David p. Steensma, MD

2010-01-01

Leukemia Group, Department of Hematological Malignancies, Dana-Farber Cancer Institute; Attending Physician, Brigham & Women’s Hospital;Associate Professor of Medicine, Harvard Medical School

Editor-in-Chief, ASH News Daily 2009

The American Society of Hematology (ASH) began its second half-century of annual meetings with a return to New Orleans for the first time since 1999. One of the highlights of that 1999 meeting was the presentation by Dr. Brian Druker of Oregon Health and Science University on the startling clinical efficacy of a then new tyrosine kinase inhibitor, STI571 — now known as imatinib — in chronic myeloid leukemia

(CML), which changed many hematologists’ perspectives on what is possible with therapies targeting the molecular linchpins of cancer. Though imatinib continues to be widely discussed and studied — e.g., a late-breaking abstract at this year’s annual meeting reported results from an 846-patient study of nilotinib versus imatinib as front-line therapy in chronic-phase CML (nilotinib induced more major molecular responses, but both drugs performed admirably) — the 2009 annual meeting was a reminder that most hematologic disorders are considerably more complex and difficult to treat than CML.

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This year’s annual meeting keynote lectures were, collectively, the most engaging that I can remember. The Ham-Wasserman Lecture on Darwinian clonal evolution in acute leukemia by Professor Mel Greaves from the Institute of Cancer Research in England was full of wit, good science, and profound biological insights. The complicated mutation patterns that have already evolved by the time acute leukemia clones are clinically detectable also explains why imatinib’s success as a single agent is exceptional rather than typical. Just as Charles Darwin’s 1859 publication On the Origin of Species by Means of Natural Selection was met with a lot of forehead slapping — the mechanism of diversity generation by evolutionary branching and selection of best-adapted organisms is obvious, in retrospect, yet it required an innovative thinker to see it for the first time — so Prof. Greaves’ clever use of identical twins and neonatal blood spots to unravel the time course of mutation acquisition may have left some attendees with a similar “Why didn’t I think of that?” feeling.

I also enjoyed Professor John Dick’s (Toronto) description of his dogged pursuit of cancer stem cells over the last three decades and the admirable humility he showed in dedicating his presentation to his former trainees. And the Presidential Symposium on the final day of the meeting — a tour de force of Yankee ingenuity as applied to cancer biology — was worth sticking around for, even with a snowstorm sweeping across the northern tier of the country and threatening to disrupt homeward travel for many attendees. In the Presidential Symposium, Drs. Timothy Ley of Washington University, Louis Staudt of the National Cancer Institute, and Todd Golub from the Broad Institute provided a seamless serial overview of next-generation high-throughput sequencing as applied to acute myeloid leukemia, functional approaches to cancer’s vulnerabilities such as RNA interference, and new methods of small molecule identification that involve massively parallel screening against protein targets of diverse function.

The ASH annual meeting has always been well-attended by delegates from outside the United States who contribute to the program and to the Society in numerous ways. This year, it was notable that the majority of Plenary Session abstracts were presented by individuals from outside the United States, and international participants were prominent in every session I attended. I was particularly impressed throughout the meeting by the dominance of European contributions in the field of lymphoma, due to national cooperative groups that capture a commendably high proportion of newly diagnosed patients.

I found two meeting moments especially moving. The first was reading the article in ASH News Daily by Dr. Marc Kahn of Tulane about the resilience of New Orleanians in the wake of Hurricane Katrina. Dr. Kahn highlighted the opportunities that Katrina provided to create a better health-care and social support system in New Orleans and reminded readers how deprivations during the storm’s aftermath underscored what is really important in life. The second heartwarming event was the Plenary Session presentation by Dr. Eduardo Rego (São Paulo, Brazil) on the initial results of the International Consortium on Acute Promyelocytic Leukemia (IC-APL). The IC-APL formed in 2004 when hematologists from developing countries met with international experts in APL and now includes centers in Brazil, Uruguay, and Mexico. The two-year survival for the first 102 patients with APL treated under the auspices of the IC-APL regimen was 77 percent — comparable to survival obtainable with ATRA and anthracycline-based therapy of APL in parts of the developed world and considerably better than the 52 percent survival reported in a Brazilian study that predated the IC-APL. It would be wonderful to see this model of international cooperation extended to other areas of hematology; the need is great indeed.

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I returned home from the meeting exhausted. It is hard to imagine that the Ernest N. Morial Convention Center — more than a kilometer long, with 1.1 million square feet of continuous exhibit space and more than $60 million in renovations and upgrades since ASH’s last visit a decade ago — is only the 6th largest convention center in the country, trailing McCormick Place in Chicago, the Orange County Convention Center in Orlando, and convention centers in Las Vegas and Atlanta. Attendees who walked between several distant sessions had little need for their hotels’ exercise facilities.

The ASH annual meeting is not just a scientific meeting and trade exhibition but also a social event. It’s a chance to catch up with friends and colleagues from across the country and around the world and to learn about a colleague’s secret talent for duckpin bowling or awkwardness at mechanical bull-riding. New Orleans proved an ideal environment for such socializing (at least for those who still had energy left after putting miles on their pedometers trekking around the convention center): According to a 2007 CNN poll, New Orleans is the best U.S. city for live music, cocktail hours, flea markets, antique shopping, nightlife, “wild weekends,” “girlfriend getaways,” and cheap food. I can’t speak to flea markets or girlfriend getaways, but the music, food, and nightlife in the Big Easy were spectacular.

I thank the capable writers for ASH News Daily, whose hard work made the newspaper what it was, and whose witty metaphors and clever headline composition made my editorial tasks easier: Drs. Anne McLeod (Toronto), Peter Marks (Yale), Mary Jo Lechowicz (Emory), Christine Duncan (Dana-Farber), Hien K. Duong (Cleveland Clinic), and Mikkael A. Sekeres (Cleveland Clinic). I also thank Karen Learner and Jenifer Hamilton from the ASH Communications Department and the staff of CustomNEWS for their patience and skill in transforming Microsoft Word files into 12,000 copies of daily printed reality. For attendees who missed an issue due to a late arrival or early departure (or impulsively tossed their copy of a paper onto an ASH heap), the full text of the 2009 ASH News Daily, including coverage of the Ham-Wasserman Lecture, E. Donnall Thomas Lecture, and Presidential Symposium, is archived at www.hematology.org/Publications/ASH-News-Daily/Archive/4586.aspx.

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