ASH regularly produces educational webinars, video series, and podcasts that feature presentations by experts in the field, cover current information on how to best diagnose and care for patients, and topical discussion on issues relevant to hematology. This content is free to stream on ASH On Demand.
To better prepare the participants for the Advanced Clinical Research Training Institute in Latin America (CRTI-LA) statistical analysis workshop, Dr. Sara Vesely introduces the basics of uploading and working with data in the statistical software SPSS. SPSS is a platform that offers advanced statistical analysis, a vast library of machine learning algorithms, text analysis, open source extensibility, integration with big data and seamless deployment into applications. SPSS is not free and requires a license to operate. To learn more about the workshop, please visit the Advanced CRTI-LA webpage for more information about the curriculum, application and your eligibility
Sara Vesely, PhD, MPH, University of Oklahoma Health Sciences Center
The Clinical Research Training Institute is a program created to produce leaders armed with ideas for clinical hematology research and the tools and resources to make their ideas a reality. It begins with a week-long workshop in La Jolla, California. During the program, participants will learn different research methods as well as work with faculty to improve their project proposals. After the workshop, the mentees are encouraged to maintain communication with their mentors, at least every three months. Small group leaders and participants will meet again at the ASH Annual Meeting in December and finally at the Final Class meeting at ASH HQ in May of the following year.
One of the most important components of CRTI is the mentorship program. The mentorship relationship is an invaluable experience, especially in the world of clinical Hematology. In this webinar, I will discuss:
∙ the expectations of mentors in the CRTI program
∙ the process of mentor/mentee pairing
∙ best practices for being a great CRTI mentor
∙ and how to work with the home mentor
∙ how to handle a mentorship pairing that may not be the right fit
Ruben Mesa, MD, FACP, Director and May’s Family Foundation Distinguished University Professor and Chair, UT Health San Antonio Cancer Center
More than half of practicing physicians exhibit characteristics of chronic stress and burnout. This trend may begin earlier with the observed decline in empathy during medical student training and the alarming rates of burnout in medical and other students in the health professions. In this presentation, Dr. Haramati will review the pathophysiology of stress and present published outcomes on curricular interventions to help students and faculty manage stress, foster empathy and build resilience. He will share his perspective on why it is essential to incorporate mind-body techniques into the work life of faculty and training curriculum for all health professionals—something that will require both skill and courage.
∙ To describe the prevalence of burnout among physicians and other health professionals
∙ To understand the physiology and pathophysiology of stress and the scientific basis for mind-body therapies used to reduce stress and improve well-being
∙ To learn about interventional models currently being explored for medical students, residents, physicians and academic faculty to prevent, limit or reverse burnout and foster resiliency
Aviad Haramati, PhD, Professor of Physiology and Medicine, Director, Center for Innovation and Leadership in Education (CENTILE), Georgetown University Medical Center
One of the key educational needs for providers treating patients with sickle cell disease (SCD) is transfusion medicine, and knowing when to transfuse. The first in an education series on SCD, this 1-hour webinar will discuss randomized control trials, acute and chronic transfusion care, complications, choice of blood product, and alloimmunization.
Jo Howard, MBBChir, MRCP, FRCPath, Guy’s and St Thomas’ NHS Foundation Trust
Victor R. Gordeuk, MD, University of Illinois at Chicago, Chicago, IL
Karina Yazdanbakhsh, PhD, New York Blood Center, New York, NY
To help ASH members meet the requirements for the Merit-based Incentive Payment System (MIPS) and submit the required data to the Centers for Medicare and Medicaid Services (CMS), ASH teamed up with Healthmonix’s MIPSPRO to provide ASH members access to Healthmonix’s 2017 Qualified MIPS Registry. ASH and Healthmonix provided a webinar to help ASH members better understand the requirements for MIPS, the impact it will have on reimbursement, and to provide a guide on how to use the MIPSPRO registry. The webinar provided a specialized MIPS reporting plan for hematologists.
