ASH News Daily - Monday, December 12, 2011 - (Page A-14)

Page A–14 ®® Page A–14 TRANSFUSION ALL The Truth Behind “TRIM” he goal of our fight against By david Garcia, Md, and Shari Ghanny, Md By BarBara pro, Md I ng the early 1980s that inhe ent r sitsandard “kill-all” drugs to “sparebe recogniz T ks related to transfusions began to me” targeted agents have been most , with the need for eval- uation of transfusion practices. More r last few decades. Also, as patients o the metabolic and biochemical changes related to storage of blood products; the clinical significance of these alterations is now being explored. In Part I ci e Education Program session, at 7:30 a.m. and again at 2:00 p.m. Blood,” we le rned about on-related TRIM), wh ch refers nflammatory and transfu- immunomodulation o the proimmunosup-- cancer is finding the MELTtransfusion-relat d nfections dur- t wasn’t until the emergence of ing (most-effective-least-toxic) of the focus of cancer research in the ecently, awareness has been drawn ber of issues due to treatment-related short- and long-term toxicities and look back and ask ourselves: How can we make it better? Is there increased efficacy a sweet spoft of the transfusion mediand minimal toxicity? This morning “Adverse Complications of Stored in Elizabeth Ballroom EFGH, Man- scihester Grand Hyatt San Diego, Dr. ( Adele Fielding, Univer tsity College i London, will chair an Education Prop essive consequ nces of RBC and platel t tran fu io s. Dr. Craig Morrcytic Leukemia,” outlining the most cal Center, o ened the ses ion by examini g platelet storage lesions. He For pediatric ALL the good news is platelets and their ability to upregulcally with five-year rates exceeding ions, as well as an increase in plateet-derived immune mediators seen gram session titled “Current Management Issues in Acute Lympho- ell, University of Rochester Medicurrent and pressing issues in the treatment of ALL. discussed the dynamic nature of that survival has increased dramati- ate MHC expression during infect 90 percent. The bad ews is that suclcess has come with a price. Chronic during platelet storage. According to Dr. Morrell: “… Platelets represent an important part of a continuum bet only a few of the many issues we are hey are inseparable processes that health issues, secondary cancers, and significant emotional hurdles for both patients and caregivers are ween inflammation and thrombosis; t left to deal with. Dr. Leslie Robinson, affect each other. Therefore, when ansfusion,- performing a platelet ifto irsm iation o St. Jude Children’s Research Hospital, will present the mos tr current i key issues associated what is being infused are inflammatity in childhood ALL survivors. diator of thrombosis.” mportant to keep in mind that with early morbidity and mortal- ory cells as well as the cellular meMost importantly, based on recent findings, she will provide recomchair, Dr. Ka ina Yazdanbakhsh, New York Blood Center, discussed iprove long-term outcomes. directions for interventions to immmunoregulation in response to red What about adult ALL? The good blood cell transfusions. According to Dr. Yazdanbakhsh, “under storage, the RBCs undergo a number of biochemical and biophysical changes and release potentially hazardous materials that may have adverse effects including perturbations i JAK2 that normally dampen inflammation in the transfused susceptible host … Characterizing host immune cells that are directly affected by the storage lesion may lead to identification of host factors that predispose certain patient groups to the adverse effects of RBC transfusions.” n the immunoregulatory networks «« From Page A-12 sity Hospital, Atlanta, GA, ended the session by discussing vasoregulatory effects of blood products in response to increased storage intervals prior to transfusion. He discussed the process of “INOBA” (insufficient nitric oxide bio-availability) whereby the eosinophilic disorders, molecularly defined as PDGFRA, PDGFRB, and FGFR1-associated neoplasms. Dr. James W. Vardiman from the University of Chicago, indicates that the promise of future targeted therapies akin to imatinib played a role in devising the 2008 WHO Classification system. While JAK2 mutations were at once enlightening, they likely represent just the first piece of a very elaborate mosaic. Dr. John Roback, Emory Univer- Dr. Landau indicated no relevant conflicts of interest. 003192_sgn35_adc_and_fa2.indd 1 news is that there are many new therapies; the bad news is that none of them are fully effective at control- The second speaker and session mendations for screening and new G E N E R AT I O N O F A N T I B O D Y - D R U G C O N J U G AT E S E N G I N E E R I N G T H E N E X T omes following transfusion of older based therapies ignificantly different is Efficacy and Toxicity — Is There a Sweet Spot in ALL? slting this challenging disease. The de- ored RBCs have decreased ability tvelopment of monoclonal antibodies eading to impaired hypoxic vasodiation. According to Dr. Roback, “We o produce and release nitric oxid , l represents one of the greatest success l stories in the treatment of hematodon’t yet know with certainty wheth- potiion. Thus, moving away from er these RBC changes translate into s University of Frankfurt, will discuss c how the introduction of antibodyversus fresher RBC units.” Certainly clinical outchanging the t live longer, we struggle with a num- Dr. Roback and others in the field will lrent data on the use of traditional tanding of the implications and clinil effects of storing blood. ead to improvements in our unders antibodies, Dr. Hoelzer will disccauss the use of the newer human- ized anti-CD20 and bi-specific an- n Part II of the tr nsfusion medine Education Program session, “Hematol gy and Transfusion Medipies in different clinical settings tibIodies in the treatment of ALL. c ne i Sub-Saharan Africa,” we logic malignancies as it is the ideal will also be addressed. targeted therapy. Dr. Dieter Hoelzer, nsfus on medicine in this part of tsion with an update on the treatment he opportunity to experience first- The Philadelph a chromoso he work being done in this area by ment of clinical addition to providing the most cur- c Siome of the challenges related to Mnneap l the use of antibody-based thera- learned about the clinical aspects of minimal tra Dr. Fielding will conclude the ses- e is the translate into low expendia t outcome for patients with ALL. In mos common cytogenetic abnormalciity a sociated with adult ALL. Before ne strategies used in Africa, where c tihe introduction of yrosine kinase mes ures on the health-care system. Dr. to chemotherapy and short survival ASH NEWS DAILY ASH NEWS DAILY Monday, December 12, 2011 Saturday, December 10, 2011 Troy Lund, University of Minnesota, spiecific ToKiIss has resulted not only in rates. Treatment with BCR-ABL, began the session by exploring the challenges of diagnosi better long-term outcome but also in nant hematologic disorders in SubSaharan Africa. “While challenging, toxicity. Dr. Fielding will he world. Many of us may not have working in Africa gets you to practice t of Philadelphia-p sitive (Ph+) ALL. hand the organization and managetransfusion medi- review a number of important issues such as the role of monotherapy with t TKIs in select patients, the role of altransplantation, and blood smear. While we cannot cure and mechanisms of resistance. Rean impact on the common ones … he fu damentals – history, exam, logeneic stem cell any d agnoses, we can have vil conflict and unstable economic we also have the o portunity to not t iinhibitors (TKIs), Ph+ ALL carrie t poor prognosis with poor r sponse flicts of interest. sults of ongoing studies with novel agents will also be presented. Dr. Pro indicated no relevant con»» TRIM Page A-15 higher complete remission rate and ng and treating benign and malig- To learn more about our ADC technology, see our medical affairs representatives at booth 129

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ASH News Daily - Monday, December 12, 2011

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