Acute Leukemia Strategies
in Kids and Big People

Three Education Sessions over the weekend deal with acute leukemias (either myeloid or lymphoid) in children as well as in adults, providing ASH attendees the opportunity to really catch up on the latest in what’s new for acute leukemias. The Molecular Basis of Leukemia and Lymphoma Session (held 8:00 – 9:45 a.m. and 2:00 – 3:45 p.m. today) is chaired by Dr. Gary Gilliland from Harvard Medical School. Dr. Gilliland has assembled an impressive team to present our current understanding of the genetics underlying acute leukemias in pediatric and adult patients.

Dr. Craig Jordan provides an in-depth view of the present vision of the “leukemia stem cell.” This includes its properties, its origins, and molecular pathogenesis, and, finally, a discussion on how we might specifically target it, hopefully without damaging normal stem cells in the process. Drs. Gilliland and Carolyn Felix will present the spectrum of recurring translocations in AML and ALL and what is presently known about their relative contributions to pathogenesis.

The Acute Myeloid Leukemia Education Session (held 4:15 – 6:00 p.m. today and 7:30 – 9:15 a.m. tomorrow), chaired by Dr. Stone from the Dana-Farber Cancer Institute, focuses on many changes in the landscape of treatment options for adults with AML. He leads things off by discussing current protocols seeking to change chemotherapy dosing schedules in induction and consolidation regimens. He covers a litany of novel therapeutic agents being developed for AML, including drugresistance modifiers, proteosome inhibitors, pro-apoptotic agents, signal transduction inhibitors, and immunotherapeutic approaches. Dr. O’Donnell will attempt to take on the enormous task of identifying who should receive a stem cell transplant, when they should be transplanted, and with what kind of transplant — “full” or “mini.” Dr. Sekeres bravely discusses the issue of age. Is age really in the eye of the beholder? Given that the median age for AML in the United States is 68 years, this is a very important issue. When are you considered elderly, at least in terms of AML therapy? Is age really an issue? When are you too old for a stem cell transplant? What are the indications and ramifications for treatment in the “very elderly?” All are questions to be brought up in this session which promises to be a lively one, no matter what your age.

The Childhood and Adolescent Lymphoid and Myeloid Leukemia Education Session (held 10:15 a.m. – 12:15 p.m. today and 7:30 – 9:15 a.m. tomorrow), chaired by Dr. Pui from St. Jude Children’s Research Hospital, will cover the spectrum from ALL to AML to MDS to JMML. Given that the FDA’s medical expert panel just recommended this past Wednesday that Clofarabine be approved for pediatric ALL, this session seems particularly timely.

Dr. Pui’s presentation includes a discussion of pharmacodynamic and pharmacogenetic factors at play in childhood ALL, as well as a discussion of current methods for accurately measuring minimal residual disease. Taking into consideration the quality of life of long-term survivors, how intense does the CNS-directed therapy need to be? Similar to Dr. Sekeres in the other session, Dr. Schrappe tackles the issue of age specific therapy, but this time in kids with ALL rather than the elderly with AML. Dr. Ribeiro covers the care of children and adolescents with AML. Are these just little adults or do they require different therapies? Last, but certainly not least, Dr. Niemeyer will bring attendees up to date on JMML and pediatric MDS. Yes, even very little kids develop MDS and it’s not any more fun for them than it is for adults with MDS.