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ATLANTA — Scientists from multiple military facilities made significant contributions to the 63rd American Society of Hematology (ASH) Annual Meeting here.
Research presented at the meeting in December ran the gamut from to managing side effects of blood cancer treatment and assessing risk of recurrence and more.
Cancer research has long been a priority for the DoD. “Members of the military are exposed to hazardous environments due to the nature of their service and deployments and thus are at risk for the development of many types of cancers,” notes the DoD’s Congressionally Directed Medical Research Programs. “Research from CDMRP’s cancer programs alone has led to 18 FDA-approved drugs and devices that are currently being used, as well as significant changes in clinical practice,” said CDMRP Director Col. Sarah Goldman.
Blood cancers were a prioritized cancer type within CDMRP’s Peer Reviewed Cancer Research Program (PRCRP) from 2010 to 2014 and have been a priority area every year since 2018 in an effort to better support servicemembers, their families and the broader U.S. population. Research funded by CDRMP led to the U.S. Food and Drug Administration’s approval of selinexor for multiple myeloma and diffuse large B-cell lymphoma in February 2021.
With that background, it is no surprise that military researchers are breaking new ground in hematologic oncology. Below is a look at the high points of presentations at ASH 2021 from these scientists.
Managing Nausea
Among the most common adverse effects of chemotherapy are nausea and emesis, which affect just under 60% of pediatric and young adult cancer patients. Chemotherapy-induced nausea and vomiting (CINV) is associated with frequent hospital visits and admissions and significant morbidities, including worrisome weight loss that can imperil successful outcomes.1
While medications and lifestyle changes can help manage CINV, parents and caregivers are often unfamiliar with the guidelines around their use and may face literacy issues that make managing CINV at home even more difficult. To address these issues, physicians at Walter Reed National Military Medical Center created a picture-based nausea action plan with 15 pictograms that patients, caregivers and clinicians gave high marks for transparency, translucency and recall, as well as comprehension, design quality and usefulness.
“The [Uniformed Service Nausea Action Plan] is poised to identify other urgent clinical developments for patients with cancer that could masquerade as nausea and may serve as an early warning sign in these instances,” noted researchers led by Scott Penney, MD, of Walter Reed. “The USNAP met all criteria for clinical implementation. The USNAP has potential to become an important tool in the care of patients with CINV, improving both quality-of-care and clinical outcomes.”
Achieving Better Outcomes
Researchers at Brooke Army Medical Center in Diberville, TX, and David Grant USAF Medical Center at Travis Air Force Base in California, found that active duty service members with lymphoma had superior overall survival rates compared to a matched group of civilians.2
“ADSMs with cancer receive prompt care without copayments, deductibles, prior authorizations, or other insurance barriers,” the team noted. “Further, disparities based on race/ethnicity and sex are not present in the [Military Health Service], despite being pervasive in the civilian sector.”
The researchers retrospectively identified servicemembers with Hodgkin lymphoma (HL), diffuse large B-cell lymphoma (DLBCL) and indolent lymphomas from 1997 to 2017 using the DoD Automated Central Tumor Registry (ACTUR). They tapped the National Cancer Institute’s Surveillance, Epidemiology and End-Result (SEER) database to create a control group that was matched 4:1 to servicemembers by age, sex, race, ethnicity, year of diagnosis and stage.
The study included 1,170 servicemembers with HL, 443 with DLBCL and 284 with indolent lymphomas. Military patients were largely enlisted soldiers between the ages of 20 and 40 who were white and non-Hispanic. Compared to civilians, servicemembers with DLBCL had 49% the risk of death, while those with indolent lymphoma and Hodgkin lymphoma had 48% and 35% the risk of death, respectively, compared to their matched counterparts.
“It is possible that better access to care within the equal-access MHS might explain our results,” Gilbert Patrick Ancira, MD, of Brooke Army Medical Center and colleagues said. “Alternatively, regular fitness tests and periodic health assessments may render ADSMs are more fit and less comorbid than their civilian counterparts, translating to a better chance of long-term survival.”
Stratifying Risk in Acute Lymphoblastic Leukemia
A team of researchers from pediatric centers across the country and the Uniformed Services University of the Health Sciences School of Medicine investigated whether assigning weights to individual risk factors in acute lymphoblastic leukemia (ALL) or using continuous rather than categorical numerical values would more accurately predict the risk of relapse among children, adolescents and young adults. Risk factors used by the Children’s Oncology Group (COG) include National Cancer Institute risk group, cytogenetics and early response to therapy as indicated by minimal residual disease using flow cytometry on Day 8 peripheral blood (D8 PB) and Day 29 bone marrow (D29 BM).3
They developed a model on 11,151 patients which was subsequently validated on 4,103 patients. The team established cutoffs for risk groups that maximized the discrimination of the predictive model, which defined four risk groups.
They found that the risk stratification using the model the team developed “improved discrimination among individuals by identifying groups with different relapse risk than expected. The PICOG can thus identify patients for whom therapeutic intensification may not result in significantly better outcomes while improving the discrimination of [high risk patients] to allow randomized interventions with achievable hazard ratios.”
- Reeves P, Penney S, Romanelli KA, et al. Development and Assessment of a Low Literacy, Pictographic Nausea Action Plan. Abstract 2978. ASH 2021. Dec. 12, 2021.
- Ancira GP, Romain J, Thornton J, Destefano CB. With Equal Access, Service members with Lymphoma Have Better Outcomes Than Their Civilian Counterparts. Abstract 4090. ASH 2021. Dec. 13, 2021.
- Delrocco N, Loh ML, Borowitz M, et al. Comparison of Current and Enhanced Risk Stratification of 21,199 Children, Adolescents, and Young Adults with Acute Lymphoblastic Leukemia Using Objective Risk Categorization Criteria: A Children’s Oncology Group Report. Abstract 2382. ASH 2021. Dec. 12, 2021.