Samuel Silver, MD, PhD, University of Michigan, Ann Arbor, MI
Providers treating patients with sickle cell disease continually struggle with inefficient reimbursement which can ultimately impact access to care. The Current Procedural Terminology (CPT) codes and the Diagnosis-Related Group (DRG) codes assigned for these patient visits have a significant impact on reimbursement. There is often a disconnect between a clinician’s documentation and the resulting CPT and DRG codes assigned by a hospital coder. The webinar will outline best practices for documentation of patients with sickle cell disease, and the many major comorbidities and complications for which these patients frequently present. Adequate documentation will help coders assign the correct CPT and DRG codes, ultimately resulting in appropriate care and appropriate reimbursement. The webinar will also provide time for speakers and participants to discuss relevant issues during a question-and-answer session.
Molly Mandernach, MD, University of Florida
Michael DeBaun, MD, Vanderbilt University School of Medicine, Nashville, TN
Thinking of attending the 2017 ASH Meeting on Hematologic Malignancies? Join us for the first in a series of special webinar previews of the 2017 meeting. Listen to speakers from the meeting as they preview their presentations, then stay for a special Q&A session to talk directly to meeting organizers and find out why you should join us in Chicago in September 2017!
The ASH Meeting on Hematologic Malignancies includes five core malignant hematology themes: leukemia, lymphoma, myelodysplastic syndromes, myeloproliferative neoplasm, and myeloma. This Focus on Myeloproliferative Neoplasms (MPN) webinar will feature a discussion with three clinicians in the area of MPNs regarding how clinical practice has evolved in recent years, as well as discussion of important conclusions from the previous year’s meeting. The doctors will also discuss what to expect in the coming year, with emphasis on how “How I Treat” is a different approach than the classic format of educational and or scientific sessions.
The webinar will include a special Q&A session with meeting organizers for participants to chat about anything related to the meeting or registration.
The next ASH Meeting on Hematologic Malignancies will be held in Chicago, IL, September 8-9, 2017. The program’s “How I Treat” presentations showcase speakers’ evidence-based treatment approaches, identify cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today.
The curriculum vitae (CV) is one of the most important records of academic achievement and serves as a tool for academic advancement and recruitment. Creating and maintaining an appropriate CV is often not done well and this webinar was designed to assist trainees and early career physicians in enhancing and optimizing their CVs. The importance of the CV and its uses are discussed, and the major sections of a CV are outlined and described. Practical tips for making a CV are reviewed, as well as common pitfalls and errors that can detract from an effective CV.
Joseph Mikhael, MD, MEd, FRCPC, FACP, Mayo School of Graduate Medical Education, Mayo Clinic Arizona
This webinar has been produced in conjunction with The Leukemia & Lymphoma Society.
May 31, 2018, was the last date for learners to claim CE/CME credit for this webinar. The video may still be viewed through December 31, 2018.
Acute myeloid leukemia (AML) is the most common acute leukemia in the United States and worldwide, but despite advances in the treatment of other blood cancers, the standard of care for most AML patients has changed very little in 40 years. The American Society of Hematology (ASH) has teamed up with The Leukemia & Lymphoma Society (LLS) through its “Beat AML” initiative to educate hematologists and other health care professionals about the importance of using advanced genomic technology to understand the genetic mutations in AML and identify targeted therapies to inhibit these mutations and more effectively treat the cancer. Tune in to this webinar on current and novel approaches to treating AML, featuring Ross Levine, MD, and Bernadette Cuello, NP, and learn more about LLS’s precision medicine Beat AML Master Trial, designed to test novel targeted therapies and change the treatment paradigm for patients diagnosed with AML.
To help you complete the post-test for CE/CME credit, please read the Additional Resources below. See the “Claim CE/CME" tab for further instructions.
Treating AML: Current and Novel Approaches
Acute Myeloid Leukemia1,2,3,4
There are 40,255 people living with Acute Myeloid Leukemia (AML) in the United States, with an estimated 19,950 new cases that will be diagnosed in 2016. According to SEER, the number of new cases of acute myeloid leukemia was 4.1 per 100,000 men and women per year. The number of deaths was 2.8 per 100,000 men and women per year. These rates are age-adjusted and based on 2009-2013 cases and deaths.
