Hematologic Updates from ASH 2022

Novel data on myeloid malignanciesIn 2022, both the World Health Organization 1 (WHO) and the International Consensus Classification (ICC) 2 revised their guidelines for classifications of myeloid neoplasms.At last year's ASH Meeting, these novel classifications were validated in a retrospective analysis of patients with myelodysplastic syndrome (MDS), specifically the uniqueness of molecularly defined entities. 3This study underlined the clinical utility of recognizing multi-hit TP53 MDS as a separate entity due to its strong association with poor survival.In low-risk del(5q) MDS, the final results from the European phase III Sintra-REV trial demonstrated that early lenalidomide treatment in patients with anemia without transfusion requirement compared with placebo significantly delayed transfusion dependency (median, not reached vs 11.6 months; p=0.003) and reduced the risk of transfusion dependency by 70% (HR: 0.302 [95% CI: 0.132-0.692];p=0.005). 4Furthermore, 94.1% of patients treated with lenalidomide achieved a cytogenetic response versus none of those treated with placebo (p<0.001), with a complete response (CR) rate of 87.5%.The study was flawed by using placebo instead of erythropoietin stimulating agents (ESA) as an inappropriate comparator, however, the high rate of cytogenetic responses suggests a relevant disease-modifying effect that cannot be achieved by ESA.Moreover, retrospective data suggest that patients with cytogenetic remissions can maintain treatment-free remission, a possibility that merits further investigations in follow-up studies.