ALLG marks 50 years of progress in 2023
With more than 200 peer-reviewed publications of ALLG clinical trials over the past five decades, our members’ ALLG trials provide the compelling clinical evidence required to change therapeutic practice. We will continue to progress better treatments and care for patients with blood cancer to deliver even more impactful outcomes in the coming decade.
The past decade, in particular, has seen the ALLG contribute significantly to advancements in blood cancer care through clinical trials, research developments and publications, which have resulted in better treatments and better lives for those living with blood cancers.
This impact has been felt across many disease areas including chronic and acute leukaemias, myeloma, lymphomas as well as the emergence of therapy areas such as bone marrow transplantation and cell therapies.
Leadership role on Blood Cancer Taskforce for National Action Plan for Blood Cancer
ALLG invited to take a leadership role on Australia’s first National Blood Cancer Taskforce formed by the Australian Federal Government. This Taskforce is tasked with delivering the National Action Plan for Blood Cancer.
Leadership role on Blood Cancer 6 Optimal Care Pathways
Launched in August 2022 as part of the National Strategic Action Plan for Blood Cancer, the Optimal Care Pathways (OCPs) set national standards of care and treatment for blood cancer patients across Australia; no matter where they live or access treatment. ALLG has a leadership role in the Taskforce and in setting the OCPs.
Changing the way acute myeloid leukaemia (AML) therapy is determined
First patient recruited to ALLG’s world-first platform trial AMLM26 INTERCEPT in September 2022 to change the way AML therapy is determined.
Accelerating blood cancer research through real-world data
3,000th patient registered on ALLG’s National Blood Cancer Registry in March 2022, to help accelerate research in blood cancer.
Established by the ALLG in 2012, the Registry (NBCR) includes participants with AML, ALL, MDS and uncommon lymphomas and represents ANZ’s largest collection of real-world data on acute leukaemia’s. The Registry features in new publication in the Journal of Clinical Oncology in 2019, determining how the presence of a specific genetic abnormality, NPM1, relates to clinical outcomes in those with AML.
ALLG collaborates with a large collaborative haematological clinical research group in 2021 that specialises in myeloma, the French Myeloma Group, to bring an international Amyloidosis trial to Australia to evaluate a new combination of medicines for patients with the disease. The ALLG is leading the trial in Australia, MM24.
National trial on transplantation complications to help save lives
An important national study in 2019 across all transplantation centres in Australia, ALLG BM12 CAST is the only randomised clinical trial looking at a new way of preventing a serious complication of transplant called graft versus host disease or GVHD; aiming to prevent this life-threatening condition and improve long-term outcomes including quality of life. BM12 is the only randomised study to address this question.
International precision medicine clinical trials
An ALLG partnership in 2015 with Leukaemia Foundation Trials Enabling Program provides Australians, living with blood cancer, access to latest research and treatments through international trials; and access to novel therapies years ahead of their expected availability on the Australian market. First ALLG trials on the Trials Enabling Program, ALLG AMLM23 and AMLM24 represent new hope for Australians living with acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS).
Advancing treatments in Acute Leukaemias & Myelodysplastic Syndrome
ALLG members have contributed widely to understanding the science of acute leakaemias such as acute lymphocytic leukaemia (ALL), acute myeloid leukaemia (AML), acute promyelocytic leukaemia (APL) and myelodysplastic syndromes (MDS).
A major breakthrough in Acute lymphoblastic leukaemia (ALL), led by Principal Investigators Matthew Greenwood and Luciano Dalla Pozza, the ALLG ALL06 interim analysis published in 2019 established feasibility and applicability of minimal residual disease (MRD) testing criteria, predicting survival in an intensive paediatric protocol deliverable in adolescents and young adults with acute lymphoblastic leukaemia.
In 2014, ALLG members Ken Bradstock and John Seymour led the important ALLG AMLM12 trial which aimed to reduce gastrointestinal toxicity after intensive induction for AML with palifermin. Palifermin is now commonly used to treat side effects of chemotherapies for various blood cancers. The AMLM12 trial remains the largest trial ever conducted by ALLG with 442 patients recruited. The trial facilitated multiple correlative research studies which have assisted with understanding the biology of AML.
Better treatment for Chronic myeloid leukaemia (CML) demonstrated through ALLG trial
In 2015, ALLG members Timothy Hughes and David Yeung led the publication of the interim results of the ALLG CML09 trial in the premier journal Blood, which demonstrated the effectiveness of using imatinib as a first-line treatment with an early switch to nilotinib for failure to achieve molecular targets. The ALLG CML09 TIDEL-II trial was closed and published in Blood Advances in 2019, with significant findings that gene expression signatures can predict early molecular response failure in chronic-phase CML treated with front-line imatinib. These data will influence treatment pathways in years to come.
Lymphomas & Chronic Lymphocytic Leukaemia (CLL)
The ALLG and its Members have made a significant impact in the treatment of lymphomas. With over 80 types of lymphoma now recognised, the ALLG trials have significantly advanced the fields of chronic lymphocytic leukaemia (CLL), non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma, or Hodgkin disease (HD).