AML, a cancer of the bone marrow and the blood, progresses rapidly without treatment, and can be difficult to treat. AML is characterized by a clonal (starting from a single malignant cell) proliferation of myeloid precursors with a reduced capacity to differentiate into the different blood cells. As a result, there is an accumulation of immature leukemic cells, called “blasts.” These are found in the bone marrow, peripheral blood, and occasionally in other tissues, with a variable reduction in the numbers of normal red blood cells, platelets, and mature granulocytes. AML that transforms from a myelodysplastic syndrome (MDS) is still considered to be AML. In disease that transforms from other myeloproliferative or myelodysplastic/myeloproliferative neoplasms, it helps to know if the acute process arose from an underlying chronic disease. Leukemia that arises from an underlying chronic disease or from previous therapy is less likely to respond to current anticancer treatments and, therefore, it is less likely to be cured.
Signs and Symptoms of AML2,3,4
General signs and symptoms of the early stages of AML may mimic those of the flu or other common diseases. Signs and symptoms may vary.
Signs and symptoms of acute myeloid leukemia include
lethargy and fatigue
shortness of breath
unusual bleeding, such as frequent nosebleeds and bleeding from the gums.
Diagnosis and Classification of AML2,3,4
There are several AML subtypes. The subtypes are based on the World Health Organization (WHO) classification. Blood and marrow tests are used to diagnose AML and the AML subtypes. A pathology report, cytogenetic analysis report and a molecular genetics report all provide information that is important for making a diagnosis and in the treatment planning process. Cytogenetic category classification is one of the most important ways to classify AML. A lab test called a “polymerase chain reaction (PCR)” may be done to see if there are certain changes in structure or function in genes. AML cells may have features of red cells, platelets, or white blood cells in addition to myeloblasts (immature white blood cells that form in the bone marrow) or promyelocytes (granulocyte precursors, develop from myeloblasts).
Despite advances in treating other blood cancers, the standard of care for AML patients has not changed in many years. AML requires immediate and aggressive treatment; however, most patients treated with conventional therapies will have a relapse of their disease. The initial goal of treatment usually is to get the patient into remission. The long-term goal is to cure the disease.
Intensive chemotherapy is required to achieve a complete remission. At least two drugs are combined to treat patients initially. Most AML patients are treated with a combination of drugs often called “7 plus 3,” which includes cytarabine which is given for seven to 10 days and an anthracycline, which is usually started at the same time, but given in the first three days of treatment.
More treatment is needed once a remission is achieved to help prevent a relapse. Postremission treatment may consist of chemotherapy, stem-cell transplantation or low-dose maintenance chemotherapy or a combination of the three.
Some patients are treated in clinical trials with new drugs and new drug combinations or new approaches to stem cell transplantation.
A number of factors affect the choice and outcome of treatment, including:
The results of cytogenetic analysis
Whether the patient has received chemotherapy in the past to treat another type of cancer
Whether the patient had myelodysplastic syndrome (MDS) or another blood cancer
Whether the AML is in the central nervous system
Whether the AML has not responded to treatment or has relapsed
The presence of systemic infection at diagnosis
The patient’s age and general health.
Treatment of Relapsed or Refractory Disease3,4,5
Patients whose AML has relapsed following first-line therapy usually receive additional different chemotherapy followed by allogeneic stem-cell transplantation (if, based on their health and age, they are a good fit for this treatment). Some patients receive other investigational therapies.
Treatment recommendations are based on the age and health of the patient. Age alone is not a contraindication to treatment for older AML patients. Physically fit patients in their 70s and 80s can achieve remission.
Treatment Side Effects3,4
Some of the side effects AML patients may experience from treatment are temporary and subside once the body adjusts to therapy or when therapy is complete. During the course of therapy and after therapy has completed, healthy new cells begin to grow and develop. Severe side effects are treated on an inpatient basis.
AML decreases the production of normal blood cells. In addition, chemotherapy is toxic to both normal blood cells and AML cells. The normal blood cells are eliminated from the marrow along with AML cells.
For the patient, this may result in a severe deficit of the
red blood cells (anemia)
white blood cells called “neutrophils” and “monocytes” (neutropenia and monocytopenia).
Transfusion of red blood cells and platelets is almost always needed for several weeks following treatment. After that, the blood cell counts usually return toward normal reference ranges.
During treatment for AML, the deficiency of neutrophils and monocytes (types of white cells) can lead to infection from bacteria and fungi normally present in the environment, on the skin and in the nose, mouth or colon. The risk of infection may be increased because chemotherapy damages the lining of the mouth and intestines, making it easier for bacteria to enter the blood. When the white blood cell count is low and the risk of infection is increased, antibiotics are given to either prevent or treat infection. Transfusion of white blood cells is not generally used for patients who have a low neutrophil count, but transfusion can be used in patients who have a high fever, infection that is unresponsive to antibiotics, blood fungal infections, or septic shock.
