Education Spotlight Sessions

The Education Spotlight Sessions are intended to provide a more in-depth review on a scientific topic. Each 90-minute session will be presented once in a small-venue format on either Sunday or Monday and will include ample time for audience questions and participation.

These sessions are restricted to medical and research professionals only; no businesspersons or media will be admitted.

Diving Into Rare Childhood Leukemias

Monday, December 9, 2019, 2:45 p.m. - 4:15 p.m.
Orange County Convention Center, W307, Level 3

Since first described over thirty years ago, acute leukemia defying conventional lineage assignment as ALL or AML have posed a therapeutic conundrum. With only limited insight available into the underlying biology for “bi-phenotypic” or “mixed phenotype acute leukemia (MPAL),” treatment included therapy intended for AML, ALL, or a combination of both with or without stem cell transplantation. Only recently, an intensive focus on the genomic landscape for MPAL has combined with a growing number of international cohort studies to result in a rapid evolution in our understanding of this rare disease.

Childhood Chronic myeloid leukemia (CML) is a rare disease. Recent data indicates biological differences between adults and children. Evidence-based guidelines have been established for adult CML, but it is challenging to develop similar recommendations in pediatrics because of the rarity of the disease. Recent approval of second-generation tyrosine kinase inhibitors (TKI) in addition to imatinib has provided more treatment options for pediatric patients, but limited data on efficacy and safety often makes management difficult. Further, host factors are different in actively growing children and children develop distinct morbidities of TKI, such as delayed growth.

Dr. Etan Orgel will explore the emerging data for MPAL biology and clinical outcomes as they relate to therapy selection and future research directions. Dr. Nobuko Hijiya will discuss the recent advances in the biology of childhood CML, challenges to the management of children, and the feasibility of a pediatric TKI “Stopping” study.

Chair:

Oussama Abla, MD
Hospital for Sick Children Division of Hematology
Toronto, Canada

Speakers:

Nobuko Hijiya, MD
Columbia University Irving Medical Center
New York, NY
Childhood Chronic Myeloid Leukemia

Etan Orgel, MD, MS
Children's Hospital Los Angeles
Los Angeles, CA
How to Treat Childhood Mixed-Phenotype Acute Leukemia

Is Chemoimmunotherapy for CLL on Life Support? (Point- Counterpoint)

Monday, December 9, 2019, 2:45 p.m. - 4:15 p.m.
Orange County Convention Center, W304EFGH, Level 3

While chemoimmunotherapy as treatment for CLL is not dead, its role in upfront treatment is clearly approaching the need for life support. This session will address whether chemoimmunotherapy is still a viable option for upfront patients who need treatment (Full code) or should not continue to be utilized in this patient population (DNR- do not resuscitate).

Chemoimmunotherapy with regimens such as Fludarabine cyclophosphamide and rituximab or bendamustine and rituxumab has been the backbone of initial treatment for patients with chronic lymphocytic leukemia who need to be treated and are eligible for chemotherapy. Complete remissions with prolonged treatment free intervals and achievement of MRD negativity can be achieved in with these regimens. While not curative, these regimens have led to longer survival in successive studies in eligible patients. 

However, the introduction of more targeted oral agents such as Ibrutinib and venetoclax and the significant responses in patients who are relapsed and refractory to chemoimmunotherapy have led to these agents being tested in upfront studies compared to chemoimmunotherapy in several large randomized trials presented at this meeting and others over the last year and recently published. These studies, which will be discussed in detail during this session, have shown that the targeted agents have progression free but no overall survival benefit as yet over chemoimmunotherapy. 

This has changed paradigms of initial treatment for patients with CLL leading to wider use of targeted agents upfront. While benefits are seen, these drugs do have their own toxicity profiles and as of the current studies, need to be continued indefinitely until progression or toxicity, whereas the chemoimmunotherapy regimens are given for a defined time period leading in a substantial portion of patients having a treatment free interval. 

This session will discuss the fate of chemoimmunotherapy in the initial treatment of patients with CLL. 

Dr. Susan O’Brien will discuss the data to support the continued use of chemoimmunotherapy in the upfront patients with CLL or, in the words of the great philosopher Monty Python, “I am not dead yet.”

Dr. Stephan Stilgenbauer will discuss the data that supports “pulling the plug” on chemoimmuntherapy for CLL.

Chair:

Carole B. Miller, MD
Saint Agnes Hospital
Baltimore, MD

Speakers:

Susan M. O'Brien, MD
UCI Cancer Center
Orange, CA
Full Code (Resuscitate)

Stephan Stilgenbauer, MD
University of Ulm
Ulm, Germany
DNR (Do Not Resuscitate)

Molecular Hematopathology Tumor Board

Monday, December 9, 2019, 10:30 a.m. - 12:00 p.m.
Orange County Convention Center, W312, Level 3

Multidisciplinary tumor boards are a cornerstone for the management of patients, from diagnosis to relapse and remission. Molecular genetic testing has added to the complexity of data now available to physicians involved in clinical practice, with problematic issues of clonal hematopoiesis, germline versus somatic variants, minimal residual disease, and clonality not equating to disease. This session will feature a roundtable approach to a series of cases derived from clinical practice that highlight practical issues involved with the diagnosis and treatment of patients in a molecular hematopathology tumor board and serve as a springboard for discussion and debate.

