ASH Practice-Changing Updates: No Novel Therapy Evidence Available
I cannot provide practice-changing updates from ASH regarding novel therapies for hematologic malignancies based on the evidence provided, as the available evidence consists entirely of 2019 ASCO/ASH guidelines on erythropoiesis-stimulating agents (ESAs) for cancer-associated anemia, not recent ASH conference updates on novel therapies.
What the Evidence Actually Contains
The provided materials focus exclusively on:
- ESA management guidelines from 2019 for chemotherapy-associated anemia 1
- Historical guidance from 2010 on epoetin and darbepoetin use 1
- One FDA drug label for isatuximab (a CD38 monoclonal antibody for multiple myeloma) 2
- General review articles on cancer therapies and hematologic malignancies from 2017-2025 3, 4, 5, 6, 7
Key ESA Recommendations (Not Novel, But Most Recent Guideline Evidence)
For Chemotherapy-Associated Anemia
ESAs may be offered only when hemoglobin drops below 10 g/dL in patients receiving non-curative chemotherapy, with RBC transfusion remaining an equally valid option 1.
- ESAs should never be used in curative-intent chemotherapy due to increased mortality risk and thromboembolic complications 1
- ESAs reduce transfusion needs but increase thromboembolism risk and may increase on-study mortality 1
- The reduction in fatigue with ESAs is statistically significant but clinically unimportant 1
For Myelodysplastic Syndrome (MDS)
Avoid ESAs entirely when baseline erythropoietin levels exceed 500 IU/L 1.
- Best responses occur with erythropoietin levels <200 IU/L 1
- Lower transfusion dependence (<2 units/month) predicts better ESA response 1
- Lenalidomide plus epoetin beta increased erythroid response (39% vs 23%) in ESA-refractory MDS but did not improve transfusion independence 1
For Non-Hodgkin Lymphoma, CLL, and Multiple Myeloma
Observe hematologic response to cancer treatment before considering ESAs, and exercise extreme caution with agents that increase thromboembolism risk (e.g., immunomodulatory drugs in myeloma) 1.
- Treatment intent determination requires clinical judgment given improved survival with modern therapies 1
- No data exist on ESA safety with newer agents like monoclonal antibodies, targeted therapies, or cellular therapies 1
Limitation
This evidence set does not contain ASH conference abstracts, presentations, or recent practice-changing trial data. The most recent substantive clinical evidence is from 2019 guidelines, with supporting research from earlier years. For actual ASH meeting updates on novel therapies (CAR-T cells, bispecific antibodies, novel targeted agents), different source materials would be required.