Growth factors may be given to adult patients to stimulate the marrow to make new white blood cells. In children, they are used only in special circumstances.
Since many patients are immunocompromised and prone to infection due to disease and/or treatment, the medical staff, caregivers, and loved ones, need to practice frequent and vigorous hand washing and take other precautions to avoid exposing patients to bacteria, viruses and other infection-causing agents.
Patients at home should not delay in seeking medical attention if any signs of infection develop. A rise in temperature to 101°F or higher, or the onset of chills, may be the only sign of infection in a patient with a very low white blood cell count. Other signs of infection may include persistent coughing; tenderness at a site prone to infection, such as the area surrounding the anus or the facial sinuses; sore throat; pain on urination; or frequent loose stools. Patients should not take acetaminophen or any other drugs unless the medication has been approved by their physician.
Chemotherapy Side Effects3,4
Chemotherapy affects tissues that normally have a high rate of cell turnover. Thus, the lining of the mouth, the lining of the intestines, the skin and the hair follicles may be affected. Common side effects are listed in the Overview of Blood Cancer Treatment Section.
As a result of a very high white blood cell count, some AML patients may have a buildup of uric acid (a chemical normally found inside the cell) in their bloodstream. The uric acid is then excreted in the urine. In addition, the use of chemotherapy may also increase uric acid values. If many cells are killed simultaneously by therapy, the amount of uric acid in the urine can be so high that kidney stones can form. This may seriously interfere with the flow of urine. Drugs such as allopurinol (Zyloprim®) or rasburicase (Elitek®) can be given to minimize the buildup of uric acid in the blood.
Peripheral neuropathy (PN), a potential side effect of several cancer therapies, is manifested as weakness, numbness and pain, usually in the hands and feet.
Please visit The Leukemia & Lymphoma Society’s Acute Myeloid Leukemia webpage for additional reading:www.LLS.org/AML
Date of release - June 2017 Date of expiration - Online access expiration and last date for learners to claim CE/CME credit for this webinar: May 31, 2018
Approval for nurses has been obtained by the National Office of The Leukemia & Lymphoma Society under Provider Number CEP 5832 to award 1.0 continuing education contact hour through the California Board of Registered Nursing.
The Leukemia & Lymphoma Society designates this enduring material for a maximum of 1 Continuing Education Credit.
The American Society of Hematology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education to physicians.
The American Society of Hematology designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Non-physicians may request a certificate of participation.
Claim CE For Nurses
To receive credit and a certificate of completion, participants must read the additional information regarding AML treatment on the Additional Resources tab and complete an evaluation and post-test on the LLS website.
Claim CME for Physicians and other Non-Physicians
To receive CME credit or a participation certificate, participants must also read the additional information regarding AML treatment on the Additional Resources tab and complete an evaluation and post-test on the ASH Academy.
To register for the free CME Evaluation and Post-Test, visit http://hematology.org/TreatingAMLCME and sign in to your ASH account. If you do not have a web account with ASH you may create one prior to registering for the CME Evaluation Module. The Module will be available on the ASH Academy website (www.ashacademy.org) through May 31, 2018. Certificates may be printed directly from the ASH Academy upon completion of the evaluation and post-test.
Ross Levine, MD, Physician Scientist; Member of the Human Oncology and Pathology Program; Attending Physician on the Leukemia Service, Department of Medicine; The Laurence Joseph Dineen Chair in Leukemia Research, Director of the Memorial Sloan Kettering Center for Hematologic Malignancies
Bernadette Cuello, NP, Outpatient Leukemia Service, Memorial Sloan Kettering Cancer Center
Wendy Stock, MD, discusses the current tools to measure minimal residual disease in acute lymphoblastic leukemia (ALL), how minimal residual disease impacts treatment decisions for ALL, and more. Dr. Stock presented on the topic at the 2016 ASH Meeting on Hematologic Malignancies in a session titled "How I Treat ALL in First Complete Remission: Role of MRD and Molecular Genetics in Treatment Decisions."