2-3 Nov 2024 Chiang Mai, Thailand
The 2nd APLC Summit in Chiang Mai highlighted advancements in leukemia management, focusing on innovative therapies, regional collaboration, and access to care. Key topics included FLT3-mutant AML, immunotherapy in ALL, targeted therapies in CLL, and optimized TKIs for CML. Industry innovations, standardized MRD protocols, and regional registries were emphasized, alongside plans for broader collaboration and future conferences, starting in Penang, Malaysia, in 2025. This year saw a total attendance of 69 delegates, guests, and industry partners (including virtual).
Event Highlights
Download the event highlights in PDF.
Event Videos
Plenary Session 1: Advances in Managing FLT3-Mutant Acute Myeloid Leukemia (AML)
Keynote Speaker: Prof. Mark Levis (USA)
Prof. Levis discussed the significance and influence of co-occurring mutations (e.g., NPM1, DNMT3A, TP53) on prognosis and therapeutic strategies. He also highlighted available tools for diagnosis and monitoring, such as PCR and MRD assays. The current therapeutic landscape includes the use of FLT3 inhibitors either alone (e.g., quizartinib, gilteritinib, and midostaurin), each with varying efficacy and characteristic adverse event profiles. Combination therapies, such as chemotherapy, have shown better efficacy but with higher myelosuppression. Emerging evidence suggests adopting a sequential strategy utilizing low-intensity induction therapy as bridges to transplant or the use of FLT3 inhibitors.
However, challenges remain in treating FLT3-mutant AML, including multi-clonal disease, which is associated with poor outcomes due to therapy resistance, making traditional approaches like transplant or FLT3 inhibition less effective. Additionally, the evolution of resistant clones often requires novel approaches, such as menin inhibitors or second-line FLT3 inhibitors. Managing toxicities is also crucial, as it involves balancing effective therapy with tolerability, particularly in elderly or frail patients.
Plenary Session 2: Integration of Immunotherapy into Frontline ALL Treatment
Keynote Speaker: Prof. Mark Litzow (USA)
Prof. Litzow presented findings from the landmark ECOG E1910 trial, which showed that adding blinatumomab to chemotherapy significantly improved survival outcomes for patients with MRDnegative B-cell precursor ALL. The three-year overall survival rates reached 85% compared to 68% for chemotherapy alone. He emphasized the importance of MRD testing in guiding treatment decisions and highlighted the potential of advanced NGS-based MRD techniques to refine therapy further. Younger patients (<55 years) derived the greatest benefit from blinatumomab, while older patients (>55 years) showed more limited results, likely due to adverse genetic factors. Prof. Litzow proposed integrating immunotherapy earlier in treatment courses to minimize toxicity. He discussed if there was sufficient evidence as to whether fewer cycles of blinatumomab could maintain efficacy while reducing costs, especially for MRD-negative patients. He also reviewed the evolving role of chemotherapy-free regimens, particularly for older or frail patients, and stressed the need for continued research into the optimal sequencing of immunotherapy and other novel treatments.
Plenary Session 3 & 4 : Advances in Chronic Lymphocytic Leukemia (CLL) Management and Industry Engagement
Keynote Speaker: Prof. Stephen Mulligan (Australia)
Prof. Stephen Mulligan provided an overview of the evolution of CLL therapies, emphasizing the shift from chemotherapy (e.g. FCR) to targeted treatments such as BTK inhibitors (ibrutinib, acalabrutinib) and BCL-2 inhibitors (venetoclax). He highlighted the potential of fixedduration venetoclax regimens, particularly in achieving MRD negativity when combined with antiCD20 antibodies, and discussed the promise of MRD-driven strategies for guiding treatment cessation and improving outcomes.
Despite the effectiveness of these novel therapies, challenges remain, including adverse events (e.g., cardiac risks with BTK inhibitors, tumor lysis syndrome with venetoclax) and disparities in access and affordability of treatments across the region. Findings from trials like FLAIR demonstrated high threeyear PFS rates (97%) with MRD-adapted approaches, supporting their growing role in CLL management.