ALLG Board Member Andrew Roberts and colleagues at the Walter Eliza Hall Institute (WEHI) in Australia developed venetoclax, a small molecule targeted therapy. In the late 1980s researchers at the WEHI discovered a protein, BCL-2, that helps cancer cells survive. For decades researchers, including ALLG Member clinician-scientists, worked to develop a way to target BCL-2 to kill cancer cells. The research was successful with venetoclax approved for the treatment of chronic lymphocytic leukaemia (CLL) in 2017. Prof Roberts would receive the Prime Minister’s Prize for Innovation for his role in developing venetoclax in 2019 and play a prominent role in Australia’s first National Blood Cancer Taskforce.
In 2014, the ALLG co-authored “Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification,” in the Journal of Clinical Oncology. This was critical to modernising the global approach for evaluating, staging and assessing patients with NHL and HD.
In 2015, ALLG NHL21, led by ALLG members Mark Hertzberg, Maher Gandhi, and Colm Keane had a major impact on Diffuse large B cell lymphoma (DLBCL), identifying prognostic biomarkers for non-invasive monitoring with PET-CT, with publications in Lancet Haematology and Blood. This trial serves as an important basis for correlative and laboratory work today.
Non Hodgkin Lymphoma ALLG trials pave the way for better treatment
The ALLG participated in the prospective randomised EORTC Phase 3 trial, ALLG NHLLOW4 in Australia, which looked at long-term outcomes of rituximab maintenance in R/R follicular non-Hodgkin lymphoma. This trial paved the way for rituximab to become a standard therapy for follicular lymphoma.
ALL member, John Seymour led the ALLG NHL16 (PRIMA) partnership with France which lead to a secondary analyses performed by Judith Trotman in 2016 demonstrating that baseline metabolic tumour volume predicted outcome in high tumour burden follicular lymphoma, important work that influenced clinical management follicular lymphoma worldwide. ALLG NHL16, the Australian arm of the European PRIMA trial, was published in the Lancet and demonstrated outcomes in high tumour burden follicular lymphoma with rituximab plus chemotherapy after two years. Judith Trotman authored a sub-analysis in J Clin Oncology of PET-CT in PRIMA trial participants.
The 10-year follow up results for ALLG NHL16 PRIMA trial were presented at European Hematology Association meeting in 2020 by lead investigator Gilles Salles, which showed significant benefit in reductions in therapy and improvements in quality of life with rituximab maintenance in patients with follicular lymphoma.
ALLG Advances for treatment of Hodgkin Disease (HD)
Results of a landmark trial ALLG HD08, led in Australia by ALG members Leanne Berkahn and Judith Trotman, were published in the New England Journal of Medicine in 2016. The findings showed that interim PET scanning can help adapt treatment successfully in advanced HD.
Work continues in a range of ALLG trials today to understand the utility of PET-CT in managing blood cancers. Further follow-up results from the ALLG HD08 RATHL trial, led again by Judith Trotman and Leanne Berkahn, were presented at the International Conference on Malignant Lymphoma in Lugano in June 2017. These data confirmed the efficacy of de-escalation of bleomycin after a negative interim PET scan in advanced HD. This is now considered standard practice.
Moving the dial on multiple myeloma treatment
ALLG MM16 led by members Joy Ho and Douglas Joshua showed safety of carfilzomib in renal impairment and enabled a change to the eviQ guidelines [The eviQ protocol identifier is to improve outcomes for people with cancer by reducing variation in treatment]. Joy was awarded the Presidential Lecture for her MM16 work at the BLOOD conference in Perth in October 2019.
Bone Marrow Transplantation & Cell Therapies
Since 2010, the emergence of the therapy areas of bone marrow transplantation and cell therapies has been a significant component of research focus, including at the ALLG.
Led by Andrew Grigg and Mark Hertzberg, the ALLG BM07 trial was published in 2017 and helped developed a risk-adapted protocol for pre- and post-ASCT zoledronic acid to prevent bone mineral density loss after ASCT, which is still used today.
ALLG member David Ritchie led our inclusion in the international trial, for ALLG BM06.
ALLG BM12 trial led by members David Curtis and Sushrut Patil, is a randomised clinical trial looking at a new way of preventing a serious complication of transplant called graft versus host disease or GVHD; in particular looking at whether a post-transplant treatment drug [cyclophosphamide] is better than standard of care to prevent GVHD and can improve long-term outcomes including quality of life. BM12 is the only randomised study to address this question.
TGA approves new drug for acute tisagenlecleucel (Kymriah) for ALL and diffuse large B-cell lymphoma (DLBCL). In 2018, the ALLG Scientific Advisory Committee reviewed the clinical evidence and contributed a Statement of Clinical Relevance, which supported this application for approval so that Australian patients could access this cell therapy for the first time.
Fostering the next generation of clinical trial researchers
The ALLG Early Career Clinician Researcher program, launched in 2022, provides mentorship and greater opportunities for junior doctors to learn more about running clinical trials.
Increasing rural and regional patients’ access to clinical trials
This ALLG Rural & Regional Haematology Working Group was established in 2020 to address issues relating to patient referrals, teletrials, and workforce matters and help increase access for rural and haematology patients to clinical trials.
Increasing clinical trials and access for New Zealand patients
ALLG established the Medicines Access Committee New Zealand in 2020 to strengthen commitment from ALLG research partners for New Zealand to be included in all ALLG-led research
Launched New Zealand’s first CAR T-cell therapy clinical trial in 2019, led by ALLG member Robert Weinkove.