Symposium Chair

Expert Faculty

This live symposium and corresponding Internet-based enduring materials will be supported by multiple commercial supporters and by a modest tuition from the learners.

The genesis of this special, first annual personalized therapies and best clinical practices for hematologic malignancies program is based upon the five highly successful annual personalized therapies symposia we have conducted for the past three years. Very recently, on February 6, 2010 in La Jolla, CA, the Oncology Learning Center (OLC) conducted its Third Annual Symposium on Personalized Therapies and Best Clinical Practices for Breast Cancer. On September 26, 2009, we conducted the Second Annual Symposium on Personalized Therapies for Lung Cancer and Head and Neck Cancer in Philadelphia, PA. And the Third Annual Symposium on Personalized Therapies for Lung Cancer and Head and Neck Cancer is currently being planned and will be held on August 28, 2010 in San Diego, CA.

The participants at each of the five personalized therapies symposia have rated them extremely high. Moreover, each symposium has averaged more than 200 participants. And the audiences have been national and consistently large, despite the current economic slowdown. The more than 1,000 participants from these five other symposia and other hematologists that we have interviewed have requested that we conduct a similar symposium on personalized therapies and best clinical ptractices for hematologic malignancies.

The Oncology Learning Center has conducted a very extensive physician Practice Gap Identification and Needs Assessment that is included in this document. As a result, we have determined that these two CME activities (symposium and enduring materials) are needed. The primary objective of the First Annual Symposium on Personalized Therapies and Best Clinical Practices for Hematologic Malignancies and its corresponding Internet-based enduring materials is to provide hematologists, hematologist/oncologists and other physicians treating hematologic malignancies with the knowledge and competence enabling them to develop subsequent practice performance changes so that they can treat their hematology patients with the personalized approaches and best clinical practices in order to improve patient outcomes and minimize drug-induced toxicities.

The underlying need for these CME activities has arisen primarily from the most current clinical and scientific data on hematologic malignancies presented at the December 2009 annual ASH meeting in New Orleans, and at other important recent meetings including the ECCO/ESMO meeting in Berlin 2009 and ASCO 2009 in Orlando, and also from what we discovered with our interviews and focus groups with hematology experts for the Needs Assessment and physician Practice Gap Identification in this document.

The hematologic malignancies covered in this symposium are divided into the following 3 sessions corresponding to the outline of the Needs Assessment and physician Practice Gap Identification:

• Session 1: Non-Hodgkin's Lymphoma, Cutaneous T-Cell Lymphoma and Peripheral T-Cell Lymphoma and Chronic Lymphocytic Leukemia
• Session 2: Myeloid malignancies: Acute Myeloid Leukemia, Chronic Myeloid Leukemia, and Myelodysplastic Syndromes
• Session 3: Multiple Myeloma

Before the program begins, Dr. Steven Rosen will conduct a pre-activity educational assessment consisting of several patient care treatment-strategy questions with multiple-choice answers with the learners to determine how they currently treat their patients with hematologic malignancies in order to determine a baseline of current medical oncologists' practices. This will be accomplished at the live course using the Audience Response System (ARS) and via questions on the OLC Web site for the corresponding Internet-based enduring materials.

The format of the program extensively utilizes adult learning principles. The learning design is one that is very highly interactive between the learners and the faculty. The faculty has been instructed to begin each didactic presentation with either a brief patient case study and/or a few clinical questions, and to use ARS for engaging the learners at the beginning of each presentation. We have been using this approach for all of our OLC symposia during the past year. This approach has been so successful that it will be used again for this symposium to further facilitate adult learning. This symposium's sessions will include numerous interactive clinical case studies. There will also be one interactive Point-CounterPoint debate. The learners will answer multiple-choice treatment questions from the clinical case studies and vote on the Point-CounterPoint debate via ARS.

