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Confex Integration - Education Spotlight

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Appropriate Use of Imaging in Patients with Lymphoma

Our understanding of the diverse biology and clinical presentation of the multitude of non-Hodgkin lymphomas is coupled with an increasingly sophisticated appreciation of the role of imaging in staging, prognostication and response assessment.  This spotlight session will focus primarily on the most significant technological advancement in lymphoma care of the past decade – the standardisation of PET-CT (PET) scanning in the staging and response assessment - which has facilitated major improvements in survival. To help the treating haematologist navigate the role of PET in lymphoma management this session will use cases from large randomised trials to illustrate the specific strengths and limitations of PET for each histology.

 

Dr Trotman will focus primarily of the role of PET in diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and peripheral T-cell lymphoma (PTCL).   PET demonstrates greater sensitivity compared to CT translating into stage migration and better outcomes in limited stage DLBCL and FL using modern treatment.  PET has excellent sensitivity in identifying BM involvement in DLBCL, making this invasive test redundant in this histology. The 5-point scale, and changes in SUVmax, used for PET-CT reporting can discriminate patients with aggressive lymphoma likely to be cured at the end of first-line treatment from those at high risk of treatment failure. The inferior prognosis of patients who remain PET positive has driven the study of interim PET assessment which identifies chemo-sensitive disease early in patients with DLBCL, but does not predict treatment failure well enough to modify treatment. Furthermore PET-directed intensification of therapy in DLBCL has been unsuccessful to date. PET at end-of-treatment is currently being evaluated as a platform for response-adapted treatment in follicular lymphoma. 

 

Dr Gallamini will address the role of PET in the management of Hodgkin Lymphoma (HL). Perhaps no lymphoma ignites greater discussion and polarisation over the optimal management, than this most curable one.  PET imaging has indeed revolutionized the entire paradigm of HL management including staging, prognostication, first-line therapy, consolidation radiotherapy and salvage treatment. To help the treating haematologist understand the different global approaches to management this session will use both case-studies aligned to the Randomized Clinical Trials (RCT) in HL, and synoptic overviews of the most important PET-adapted clinical trials in early and advanced stage HL tested by co-operative groups, which have been central to tremendous advances in the survival of HL globally.  Again, applying the 5-point scale to interim PET assessment is critical to separating good-risk patients from those who warrant more intensive approaches but in HL the different cut-offs applied in this scale in different trials merit specific attention. Unmet needs in HL imaging include awaiting longer-term overall survival data for each approach as the role of TMTV as possible alternative to Ann Arbor staging, and response assessment in the setting of PD-1 inhibitor therapy.

Chair:

Judith Trotman, FRACP
Concord Repatriation General Hospital, University of Sydney
Concord, Australia

Speakers:

Andrea Gallamini, MD
Azienda Ospedaliera S. Croce e Carle
Cuneo, Italy
Modern Use of Imaging Studies in Hodgkin Lymphoma: Algorithm for Initial Staging, Assessment of Response, and Monitoring for Relapse

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Emicizumab’s Impact on the Landscape of Hemophilia A Treatment: Two Artists Debate the View

Hemophilia management continues to evolve as new classes of prophylactic therapy become available. Emicizumab, a novel bispecific antibody substitutive therapy, is the first non-factor replacement therapy licensed for prophylaxis for individuals with hemophilia A with or without FVIII inhibitors of all ages.

This session contrasts the potential for favorable clinical and patient outcomes when incorporating emicizumab into patient management with the potential consequences focusing on specific hemophilia A subgroups. Speakers will highlight current data, considerations for clinical decision-making, and gaps in available information in a number of clinical situations including: previously untreated patients (PUPs), managing new FVIII inhibitors patients and immune tolerance induction, peri-surgical management, non-severe hemophilia, and the aging hemophilia population.

Chair:

Stacy E. Croteau, MD
Boston Children's Hospital
Boston, MA

Speakers:

Guy Young, MD
Children's Hospital Los Angeles, University of Southern California Keck School of Medicine
Los Angeles, CA
Speaker 1

Robert F. Sidonio Jr., MD, MSc.
Children's Hospital of Atlanta
Atlanta, GA
Speaker 2

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How Do We Maintain the Joy of Medicine and Get Better at What We Do?

Chair:

Marc J. Kahn, MD, MBA
University of Nevada, Las Vegas School of Medicine
Las Vegas, NV

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How to Manage Common Challenging Situations in Patients with Multiple Myeloma

Multiple Myeloma (MM) is a heterogenous disease, presenting with a variety of clinical complications. Classical presentation at diagnosis includes anemia, bone disease and renal insufficiency. Renal failure is present in 20-50% of newly diagnosed patients and if severe is associated with increased early death. Acute renal failure is a medical emergency. Anti-MM treatment should start immediately to restore renal function and further adverse events should be prevented and managed to optimize patient outcome.

Rare at diagnosis, but more frequent at the time of relapse, are less typical disease presentations such as plasmacell leukemia, extramedullary disease and central nervous system (CNS) involvement. These clinical features, mostly due to very aggressive disease, are also associated with poor prognosis, and require prompt, proper and often aggressive management, with a careful look at preventing and managing adverse events to improve survival. This session will focus on the complexities of providing optimal management to patients with “difficult to treat MM”, presenting with renal failure, plasmacell leukemia, extramedullary and CNS disease.

