This year’s ASH Annual Meeting and Exposition, taking place December 9-12 in Atlanta, Georgia, features a diverse lineup of educational activities, networking opportunities, and practice-changing science. ASH Clinical News asked the program co-chairs and for an exclusive look at highlighted sessions and what attendees can expect from the meeting.
Insights from Education Program Co-Chairs
What are the “can’t-miss” events?
Dr. Sehn: This year’s program is well rounded and exciting, with important basic-science developments and new therapies across the field of hematology; the area of hematologic malignancies, in particular, is exploding.
This year, there are two ASH-FDA Joint Symposia discussing new drug approvals (one on acute lymphocytic leukemia and non-Hodgkin lymphoma and one on acute myeloid leukemia), in which experts will discuss the latest treatments coming to market for these malignancies. The timing is prime right now: We are seeing so many new developments in our fields, and we’re all grappling with how to fit these newly available therapies into our clinical practices. This year’s meeting is the perfect place to get caught up on the latest information.
Dr. Cuker: There are four sessions I believe attendees need to put on their agendas. First, the Special Education Session on New ASH Clinical Practice Guidelines on Venous Thromboembolism (VTE) will put a spotlight on ASH’s efforts to develop a comprehensive set of guidelines on VTE. The final manuscript will include recommendations from 10 panels, and this is sort of a “speed-dating” session: The chairs will each highlight one key, practice-changing recommendation from their respective panels in short, three- to five-minute presentations. It is also designed to be an interactive session, so there is time built in for audience questions.
The Quality Conversations on Social Media Special-Interest Session also will be interesting. Like the rest of the world, hematologists are using social media in our practices as a way of communicating with patients, colleagues, researchers, and more. In this session, experts will discuss how social media can be a positive tool for these purposes, as well as the potential pitfalls we should avoid.
Which areas of research will have the most exciting implications for clinical practice?
Dr. Cuker: There is so much good research presented at the ASH annual meeting in every area of hematology, but from my perspective, the treatment of hemophilia is undergoing a true revolution, with the advent of gene therapy and the development of novel, non-factor products to treat patients with inhibitors. Many of these therapies are in the late stages of investigation and are likely to receive regulatory approval in the near future. They will completely change the hemophilia treatment landscape, so this year’s meeting is honoring this exciting work in a Featured Topic Discussion on the Hemophilia Revolution.
This year, there will be an education session on Common Clinical Questions in Cancer-Associated VTE, focusing on a question on many of our minds as clinicians: the role of direct oral anticoagulants to treat cancer-associated VTE.
Dr. Sehn: Across the board, I think the most exciting area will be immunotherapies. Many immunotherapeutic drugs and cell-based therapies are now making their way into routine practice, and everybody is excited to learn more about these agents. There are a variety of sessions dedicated to immunotherapies in different disease states, and there is an Education Spotlight Session covering the management of immunotherapy-related toxicities – including those associated with emerging chimeric antigen receptor T-cell therapies.
In designing this year’s Education Program, what goals did you have in mind?
Dr. Sehn: With this year’s program, our goal was to link the emerging clinical information to the science behind it. That means understanding what the drugs are doing and using that information to tailor treatment for patients. The number of therapeutic options for patients with hematologic malignancies has expanded recently; the real issue is how to optimize these options for the right patient at the right time.
Dr. Cuker: One of our goals was to cover the breadth of hematology. People come to the ASH annual meeting with different interests and perspectives. When I developed the non-malignant hematology program, I thought about the questions challenging clinicians today and built sessions around answering them.
We’re covering topics and questions from previous years, but with updated evidence and new viewpoints. One area where we truly differ from past programs is in prioritizing sickle cell disease (SCD) research, which is the subject of several ASH initiatives. For the first time, the annual meeting’s Education Program includes three separate sessions related to SCD, focusing on treatment, chronic pain management, and quality improvement.
Can you describe the sessions designed specifically for trainees and fellows? For medical educators?
Dr. Sehn: Education is obviously a huge focus of ASH, and the Society has built an ever-growing program directed at both educators and trainees. Every year, there is a half-day workshop specifically designed for hematologic educators and program directors where they can learn about new tools and ideas from education specialists – and from each other – to take back to their own training programs.
Another strength of ASH and the annual meeting is the promotion of trainees who will eventually become key leaders in the field. That includes a day of events for trainees on Friday, December 8. Trainee Day is a good opportunity for early-career people to learn how to navigate the information at ASH and make contacts with other trainees.
Dr. Cuker: There are many other sessions tailored to trainees’ interests, including a Special Education Session about how to get grant funding and keep it going – a topic of great importance for early investigators who are trying to build an academic career. There are many special trainee-focused didactic sessions that cover practical topics like time management, setting up an independent research laboratory, effective trial design, and more.