Both the morning and afternoon sessions will conclude with a lengthy interactive summary period where additional case studies will engage the audience with the faculty. Case studies will be solicited by the OLC from the pre-registered attendees prior to the symposium and cases may also be submitted on site during the symposium. In addition, during these two summary periods Dr. Steven Rosen will moderate an Interactive Roundtable Panel Discussion to review the data presented during the entire symposium and solicit individual perspectives from each of the expert faculty for personalizing treatment and best clinical practices of the hematologic maligancies discussed thus far. Dr. Rosen will ask each faulty for their specific recommendations on areas of uncertainty for treatments that are still not yet considered standards of care. And there will be plenty of time for the learners to ask questions of the expert faculty. The morning summary period will last 45 minutes and the afternoon summary period will last 30 minutes.

One new methodology we will be employing at the live symposium to further engage the learner and foster interaction is the use of Twitter™. The audience will be able to "tweet" via Twitter™ to ask questions or make comments that will be given to the symposium Chair, Dr. Rosen. This will require the use of the learners' own computers with a wireless internet connection or the use of the learners' "smart cell phones" with Twitter™ already installed....most Blackberries™, iPhones, and most other newer cell phones can easily be Twitter™ enabled.

The symposium will conclude with Dr. Steven Rosen re-asking the pre-activity questions as a CME post-activity assessment of the audience of learners utilizing the interactive ARS. Dr. Rosen will compare the pre- and post-activity answers. This will, hopefully, demonstrate that the learners closed knowledge and competence gaps that they can incorporate into their practices regarding the use of the most current therapies for hematologic malignancies resulting from their participation in the symposium.

NON-HODGKINS LYMPHOMAS
OVERVIEW
The National Cancer Institute 2009 definition of non-Hodgkin lymphoma (NHL) includes any of a large group of cancers of lymphocytes. Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of NHL. These types can be divided into aggressive and indolent types, and they can be formed from either B-cells or T-cells. In the US each year, nearly 54,000 people are diagnosed with NHL. It is the most common type of blood malignancy in the US.

FOLLICULAR LYMPHOMA
Follicular lymphoma is an indolent form of NHL and comprises approximately 20 to 30 percent of NHL cases diagnosed in the US. Standard therapy for non-bulky, localized, Stage I and II follicular lymphoma includes potentially curative local regional radiation therapy, alone or with the addition of induction chemotherapy, or more extended radiation therapy, although the latter two approaches have not been shown to improve overall survival in early disease. Optimal therapy selection in the treatment of local regional disease is thus an area that is challenging for physicians who treat follicular lymphoma. Bulky Stage II or systemic follicular lymphoma (Stage III and IV) is generally considered an incurable disease, and the decision regarding timing and type of treatment is individualized.

For follicular lymphomas, once therapy is initiated, a rituximab-containing regimen has resulted in the highest rates of complete response and improvements in progression-free survival over chemotherapy alone. A current area of active investigation is personalized treatment selection in the first-line treatment of advanced disease. Currently, there are several chemotherapy regimens (single agent or combinations) that are used in the first-line setting. The role of radio-immunotherapy in the first-line setting is also area of interest in the treatment of follicular lymphoma. The treatment of relapsed disease is more challenging.

Personalizing therapies and patient selection in the clinical application of these therapies is an important factor in the optimal approach to the treatment of follicular lymphoma and may represent a significant physician practice gap, given the number of treatment options and the heterogeneity of the disease.

DIFFUSE LARGE B-CELL LYMPHOMA (DBLC)
DLBCL, accounts for approximately 30 percent of United States NHL cases. Although front-line treatment options for localized (Stage I and II) and advanced (Stage III and IV) DLBCL differ to some degree, the goal of induction therapy is to eradicate the disease, and almost half of such patients may be cured with conventional approaches. This means that half of the patients diagnosed with DLBCL will not be cured. Thus, achieving a quality durable response in first-line is very important for optima clinical outcomes. The mainstay of therapy for DLBCL is treatment with R-CHOP.

The role of adjuvant-involved field radiation therapy and the duration of the rituximab-based regimen, R-CHOP, are variable (range 3 to 8 cycles) and dependent upon the stage at diagnosis and presence of adverse risk factors. For patients greater than age 60, dose-dense CHOP might be an option. Currently, much of the clinical research conducted focuses on ways to induce high-quality responses and long duration of response. In an effort to further enhance the significant activity of R-CHOP as initial treatment of DLBCL, clinical trials are currently studying numerous new regimen combinations, which will be discussed in great detail in the symposium.

