ASH Preview: The Leonard List

For this post, I'm letting someone else do the previewing: Dr. John Leonard, Lymphoma Rock Star and oncologist at the Weill Cornell Medicine in New York.

Every year, Dr. Leonard creates the "Leonard List," his Top 10 abstracts at the ASH conference. He counts them down on Twitter in the days leading up the ASH, and then discusses them in more detail (and adds 5 more as a bonus) on a podcast.

The podcast, which you can find here, is easy to access.

This year's Leonard List includes a lot of discussion about DLBCL (Diffuse Large B Cell Lymphoma). It seems like every year there is one type of blood cancer that has a bunch of exciting things happening, and from this list, it seems like DLBCL is the star this year.

Unfortunately, that means Follicular Lymphoma is not the star. That doesn't mean there isn't good stuff happening this year, just not the big, important things that are happening for other diseases.

But he does include 2 Follicular Lymphoma abstracts on his List.

The first is #9 on his list: "EARLY STAGE Follicular Lymphoma: First Results of the FIL 'Miro' Study, a Multicenter Phase II Trial Combining Local Radiotherapy and MRD-Driven Immunotherapy." For this study, researchers looked at FL patients with stage 1 or stage 2 cancer. As they note, many patients at this stage can receive traditional radiation treatments and can possibly be cured. Because the FL is localized (staying in one or two spots), a beam of radiation can take care of it.

For this study, patients were given radiation, and then were given immunotherapy (in this case, Ofatumumab, which is anti-CD20 monoclonal antibody, like Rituxan). After the radiation, the patients were tested for MRD -- Minimal Residual Disease. Basically, this means  finding very small amounts of cancer cells left over after the treatment was finished. Those with MRD were then given the immunotherapy, which helped clear the small amounts of disease that were left.

As Dr. Leonard points out, the techniques for finding MRD are still being developed, but he thinks this idea of measuring for them as a way to guide treatment is innovative and might be very useful in the future.


The second Follicular Lymphoma presentation that made the List is his #3: "Evaluation of the m7-FLIPI in Patients with Follicular Lymphoma Treated within the Gallium Trial: EZH2 mutation Status May be a Predictive Marker for Differential Efficacy of Chemotherapy."

Dr. Leonard likes the idea of m7-FLIPI. It made his List in 2016, too.

 m7-FLIPI is an updated version of the FLIPI index, which is meant to guide researchers who are developing clinical trials by making sure everyone in the trial is similar in terms of age, grade, etc. It's a misunderstood tool that too many patients use as a way of understanding how severe their disease is. Read more about FLIPI here, at Lymphomation.org. And don't use it to try to understand your own disease -- it will only cause you unnecessary stress.

The m7-FLIPI takes the traditional FLIPI and adds seven biomarkers. This is supposed to make the FLIPI index more accurate -- age doesn't tell us much about which patients might run into problems, but the presence of certain gene mutations in a cancer cell could probably tell us more about individual patients.


In this research, patients had biopsies that allowed researchers to look at gene mutations. Many were classified as high risk by the FLIPI, but were then reclassified as lower risk by the m7-FLIPI (which would seem more accurate). Patients in the study were given Immunochemotherapy (either CHOP, CVP, or Bendamustine, plus Rituxan or Obinutuzumab). The big takeaway here is that EZH2 gene mutation resulted in longer Progression Free Survival in patients who had CHOP, but not in Bendamustine.

As Dr. Leonard points out, there are lots of reasons why this needs to be tested in another study to confirm, but hes excited at the idea that a biomarker like the EZH2 gene mutation could be used in helping doctors decide which treatment would work better. That's the goal, after all -- using something in the cell to hep decide how to treat. It's a step forward in this process, not the final step.

The ASH conference begins in less than a week. I'll take a look at a few more FL abstracts that seem interesting to me. I'm not an oncologist or a cancer researcher -- just a Cancer Nerd who is a patient, as I like to remind you all. So I always enjoy hearing what actual experts like Dr. Leonard find interesting and exciting.