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November 2008
EHA New
Newsletter MayStates
Jersey, United 2007 Marc2Rudoltz
by >
President’s Message:
Education in hematology:
the annual congress and more
In this issue we look back at the 13th Congress in Copenhagen. We are happy
6,600, and its program was of highest scientific and educational quality. This
(SPC) and its Advisory Board (SPC AB), which I would like to thank for
fulfilling their tasks so proficiently. Also, I would like to thank the sponsors
for their contribution to make the congress possible. I believe that a creative
> We also look forward. The prepara- and has developed training online (EHA-
tions for the 14th Congress in Berlin are Tol). What EHATol exactly is, is explained
in full swing. To enlighten you on how the in this issue by Gina Zini, who, together Willem Fibbe
educational and scientific program of the with the EHA executive office, shows
annual congress is put together, Radek great dedication in making available five and skills across Europe. The results will
Skoda has written a very informative ar- self-evaluation tests every three months. serve to target the gaps with existing and
ticle about the SPC and the SPC AB. I kindly invite you to take these tests novel educational tools. In addition, H-
yourself. Furthermore, plans are under Net will develop an online portfolio sys-
The annual congress of EHA is one, al- way to have the webcasts themselves tem which identifies educational needs
beit important, instrument to promote CME accredited and to extend the web- of individual hematologists and offers
education and lifelong learning in hema- casts to the workshops. In the end, the suggestions to meet them. In coordinat-
tology. For instance, EHA would like to goal is to combine these learning tools ing H-Net, EHA reinforces its dedication
reach out to those who are unable to into a blended learning experience. to arrive at a truly harmonized curricu-
come to the annual congress. Also, de- lum for European hematologists, raising
spite our efforts to arrive at a compre- Another aspect of education concerns competence levels and, ultimately, im-
hensive and well balanced educational not so much how we learn, but what we proving patient care and public health. I
program at the annual congress, not all learn. Recently, the European Commis- encourage you to read Eva Hellström-
topics in the field of hematology can be sion has awarded a network of European Lindberg’s contribution to this issue
covered. Here, I would like to focus on national societies of hematology, the Eu- which describes the grant application
those instruments that may be a little ropean School of Haematology (ESH), the process and the details of the H-Net’s
less known to you. Universities of Uppsala and Liverpool, ambitions.
and EHA a grant of up to € 600,000. The
To achieve greater outreach and to cover network’s name is H-Net and it aims to Willem Fibbe
niche topics EHA organizes two-day tu- further develop the European Hematolo- EHA President
torials and workshops, it webcasts its gy Curriculum by identifying and mea-
annual congress’ educational sessions, suring gaps in hematological knowledge
Contents
President’s Message 2 SPC and SPC AB 11
> The TRTH program, first proposed medical students, is for participants to Issues that still remain to be resolved in-
at the 2006 ASH-EHA leadership meet- attend a six day residential course. clude eligibility for participation and re-
ing, in Orlando, Florida, is currently be- Subjects likely to be covered in the view of the applications. Another impor-
ing planned along similar lines to the ‘bench to bedside’ course include, di- tant open item is funding of the scheme.
ASH Clinical Research Training Institute, agnostics, bio banking, bio statistics, We will keep you posted as this exciting
a program that focuses on Phase I and II bio informatics, candidate gene testing initiative unfolds.
clinical trials. and stem cell research. In addition, EU
legislation, rules, directives and guide- Ivo Touw, Co-Chair TRTH Subcommittee
The proposed format of the TRTH pro- lines related to good clinical practice Erasmus Medical Center, Rotterdam,
gram, which is being targeted at clini- will be discussed, and sessions cover- The Netherlands
cians, translational scientists and bio- ing issues relevant to grant applica-
> There has always been a symbiosis between the pharma- be beneficial, and if the regulator releases new drugs without
ceutical industry and the medical profession. Although certain- adequate testing they are admonished for not protecting pa-
ly not a marriage, the relationship possesses similar qualities, tients!
despite the fact that neither party can ever truly divorce! The Drug costs are now a huge issue for society, especially when
protagonists come from different backgrounds but share simi- linked to efficacy. It is quite amazing when a number of drugs
lar desires. The loyalty of the pharmaceutical companies is to with similar modes of action, but different development histo-
satisfy their shareholders, while the primary role of physicians ries, are similarly priced without any regard to their research
is to provide the best medical care for their patients. Pharma- and development costs!