Treatment of relapsed or refractory DLBCL includes consideration of multiple high-dose, non-cross-resistant combination systemic therapy regimens with or without consolidation autologous stem cell transplantation (ACST). For example, the activity of lenalidomide in the treatment of relapsed or refractory aggressive NHL has been demonstrated several clinical trials. Response rates in this poor prognosis population approached 30-35 percent and were durable beyond a median of 10 months. The culmination of these therapeutic advances and controversies in the rational induction, maintenance and salvage treatment of both indolent and aggressive lymphomas has provided ample evidence to support innovative medical education activities for hematology professionals.

Systemic Therapies either FDA Approved or in Late-Stage Clinical Development for NHL
Standard treatment of relapsed or recurrent NHL has traditionally included autologous or allogeneic stem cell transplant for appropriate candidates, radio-immunotherapy or rituximab. In November 2008 the FDA approved bendamustine, a chemotherapy agent, for the treatment of relapsed or refractory indolent lymphoma. Additionally, numerous other investigational agents with potential additive or synergistic activity in combination with rituximab, or with novel combinations, or demonstrating monotherapy activity in indolent forms of recurrent NHL include lenalidomide, bortezomib, 90Y-ibritumomab tiuxetan, temsirolimus, galiximab, tositumomab, ofatumumab, epratuzumab, pixantrone and a personalized follicular lymphoma vaccine. These agents are being evaluated in numerous research trials and present alternative treatment options for patients eligible for enrollment. Agents and regimens reviewed in this Needs Assessment include:

CUTANEOUS T-CELL LYMPHOMA (CTCL)
OVERVIEW
This subtype of lymphoma is relatively uncommon. The incidence of Cutaneous T-cell Lymphoma (CTLC) is significantly less than other forms of lymphoma. There are an estimated 1,500 new cases per year in the US versus 59,000 for all types of NHL. The incidence of all T-cell lymphomas combined is approximately 10 to 15% of all NHL.

CTCL is often a devastating cancer in which many patients suffer from disfiguring tumors, horribly itchy and infected skin. And in advanced stages this disease can spread to other organs. Current therapies, while effective, are not effective for every patient, thus leaving an unmet need as is the case with most malignancies, even with the best of drug therapies available. Treatment of CTCL depends upon the type and stage of the disease. Localized disease is usually treated topically with agents such as retinoids, nitrogen mustards or ultraviolet light.

The prognosis for CTCL patients is varied. Some patients may have stable or slowly progressive disease, while others may progress rapidly. Patients may live normal lives while being treated for this disease and some are able to remain in remission for long periods of time. A minority of patients will experience progressive disease. Outcomes for patients with progressive disease are improving as a result of better therapies.

Widespread CTLC disease is treated by any of a variety of agents. Bexarotene is one agent that is FDA approved for CTLC. Denileukin diftitox is another drug approved for treating CTCL. Vorinostat and romodepsin, both HDAC (histone deacetylase inhibitors) are FDA approved for treating CTCL. Agents reviewed in this Needs Assessment include:

PERIPHERAL T-CELL LYMPHOMA (PTCL)
Peripheral T-cell lymphomas (PTCL) also represent a small subgroup of non-Hodgkin lymphomas that historically, are difficult to diagnose. This subtype of lymphoma is also relatively uncommon with only a few thousand new patients diagnosed per year in the USA. Pralatraxate is currently the only drug approved by the FDA to treat PTLC. Investigational drugs used to treat this subtype of lymphoma include the HDAC inhibitors, bortezomib, and some bcl-2 inhibitors. Agents reviewed in this Needs Assessment include:

CHRONIC LYMPHOCYTIC LEUKEMIA
OVERVIEW
Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasm in the family of the non-Hodgkin's lymphomas. It is the most common type of the four major types of leukemia and it accounts for one-third of all leukemias. About 15,490 new cases of CLL will be diagnosed in 2009 in the US. In 95 percent of people with CLL it is a B lymphocyte malignancy. It is estimated that nearly 90,000 people in the US are now living with or are in remission from CLL. This malignancy is more common in people who are 60 years and older than in younger adults. The number of people with CLL starts to increase after age 50. A small number of people are diagnosed with CLL in their 30s and 40s. Children do not get CLL.

