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Lymphoma programme

Coordinator: Emanuele Zucca, CH

ESO has a long tradition of education in the diagnosis and treatment of lymphoma, which it has promoted through several initiatives for more than a decade.

Leukaemia and Lymphoma, advanced course

This is an intensive and interactive course organised in co-operation with the International Conference on Malignant Lymphoma (ICML). It takes place immediately before the ICML, which is held every two years in Ascona or in Lugano, Switzerland. 

The international faculty, including ICML key note lecturers, guides participants through the complexity of the biology and the most relevant clinical problems in leukaemia and lymphoma, offering plenary lectures, practice-oriented training through case presentations, workshops in small groups and ample discussion slots. The next will take place on 14-16 June 2021.

Certificate of Competence in Lymphoma

This blended traditional seminars and  distance learning curriculum of studies is organised  in co-operation with University of Ulm. The programme is ECTS accredited across Europe (European Credit Transfer and Accumulation System). Unlike CME credits (Continuous Medical Education), these are recognised by Europe’s academic establishments.

The initiative provides professional development in the competence of treating lymphoma patients, opening up a new educational avenue for the School.

The programme that integrates three attendance seminars with four e-learning modules over a period of 14 months, involves a total of 405 hours of study leading to 14 ECTS points.

The first programme started in January 2013 and ended in April 2014. The second cohort started in February 2015 and ended in April 2016. The third cohort started in February 2017.
The fourth edition started in February 2019 and will conclude in April 2020.
Further information can be found here

ESO Workshop at 11-ICML: Lymphoma pretreatment assessment and response evaluation in the new millennium

On the day before the official opening of the 11-ICML in Lugano a closed workshop was held to discuss how to improve, standardize and legitimize the current and evolving staging procedures for nodal lymphoma (Hodgkin and non-Hodgkin)and also the criteria for response to therapy in order to achieve a consensus that can last and be relevant for community physicians, investigators'-led and cooperative phase III trials and registration trials. Discussions were mainly focused on the state of the art of the currently available technologies for lymphoma staging. Several issues were identified as requiring updating, including standardization of PET methods, current indications for bone marrow biopsy, use of ‘interim’ PET-CT and the potential prognostic value of quantitative analyses using PET and CT scans. Working groups of lymphoma physicians, nuclear medicine and radiology experts were appointed to undertake a literature review and share knowledge about research in progress in order to establish the state of current knowledge, identify emerging applications, highlight key areas for research and prepare consensus guidelines.

The ICML recommendations for using PET-CT in Lymphoma have been published online  and in the Journal of Clinical Oncology at http://jco.ascopubs.org/content/early/2014/08/11/JCO.2013.53.5229

As a follow up to the new guidelines on lymphoma staging and re-staging, ESO and the European School of Nuclear Medicine (ESNM) are organising a learning course on 18FDG PET-CT in Lymphoma.

ESO Workshop at 12-ICML: Identification of diffuse large B cell lymphoma subtypes: a way towards tailored treatment

The 2013 closed workshop was organized to discuss how to improve our current therapeutic approach to diffuse large B cell lymphoma (DLBCL) by exploiting the knowledge mostly recently gained on disease. Topics discussed included the state of the art of the currently available technologies, the genes and pathways affected, and the modalities to integrate all the data that can be collected and develop targeted single or combination therapies for the individual DLBCL patients.

ESO workshop at 13-ICML: Follicular Lymphoma: Recent Insights and Future Directions (moving towards biology-driven treatments)

The main focus of the workshop was to develop an up-to-date understanding of the biology of FL and the clinical implications of new findings in the field. Specific topics were discussed including:1) a detailed understanding of the molecular correlates of disease progression and histological transformation, 2) a cataloging of the mutational spectrum at diagnosis and the clinical correlates of recurrent genetic alterations, 3) a firm understanding of clonal evolution and the role therapy has on clonal architecture over time, 4) understanding the crosstalk between the tumour cells and the microenvironment and whether this represents a targetable treatment strategy, and 5) what role does disease monitoring have in FL including the assessment of minimal residual disease (MRD).

ESO /AACR worksop at the 14-ICML: Design of clinical trials: biological and clinical endpoints in the design of future clinical trials (13 June 2017, Lugano, Switzerland)

The main focus of the meeting is to review the current critical problems for the proper development of novel non-chemotherapy based targeted treatments in malignant lymphomas. Topics that will be discussed include: the proper design of preclinical studies (how to prioritize novel combinations that should be tested in the clinical setting?) as well as the design of clinical trials (should we test novel endpoints? can a biomarker-driven study be designed? Should response criteria be redefined? Should novel agents be tested in sequence or as novel-novel combinations?)

ESO/AACR workshop at 15-ICML: Bridging liquid biopsy into management of lymphoma patients: development of frameworks for clinical research and recommendations for clinical practice (22 June 2019, Lugano Switzerland)

Chairs: Wyndham H. Wilson, Davide Rossi, Emanuele Zucca.

Recent research efforts have been devoted to developing circulating tumor DNA (ctDNA) as a tool for lymphoma genotyping, clonal evolution analysis and minimal residual disease (MRD) monitoring. The clinical use of ctDNA in lymphoma patients includes non-invasive detection of cancer gene mutations, and response assessment beyond imaging.

Different areas of the same tumor may show different genetic profiles. A biopsy from a part of a tumor may miss clones residing in anatomically distant sites. This may lead to overlook small clones carrying clinically relevant mutations. In follicular lymphoma, the use of ctDNA genotyping offers a solution for the early detection of clones harboring those genetic lesions that may prime transformation. Limited access to the tumor cells from the tissue biopsy has also hampered the molecular understanding of some lymphoma types such as classical Hodgkin Lymphoma (cHL) in which the rarity of tumor cells in the biopsy hampers the identification of tumor mutations. By identifying STAT6 as the most frequently mutated gene, ctDNA genotyping has allowed to refine the current knowledge of cHL genetics.

Resistance to several active targeted agents is promoted by gene mutations and longitudinal ctDNA genotyping can detect resistant mutations also in mature B-cell malignancies lacking a leukemic phase as DLBCL, in whom serial sampling through repeat tumor biopsies is usually not feasible hindering identification of resistant mutations. Minimal residual disease (MRD) monitoring has been shown to be a promising outcome predictor in most B-cell lymphomas and MRD can be monitored by using plasma as a source of cell free DNA. This may lead to early relapse detection allowing pre-emptive interventions before the development of overt disease.

Given this increasing evidence of the utility of ctDNA in lymphomas, the use of assays that detect genomic variants and minimal residual disease in ctDNA will conceivably increase in the lymphoma setting, despite uncertainties around pre-analytical considerations, analytical validity, and clinical utility. The International Conference on Malignant Lymphoma (ICML), workshop on the role of circulating tumor DNA (ctDNA) analysis in lymphoma. intended to provide an assessment of the evidence on ctDNA assays in lymphomas and a framework for future research and clinical practice guidelines to help better inform clinical practice.

Dr. Fedro Peccatori is the ESO Representative in the ICML Local Organising Committee.

Haemato-oncology, Leukaemia, Lymphoma

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