We also encourage trainees to take advantage of the Career-Development Lunch Sessions; they offer a chance to sit with a small group of established hematologists from many different career models – clinicians and laboratory-based researchers, those who work in academia, industry, and government – and have questions answered.
Insights from Scientific Program Co-Chairs
What are this year’s “can’t-miss” events?
Dr. Weyrich: This year’s Scientific Spotlight Sessions (focusing on analyses of complex sequencing data in acquired and inherited hematologic diseases and the impact of the microbiome on the hematologic system) will deliver cutting-edge, clinically relevant information that will resonate with a broad audience.
ASH’s scientific committees have been working all year to develop outstanding scientific sessions that feature presentations from internationally-recognized experts in benign and malignant hematology. These sessions will reveal new discoveries relevant to hematology researchers.
Dr. Armstrong: There are three sessions that I think will be of particular interest to attendees: the Ad Hoc Scientific Committee on Epigenetics and Genomics discussing “Novel Epigenetic Modifications in Cancer and Development,” the Joint Session of the Scientific Committee on Myeloid Biology & Scientific Committee on Myeloid Neoplasia discussing “Clonal Evolution in Myeloid Malignancies,” and the Special Scientific Symposia on “Understanding and Modulating the DNA Damage Response.”
How does this year’s Scientific Program differ from previous years?
Dr. Armstrong: In designing this year’s program we had two specific goals: feature basic-science presentations that have practice-changing implications and include sessions with themes and speakers whose work cuts across malignant and non-malignant hematology.
Dr. Weyrich: For this year’s scientific program, we’ve added a Special Scientific Symposium on “Hot Topics in Hematology” that highlights late-breaking, high-impact stories in hematopoiesis, thrombosis, and cardiovascular disease. This session features cutting-edge science with significant clinical implications and is sure to be a standing-room-only event.
Which areas of research do you think will have the most exciting implications for clinical practice?
Dr. Weyrich: The late-breaking abstracts always deliver exciting news, and shouldn’t be missed. This year’s Ernest Beutler Lecture and Prize, to be delivered by Luigi Naldini, MD, PhD, and Marina Cavazzana, MD, PhD, will focus on how HIV has been exploited to generate efficient and safe vectors used for the treatment of acquired blood diseases – a fascinating topic.
Attendees will learn about the historical development of hematopoietic stem cell (HSC) gene therapy and the present clinical applications and benefits of HSC gene transfer by lentiviral vectors.
Dr. Armstrong: We are witnessing ongoing discovery in clonal hematopoiesis in regards to how the clinical entity CHIP (clonal hematopoiesis of indeterminate potential) predicts for hematopoietic malignancy and cardiovascular disease.
Blood and Beyond: A Closer Look
This year’s “Blood and Beyond” session features art historian Amy E. Herman, JD, MA, who will discuss the intersection of medicine and the humanities. Her celebrated seminar, “The Art of Perception,” teaches experts from a variety of fields to use their visual intelligence effectively. ASH Clinical News spoke with Ms. Herman for a sneak preview of her presentation, which takes place Sunday, December 10, from 4:30 – 6:00 p.m. at the 2017 ASH Annual Meeting in Atlanta.
Can you describe the concept of “visual intelligence” and how you developed “The Art of Perception”?
We are barraged with information; visual intelligence is the ability to filter that information to ascertain what we need to live our lives productively and efficiently. We also need the best filters possible. I use art as a vehicle to help people sharpen their visual intelligence.
I developed the program while I was head of education at The Frick Collection in New York City. The concept was straightforward: Take medical students out of a clinical setting and bring them to an art museum to teach them how to analyze works of art. Medical students have a focused curriculum; it’s all about diagnosis, anatomy, physiology, and analyzing data. So, the driving idea behind the program was to force the students to leave their comfort zones. The hope is that, when they go back to the clinical setting, they will be better observers of patients.
The program was so successful at The Frick that we expanded it to seven medical schools. In 2004, I expanded it to include the law-enforcement and intelligence communities. I still do grand rounds around the country, working with hospitals and first responders.
When did you recognize the connection between medicine and art?
I’m a firm believer in both the science and art of medicine – each is equally important. The science involves the acquisition of knowledge, pattern recognition, and understanding disease and diagnosis. The art of medicine is the safe, compassionate care of the patient, and treating the whole person rather than just a set of symptoms.
This became even clearer to me during my own battle with cancer. I spent hours, days, months, years in treatment at Memorial Sloan Kettering Cancer Center. I was successfully treated, which I believe depended as much on the art of medicine as it did on the science of medicine.
We can’t let the humanity leave the practice. Without the humanity, you’re left with only the terrible stuff: the administrative tasks, the bills, the invoicing, the insurance. … It’s the humanity that breathes life into medicine.