Patients with CLL present with significant clinical diversity. Cytogenetic aberrations have important prognostic significance with respect to long-term outcome. Specifically, deletions on chromosome 12 and chromosome 11 confer a poor prognosis. Currently, there is active research to assess how cytogenetic features can be used in personalizing treatment planning for patients with CLL. Treatment is guided by staging systems such as the Rai staging system and the Benet staging system. 57 Patients with low-risk disease may simply be observed, as survival times are equivalent to those of age-matched controls. In contrast, intermediate and high-risk disease typically requires therapy at diagnosis. Novel serum-based markers of prognosis are emerging, including expression of CD38 and Zap-70, which might eventually further risk stratify CLL patients at time of diagnosis. Patients who have intermediate- and higher-risk CLL are usually treated with combination chemotherapy and/or monoclonal antibody therapy. Such treatment is often an alkylating agent and/or a purine analog with either alemtuzumab, ofatumumab or rituximab. Agents and regimens reviewed in this Needs Assessment include:

Systemic Therapies either FDA Approved or in Late-Stage Clinical Development for CLL

MYELOID MALIGNANCIES
Chronic Myeloid Leukemia (CML)
OVERVIEW
CML accounts for 15 percent of adult leukemias, and the median age of onset is 67 years. If left untreated, CML will progress from a chronic phase to a blast phase over approximately three to five years, leading to rapid disease progression and death. The hallmark of CML is the molecular presence of the Philadelphia chromosome (gene translocation between chromosomes 9 and 22), resulting in production of the bcr-abl fusion protein.

The 2001 FDA approval of imatinib mesylate, a specific inhibitor of the bcr-abl tyrosine kinase, marked a revolutionary breakthrough in the management of CML, leading to durable major cytogenetic responses in 87 percent and complete cytogenetic responses in 76 percent of treated patients. Importantly, five-year overall survival exceeds 90 percent, with 84 percent of patients free of disease progression while continuing on treatment.

Some patients develop acquired resistance that may be related to mutations in bcr-abl and resultant conformational changes in the tyrosine kinase binding domain. Two next generation drugs are available to treat CML patients failing imatinib. Dasatinib is an bcr-abl kinase inhibitor that has demonstrated clinical benefit in patients who are resistant or intolerant to imatinib therapy while in chronic-, accelerated- or blast-phase CML. Dasatinib binding occurs at both the active and inactive conformational sites of bcr-abl which may account for its ability to overcome many resistance-associated mutations. Nilotinib, a highly selective bcr-abl TKI, is yet an additional option that has demonstrated evidence of clinical utility in patients with imatinib-resistant or intolerant Philadelphia chromosome-positive chronic- or accelerated-phase CML. More detailed current clinical data about all three of these important drugs will be discussed in this symposium.

Despite impressive advances in the treatment of CML, a minority of patients continue to have disease progression even with standard therapeutic options. Various clinical research studies are continually evaluating the utility of stem cell transplant, combination therapy (imatinib with dasatinib) and other novel compounds in this highly refractory treatment setting. The practical application of imatinib dose escalation, the rational integration of dasatinib and nilotinib into the CML treatment algorithm, the role of molecular monitoring of response and whether stem cell transplantation still play critical roles in the management of CML and remain issues of considerable educational opportunity among clinical investigators and community oncologists caring for patients with CML. The significant and potentially practice-changing data involving these agents and the treatment of CML has recently been published and will be discussed in the symposium. Agents and regimens reviewed in this Needs Assessment include:

Systemic Therapies either FDA Approved or in Late-Stage Clinical Development for CML

