Newsletter May 2012 - European Hematology Association

disease progression better in MM
patients and potentially predict the
development of drug resistance.
Hemostasis and thrombosis
highlights (Anna Falanga)
This program offered ample space for
non-oncological hematology, particularly
on the topics of hemostasis and
thrombosis, with 4 educational sessions
devoted to thrombosis, bleeding,
platelets and coagulation problems in
intensive care. In addition, a successful
lunch debate, which was very well
attended, took place on the need or not
for laboratory monitoring during
anticoagulation with new oral agents.
Finally, the Hematology-in-Focus
sessions showcased the most recent
advances in research on the relation
between the hemostatic system and cancer biology, as well as
on platelet functions, genomics and proteomics. A good
number of abstracts were also presented, with a net
prevalence of the ‘platelets’ topic, particularly immune
thrombocythopenia (ITP). Indeed, still open is the debate on the
priority or not of TPO-receptor agonists as a choice for secondline
treatment of ITP and the possible limitations to their longterm
use from side effects. In this regard, the presentation of
the ‘bleeding assessment tool’ (BAT), was important as a new
standardized evaluation of the bleeding phenotype, originally
designed to guide the diagnosis of mild inherited bleeding
disorders, but potentially applicable also to platelet disorders.
On the subject of thrombosis, one of the most important
messages from EHA17 was the need for primary prevention of
venous thromboembolism (VTE) in medical patients,
particularly those with malignancies. This is clearly shown
from the results of large clinical trials, especially in acutely ill
hospitalized patients. However, there is a lack of adherence
worldwide to international recommendations/guidelines. On
the other hand, current trials are evaluating the role of
thromboprophylaxis in the outpatient setting. To examine this
role in ambulatory cancer patients undergoing chemotherapy,
who are at high risk of VTE, new approaches are being utilized,
such as targeting specific cancer types or selecting high-risk
patients by risk-model and/or biomarker-based interventions.
Generally, a careful evaluation of the patient bleeding risk is
advised when opting for an anticoagulant regimen.
Finally, very relevant to these ‘highlights’ was the broad
discussion at EHA17 about management in clinical practice of
the new classes of antithrombotic drugs, both anti-platelets
and anti-coagulants. Also of interest, while there are efforts to
discourage the routine monitoring of new anticoagulants (i.e.
dabigatran, rivaroxaban, apixaban) with emphasis on the
advantages, on the other hand there is a difficult search for
new tests to monitor and dose-adjust anti-platelet agents. In
both cases, we are far from the ideal solution, as no tests are
reliable nor standardized to monitor anti-platelet therapies,
and no tests are available 24 hours a day in all hospitals to
measure (not to monitor) the levels of anticoagulation with
new oral anticoagulants when needed, i.e. in cases of
overdose, renal insufficiency, severe bleeding, recurrent
thrombosis or urgent surgery. Hopefully, answers to these
questions will be found during future EHA conventions.
Scientific highlights in the myeloid malignancies
(David Grimwade)
The Congress provided an exciting glimpse into the not too
distant future as to how hematological malignancies, such as
acute myeloid leukemia (AML), might be diagnosed, taking
advantage of advances in high throughput sequencing
technologies, and highlighted prospects for the development of
novel molecularly-targeted therapies, which may ultimately
help improve outcome in patients with poor risk disease.
Investigators from Washington University, St Louis have
pioneered the application of whole genome sequencing to
define the mutational landscape of AML. Tim Graubert and
John Welch summarized their work characterizing the
evolution of myelodysplasia to AML and showed the
relationship between mutational burden and age, providing
insights into the epidemiology of the disease. In addition, Dr
Welch summarized a large body of recent data supporting the
hypothesis that the PML-RARα oncoprotein generated by the
t(15;17) in acute promyelocytic leukemia (APL), and mutations
involving nucleophosmin and various epigenetic modifiers i.e.
DNMT3A, TET2 and isocitrate dehydrogenase (IDH) are
initiating events in the process of leukemic transformation.
The role of TET2, which is involved in DNA demethylation and
targeted in a wide range of hematological malignancies, was
explored further in the “Hematology-in-Focus” session by
Olivier Bernard and Henk Stunnenberg. Further insights into
the biology of myeloid malignancies were provided in the
Presidential Symposium. Raphael Ceccaldi and colleagues
presented new data showing that the bone marrow failure that
characterizes the pre-leukemic condition Fanconi Anemia,
relates to an exaggerated p53/p21 DNA damage response.
Equally of interest, Bert van der Reijden and colleagues
provided evidence that the transcription factor GFI1 is a direct
target of the RUNX1-RUNX1T1 fusion, showing that this is
important for the development of the t(8;21) subtype of Core
Binding Factor (CBF) leukemia.
The merits of defining mechanisms, by which chimeric
oncoproteins, resulting from leukemia associated translocations,
transform hematopoietic progenitors to inform
development of novel treatment approaches, were exemplified
in work presented by Brian Huntly and Tim Somervaille in
relation to leukemias involving MLL fusions. Proof of principle
for the therapeutic potential of agents that specifically target
the underlying leukemogenic lesion has already been provided
by the use of combined ATRA and arsenic trioxide therapy to
cure patients with APL. This success story prompted a lively
lunchtime debate between Alan Burnett and Eli Estey, as to
whether chemotherapy has now become redundant in this
subset of leukemia. The 17 th Congress of EHA certainly gave
cause for optimism that this treatment paradigm could be
extended to other molecularly-defined subsets of AML in the
future.
Delegate survey
The results of the survey amongst delegates after the congress
(over a thousand responses were counted) have been
thoroughly examined by the EHA Board and the EHA Executive
Office. It was interesting to note that the main reason for
attending the congress is the invited speaker program. The
quality of the chairs and speakers was scored “good” to
“excellent” and the same applies to the session formats, as
well as the abstract program. Only 25% of the respondents
downloaded the Congress mobile app, but those who did, rated
the contents as “good” to “excellent”.
Finally, 82% of the respondents indicate they will attend next
year’s meeting, which is very encouraging!
Upcoming congress(es)
EHA considers the 17 th Congress as another highlight of the
year and we hope you feel the same way after attending. If you
did not attend, we do hope to see you in Stockholm next year.
Preparations are in full swing and everyone is welcome to
submit abstracts and register online from January 1, 2013.
PS: Do you have any idea where the 20 th Congress will take
place? Follow us on Twitter to find out.
As chair of the Scientific Program Committee of the 17 th Congress, Tony Green presented the facts and figures of the program to the press.
20 > EHA Newsletter November 2012 EHA Newsletter November 2012 > 21