On Location
including those with high-risk cytogenetics and those
with del17p. The benefit was greatest in patients who
had not received a prior proteasome inhibitor.
The overall response rate was also higher in patients
assigned to SVd (76.4% vs. 62.3%; p=0.0012). Patients
assigned to weekly SVd also had a significantly higher
rate of deep responses. In the weekly SVd group, 44.6%
of patients achieved a very good partial response or
better compared with 32.4% in the Vd arm (p=0.0082).
Time to next treatment also was longer with selinexor
compared with Vd (16.1 vs. 10.8 months; HR=0.66;
p=0.0012).
“These data indicate that a once-weekly regimen
of selinexor plus bortezomib and dexamethasone is
more active and more convenient for patients, than
twice-weekly bortezomib and dexamethasone for
patients with relapsed/refractory multiple myeloma,”
Dr. Dimopoulos said. ●
Study authors report relationships with Karyopharm
Therapeutics, the manufacturer of selinexor.
References
1. Dimopoulos MA, Delimpasi S, Simonova M, et al. Weekly Selinexor, bortezomib, and
dexamethasone (SVd) versus twice weekly bortezomib and dexamethasone (Vd) in patients
with multiple myeloma (MM) after one to three prior therapies: Initial results of
the phase III BOSTON study. Abstract 8501. Presented as part of the ASCO20 Virtual
Scientific Program. May 29-31, 2020.
2. Chari A, Vogl DT, Gavriatopoulou M. Oral selinexor-dexamethasone for triple-class
refractory multiple myeloma. N Engl J Med. 2019;381:727-738.
Breakthroughs in Blood Disorders
The virtual edition of the European Hematology Association’s 25th Congress, known as EHA25
Virtual, was held June 11-21, offering international hematologists a platform to access recorded oral
abstract sessions and view live plenary presentations. As part of the program, presenters shared the
latest results from clinical and translational research in hematologic disorders remotely. Here, ASH
Clinical News presents highlights from the virtual meeting, including a BCMA bispecific antibody for
myeloma and a gene-editing therapy for sickle cell disease and beta-thalassemia.
Look for more reporting from the conference in our August issue.
Systemic Bevacizumab Improves Anemia, Reduces
Bleeding in Hereditary Hemorrhagic Telangiectasia
Treatment with systemic bevacizumab reduced
bleeding and significantly increased hemoglobin
levels in patients with the rare bleeding disorder
hereditary hemorrhagic telangiectasia (HHT),
according to results from the InHIBIT-Bleed
study presented at EHA25 Virtual, the virtual
edition of the 25th European Hematology Association
Annual Congress. Bevacizumab is a monoclonal
IgG1 antibody that neutralizes circulating
vascular endothelial growth factor (VEGF) and is
often used off-label as an anti-angiogenic treatment
in HHT.
“Given the striking effectiveness observed in
the InHIBIT-Bleed study coupled with the fact
that there are no FDA-approved medications to
treat the manifestations of HHT, we expect that
these findings will establish systemic bevacizumab
as a treatment option for moderate-to-severe
HHT-associated bleeding,” said study author and
presenter Hanny Al-Samkari, MD, of Massachusetts
General Hospital.
The current standard of care for the management
of bleeding in HHT is local hemostatic
procedural interventions, such as argon plasma
coagulation for gastrointestinal tract telangiectasias,
or laser cautery treatments for nasal telangiectasias,
Dr. Al-Samkari explained. He noted
that these interventions can improve local bleeding
“but do not address the underlying disease
pathophysiology the way that a systemic antiangiogenic
agent like bevacizumab does, so their
effects usually wear off after a few months and
the patient has recurrent bleeding.”
Dr. Al-Samkari added, “It is quite common
for patients with HHT to have had dozens and
dozens of these procedures over time,” he said,
“and in severe cases of recurrent nose bleeding,
patients may resort to a nasal closure procedure,
sacrificing their sense of taste, smell, and their
ability to breathe through their nose.” In addition,
standard care rarely leads to resolution of
patients’ iron-deficiency anemia, which results
from recurrent bleeding.
The InHIBIT-Bleed study was an international
retrospective analysis of 238 patients from 12
centers with a clinical diagnosis of suspected or
definite HHT, defined by the presence of at least
2 of the following criteria:
• spontaneous and recurrent epistaxis
• telangiectasias at characteristic sites
• visceral arteriovenous malformations
• first-degree relative with HHT
Participants also had red blood cell (RBC) transfusion
dependence and/or iron infusion dependence.
Treatment consisted of an induction phase
that comprised 4 to 6 intravenous infusions of
bevacizumab 5 mg/kg administered every 2 weeks
for up to 12 weeks. In the maintenance period
following induction phase, bevacizumab 5 mg/kg
was administered every 4 to 12 weeks.
During a median treatment period of 12
months (range = 1-96), patients in the retrospective
cohort received a median of 11 bevacizumab
infusions (range = 1-74). The mean age of the HTT
population was 63 years (range = 29-91), and a
slight majority of the patients (62%) were women.
Primary bleeding sources across all patients
included:
• epistaxis (42%)
• gastrointestinal (GI) bleeding (19%)
• epistaxis and GI bleeding (39%)
In a safety analysis that included 340 patientyears,
38% of patients treated with bevacizumab
experienced adverse events (AEs), such as:
• hypertension (18%)
• fatigue (10%)
• proteinuria (9%)
• myalgia/arthralgia (6%)
Approximately 5% of patients discontinued bevacizumab
because of AEs. All 5 patients (2%) who
experienced venous thromboembolism were anticoagulated
without bevacizumab interruption or
increased bleeding incidence. There were no fatal
AEs and no increase in treatment-related AEs in
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24 ASH Clinical News July 2020 Bonus Mid-Year Edition