Acute Myeloid Leukemia (AML)
OVERVIEW
Acute myeloid leukemia (or non-Acute Promyelocytic Leukemia) is a rapidly progressing cancer of the blood and bone marrow characterized by an overgrowth of abnormal blood cells that quickly crowd out the healthy blood cells needed by the body. The National Cancer Institute estimated that more than 13,000 patients would be diagnosed with AML in 2009, and nearly 9,000 deaths would occur as a result of the disease that same year. The average age of a patient with AML is 67 years old, with diagnoses very rarely occurring before the age of 40. Due to the fast-growing nature of AML, it is important for patients to be treated promptly upon diagnosis to minimize the risk of the disease progression. Induction chemotherapy, the standard front-line AML therapy, is associated with high toxicity, including bone marrow suppression and increased risk of infection, which often limits use in elderly patients with a poor prognosis.

AML often stems from underlying pathology or risk factors including pre-existing myelodysplastic syndromes (MDS), ionizing radiation, exposure to prior chemotherapy or occupational chemicals. Among the elderly, the most common etiology is marrow blast transition from MDS, which, in itself, portends a poor prognosis for AML patients. Untreated AML is a uniformly fatal disease, and even with adequate therapy, the five-year survival rate among all risk groups combined is approximately 22 %, diminishing to only 5% among those with poor-risk cytogenetics.

Despite our increasing understanding about the biology of AML, the prognosis is poor for the majority of the patients. Allogeneic stem cell transplantation is a curative option, however, only a small % of patients are candidates for this procedure. Treatment-related deaths are a major concern with this strategy. First-line treatment for AML includes induction chemotherapy with cytarabine and an anthracycline in an effort to reduce leukemic burden and induce disease remission, followed by consolidation strategies utilizing various doses and sequences of similar agents with or without stem cell transplantation. Weighing the risks versus the benefits of treatment, especially where elderly patients are concerned, is a very important consideration, and in some cases a palliative approach is more appropriate than aggressive anthracycline therapy.

For salvage therapy in patients who fail to achieve remission remaining options include allogeneic stem cell transplantation if a suitable matched donor can be found, and an FDA-approved therapy, gemtuzumab ozogamicin (an anti-CD33 antibody with evidence of activity in relapsed or refractory AML of the elderly) or enrollment into a clinical trial for treatment with an investigational agent. 92,93 The treatment of AML is highly challenging. Therefore, a personalized approach to therapy is very important. The role of supportive care, especially in the treatment of elderly patients, is also an important aspect to optimizing clinical outcome. Agents reviewed in this Needs Assessment include:

Investigational systemic agents (some approved for other indications) in late-stage development for treating AML

Myelodysplastic Syndromes (MDS)
OVERVIEW
The myelodysplastic syndromes (MDS) are extremely heterogeneous in nature and may present with a variety of peripheral blood cytopenias. Prognosis is largely dependent upon the percentage of marrow blasts at diagnosis, the presence of ringed sideroblasts and other cytogenetic characteristics (e.g., PDGFRbeta, 5q31-33 translocations). As discussed earlier (see AML in the previous section of this needs assessment and practice gap identification), the transformation of MDS to AML is the ultimate disease complication leading to patient morbidity and mortality, with treatment goals of MDS focused on supportive care and reducing the risk of incipient progression to AML (WHO classification of >20 percent blasts).

MDS are diagnosed in slightly more than 10,000 people in the United States yearly for an annual age-adjusted incidence of 3.4/100,000 people. The vast majority of low- and moderate-risk patients are initially managed with low intensity chemotherapy (e.g., azacitadine, decitabine), biologic response modifiers (e.g., lenalidomide, thalidomide, antithymocyte globulin or molecular targeted agents in specific populations, e.g., imatinib). Those with higher-risk disease may be managed with induction chemotherapy, similar to regimens utilized in AML, or preferably with allogeneic hematopoietic stem cell transplant if a donor is available. 108 Both azacitadine and decitabine are approved by the FDA for treating MDS in all risk subsets, but azacitadine is the only agent of the two currently administered in the outpatient setting that has recently demonstrated improved overall survival versus standard care, even in patients with higher-risk disease.

