medical director of Hematology at the Umberto I Polyclinic, Sapienza University of Rome – the therapeutic history of multiple myeloma has changed since The beginning of 2000 with the advent of immunomodulators, which fall within the chapter of immunotherapy, together with proteasome inhibitors “which block the elimination of proteins within tumor plasma cells causing toxicity and programmed death” and lastly monoclonal antibodies which have brought an advantage of survival and quality of life. We have changed the natural history of a chronic disease. We have many weapons that we must know how to use appropriately in a complex disease, which does not only affect the plasma cell, for this reason the monoclonal antibody may not be sufficient to resolve the pathology. There will be patients who will be able to suspend the therapy – he observes – there are evaluation protocols to understand whether or not it is possible to interrupt the treatment “.
On the Car-T cell therapy, present since 2019, “the one for mantle cell lymphoma has recently been on the market, while those for indolent lymphomas and multiple myeloma will soon arrive”, says Paolo Corradini, president of Sie and director of the Hematology Division of the Foundation Irccs National Cancer Institute of Milan “In mantle cell lymphoma, Car-T cells are the boundary between hospice and recovery, for this – says Corradini – we consider the complete, not partial, response. Currently it is seen that 80% of patients have a complete response, without the risks of transplantation, but it should be considered that they have an infectious complication of 9% compared to 3-4% of diffuse large cell lymphomas. In follicular or indolent lymphomas there are 2 therapies available. If we look at the complete response, we see that for both they hover around 70%, so the figure is robust, given that it comes from two different therapies”.
“The arrival of Car-T in multiple myeloma is highly anticipated – recalls the president Sie – 2 products will arrive. One for patients who have failed the current 3 classes available. The first, which will soon be available, is already in the Official Gazette, has the complete answers on 33% (in lymphomas it is more than double). The duration of response slowly tends to decline, but we see different populations based on the type of response in the patient. There is another product in which Car-T gave a complete response in 82% of those treated, compared to 0.6% of those who received conventional therapy was 0.6%. These are astonishing numbers for therapies that will be available in the short term. However, it will be necessary – concludes Corradini – to review the organization for the management of these therapies”.