The Universe Continues to Expand: Reflections From the 2024 ASH Annual Meeting

Access to advanced diagnostics and novel therapies continued to be in the spotlight at the 2024 annual meeting. From the Presidential Symposium and Plenary Scientific sessions all the way to the poster presentations, access remained a consistent goal of clinicians and scientists across the globe. However, distinguishing between access and accessibility is vital. Access focuses on whether treatments are available and affordable, but accessibility goes deeper — encompassing factors like equitable distribution, patient education, and ease of navigating complex health care systems. The Health Equity Studio brilliantly bridged this gap with interactive sessions that not only described the issues, but proposed solutions to achieve language justice, combat racism, and ensure equitable access to undocumented patients. It is not enough for innovative therapies to be created; to truly transform lives, they must reach every patient who needs them, breaking down barriers of cost, geography, culture, and knowledge.

Recent therapeutic advances are proving to be game-changing, with the potential to serve as versatile tools well beyond their initial approvals. CAR-T therapy, originally designed for cancer, is breaking new ground in treating autoimmune disorders, while rebalancing hemostatic agents are finding applications in rare inherited bleeding disorders and those of unknown cause. These breakthroughs showcase how the expertise gained in cancer therapies and hemophilia care is being repurposed to push the boundaries of innovation, reaching broader applications and transforming patient outcomes. The next goal: defining who benefits from each tool (as well as when and how they benefit) and establishing the right time to change strategy.

The meeting also spotlighted the remarkable mechanistic advances in cellular therapy, showcasing the brilliance of our scientific community. We were captivated by the depth of scientific questions posed, all aimed at advancing the frontiers of CAR T-cell science. CAR T cells can be likened to firefighters battling a blaze in a building filled with smoke, traps, and toxic fumes — where the tumor microenvironment works relentlessly to suppress, distract, and exhaust their efforts to eliminate malignant cells. At the ASH 2024 meeting, it was clear that our clinician-scientists have carefully analyzed counterstrategies to overcome these challenges — to improve CAR T-cell proliferation, persistence, and resilience against the hostile microenvironment. For instance, we learned that CD5 elimination enhances CAR T-cell proliferation through the JAK-STAT, MAPK, and mTOR pathways, optimizing their antitumor efficacy. Equally fascinating was the introduction of Zip-sort technology for dual-vector CAR T cells — an ingenious approach to engineer complex cells with multiple transgenic payloads, capable of targeting multiple antigens and navigating intricate tumor microenvironments.

The meeting also highlighted the unified commitment within the hematology community to prioritize patient care. The withdrawal of voxelotor for sickle cell disease (SCD) treatment stunned hematologists globally. Through phone calls, emails, and grassroots efforts, hematologists came together in a shared effort to facilitate seamless care transitions and restore patient trust and confidence. Furthermore, the ASH meeting provided a forum for SCD physicians to perform their own “root cause” analysis of this unforeseen event and leverage those insights into improving present and future trials.

Looking back at another successful and inspiring ASH meeting, we are awed by the groundbreaking science, the brilliant intellect behind the clinical trial designs and new therapeutic approaches, and the unwavering care and compassion shown by our community during times of unexpected challenge. The theme that resonates throughout every aspect of ASH’s annual meetings is loud and clear — a shared sense of purpose and justice that propels us as hematologists to push scientific boundaries and advance health outcomes and inclusive medicine for all people. It is a moment of immense pride to be hematologists and to belong to this incredible organization.