Importantly, clinical trial data with azacitadine has additionally provided evidence that, contrary to historical experience in AML, a complete remission (CR) may not be requisite to achievement of an overall survival benefit in patients with MDS. This finding suggests that the utility of azacitadine treatment may extend to a broader population than initially anticipated, and the absence of a CR does not necessarily portend a suboptimal outcome. Up-front therapy with lenalidomide is indicated in those patients with documented del(5q) chromosomal abnormalities. However, recent evidence suggests that the agent can also be of benefit in lower-risk patients without this cytogenetic characteristic. MDS patients with documented PDGFR beta gene rearrangements have been found to respond well to treatment with the bcr-abl/PDGFR inhibitor, imatinib, and this agent should be considered as front-line therapy in such individuals.

Rational integration of the growing number of treatment options in the management of MDS is becoming increasingly complex and the utility of evidence-based algorithms and guidelines are of mounting importance to ensuring quality care.

The extraordinary need for continuing education in this area of hematology is demonstrated by the multiple subtypes of hematologic malignancies and their unique treatment algorithms evident in the preceding review of current literature. Furthermore, as additional agents and new data regarding existing treatments enter into this already complex therapeutic environment, integration of this information into disease management strategies will be a considerable challenge for the practicing oncologist. Agents reviewed in this Needs Assessment include:

Systemic Therapies either FDA Approved or in Late-Stage Clinical Development for MDS

MULTIPLE MYELOMA
OVERVIEW
Multiple Myeloma (MM) is a plasma cell neoplasm that accounts for approximately 10% of all hematologic malignancies and carries with it the worst death/new cases ratio (4:3) among the whole of the subtypes. Multiple Myeloma is characterized by the production of M-protein in the blood, and upon development and proliferation within the marrow, the disease often invades adjacent skeletal structures, resulting in the clinical presentation of bone pain. Patients with smoldering (asymptomatic) or Stage I active myeloma (absence of bone lesions, anemia, etc), may be observed, as they often have an indolent course for many years without therapy. However, patients with more advanced disease (Stage II and III) require immediate induction therapy in an effort to prepare eligible candidates for autologous stem cell transplant (ASCT).

The utility of lenalidomide or bortezomib in combination with dexamethasone and other agents has traditionally lead to substantial rates of objective and complete response, as well as subsequent successful ASCT.

In the setting of poor ASCT candidates, induction chemotherapy frequently includes the well-studied alkylating agent melphalan with steroids and/or thalidomide. However, as in the context of planned ASCT, the newer agents lenalidomide and bortezomib are now used in the front-line setting.

The VISTA trial data was presented at ASH 2008 indicating that bortezomib/melphalan/prednisone (VMP) demonstrated a significant prolongation in progression-free survival (PFS) and overall survival (OS), as well as increases in complete remission rates with this triple therapy combination among MM patients ineligible for primary ASCT in the first-line setting. These findings prompted the independent data monitoring committee to halt the trial and allow patients on the MP control arm to cross over to the novel VMP superior regimen. At the 2009 ASH meeting Dr. Mateos provided a 3-year update to VISTA. 128 According to Dr. Mateos this updated analysis confirmed that VMP results in significantly longer OS compared with MP, despite 50% of MP patients being rescued with bortezomib-based therapy in the relapsed setting. VMP treatment used upfront appears more beneficial than treating with conventional agents and saving bortezomib and other novel-agent-based treatment until relapse. Subsequent therapies appeared similarly effective in the VMP and MP arms, with this recent analysis also demonstrating the benefit of retreatment with bortezomib-based therapies following VMP. In addition, post-relapse survival among all patients receiving subsequent therapy appeared longer following VMP, indicating that frontline bortezomib use does not induce more resistant relapses.

Data from another phase III trial in 2008 revealed an alternative front-line regimen, lenalidomide plus low dose dexamethasone, resulting in significant improvements in response rate, PFS and 2-year OS versus dexamethasone monotherapy.

