Concepts in Development
The ALLG Acute Myeloid Leukaemia (AML)/Acute Lymphoblastic Leukaemia (ALL)/Myelodysplasia Syndrome (MDS) Disease Group is focused currently on developing the following:
- Making the treatment of acute promyelocytic leukaemia easier by investigating the ability of oral arsenic to replace intravenous arsenic.
- Designing trials with new agents aimed at prolonging remission in patients with AML.
- Introducing novel non-chemotherapy based approaches (such as Blinatumomab) to improve the safety and effectiveness of treatment for B-cell acute leukaemia.
- Increasing the knowledge of treatment outcomes in Australia through the expansion of the ALLG National Blood Cancer Registry to include ALL.
- Introducing new therapies for elderly patients with AML in collaboration with the Leukaemia Foundation of Queensland and researchers from Cardiff University.
- Introducing targeted treatments for patients with relapsed AML and the gene mutation (FLT3-ITD) that predisposes them to relapse.
- Harmonising the use of molecular profiling to enhance the prognostic stratification of AML.
Bone marrow transplantation is a treatment used in many haematological cancers. The ALLG Bone Marrow Transplant Disease Group is interested in clinical trials that improve patient outcome after transplantation or try to determine which patients are most likely to benefit from transplantation.
The current major ALLG clinical trial — a collaboration with the Canadian and Swedish bone marrow transplant groups — is addressing this question in older patients with acute myeloid leukaemia which is the most common disease indication for bone marrow transplantation.
The ALLG Chronic Myeloid Leukaemia (CML) and Myeloproliferative Neoplasms (MPN) Disease Group coordinates the Australasian effort in clinical and correlative research to improve outcomes for patients with these conditions.
Life-long treatment with targeted therapies called tyrosine kinase inhibitors (TKI) are currently the standard of care in CML. Clinician researchers in ALLG are currently conducting studies to explore new strategies to minimise treatment related toxicities, and combining TKIs with novel therapies to increase their effectiveness. We are also actively studying ways to maximise treatment free remission — where patients can safety and successfully stop their TKI treatment without disease recurrence.
MPN is a collective term for diseases such as essential thrombocytosis, polycythaemia rubra vera, and myelofibrosis. Discovering new therapeutic combinations for disease control and to improve patient's quality of life remains our priority.
Clinical studies are accompanied by correlative laboratory studies that continue to unravel hidden answers about the disease biology. A national registry in CML/MPN is currently under development. This will help us better understand current outcomes for ANZ patients and will provide valuable data to help guide future trial development.
The ALLG High Grade Non Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL) Disease Group is focussing its efforts on continuing the momentum gained from the recently completed successful clinical trials in HL and high grade NHL.
The group has opened a trial among older patients with diffuse large B-cell lymphoma incorporating a very promising novel agent in combination with conventional chemotherapy.
In the area of HL, the ALLG is collaborating on a very large clinical trial with the German HL study group looking at another highly effective drug in combination with conventional chemotherapy.
Other potential trials are being pursued in collaboration with various co-operative trial groups in Europe with whom active partnerships can be forged in order to bring new drugs to Australian lymphoma patients.
The ALLG Low Grade Lymphoma and Chronic Lymphocytic Leukaemia (CLL) Disease Group is focussed on identifying potential clinical trial options for the ALLG with a number of exciting new agents. Ongoing studies are concerned with the role of lenalidomide in Follicular Lymphoma with the ALLG Clinical Trial NHL26 (RePLY) still recruiting. A study proposal to combine the anti-CD38 antibody Daratumumab directed against plasma cells with the anti-CD20 antibody Rituximab and the B cell receptor kinase inhibitor Ibrutinib in patients with Waldenström’s macroglobulinaemia is under development. Discussions are also underway with the UK NCRI Lymphoma Group to assess the feasibility of ALLG participation in their PETREA study of PET-adapted therapy after induction rituximab-chemotherapy in patients with Follicular Lymphoma. This would build on the ALLG's leading role internationally in establishing PET as the imaging modality for assessment of response and determination of prognosis after first-line treatment of this common incurable lymphoma. Establishing the uncommon lymphoma registry (as part of the ALLG National Blood Cancer Registry) as a tool to support future research remains an important goal.
In future clinical trials, the ALLG Myeloma Disease Group is aiming to use new promising drugs to improve treatment strategies for patients with multiple myeloma and AL amyloidosis. This includes: the combination of carfilzomib, thalidomide and dexamethasone for patients whose myeloma has relapsed; assessing whether the new anti-myeloma antibody, elotuzumab can improve outcomes when added to cyclophosphamide, thalidomide, dexamethasone (CTD) chemotherapy for patients whose myeloma has relapsed; and assessing pomalidomide-based chemotherapy in patients with AL amyloidosis.
The ALLG Laboratory Science Committee (LSC) oversees the conduct of translational scientific studies, in which clinical samples are used to answer specific scientific questions of importance to haematological malignancies. Whilst the majority of such studies are embedded into clinical trials, many 'stand-alone' laboratory science studies are also being performed.
The ALLG Supportive Care group aims to alleviate the symptoms and complications of blood cancers and to minimise toxicities of treatment. The group is currently focussing on studies that investigate strategies to prevent infections that can occur during and after treatment. The group is also looking at red cell transfusion thresholds and is planning comparative research in this space; this is a highly relevant to older patients who have a blood cancer diagnosis. Group members are also involved in developing and publishing Australasian Supportive Care guidelines.