As I begin my term as ASH president, I would like to both thank and congratulate Dr. Stephanie Lee for her leadership in an extremely challenging year — one with unprecedented roadblocks and sweeping change that affected everyone globally. These fluctuations were hard to predict this time last year, but as we embark on this new year, I invite you to consider a few (four to be exact) challenges I’ve observed facing hematology right now.
The single most important of these is the rapid pace of progress in the discovery, dissemination, and implementation of emerging knowledge. It is important to note that while the flood of information can present challenges, it is also hematology’s most valuable commodity. The second challenge lies in our need to collaborate with an increasingly diverse community of colleagues. This includes laboratory-based scientists, hematopathologists, partners in industry, and others such as clinical pharmacists, who have become invaluable members of the patient care team. They identify drug-drug interactions, advise dose modifications, monitor drug levels, and educate us all regarding toxicities, particularly for patients on clinical trials evaluating novel agents. Advance practice providers are indispensable colleagues who provide consistent care and play a major role in the education of not only patients and families, but also rotating house staff, fellows, and attending physicians. Furthermore, hematologists now even interact with solid tumor oncologists who collaborate in basket trials enrolling patients based on a common genetic mutation rather than a specific disease. More than ever before, we need to join forces with international colleagues to exchange knowledge, to facilitate timely clinical trial accrual, and to bring all that our Society has to offer to developing parts of the world. The third challenge is the obligation to educate each other and ourselves. Therapeutic paradigms are rapidly shifting. These changes include the development of new strategies for frontline treatments as well as the opportunity to sequence effective new approaches with each other and with well-recognized therapies. For example, during the 44 years (approximately 1973-2017) since the initial description of induction chemotherapy for acute myeloid leukemia, the field had seen no new sustained drug approvals. However, between 2017 and 2020, the U.S. Food and Drug Administration (FDA) and other regulatory agencies approved nine new agents. The optimal strategies to incorporate these novel drugs require collegial interaction and education.
The fourth challenge is the need for a less cumbersome and more inclusive clinical trials process. Academic and community-based institutions, cancer centers, and cooperative groups have invested an enormous amount of time, money, and energy in promoting accrual to clinical trials throughout the past several decades. However, a recent study suggests that only approximately 8 percent of patients with cancer participate in clinical trials (Unger et al, J Nat Cancer Inst, 2019), though this number may be modestly higher for patients with hematologic malignancies. Cooperative oncology groups, whose raison d’etre is the conduct of clinical trials, often have no open trials for numerous diseases for years at a time. While important advances in understanding barriers to clinical trial participation have occurred, there is opportunity for major improvement. There are racial, socioeconomic, and geographic disparities limiting participation that need to be addressed once and for all. During the height of the pandemic, many institutions streamlined the development and activation of COVID-19–related clinical trials. This should be an impetus to do the same for all clinical trials. Telemedicine and electronic consent are new advances to expedite the clinical trials process and extend the reach beyond familiar borders to encourage trial participation. Nevertheless, clinical trials are available only to a relatively privileged few, and most patients around the world do not have access to them.
Our Society has unique strengths that can be harnessed to tackle these challenges. Given our assets, the opportunities abound. Our Society can be proud of the wide array of disciplines within hematology on which it focuses. ASH can expand its role as a platform for communication to exchange new knowledge through an always relevant and innovative annual meeting, its breadth of publications (such as The Hematologist!), and smaller, more focused, subspecialty-based meetings to foster collaboration and education. All such endeavors can continue to expand the Society’s reach to less developed parts of the world — an objective that must continue to be an important part of our collective vision. ASH must be a leader in advocating for a more efficient and inclusive clinical trials process. This will require a change in culture more than anything else. We must convey to all stakeholders, particularly patients, the promise of clinical research. There has never been a more exciting time to be in the field of hematology!
In closing, I would like to acknowledge all those volunteers, members, and individuals all throughout the community who identified the opportunities and made 2020, and in particular the ASH annual meeting, a resounding success, despite the challenges. Together in the coming year and well beyond we must continue to exploit the opportunities these challenges present with newfound purpose and new tools so that our Society and our patients will flourish more vigorously than ever.
