Reliving #ASH21: The Historic 63rd ASH Annual Meeting

“Phygital,” a freshly minted term during the pandemic, is essentially a fusion of “physical” and “digital.” The successful integration of the Atlanta-based live event and virtual platform brought on a unique and personalized experience. But human interactions are deeply valued, and nothing has replaced the energy of a session room, hallway conversations, and the exchange of interpersonal stories. Accordingly, to make up for the two-year meeting hiatus, a special DJ on wheels greeted in-person participants at the Welcome Back reception. Additional conspicuous pieces included the fASHion store (ASH#22 runway collection), Headshot Alley, and “Selfie-cinnos” (cappuccinos with faces on froth).

A total of 5,041 oral and poster presentations, 32 Education, 17 Scientific, and 23 Special-Interest Program sessions captured the richness of all disciplines within hematology. The meeting shined a harsh light on health disparity and inequity, and a plea by Dr. Ruemu Birhiray for diversity within clinical trial participants hit home hard. Accordingly, the Anti-Racism Studio and a Special Scientific Session on Race and Science provided clarity on definitions of race, ethnicity, genetic ancestry, and structural racism, and the implications on research — who is studied, how, when, and by whom. Dr. Lachelle Weeks led a profound discussion centered on ways to generate diversity in both clinical and basic research, and Dr. Deirdra Terrell offered powerful remarks as well. “In reality, racism is beyond a social construct,” she said. “It is real; the structure of racism has created inequity, and to just be colorblind to race does not give justice to the stressors that happen by having darker skin in this country.” As researchers, it is incumbent on us to initiate a concerted effort …[to] dig deeper to understand disparities in our findings, and weave in social constructs within scientific investigations through multidisciplinary collaborations. Furthermore, Dr. Gilda Barabino underscored the importance of fostering relationships with diverse communities. Altogether, “systemic change” is imperative to move the needle on disparity and inequity.

The intersection of COVID-19 and hematology yielded an overwhelming number of abstracts (>300) with practice-relevant findings on thrombosis, vaccination, and outcomes, showcased at a dedicated session “ASH Advances COVID Research 2021.” Foremost, the seminal discovery of a virus-intrinsic mechanism of COVID-19–induced thrombosis was unveiled at the Plenary Scientific Session, implicating virus encoded accessory protein ORF3a (calcium channel), and a transmembrane protein TMEM16F (scramblase) as key drivers of coagulation by triggering phosphatidyl serine exposure, which in turn enhances tenase and prothrombinase complex activity. With the ongoing emphasis on COVID-19 vaccination, we learned more about vaccine-induced thrombocytopenia and thrombosis, and how neutrophil-activating protein (NAP-2) antibodies might contribute to thrombosis by neutrophil activation in addition to high levels of platelet factor-4 (PF4) antibodies that are distinct from heparin-induced thrombocytopenia. The safety of COVID-19 vaccination in patients with immune thrombocytopenic purpura was also addressed in a multicenter study. A decrease in platelet counts following vaccination occurred in 30 percent of patients, particularly after splenectomy, and importantly, none experienced severe bleeding or refractory thrombocytopenia.

Chimeric antigen receptor T-cells (CAR-Ts) generated waves in the lymphoma sphere with the ZUMA-7 and TRANSFORM studies. Axicabtagene ciloleucel (axi-cel) and lisocabtagene maraleucel (liso-cel) emerged superior to salvage chemotherapy and autologous stem cell transplantation in the second-line setting for relapsed/refractory large-cell lymphoma, while contrary findings were noted with tisagenlecleucel (tisa-cel) in the BELINDA study. Additionally, the POLARIX study demonstrated a progression-free survival advantage of polatuzumab vedotin in addition to rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) over R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) in untreated large-cell lymphoma.

Clonal hematopoiesis was prominent throughout the meeting, with newly discovered associations of clonal hematopoiesis and Alzheimer's dementia and gout. Its salutary effect on Alzheimer's dementia caused a stir at the plenaries, while elegant work on lifelong clonal dynamics and selection pressure was featured at the Late-Breaking Abstracts session. In the classical hematology space, fitusiran prophylaxis (siRNA therapeutic targeting antithrombin) led to remarkable efficacy with quality-of-life improvements in people with hemophilia A or B with or without inhibitors and created much enthusiasm with the potential to shift treatment paradigms.

My personal favorites each year, which I cannot leave off the list, are lectures that commemorate trailblazers in hematology, recognizing the past and the present. I have not been disappointed yet, and this year was no exception, with inspirational talks on “Leukemia Stem Cells” (Ham-Wasserman) delivered by Dr. Andreas Trumpp, “Rh and Transfusion in the Era of Genomics” (E. Donnall Thomas Lecture) by Dr. Connie Westhoff, and the Ernest Beutler Lecture on “Releasing the Brake: Check Point Inhibition in Lymphoid Malignancies” by Drs. Margaret Shipp and Stephen Ansell. Similarly, the Presidential Symposium on “p53 Mutations: Biology and Clinical Aspects” featuring Drs. Carol Prives, Guillermina Lozano, and Matthew Davids, and the ASH-EHA Symposium on the “innate immune system” by Drs. Ravi Majeti and Claudia Lengerke were equally engaging.

Having tried to pin down my favorites, I found myself struggling, and perhaps this overflow of high-class work is exactly the reason why ASH remains at the forefront of science. If I had to sum up #ASH21 in one word, I would choose: “ritzy.”

In the realm of ASH Honorifics, we celebrated the accomplishments of Coulter Award winner Dr. Harvey Lodish, the extraordinary mentors Drs. Jonathan Licht and Anthony Goldstone, and Dr. Deepika Darbari for Leadership in Promoting Diversity. Dr. Peter Marks and Rep. Rosa DeLauro were recognized for Outstanding Service and Public Service, respectively; Dr. Elizabeta Nemeth earned the William Dameshek Prize; and Drs. Denisa Wagner and Kwaku Ohene-Frempong were presented with the Henry M. Stratton Medal.

The annual meeting is viewed as a grand finale of a scientific process, a celebration of the fruits of months and years of labor. However, as we embrace the virtual platform, #ASH21 serves as a turning point, opening up the possibility of enjoying scientific content perennially. My sincerest gratitude to the technology staff for their flawless coordination, offering a seamless experience, ASH News Daily authors and their witty contributions (ashpublications.org/ashnewsdaily), and the ASH Communications staff for their efforts, including broad social media engagement that enabled global participation. It has been a privilege to serve as Editor of the 2021 ASH News Daily. The future is bright, and I look forward to connecting at #ASH22.

Dr. Gangat indicated no relevant conflicts of interest.