In Session 4, the industry engagement session showcased advancements in hematology from leading companies, highlighting progress in bispecific T-cell engagers (BITE®) and checkpoint inhibitors. Updates on commercialized therapies, including expanded indications, global development pipelines, and clinical trials in Southeast Asia, were also presented. Diagnostic innovations featured an AI-driven functional precision diagnostic platform designed to guide personalized treatment decisions, validated in hematologic malignancies with 80% accuracy. The session underscored the critical need for collaboration between academia and industry to enhance access to innovative therapies and diagnostics, particularly in resource-limited settings.
Plenary Session 5: Updates from APLC Working Groups
Acute Myeloid Leukemia (AML) Working Group:
Regional AML Guidelines: Emphasis on creating a consensus to address regional disparities in patient demographics, genetic subtypes, and access to diagnostics and therapies. Highlighted the unique prevalence of subtypes like CBF and FLT3-ITD mutations in the Asia-Pacific.
MRD Standardization: To establish regional MRD (Measurable Residual Disease) monitoring protocols using techniques like flow cytometry and NGS to harmonize treatment outcomes.
Acute Lymphoblastic Leukemia (ALL) Working Group
Secondary AML Survey: An ongoing project aims to understand management practices across the region, with the goal of improving care for this high-risk population.
Updates on consensus guidelines for MRD assessment and asparaginase use, including challenges with supply and switching formulations.
Discussions on integrating blinatumomab and CAR-T therapies into frontline and consolidation treatment. Highlighted the need for broader access and funding for these therapies in the region.
Proposed new collaborations for rare adult conditions like lymphoblastic lymphoma to pool data and improve management strategies.
Chronic Lymphocytic Leukemia (CLL) Working Group:
Development of a regional registry for prospective observational studies on treatment outcomes.
Consensus on treatment approaches, including watch-and-wait strategies, BTK inhibitor resistance management, and the role of chemoimmunotherapy in resource-limited settings.
Emphasis on personalized management, including addressing comorbidities and long-term monitoring for complications such as cardiac issues and secondary malignancies.
Registry Working Group:
Plans to establish disease-specific registries using standardized data collection models like REDCap. A federated approach was proposed to enable data aggregation while maintaining data integrity and minimizing governance challenges.
Focused on AML and ALL registries to track molecular diagnostics and treatment responses.
Panel Discussion
Consensus on prioritizing cost-effective strategies for resource-limited countries, such as using chemoimmunotherapy when targeted therapies are inaccessible.
Acknowledgment of the importance of including rare conditions like lymphoblastic lymphoma and double-refractory CLL in collaborative projects.
Addressing the challenges of data sharing and governance for multinational registries, with a focus on practical solutions like de-identified data sharing.
Plenary Session 6: Optimizing TKI Use in CML Management
Keynote Speaker: Prof. David Yeung (Australia)
Dr. David Yeung highlighted key priorities in managing chronic myeloid leukemia (CML) in 2024, emphasizing the importance of achieving early molecular response milestones to prevent disease progression. He underscored the benefits and risks of second-generation TKIs, which offer faster responses but higher cardiovascular toxicity compared to imatinib. Asciminib, a novel STAMP inhibitor targeting the myristoyl pocket of BCR-ABL, was showcased as a promising option with superior tolerability and efficacy. Treatment-free remission (TFR) was discussed as an attainable goal for approximately 50% of patients with sustained deep molecular responses. Advanced diagnostics like NGS and mutation-specific strategies were highlighted as essential for managing resistance in high-risk patients. Dr. Yeung also touched on emerging combination therapies and the need to balance efficacy with toxicity in therapy selection.
Penary Session 7: APLC Business Meeting and Future Directions
The session focused on electing new leadership, reviewing the consortium’s achievements, and outlining future plans. Prof. Wang Jianxiang was elected as the new President, with Prof. Ng Soo Chin as Vice President, succeeding Dr. Suporn, who was commended for two successful years of leadership. Accomplishments included expanding membership to 55 key opinion leaders, hosting educational events such as mentorships, laboratory workshops, and consensus updates for CLL and ALL. Future plans highlighted the next APLC summit to be held in Penang, Malaysia, in 2025, and a broader scientific conference by 2026-2028, possibly moving to China and Kuala Lumpur for the first scientific conference. Emphasis was placed on sustainable growth and strengthening regional collaborations.
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