Joshua Fein

Sackler School of Medicine, Tel Aviv University, Tel Aviv

The principal reason for attending conferences is to beat your all-time record on your cell phone’s step counter. Somehow while staying in the same building all day, I managed to rack up 6 miles. It almost justifies eating all the fancy pastries the pharmaceutical companies are handing out in the arena-sized exhibition hall.

But now that I’ve explained my real reason for going, let me spend a few words on the justification I gave the school administration for my (very) brief absence. I was honored by the opportunity to present my group’s work at this year’s American Society of Hematology (ASH) annual conference, in a poster entitled “Comorbidity-Driven Risk across Preparative Regimens for Allogeneic Hematopoietic Stem Cell Transplantation.” Or, in a version that is slightly less of a mouthful, “how do you choose the stem cell transplant drugs, if you’ve got any other diseases in addition to the one requiring the transplant?”

Meanwhile, I had the chance to fill my two days by attending some exciting talks. The hottest topic at ASH this year was CAR (Chimeric Antigen Receptor) T-cell therapy. Approved this year by the FDA, CAR-T is a new paradigm in treatment, in which a patient’s own T-cells are genetically re-engineered with the addition of a cell-surface receptor which (at least so far, lots of new ideas are in pre-clinical or clinical trials) binds to the CD19 marker on B-cells, leading to the death of the cancerous (as well as the not-cancerous) B-cells. The therapy has shown to be quite effective in acute lymphoid leukemia and some lymphomas, even among patients who have received many other therapies without responding. On the other hand, CAR-Ts are associated with very striking (and sometimes fatal) adverse reactions, especially cytokine storm (massive release of inflammatory cytokines) and even cerebral edema. Not to mention the cost – just the manufacture of the drug alone costs nearly $500,000. There were many sessions on trials with new CAR designs (no Porsches here, except in the pharmaceutical companies’ parking lot…) using other cell-surface markers to target myeloma or resistant lymphomas.

That said, the most interesting sessions I attended were “educational sessions,” in which a leader in a particular field shares what s/he thinks about recent advances and changes in clinical practice. In one particularly interesting session, Peter Martin from Weill Cornell Medical College spoke about the treatment of uncommon presentations of mantle cell lymphoma. He pointed out that clinical trials tend to include only the ‘common’ presentations, so that the responses can be standardized, making it difficult to know what the evidence tells us about treating these more unusual variations of the disease. With the current discussions about personalized medicine, I think there’s an important message here—we need more clinical trials specifically designed to study rare diseases and rare variants; these trials likely need to be shared across many centers in order to have enough patients to make the results meaningful. Given my own tendency to be more interested in something the rarer it is, this was music to my ears.