Dr. Francesca Gay will review the main pathogenetic mechanisms of renal damage in MM and treatment guidelines. The main focus will be on patients with severe renal insufficiency, including patients on dialysis. Specific and effective treatment strategies to achieve recovery of renal function will be addressed. These will include supportive care and anti-MM therapy. Evidence on the use of different novel agents (proteasome inhibitors, immunomodulatory agents, monoclonal antibodies) in patients with renal insufficiency will be summarized. Furthermore, how to optimally and safely administer each of them will also be addressed.

Dr. Laura Rosinol will review the incidence, types, prognosis and treatment recommendations of the extramedullary involvement in MM. The prognosis of the extramedullary disease at diagnosis and at relapse will be analyzed, as well as the efficacy of novel drugs. The presentation and treatment approach of CNS involvement, a condition with extremely poor prognosis, will be reviewed. Plasma cell leukemia is a rare entity with an aggressive course. The diagnostic criteria as well as the therapeutic algorithm will be discussed.

Chair:

Francesca Gay, MD
University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino
Torino, Italy

Speakers:

Francesca Gay, MD
University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino
Torino, Italy
Management of Multiple Myeloma for Patients with Renal Failure

Laura Rosinol, MD, PhD
Hospital Clinic i Provincial
Barcelona, Spain
Difficult Conditions to Manage: Plasma Cell Leukemia, Extramedullary Disease, CNS Involvement

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Transfusion and Anemia in Global Health

The approach to treating a patient with severe anemia often includes blood transfusion, however transfusion therapy is not uniformly available in all parts of the world. In this session two speakers will discuss their recent high impact publications that studied the use and availability of blood transfusion in low and middle income nations. The speakers will join a panel at the end of the session for question and answer with the audience.

Professor Kath Maitland is Professor of Paediatric Tropical Infectious Diseases at the Faculty of Medicine and Director of the ICCARE Centre at the Institute for Global Health Innovation, Imperial College, London and an Honorary Fellow at MRC Clinical Trials Unit, University College, London. Dr Maitland is based in East Africa, where she leads a research group tackling childhood mortality in resource-limited hospitals in sub-Saharan Africa. Her research portfolio includes severe malaria, bacterial sepsis and severe malnutrition. In this lecture, Dr Maitland will describe the treatment of severe life-threatening anaemia in children and improving childhood mortality in low resource settings.

Dr Christina Fitzmaurice, MD, MPH, is an Affiliate Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and Attending physician of Hematology/Oncology at St. Charles Medical System. Her research interests focus on global oncology and cancer disparities. In this lecture, Dr Fitizmaurice will describe a global modeling study that enumerated the available blood inventory in every nation and the need for more blood products in many low and middle income nations.

Chair:

Meghan Delaney, DO
Children's National Hospital
Washington, DC

Speakers:

Kathryn Maitland
Imperial College
Kilifi, Kenya
Pediatric Anemia in Africa: Evidence-Based Approach to Transfusion

Christina Fitzmaurice, MD MPH
University of Washington
Seattle, WA
The Unmet Global Need for Blood Transfusion

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Vascular Anomalies 101: Case-Based Discussion on the Diagnosis, Treatment and Lifelong Care of These Patients

Vascular anomalies represent a spectrum of disorders with dysregulated blood or lymphatic vascular architecture that can result in multiple complications, including venous insufficiency, consumptive coagulopathy, thromboembolic disease, thrombophlebitis, and high output failure, among others. Over the past decade, genomic and somatic mutations have been identified as causal for many vascular anomalies. Medical therapy is now possible, targeting abnormalities in pathways associated with these mutations. These developments, as well as improved surgical and interventional techniques, are increasing the lifespan of patients with vascular anomalies

Traditionally, these patients have been treated by pediatric hematologists, however, we now have a generation of older patients that can no longer be followed in children’s hospitals. Unfortunately, there are only a few adult hematologists comfortable with these patients. Through a dynamic and interactive presentation of a pediatric hematologist-oncologist and a geneticist, the session will focus on management of 3 clinical scenarios where the adult hematologist’s knowledge and interest in vascular anomalies is essential.

Dr. Denise Adams will discuss the clinical and therapeutic aspects with a case-based approach, including: 1) Thrombotic Painful Event in a Venous Malformation; 2) Multifocal Bone Lesions and Profound Lymphopenia that is Not Langerhans Histiocytosis; and 3) Recurrent Familial Epistaxis: It is Not Always von Willebrand Disease.

Dr. Mikka Vikkula will review the genetic discoveries (genomic and somatic mutations, second hit hypotheses) in vascular anomalies, which have contributed to new targeted therapies.

Chair:

Francine Blei, MD
Lenox Hill Hospital
New York, NY

Speakers:

Miikka Vikkula
Universite Catholique De Louvain
Brussels, Belgium
Case #1.Thrombotic Painful Event in a Venous Malformation

Denise M Adams, MD
Children's Hospital of Philadelphia
Philadelphia, PA
Case #1.Thrombotic Painful Event in a Venous Malformation