(Adnkronos) - “La leucemia linfatica cronica è una patologia tipica dell'anziano, per cui ci sono anche delle problematiche di trattamento, legate al fatto che spesso i pazienti molto anziani hanno anche delle comorbidità e quindi il trattamento e l'approccio terapeutico è molto più difficoltoso”. Lo afferma Alessandra Tedeschi, specialista ematologo struttura complessa di Ematologia Asst Grande ospedale metropolitano Niguarda di Milano, in occasione del media tutorial promosso da Intermedia a Milano e dedicato al Congresso Ash, il 66esimo appuntamento annuale della Società Americana di Ematologia, svoltosi a San Diego dal 7 al 10 dicembre.
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00:00Leucemia lymphatica chronica is a neoplasia, a blood tumor, it is characterized by the fact
00:11that the tumoral disorder hits cells that are already immature cells, so they are not
00:17immature cells, it is not an aggressive form and hence the definition of chronic lymphatic
00:23chronic. Often the encounter is absolutely occasional, the patient realizes only because
00:31he has blood tests, high lymphocytes, rarely is symptomatic at birth. There will be a
00:36part of the patients who are never treated for this pathology, while a part of the
00:41patients will need treatment for various reasons, such as insurgency of increase
00:48in the volume of the joints, amyloid discomposition, anemia, pyasthenia. At that time the patient
00:54must be treated. Let's say that it is a typical pathology of the elderly, so I suggest that there are
01:00also problems of treatment due to the fact that often very old patients also have
01:06comorbidities and therefore the treatment, the therapeutic approach is much more difficult.
01:12Over the years we have had changes in the paradigm of therapy of chronic lymphatic
01:16chronic. Once it was treated only with immunotherapy, now we are absolutely using inhibitors,
01:23the LBTK inhibitors first, which are drugs that are given continuously when
01:29administered in monotherapy. Venetoclax has allowed us to obtain deeper responses,
01:34so we have used it in combination with monoclonal antibodies, in order to give a
01:40long-term therapy, because in any case the long-term therapy is better for the patient, it has free-of-progression
01:46survival and free-of-prolonged treatment, and therefore we have moved on to using the
01:53combinations of LBTK inhibitors with Venetoclax, which are the best therapies we have for
02:00patients at the moment. This study, which was presented this year at the ASCH, and which
02:06also received the award for being one of the best studies presented at the ASCH, is an important study
02:12because it is a randomized study. Randomized studies are fundamental for us, but also include many patients,
02:18so this is important to have absolutely consistent data. It provided for the randomization of patients
02:26with chronic lymphatic leukemia, never previously treated, therefore virgin in treatment, in three different arms.
02:34Akalavrutinib Venetoclax, therefore a second-generation LBTK inhibitor, in association with Venetoclax.
02:40Akalavrutinib Venetoclax Ovinotuzumab, compared to immunochemotherapy, which at the time the study was designed,
02:46was the treatment standard. The study has shown that the arms we have with Akalavrutinib Venetoclax
02:54have better free-of-progression survival compared to immunochemotherapy,
03:00even free-of-progression survival has been achieved with immunochemotherapy,
03:06while three years ago with Akalavrutinib Venetoclax it was 77%, 83% when we also combine the monoclonal antibody.
03:16This is seen above all in patients at the highest risk, with non-mutated immunoglobulin characteristics
03:22at the surface level, who have a slightly happier disease, let's say, in quotation marks,
03:26compared to mutated patients, and it is a bit premature to talk about survival,
03:32but we also have a better survival of Akalavrutinib Venetoclax compared to immunochemotherapy.
03:38All this, evidently, the effectiveness must be associated with excellent tolerability,
03:44and let's say that the tolerability has been very good, we have not had any unexpected problems
03:50in this therapeutic regime, so an excellent fixed-duration therapy for our patients
03:58that will probably change the therapeutic paradigm again when the combination is approved.