Many patients with blood cancers can now be cared for as outpatients, even using complex treatments such as chimeric antigen receptor (CAR) T-cell therapy. It’s a concept that was unheard of just a few years ago, when the sophisticated care was available only on an inpatient basis at large university hospitals.

Specialists with Baptist Health Miami Cancer Institute played a key role in the OUTREACH clinical trial that showed outpatient CAR T-cell therapy can be administered safely and effectively for many patients with relapsed/refractory large B-cell lymphoma. Results of the trial, published by first author Yuliya Linhares, M.D., chief of lymphoma at the Institute, appeared recently in the journal Blood Advances.

“Our study showed that at specialized medical centers with a multidisciplinary team trained in CAR T-cell toxicity management, outpatient CAR T-cell treatment is feasible and that complications occurred among outpatients and inpatients at a nearly equal rate,” Dr. Linhares said.

Blood cancers such as leukemia, lymphoma, myeloma, myelodysplastic syndromes and myeloproliferative neoplasms, will be diagnosed in nearly 188,000 people in the U.S. this year. But with significant advances in their diagnosis and treatment in recent years, an estimated 1.7 million Americans are living with or in remission from blood cancer, according to the Leukemia and Lymphoma Society.

Dr. Linhares and the blood cancer team at Miami Cancer Institute are part of a group of physician-scientists whose work has led to significant improvements in life expectancy and quality of life and, in some cases, cures where there was no hope a decade or two ago.

Guenther Koehne, M.D., Ph.D., deputy director of the Institute and chief of blood and marrow transplantation and hematologic oncology, is a pioneer in stem cell transplantation and immunotherapies. He is renowned for developing a method of manipulating donor stem cells to reduce the risk of graft-versus-host disease, a common life-threatening complication of transplantation.

In their efforts to improve CAR T-cell resistance in hematologic malignancies, physicians are researching the use of bispecific CAR T-cells, a type of immunotherapy that harnesses the body’s own immune system and targets two tumor antigens simultaneously.

“When we target multiple antigens, we are aiming to overcome resistance mechanisms so that we lower the chance of disease recurrence,” Dr. Koehne says. “Through more comprehensive approaches, we can also prolong remission.”

Dr. Koehne leads the first-in-human VBP101 (NCTO4849910) trial, “Allogeneic Engineered Hematopoietic Stem Call Transplant (HCT) Lacking the CD33 Protein, and Post-HCT Treatment with Mylotarg, for Patients with CD33+ AML or MDS. The study involves CRISPR gene-editing technology, deleting CD33 protein that is found on the surface of leukemia cells, but also on normal blood-producing stem cells. By eliminating the protein on the stem cells with this technology, there is a chance to specifically target residual leukemia, expressing CD33, with the donor’s immune system following a stem cell transplant.

He is also involved in the VBP301 (NCT05984199) trial, “Donor-Derived Anti-CD33 CAR T-Cell Therapy (VCAR33) in Patients with Relapsed or Refractory AML after Allogeneic Hematopoietic Cell Transplant.

“We are very hopeful that we will continue to see improved outcomes as our technologies and techniques evolve and we adjust conditioning regimens, induction timing and dosing levels, as well as introducing different drug combinations,” Dr. Koehne said.

Miami Cancer Institute physicians presented their latest findings at the 2024 American Society for Hematology (ASH) meeting in San Diego in December. ASH is the world’s largest professional society for clinicians and scientists who treat blood and bone marrow disorders. Presentations by Ariel Perez Perez, M.D., and Dr. Linhares included:

• Updated Analysis of Brentuximab Vedotin, Nivolumab, Doxorubicin and Dacarbazin for Nonbulky, Early-Stage Classical Hodgkin Lymphoma
• Real-World Experience with Sequential Brentuximab Vedotin, Plus AVD Chemotherapy as Frontline Therapy for Older Patients with Classical Hodgkin Lymphoma: A Multicenter Retrospective Study.

As advances in blood cancer care continue at a rapid pace, Institute hematologist/oncologist Peter Citron, M.D., has enjoyed giving encouraging news to patients with multiple myeloma. “I actually paint a very positive picture because things have changed dramatically,” Dr. Citron said. “When I started doing this, nearly 100 percent of patients succumbed to their disease within three or four years. Now I tell patients, ‘You’re going to be here and doing well 10 years from now.’ “

As physicians better understand the genetic manifestations that drive an individual’s cancer, Dr. Koehne said he sees even more personalized care and treatments on the horizon that have far fewer side effects. “We are excited about the future because we see so many new options for our patients,” he said. “And as we collaborate with other physicians around the globe, together we can accomplish great things.”

Dr. Koehne is medical director of Miami Cancer Institute’s Global Summit on Immunotherapies for Hematologic Malignancies, March 7-8 at the JW Marriott in downtown Miami. Physician-researchers from Weill Cornell Medicine, Dana-Farber Cancer Institute, Memorial Sloan Kettering Cancer Center, Cleveland Clinic, Abramson Cancer Center/University of Pennsylvania and other leading institutions join Institute physicians to present the latest research and evolving therapeutic strategies. For more information, click here.