A/Prof Max Wolf Named ALLG Life Member
We are pleased to announce that A/Prof Max Wolf, MBBS FRACP FRCPA, was awarded Life Membership with the Australasian Leukaemia & Lymphoma Group (ALLG) at the November 2019 ALLG Scientific Meeting in Adelaide.
Recognising a person who has made a sustained and significant contribution to the organisation, the ALLG Life Membership is certainly befitting of A/Prof Wolf.
A consultant haematologist at Peter MacCallum Cancer Centre, A/Prof Wolf has been a doyen of haematology research at the ALLG for more than two decades. He was a founding member of the organisation and has been a leading contributor to the design and conduct of many ALLG clinical trials. He has also been instrumental in the establishment of international cooperative group collaborations, which have allowed ALLG investigators to have a presence on the world stage. His clinical trial contribution, particularly in lymphoma clinical trials, has changed clinical practice and improved the lives of patients.
The ALLG can trace itself back to 1973 the inaugural event being the first meeting of the Australian and New Zealand Lymphoma Group (ANZLG). This group was chaired by Ian Cooper until 1993, when A/Prof Wolf assumed the leadership position in which he served until 1999. The Australian Leukaemia Study Group (ALSG) was established in 1982, and the two organisations cooperated closely in the 1990s. They merged formally in 1999 to form the Australasian Leukaemia and Lymphoma Group (ALLG).
ALLG involvement in low-grade lymphoma clinical trials can be traced back to the inception of the ANZLG in 1974. That year the NHL01 study – a randomised study of COP vs CTP – substituted teniposide for vincristine across a range of non-Hodgkin lymphomas (NHL) described according to the now unfamiliar Rappaport classification. Across eight ANZ sites, 164 patients were randomised, and the study found that outcomes were similar in both groups, the exception being that peripheral neuropathy was virtually non-existent in the teniposide-treated group (versus a significant occurrence in the standard COP arm). The study was published in Cancer Treatment Reports in 1982.
Throughout the 1990s, the ANZLG looked at the role of 2CDA in follicular and low-grade NHL in studies coordinated by Kerry Taylor and Prof Wolf. They completed accrual for NHLLOW01, an investigation of the role of autologous transplantation followed by interferon maintenance for poor prognosis low-grade and mantle cell NHL, under the guidance of chief investigator Andrew Grigg.
The late 1990s and 2000s saw the introduction of the revolutionary agent, rituximab, and the ALLG participating in several pivotal collaborations with high-profile international study groups. The ALLG was a substantial contributor to the EORTC Intergroup study that established a role for rituximab in treatment and maintenance for relapsed and refractory follicular NHL (NHLLOW04). Prof Wolf was the local Principal Investigator.
Following an early international collaboration with the NCIC in 1987, the first local HL trial (in collaboration with TROG) was HD03. This study accrued 150 patients from 28 centres, with the aim of providing local benchmark results for a combination of limited chemotherapy and involved field radiotherapy in early stage disease. The approach led to 83% of participants in complete recovery (CR/Cru) and was published in 2011. The HD04 study was a collaborative study conducted with the EORTC in advanced HL, which investigated early treatment escalation in patients with advanced stage disease. The first analysis was presented at the European Haematology Association annual conference in 2012 and showed no difference in survival outcomes between the two arms.
The NHL07 study was designed as a direct dose-intensification comparison and therefore replaced doxorubicin with epirubicin in order to achieve adequate dose intensification and less cardiac toxicity. Between March 1994 and March 1999, 250 patients with previously untreated aggressive NHL were randomised to standard (s) or intensive (i) CEOP chemotherapy. A 78% increase in relative dose intensity (RDI) was achieved for patients in the i-CEOP arm. Despite this, long-term follow up at 10 years showed no significant differences in OS or PFS, while the i-CEOP arm had higher rates of toxicity.
Thus, in the pre-rituximab era, increasing relative dose intensity in patients with aggressive NHL did not improve outcomes while at the same time resulted in increased toxicity. In an alternative approach, the ALLG took part in a large British trial, looking at early autologous stem cell transplantation (ASCT) after 3-cycles of CHOP. After 10 years of follow-up there was no difference in outcome. This has been the general experience: after 20 years and 13 large trials, no substantial benefit has been seen for the use of ASCT in front-line treatment of DLBCL.
The ALLG has been a major contributor to two of the most important and influential international treatment trials for aggressive lymphoma.
He almost single-handedly, initiated and ran to completion some of the largest lymphoma studies ever done in Australia. He continues to provide mentorship to younger investigators and is a more than worthy recipient of ALLG life membership. Because of members like Prof Wolf, the ALLG has been a major player in clinical trials research in NHL, not only within Australia and New Zealand, but also internationally. He has brought the ALLG to the forefront of major advances.
When A/Prof Wolf led the merger the ANZLG with the new ALLG, he created a high-performing environment for haematologists such as Jeff Szer, Tim Hughes, Paula Marlton to continue world-class work. His mentorship of ALLG Members continues to this day.
We celebrate the legacy that A/Prof Wolf has built and the value that he has provided to medical science and clinical practice.