By Ruben A. Mesa, MD
2009-01-01
Dr. Mesa is Associate Professor of Medicine in the Department of
Medicine, Division of Hematology at Mayo Clinic Rochester, MN. He was
also the Editor-in-Chief of ASH News Daily 2008.
What did you do for your 50th birthday (or if, like me, you haven’t
quite reached it yet — what would you like to do?) Did you splurge on a
sports car, or take an exotic vacation? Will you compete in a marathon
or triathlon, or perhaps celebrate the event more quietly? Chances are
that at least some time was, or will be, spent reflecting on your life
thus far, and realigning or refocusing for the journey ahead. Such
important milestones often prompt individuals or organizations to take
stock of their past, and to carefully plan for their future.
The American Society of Hematology (ASH) is no different. ASH capped
off its yearlong celebration of the 50th anniversary of the Society
with the 50th ASH Annual Meeting in San Francisco from December 6 - 9.
From humble beginnings on the porch of a seaside hotel in Atlantic
City, to the colossal 24,000-attendee convention center gathering last
month, the ASH meeting has grown over the past half-century to become
the essential international meeting focused on hematology research and
practice.
This past year’s meeting set a high-water mark in terms of the
number of attendees, total number of submitted abstracts (6,362), and
breadth of educational offerings. But even more important than the
annual meeting’s size, scale, or venue (how can one not enjoy San
Francisco?) is the important role it plays in advancing the field of
hematology and furthering the goals of the Society. Fundamentally, this
year’s 50th anniversary meeting accomplished four important tasks: 1)
It provided a venue for the highest-quality educational offerings — an
up-to-the-minute summary of the current state of diagnosis and
management of hematologic disease; 2) it was a time for intense
discussion and scrutiny of new scientific observations; 3) there were
plenty of opportunities to discuss and critique therapeutic trials,
including the first presentations of numerous novel therapies; 4)
physicians and scientists representing broad and diverse disciplines
relevant to hematology met for discourse, planned collaborations, and
celebrated the past, present, and future of our field.
Learning Hematology: A Lifelong Pursuit
Staying up-to-date in any field of medicine is increasingly
challenging, and this is particularly true in our own specialty area.
Rapid application of scientific observations to the diagnosis or
management of hematologic diseases means that there can be significant
changes in the state of the art, even over the course of a single
calendar year. This year’s program spanned the diversity of hematology,
with 72 different time slots (38 for education topics and 34 for
scientific committee sessions), each of a quality and scope to rival
any independent continuing medical education program. More intimate
discussion opportunities were offered through 40 different
limited-access Meet-the Expert Sessions, or one of six special sessions
in which participants had a chance to interact with the “Pioneers in
Hematology.” Robert Kyle, MD, known as the “father of myeloma” to many,
received the Wallace H. Coulter Award for his lifetime contributions to
the study of multiple myeloma. A highlight of the meeting was the
outstanding Ham-Wasserman Lecture, presented by Dr. Bob Löwenberg of
Rotterdam, who focused on the use of cytogenetics, gene expression
markers, and molecular genetic results for better prognostication and
tailored therapy in acute myeloid leukemia.
Scrutinizing the Science: Key Observations
The Plenary Session is the scientific centerpiece of every ASH
meeting. The abstracts selected are felt by meeting organizers to be
most likely to have a broad impact on either the understanding or
therapy of a hematologic disease. Three of the six plenary abstracts
focused on the sequence of genetic events after acquisition of ETV6-RUNX1
in childhood precursor B-cell ALL (Dr. Caroline Bateman), how the
sympathetic nervous system helps create the hematopoietic stem cell
niche from mesenchymal stem cells (Dr. Simon Mendez-Ferrer), and the
description of a novel neutropenia-dysmorphology clinical syndrome
caused by deficiency of G6PC3 (Dr. Kaan Boztug). Key additional
observations in the Late-Breaking Abstracts Session (held on Tuesday)
ranged from the recognition of Ten Eleven Translocation 2 (TET2),
a novel tumor suppressor gene with rearrangements that precede the
JAK2-V617F mutation in myeloproliferative disorders (Dr. Francois
Delhommeau), to the role that human adenylate kinase 2 deficiency plays
in maturation arrest in myeloid and lymphoid maturation (Dr. Marina
Cavazzana-Calvo). With a monumental series of simultaneous sessions
brimming with more than 800 oral presentations, the ideas presented and
discussions that ensued will fuel the engine of experimental hematology
well for 2009.
Vetting New Therapies: Improving Treatments for Our Patients
Although we all read a myriad of journal articles and rely upon the data in the (now weekly) editions of Blood,
nothing matches the ASH meeting for the spirited discussion and vetting
of clinical trial outcomes. The Plenary Session included several
high-profile trial results, describing improved outcomes with the
addition of rituximab to dexamethasone for treatment of immune
thrombocytopenia purpura (Dr. Francesco Zaja), responses induced by a
new oral inhibitor of the tyrosine kinase Syk (fostamatinib
disodium) in patients with lymphoid neoplasms (Dr. Jonathan Friedberg),
and results of a multicenter trial (PROTECHT) of nadroparin for
prophylaxis of cancer patients against thromboembolic events (Dr.
Giancarlo Agnelli). Many questions echoed through the large halls of
the Moscone Center: How effective are the JAK2 inhibitors for the
myeloproliferative disorders? What is current status of the oral
thrombopoietin agonists? Which patients with chronic lymphocytic
leukemia need to be treated, and what’s the best way to do it? For
every question the meeting sessions answered, two more arose in their
place. Nothing beats the animated discussion in the lecture or poster
hall after a trial is presented to highlight the trial’s strengths and
weaknesses, applicability, and most likely follow-up steps.
Hematology — Past, Present, and Future
For the hematologist, the ASH meeting marks the transition to a new
year. The annual meeting is a time to present the fruits of one’s past
year’s efforts and plan for next year’s experiments or clinical trials.
In addition to the official events, the meeting is a time to meet with
friends and colleagues from around the world and to gather for early
morning investigator breakfasts or late night drug-development-pipeline
dinners. This year’s meeting added a special wrinkle: an anniversary
reflection on where we have been as a field and where we are going.
Capping the wonderful yearlong 50th Anniversary Review series in Blood,
the meeting was filled with historical vignettes, ranging from the
development of the Society’s logo to the Nobel Prize of E. Donnall
Thomas for bone marrow transplantation. The halls echoed with
interviews of ASH presidents from years past, to placards of the myriad
of major accomplishments that the field can boast. I am sure I speak
for many of my colleagues when I say I was filled with tremendous pride
over the accomplishments of our field both for science and for
patients, I was impressed by the vigor and strength of our Society, and
I look with optimism toward our next 50 years.
Finally, I would like to express my gratitude to the dedicated ASH News Daily authors, Drs. Rafat Abonour, James Foran, Michael McDevitt, Bart Scott, and David Steensma.
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