Relapsed or refractory myeloma is considered a salvage situation, and acceptable regimens in this setting include monotherapy and various combinations with the following lenalidomide, dexamethasone, bortezomib, vorinostat, thalidomide, doxorubicin, cyclophosphamide, etoposide, and cisplatin. Refractory MM is also an ideal setting for investigation of novel compounds with potential activity in the disease, including heat shock protein inhibitors, RANK-Ligand inhibitors specifically targeting involved bone lesions (e.g., denosumab) and several other monoclonal antibodies (anti-CD20, anti- CD40, VEGF).

But the landscape for treating MM changed substantially in December 2009 with the publication at ASH of the results of several important investigational data that provide hematologists with even more therapeutic options, including maintenance therapies. So, the current issues with MM research are to determine the optimum sequencing or combination of these systemic therapies, determine which maintenance strategy may be optimal, and determine whether retreatment is a feasible option. For hematolgists, knowledge of the many therapeutic advances and changing practice standards is essential to ensuring the most successful patient outcomes.

The integration of both levolidomide and bortezomib into routine clinical care of MM is imminent. The new data presented at ASH 2009 on these two important therapies, plus data on another emerging proteasome inhibitor, carfilzomib, will be reviewed in the symposium.

Systemic Therapies either FDA Approved or in Late-Stage Clinical Development for treating Multiple Myeloma

Hematologists, hematologist/oncologists, radiation oncologists, surgical oncologists, pathologists and medical oncologists who are involved in the treatment and/or management of patients with hematologic malignancies. Fellows, Physician Assistants, Nurse Practitioners, Nurses, oncology nurses, pharmacists and other health care professionals involved in the treatment and care of patients with hematologic malignancies including primary healthcare providers treating patients with hematologic malignancies, Managed Care Directors, Medical Directors, and/or Case Managers. These malignancies are treated optimally by a multi-disciplinary approach of clinicians and, thus, they are all targeted for invitation to these educational activities.

The following learning objectives were derived from our physician practice gap analysis and needs assessment. At the conclusion of this symposium, and/or after reviewing the enduring materials, participants will be able to:

1. Determine how cytogenetics, molecular biomarkers and other predictive or prognostic factors can be integrated into the decision-making process for choosing the optimal therapies for patients with hematologic malignancies.
2. Develop therapeutic algorithms for the clinical management of indolent NHL and CLL, addressing benefit to risk considerations in the selection of treatment strategies.
3. Because the goal of therapy for DLBCL is often curative, define a personalized approach to the treatment with DLBCL to increase the quality and durability of response and devise treatment strategies to improve clinical outcome in patients who have relapsed after initial treatment.
4. Evaluate current treatment options for patients with CML and determine the optimum personalized approach to treatment selection based on the latest clinical evidence.
5. Determine how biomarkers and cytogenetics can be optimally utilized in the monitoring of CML patients and determine when second-line therapy should be initiated to optimize clinical outcome.
6. Devise a treatment strategy for AML based on the individual characteristics of the patient, integrating supportive care with therapeutics to optimize patient outcome.
7. Explain how the heterogeneous manifestations of MDS and the associated cytogenetic markers impact therapy choice among low-intensity chemotherapy, biologic response modifiers, and molecular targeted agents in specific patient populations, and apply this information to clinical decision-making.
8. With several effective treatment options currently available, select the optimal personalized strategy for the treatment of patients with multiple myeloma based on the latest clinical data.
9. Counsel appropriately selected patients on the availability of clinical research studies offering novel treatment approaches in the management of hematologic malignancies.

The Oncology Learning Center is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Oncology Learning Center designates this educational activity for a maximum of 9 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, all educational programs sponsored by the Oncology Learning Center (OLC) demonstrate fair balance, complete independence from any commercial supporters, objectivity, and scientific rigor. All faculty, authors, editors, OLC staff and planning committee members participating in an educational activity who are in control of content or in communication with faculty are required to disclose any relevant financial interest or other relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an OLC educational activity. All disclosures will be made available to all activity participants prior to the conduct of its educational activity. In addition, all conflicts of interest will be resolved prior to the conduct of its educational activity.

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The Oncology Learning Center does not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the Oncology Learning Center. Please refer to the official prescribing information for each product for discussion of approved indicated, contraindications, and warnings.

Participants of OLC's educational activities have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development and practices. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.