ceutical companies are, of course, in the business of manufac- Tyrosine Kinase inhibitors (TKI’s) are examples of drugs which
turing drugs which benefit patients, and physicians depend on have totally changed the outlook for patients with Chronic My-
the industry to develop new and effective compounds. eloid Leukemia (CML). However this disease has been trans-
Dr M Greaves, from the University of Aberdeen, addressed both formed into a chronic illness and thus patient numbers are ac-
the possible tensions and opportunities for collaboration at the cumulating. It is estimated that in the USA there soon will be
EHA annual meeting in June 2008. He began by quoting David 250,000 patients alive with CML, representing an annual cost
Blumenthal’s statement from the New England Journal of somewhere in the region of € 7,5 billion for TKI’s. While the
Medicine: ‘when a great profession and the forces of capitalism FDA does not take cost into account, countries – for example
interact, drama is the likely result’. He pointed out that re- the UK - restrict new agents on the basis of cost-effectiveness,
search and development is declining in the industry due to a often resulting in a public outcry!
combination of patent expiration and generic competition, to- With other expensive drugs, efficacy is difficult to demonstrate.
gether with the huge costs involved in bringing new drugs to The FDA approved a cholesterol-lowering agent in 2002 after a
the market. It is predicted that between 2007 and 2012, $ 67 small number of clinical trials, which included 3,900 patients!
billion will be lost from the top pharmaceutical companies in In the absence of proven efficacy against heart attacks the drug
the USA. earned billions of dollars for the company, presumably due to
the robust advertising campaign. We would all agree (as men-
Greaves pointed out that 'conflicts of interest' occur when indi- tioned in a previous newsletter) that all clinical trials should be
viduals have material gains, irrespective of financial value, that registered and the results, whether favourable or not, be made
could influence or be perceived as influencing their opinions, available to the public.
decisions or actions in relation to patient care or the conduct of Finally I am always intrigued by serendipity, especially in medi-
research. Potential conflicts have happened to all of us in the cine. Although we live in an age of ‘certainty’ and people speak
form of hospitality, attendance at conferences, and gifts, al- about focused research, it remains that many great medical
though we always claim that our judgement is not affected. A developments still happen by chance and hopefully will contin-
more difficult situation arises with clinical trials, especially in ue to do so in the future.
Europe. Because of difficulties with cost and indemnity, the
number of ‘investigator-led trials’ has decreased and the num- Shaun Mc Cann
ber of industry sponsored trials increased. Coupled with this is Editor in Chief
the payment for enrolling patients in industry-led tri-
als. It must be remembered, however, that Health
Services do NOT provide much support for conferenc-
es and even light lunches at clinical meetings are
provided by industry in many hospitals. The industry
invests large amounts of money supporting educa-
tion, bringing new treatments to the attention of doc-
tors and supporting biomedical research. Educational
support is commonly in the form of an unrestricted
grant but industry sponsored clinical trials are more
likely to be associated with positive outcomes than in-
vestigator–led trials. Hopefully, a change in legisla-
tion in Europe will make investigator–led trials easier
to conduct without endangering the public.