Chair:

Tracy I. George, MD
University of Utah
Salt Lake City, UT

Speakers:

Tracy I. George, MD
University of Utah
Salt Lake City, UT
Hematopathologist

Luke Fletcher, MD
OHSU
Portland, OR
Case 1:Clinical Presentation

Elie Traer
Oregon Health & Sciences University
Portland, OR
Case 1: Discussion

Michael A Spinner, MD
Stanford University
Stanford, CA
Case 2 : Clinical Presentation and Discussion

Tsewang Tashi, MD
Huntsman Cancer Institute, University of Utah
Salt Lake City, UT
Case 3: Clinical Presentation

Andreas Reiter
Department of Hematology and Oncology, Medical Faculty Mannheim, Heidelberg University
Mannheim, Germany
Case 3: Discussion

Richard D. Press, MD, PhD
Oregon Health & Science University
Portland, OR
Molecular Diagnostician

Point-Counterpoint: Curative Therapies for SCD - Does it Make More Sense to Target the Root Cause Than All the Downstream Events

Sunday, December 8, 2019, 4:30 p.m. - 6:00 p.m.
Orange County Convention Center, W312, Level 3

Since the initial discovery of sickle cell disease more than 100 years ago, investigators have been working to unravel both the cause of the disease and the pathophysiologic mechanisms whereby it engenders the panoply of effects it has on essentially all organ systems. However, to date, only two therapies are FDA-approved, and at best only a handful are likely to be approved in the near future. Moreover, all the current and near-term future therapies are palliative rather than curative.

Meanwhile, hematopoietic stem cell transplantation as a curative therapy has progressed from a high-risk procedure to one that is routinely successful, although not without morbidity and still an appreciable mortality. And recently, gene therapy has been in active phase 2 clinical trials, with at least some successes reported, although gene therapy still also requires bone marrow ablative therapy and entails both known and unknown risks.

Dr. Saunthararajah will discuss the various approaches being designed and tested to achieve cure in sickle cell disease, the progress already made, and the challenges for the future.

Dr. Marilyn Telen will discuss how development of an in-depth understanding of the pathophysiology of vaso-occlusion and end-organ damage in sickle cell disease has led to the development of targeted therapies designed to reduce disease symptoms as well as prevent or ameliorate end-organ damage.

Chair:

Marilyn J. Telen, MD
Duke University Medical Center
Durham, NC

Speakers:

Yogenthiran Saunthararajah, MD
Cleveland Clinic Case Western Reserve Univ.
Cleveland, OH
The Case For:

Street Drugs: Emerging Hematologic Complications of Illicit Drug Use

Monday, December 9, 2019, 2:45 p.m. - 4:15 p.m.
Orange County Convention Center, W312, Level 3

Cutting agents in illicit drugs include diluents, which are pharmacologically inactive and readily available, and adulterants, which are pharmacologically active but more expensive and/or less available than diluents. Adulterants may be added to enhance or mimic the effect of the illicit drug, or to make administration of the drug more efficient. Adulterants may introduce unwanted side effects, however, including potentially devastating hematologic complications.

Dr. Thomas Ortel will discuss how synthetic cannabinoids, developed as alternatives to marijuana, are attractive to the illicit drug market because of ease of synthesis and lack of detection by routine drug testing. A series of patients were described in 2018 who presented with hemorrhagic complications and elevated INRs several days after using synthetic cannabinoids. The adulterant most frequently associated with this presentation was brodifacoum, a long-acting anticoagulant rodenticide, introduced to presumably enhance the psychoactive effects of the drug. Therapy with vitamin K and, if needed, 4-factor prothrombin complex concentrates, should be initiated as soon as the effect of a vitamin K antagonist is documented.

Approximately 18.1 million people were users of cocaine in 2017, and global manufacture of cocaine increased by 25% from 2016 to 2017. Dr. Daniel Federman will discuss how, Levamisole, an antihelminth used in veterinary medicine, is an adulterant that is similarly added to enhance the euphoric effect. Levamisole has been shown to be present in at least 65% of cocaine samples tested worldwide. Adverse effects associated with levamisole exposure include neutropenia and agranulocytosis, cutaneous vasculitis, and hemorrhagic bullae and skin necrosis. Most symptoms resolve without intervention by avoiding re-exposure to levamisole.

Chair:

Thomas L. Ortel, MD, PhD
Duke University Medical Center
Durham, NC

Speakers:

Daniel Glenn Federman
Yale University School of Medicine
West Haven, CT
Levamisole and Cocaine: Contaminants in Illicit Drugs and Hematologic Complications