Could you walk us through a typical seminar? What are the medical students doing as they look at the art?
This is not a subjective program about liking the art or learning the differences between van Gogh and Monet. It’s about looking closely at a new set of visual data (artwork rather than a patient encounter or an electronic medical record); analyzing it; and communicating with clarity, precision, and objectivity exactly what it is you see – or don’t see.
Each session is divided into three sections. In the first, I show students a slideshow of artwork and we discuss how we are going to talk about art. In the next section, we go into the galleries, and pairs of medical students spend five minutes with each of 10 works of art, putting those skills we just introduced into practice and deciding how they would describe what they see to their colleagues. They are not allowed to read the labels that accompany each piece; everything must be based on their inherent observation, not knowledge they are presented with.
Finally, we head back to the classroom for a series of interactive exercises that bring everything together. The students describe works of art to each other – talking, drawing, writing. … This is when we bring it back to the practice of medicine, to make sure that when they leave the session, they have the tools to make them more effective clinicians.
How can health-care professionals apply these skills in the clinic?
An internist whom I worked with to tailor this program to medicine said he looks for three things when he walks into the hospital room with a new patient: Is there anything on the table next to the patient – cards, balloons, any evidence of contact with the outside world? Is the patient wearing his or her own pajamas or a hospital-issued gown – in other words, how does the patient feel about his or her appearance while in the hospital? And, finally, what is the patient’s facial expression when he enters the room – happy, sad, nervous, anxious, calm? He said that those three observations, which take about three seconds to register, give him tremendous insight into how he will work with that patient. Honing visual intelligence can help physicians better discern that information.
When we’re looking at artwork, I ask students to think about putting what they see into a coherent narrative. That’s something they can also do during patient visits: Rather than tying together a list of symptoms, I ask them to think about how they fit into the person’s whole narrative and how a diagnosis will affect the patient’s entire life.
I gained another perspective when I was diagnosed with cancer. During treatment, I never stopped teaching. I would come into my chemotherapy session with a packed suitcase, ready for a trip to California or Nebraska or any of the hospitals where I was speaking. The nurses would roll their eyes because they couldn’t believe that I was keeping up my busy work schedule! Every patient has a different way of dealing with his or her reality. For me, there were bigger things to deal with apart from my diagnosis or my treatment. Those observations and understandings about the whole person go a long way.
The two overarching goals for each session are for students to think differently about their work and to better convert observable details into actionable knowledge. We are so tied to our practices and our technology that occasionally we have to remind ourselves of the importance of interaction. The greatest sources of creativity and innovation are hiding in plain sight. Medical students and clinicians have a focused lens to begin with, and I want to widen that lens a little bit.
What are the biggest challenges to applying visual intelligence?
Our biggest obstacles are our biases. Biases are not inherently negative – in the world of medicine, one must make assumptions and inferences based on biases – but they can impede decision making. In my seminars, I want to give people the tools to recognize their biases, then determine whether they are unfairly affecting decisions. A seminar attendee once told me, “Your session really opened my eyes. The problem is I didn’t know they were closed.”
Diary of a First Timer
The sheer volume of posters, talks, and educational sessions at the ASH annual meeting can be overwhelming, especially for those attending for the first time. Fellows Rahul S. Vedula, MD, and Kelly Schoenbeck, MD, share plans for their maiden voyage to the largest gathering of hematologists in the world. Check back in our January issue to see how it went!
Do you have a strategy for navigating the meeting?
Dr. Vedula: My goal is to hit the high points of myeloid malignancies, while maintaining a good deal of breadth and diversity in the sessions I attend.
Dr. Schoenbeck: My strategy involves mapping out my time on a calendar to create my own personalized itinerary.
Have you received any tips from veteran attendees?
Dr. Vedula: To have a plan, but not to obsess too much about it. Remember to collect some swag.
Dr. Schoenbeck: One of my mentors advised that preparing for ASH is like preparing for a test – you need to do your homework before you go! I have also been told that it is important to factor in the anticipated popularity of a session, travel time between sessions, and downtime during potentially long conference days.
What are you most looking forward to?
Dr. Vedula: Being in an environment where the world’s finest malignant and non-malignant hematologists are sharing their passions and discoveries with the common goal of improving the health of our patients. I know it will be a very memorable experience!
Dr. Schoenbeck: Trainee Sessions that focus on optimizing research strategies; I am also interested in attending the Friday Satellite Symposium titled, “Current Status and the Future Potential of CAR T-Cell Therapy for Lymphoid Malignancies” and the oral abstracts session titled, “Outcomes Research — Malignant Conditions: Impacting Healthcare Utilization and End of Life Care.”