Although we must work together, it behoves the med-
ical profession to be advocates for their patients. The
regulatory bodies are constantly criticised, not always
justifiably. If they are too cautious the public becomes
upset by delays in introducing new agents, which may
number of groups to eleven. The main objectives of the EHA Scientific Working Groups are to create scientific networks
that both promote high quality science during the annual congress and attract basic scientists to meetings. To complete
the picture of SWG’s - some of whom featured in earlier issues of the Newsletter - we high-light the recent activities of
Scientific Working Group on Granu- fining various B-cell compartments that group and the BIOMED-2 Concerted
locyte and Monocyte Disorders may carry early clonal characteristics. Action group, the European Study Group
Surinder Sahota (Southampton, UK) de- on MRD-detection in ALL (ESG MRD-
> The EHA SWG on granulocyte and scribed molecular approaches to track ALL) has provided a framework for stan-
monocyte disorders was established in the myeloma compartment and identify dardizing, improving and comparing
2005 during the 10th EHA Congress in distinct profiles for pre-plasma cells that molecular MRD-diagnostics using Ig/
Stockholm, Sweden. The main goal is to may belong to the myeloma clone. Pieter TCR-gene rearrangements as RQ-PCR
promote co-operation between clinicians Sonneveld presented gene expression targets. Through 13 quality control
and scientists involved in basic, transla- data of myeloma patients, introducing ‘rounds’ with subsequent problem reso-
tional and clinical research in the field of the concept of undertaking molecular lution meetings, common guidelines
granulocyte and monocyte disorders. Un- profiles of chemo resistance in myeloma have been developed regarding both
der this remit, scientific sessions during stem cells. Finally, Karin Vanderkerken technical aspects and issues regarding
the 13th EHA Congress, covered topics on (Brussels, Belgium) presented data of interpretation of data (see: Van der
clinical and molecular diagnosis of neu- the 5TMM myeloma mouse model, which Velden et al., Leukemia 2007;21:604-
tropenias and unknown aspects of the serves as a pre-clinical model for my- 611). At the same time, the group has
role of neutrophils in innate immunity, eloma (stem-) cell analysis. grown, now representing nearly 40 lab-
stimulating interesting discussions in the oratories from Europe, Asia and Austra-
audience that included for the first time Pieter Sonneveld, Chair lia, with its remit extended to cover
clinicians, basic scientists and trainees Erasmus Medical Center, Rotterdam, MRD-diagnostics in malignant lympho-
in hematology. In addition, a major high- The Netherlands ma. The ESG MRD-ALL SWG, provides a
light for the year was the 3rd Neutropenia framework for clinical study groups who
Network Conference, that took place in want to use MRD diagnostics within
Crete, Greece, September 26-27, 2008, Scientific Working Group: The their treatment protocols.
under the auspices of EHA and covered European Study Group on MRD-
acquired and congenital neutropenias in Detection in ALL (ESG MRD-ALL) Thorsten Raff, Chair
a clinical, laboratory, cellular, and mo- University Hospital Schleswig Holstein, Kiel,
lecular biology settings. > Originating from a group of 15 Germany
MRD-laboratories from the I-BFM study
Helen Papadaki, Chair
University Hospital of Heraklion, Heraklion
Crete, Greece The current EHA Scientific Working Groups are:
Scientific Working Group on Phar- Scientific Working Group Euro- close collaboration between industry and
macokinetic, Pharmacodynamic Flow: Flow cytometry for fast and academia. The EuroFlow consortium con-
and Pharmacogenetic sensitive diagnosis and follow-up sists of two SME’s and ten diagnostic re-
of haematological malignancies search groups, composed of experts in
> Chemotherapy – despite intensive the fields of flow cytometric and molecu-
research to find more specific treatment > Laboratory diagnostics of hemato- lar diagnostics.
to target tumour cells - remains the logical malignancies has three major ap-
corner stone of the majority of hemato- plications: establishing diagnosis, prog- The EuroFlow Consortium is developing
logical protocols. Most treatment proto- nostic classification, and evaluation of new software for fast and easy handling
cols today are empirical and based on treatment effectiveness. While molecular of large data sets and for integration of
clinical experience. Despite long clinical techniques have brought new insights into eight -color stainings into a single multi-
use, little information is available about classification and monitoring of treatment color data file; standardization of eight
the mechanisms of action, individual- effectiveness, they are frequently time -color immunostaining protocols for fast
ization of those factors affecting thera- consuming (taking two to three days), not and easy flow cytometric diagnosis and
peutic efficacy and last but not least, in- applicable for all patients, and unable to classification of hematological malig-
teractions with other drugs. focus on cellular subpopulations without nancies (as well as evaluation of treat-
The Pharmacokinetic, Pharmacody- prior purification. Flow cytometric immu- ment effectiveness); multiplex immuno-
namic and Pharmacogenetic SWG aims nophenotyping is the sole technique ful- bead assays for detection of fusion
to improve understanding of the mech- filling requirements of high speed, broad proteins and oncoproteins per disease
anisms of action of cytostatic drugs, to applicability at diagnosis and during fol- category (particularly ALL and AML); and
establish data-bases for EHA mem- low-up, and accurate focusing on malig- software for automated pattern recogni-
bers, to organize and design random- nant cell populations using membrane- tion of normal, reactive, and aberrant
ized PK/PD multi-centre studies, to bound and intracellular proteins as (malignant) leukocyte populations in
provide help in designing and coordi- targets. Innovations are needed in flow blood and bone marrow. In addition, we
nating studies and to introduce thera- cytometry, such as development of novel are looking to create large data bases
peutic drug monitoring and dose ad- antibodies, novel immunobead technolo- with 100s of well-defined normal, reac-
justment to optimize individual gy, eight-color immunostaining protocols, tive and malignant cell samples, which
chemotherapy treatment. The hope is and novel flow cytometry software for fast can be used as ‘templates’ for fully auto-
that implementation of PK/PD/PG and easy interpretation of complex data mated comparisons with patient sam-
knowledge of cytostatics will ultimately and for automated pattern recognition, all ples. As soon as the projects have been
improve treatment strategies and pa- of which are key objectives for the Euro- completed and approved, the results will
tient outcomes. Flow consortium (EU-FP6 project LSHB- be shared at Scientific Working Group
CT-2006-018708). This needs a multidis- sessions of the annual EHA meetings.
