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Oncology Advances October 2015

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Dana-Farber/Brigham and Women's Cancer Center | 5 New Clinic Studies Innovative Approaches to Prevent the Progression of Blood Cancer in Patients with Precursor Conditions The new Blood Cancer Prevention of Progression Clinic is an extensive research program designed to better understand the progression and clonal evolution of blood cancers in order to provide targeted approaches to prevent the development of blood cancers in patients with precursor conditions. These conditions include monoclonal B cell lymphocytosis (MBL), monoclonal gammopathy of undetermined significance (MGUS), and early cases of myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN). "In the majority of cases, there are no effective disease-mod- ifying therapies available for patients with precursor conditions to blood cancers," said Irene Ghobrial, MD, Co-Principal In- vestigator of the Clinic. "We are left waiting until the patient's condition progresses to initiate treatment." Experts in the Clinic are aiming to: • Promote earlier detection of precursor conditions; • Identify patients that are most likely to progress in order to focus treatment in this patient population; • Deliver targeted intervention, including the use of short- ened duration of therapy with newer agents with low toxi- city, to eliminate disease before symptoms appear. with age and is associated with an increased risk of hemato- logic malignancy. Current studies in the Clinic include: • Phase II Trial of Combination Elotuzumab and Lenalido- mide +/- Dexamethasone in High-risk Smoldering Multiple Myeloma – This research study will determine the proportion of high-risk smoldering multiple myeloma pa- tients who are progression free at two years after receiving elotuzumab and lenalidomide+/- dexamethasone combi- nation therapy. For more information regarding this trial, please contact Principal Investigator Irene Ghobrial, MD, at Irene_Ghobrial@DFCI.Harvard.edu; • Study of Precursor Hematological Malignancies to Assess the Relationship between Molecular Events of Progression and Clinical Outcomes – This national observational study, led by Principal Investigator Irene Ghobrial, MD, is identify- ing molecular changes in cells of patients with precursor hematological malignancies using patients' bone marrow, blood, buccal swab or mouthwash, lymph node, urine, or other specimens. The study will link the participants' molec- ular alterations with clinical information that has been gen- erated during the course of clinical care in a large database with a goal to capture data on at least 10,000 patients. For more information regarding this trial, contact Adriana Perilla Glen at (617) 582-8664. "Prevention is the best way to eradicate disease," said Robert Soiffer, MD, Co-Principal Investigator of the Clinic and Chief of the Division of Hematologic Malignancies at Dana- Farber/Brigham and Women's Cancer Center. "This clinic has the potential to change the trajectory of many blood cancers." Irene Ghobrial, MD Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic; Medical Oncologist, Jerome Lipper Multiple Myeloma Center, Dana-Farber/Brigham and Women's Cancer Center Robert Soiffer, MD Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic; Chief, Division of Hematologic Malignancies; Co-Chief, Adult Stem Cell Transplantation Program; Dana-Farber/Brigham and Women's Cancer Center David P. Steensma, MD Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic; Medical Oncologist, Adult Leukemia Program, Dana-Farber/Brigham and Women's Cancer Center Benjamin Ebert, MD, PhD Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic; Medical Oncologist, Center for Hematologic Malignancies, Dana-Farber/Brigham and Women's Cancer Center Irene Ghobrial, MD, and colleagues have established the Blood Cancer Prevention of Progression Clinic to better understand the evolution of blood cancers in order to provide targeted preventive treatment for patients. Clonal Hematopoiesis Co-Principal Investigators Benjamin Ebert, MD, PhD, and David P. Steensma, MD, recently defined and outlined the na- ture and prevalence of clonal hematopoiesis of indeterminate potential (CHIP), which is characterized by acquisition of so- matic mutations that drive clonal expansion in the absence of cytopenias and dysplastic hematopoiesis (NEJM. 2014 Dec 10; Blood. 2015 July 2;126(1).) CHIP increases in prevalence

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