MP-3 - Recent advances in treatment for hematological malignancies

Abstract

Treatment for hematological malignancies had progressed to obtain 30-40% long-term remission in some lymphomas and acute leukemias up to a year 2000 by cytotoxic anti-cancer agents. However, there had been little further improvement only with cytotoxic drugs. At turning the century, molecularly-targeting agents became available and treatment strategy was dramatically changed to enter a new era. I want to congratulate the JSMO founders who had a great keen insight to establish the society in this era (2002). Since then, we have experienced tremendous progress in this field. In diffuse large B-cell lymphoma which had no change in a cure rate with the standard chemotherapy (CHOP) for 30 years, 10% improvement was reported by adding anti-CD20 monoclonal antibody, rituximab (2001). It was surprised by not only hematologists but also oncologists that chronic myelogenous leukemia had an excellent response to a single oral agent, imatinib (2005), targeting the bcr-abl chimeric protein. Furthermore, over 1/3 patients who stopped imatinib after acquisition of undetectable residual disease for at least 2 years sustained molecular remission for longer than 5 years. Multiple myeloma is a chronic uncurable disease in the elderly which had no improvement in survival with melphalan or other intensive cytotoxic drugs for years. A proteasome inhibitor, bortezomib (2006) and immunomodulatory drugs, thalidomide (2008) or lenalidomide (2010), had improved a median survival of 3-5 years to longer than 5 years. Introduction of arsenic trioxide (2004) and all trans-retinoic acid (2007) made it possible to control DIC more easily and raised a cure rate in acute promyelocytic leukemia, and hypomethylating agents gave rise to prolong the survival in MDS. Supportive care has also advanced to control grave complications and prolong the survival. Development of new drugs along with new discovery of tumor biology in hematology will continue to improve treatment outcomes in the future.