Moustapha Hassan, Chair ciplinary translational research approach
Karolinska University Hospital, Stockholm, using cutting edge technologies and bio- J van Dongen, Chair
Sweden logical data arising from genomic re- University Medical Center, Rotterdam,
search, which can be addressed best via The Netherlands
heart health story, and delivers a mixed bag of news for wine lovers. A
decline in wine consumption in France and craving for fast food is being
> The wine industry extols the merits four glasses of red wine daily), fulfills the
of drinking wine, and we all marvel at the definition of a dietary compound that
proposed health benefits. We mentioned mimics some aspects of calorie restric- Wine tasting can be fun unless taken too seriously!
the possible benefits of resveretrol in tion. Some may feel three to four glasses
previous newsletters but decided that of wine daily to be excessive and that but the wine business is not immune
the amount of wine required daily to pro- perhaps one or two glasses of wine sup- from controversy. In Montalcino, that
vide a protective effect would probably plemented with oral resveretrol would do most beautiful of hill towns in Tuscany,
induce severe liver damage, thereby ne- the trick. their high priced Brunellos have come
gating any putative benefit. However A lot of this type of research is based on under scrutiny. The public prosecutor in
things might be getting better! In a study, the so-called 'French paradox'. However Siena, Nino Calabrese, is investigating
published by Richard Weindruch and col- the bad news is that the French are re- famous names including Frescobaldi and
leagues, from the University of Wiscon- ducing their intake of red wine and tak- Banfi for possibly using grapes other
sin-Madison, (PloS ONE 2008:3: e2264) ing to fast-food. Yes, less than 50 percent than Sangiovese or importing grapes
they claimed that mice given low dose of young people in France are drinking from other areas. In the US billionaire
resveretrol were protected from heart wine and only 10 percent consume it wine collector, William Koch - no rela-
disease. They report that low dose resv- regularly! In 1980 the average consump- tion as far as I am aware to Robert Koch
eretrol inhibits gene expression profiles tion of wine in France was 120 liters per who in 1890 established the etiology of
associated with cardiac and skeletal year and this has fallen by 50 percent. Anthrax and Tuberculosis - found that
muscle aging, and prevents age-related Paradoxically wine drinking in America wines that he had bought were not in fact
cardiac dysfunction. Dietary resveretrol in the 21 – 29 year age group is the most part of Thomas Jefferson’s collection as
also mimics the effects of calorie restric- rapidly growing segment of the world he had been led to believe! He paid a
tion in insulin mediated glucose uptake market. large amount of money for his mistake!
in muscle. Gene expression profiling What is more worrying is the loss of eat-
suggests that resveretrol may retard ing habits and the craving for fast foods. There is a huge surplus of wine (mostly
some aspects of aging through altera- The number of family meals and busi- poor quality) in Europe today, illustrated
tions in chromatin structure and tran- ness lunches has decreased by 50 per- by the fact that in 2006 the EU spent € 2
scription. Resveretrol, at doses that can cent in the last 10 years in France and billion distilling surplus wine into indus-
be readily achieved in humans (three to obesity is on the increase. Diana Macle trial alcohol! Marianne Fischer Boel, EU
writing in the Wine Spectator quotes agriculture commissioner, is trying to
Professor Francois d’Hauteville as say- help by convincing small growers to re-
ing: ‘The young people I interviewed rec- tire and pull out 400,000 acres of vines
ognized that wine was part of French and subsequently to phase out distilla-
culture and identity but they know very tion subsidies. Michael Mann, spokes-
little about it, and many didn’t even like man for the EU agriculture and rural de-
the taste!' Perhaps the French Paradox velopment department, is quoted as
will become a thing of the past. saying: ‘In the short term production will
Another interesting use of resveretrol is decrease but when planting restrictions
in the treatment of MELAS. This syn- go, there is no reason why production of
drome, characterized by mitochondrial quality wine should not expand’. For both
myopathy, encephalopathy, lactic acido- our heart health and drinking pleasure,
sis and stroke-like episodes, is caused let us hope that both Weindruch and
by mitochondrial dysfunction and is cur- Mann prove correct.
rently undergoing a randomized trial us-
ing resveretrol (STR501) as a mitochon- Giovanni Morelli
drial stimulant!
As physicians we all have become aware Giovanni Morelli is a hematologist who divides
All grapes are green in the beginning of a number of drug scandals recently, his time between Dublin and Tuscany
every congress, the EHA Board appoints a Scientific Program Committee (SPC), whose role is to compose a program for
the annual congress that meets the highest scientific and educational standards. The SPC is supported by members of
the EHA Executive Office under the lead of Rik Craenmehr, who serves as the Congress Assistant, with the remit of
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The poster area attracted many visitors
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WWW.EHAWEB.ORG 10th 11th 12th 13th
Exhibition area
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the Joint Executive Committee was established to formalize the collaboration for future events and new projects. The
committee representing both organizations includes W Fibbe, R Foà, E Gluckman and B Löwenberg. Selection of topics
for workshops and development of new initiatives are amongst the most important tasks of this committee.
> Scientific workshops are smaller scale meetings on dedi- ESH-EHA Joint Activities in 2009
cated topics of relevance for hematology. They are intended to ESH-EHA Scientific Workshop: Leukemic and Cancer
promote informal interaction and discussion between scien- Stem Cells
tists and clinicians working in the field. Another part of joint April 3-5, 2009, Mandelieu, France
projects are the interactive hematology tutorials. Hematology Chairs: C Chomienne, D Bonnet, P Valent and D Louvard
tutorials are annual courses aiming to provide laboratory and ESH-EHA Hematology Tutorial: Hematology Tutorial
clinical hematologists with an integrated diagnostic and clini- on Lymphoid Malignancies
cal work-up of hematological disorders. May 15 - 17, 2009, Tallinn, Estonia
Chairs: R Foà, E Kimby and G Zini
A new logo was designed to give ‘face’ to the new style collabo- ESH-EHA Scientific Workshop: Innovative Therapies
ration. for Red Cell and Iron Related Disorders
Hema
tology A
sso
November 6 – 8, 2009
n
ea cia Coordinators: Y Beuzard and C Camaschella
op t
ESH-EHA Annual Diagnostic Workup of
r
ion
Eu
Hematological Malignancies:
Focus on Chronic Diseases
atology
Autumn 2009
Chairs: B Bain, R Foà, G Zini
Haem
of
Cover photographs
Please be encouraged to send in your scenic photographs for future newsletter covers (size: standing).
The EHA offers € 100 for the photograph chosen as cover photo, starting next issue.
Editors
Editor-in-Chief Shaun McCann
Editor Catherine Lacombe
Sub-editor Janet Fricker London
Editorial Coordination Ineke van der Beek
Printing
Drukkerij BibloVanGerwen,
’s-Hertogenbosch > 16th Congress of EHA
Date: June 9-12, 2011
Contact editors Place: London, United Kingdom
For general remarks, questions and suggestions e-mail p.stork@ehaweb.org Congress President: Prof I Roberts
Contact Information
Corporate
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Contributors
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T. +31 (0)10 436 17 60
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