Day 1 :
Keynote Forum
Pham Thi Viet Huong
Vietnam National Cancer Hospital, Vietnam
Keynote: Keynote Speaker
Time : 09:30-10:15
Biography:
Pham Thi Viet Huong is currently researching on Pediatric Oncology and curing cancerous children patients. She has passion in presenting rare cases publicly in the field of Pediatric Oncology in an attempt to increase awareness amongst the field and improve management guidelines in such cases.
Abstract:
Summary: Acute lymphoblastic leukemia (ALL) is the most common type of cancer in children. Cholestatic jaundice is an unusual presentation of ALL. It is even rarer to be caused by involvement of the pancreas resulting in obstructive jaundice.
Purpose: Describing obstructive jaundice secondary to a pancreatic involvement in childhood mature B cell ALL.
Object: A four years old girl who had been diagnosed as mature B cell ALL in pediatric oncology department, Vietnam National Cancer Hospital.
Result: Pancreatic involvement is rare, obstructive jaundice as secondary and pancreatic mass as a primary presentation has not been reported, only in some case reports. Primary result of treatment by FAB LMB 96 protocol is statistically satisfied.
Conclusion: This is a rare clinical case of mature B cell ALL in children with very severe conditions. Exact diagnosis results in successful treatment.
Biography:
Roopam Jain has completed his MD, DNB, DCP, MNAMSP from Diplomate of National Board University and Saurashtra University and Postdoctoral Certification from NBE in Transfusion Medicine. He is the Associate Professor in R D Gardi Medical College in Ujjain in India, a premier Tertiary Teaching Hospital in India. He has published one book on Thalssseimia and more than 28 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Background: The development of alloantibodies complicates transfusion therapy in all multiply transfused patients including thalassemia, hemato-onco patients etc. Alloimmunisation to red cell antigens is one of the most important immunological transfusion reaction and causes delayed type of transfusion reaction. Increasing red cell transfusion requirement, iron deposit and development of alloantibodies complicates transfusion therapy in Hhemato-onco patients.
Aims: (1) To investigate the frequency and distribution pattern of various types of irregular red cell alloantibodies in Hemato-oncology patients and (2) To determine the rate of development of red cell alloantibodies in Hemato-onco patients.
Methods: A prospective study was conducted from January 2008 to December 2015 at three diffirent centre of india. Purposive sampling was done and all patients diagnosed to have thalassemia major were included in the study. 78 diagnosed thalassemia major patients were included in this study and samples collected and investigated for the development of alloantibody to red cell antigens by using matrix gel system. Five to seven ml of blood was collected in plain tube and serum was separated. Separated serum was taken in two aliquots, labeled properly and stored in two different boxes at -30 ℃ in deep freezer, till the antibody screening and identification performed. Tests for antibody screening and identification were performed on preserved sample to investigate prevalence of red cell alloimmunization by standardized laboratory techniques by same person. Antibody screening was carried out on serum employing commercial three-cell panel using standardized blood bank techniques. If patients were found to have an irregular red cell alloantibody then the antibody identification was performed using commercial 11 cell panel cells.
Results: A total of 100 patients were included in the study. 53 patients were males and 47 females. Mean age was 10.83 years. Irregular red cell alloantibodies were found in 9 (9%). Mean age of patients who developed red cell alloantibody was 7.9 years. Three (33.3%) patients developed anti-D while two (22.2%) had non-specific antibody. One patient each developed anti-K (11.1%) and anti-E (11.1%). Two had anti-D (11.1%) and anti-C while the other one (11.1%) developed anti-E and anti-K.
Conclusion: Red cell alloimmunisation should be kept in mind in the patients receiving multiple transfusions. We concluded that there is relatively high rate of alloimmunization in our set of patients when compared to data from our region. In present study, alloimmunisation rate was 9%. Mean transfusion duration in these patients was 22.18 days, probably due to presence of alloantibody. We also suggest that red cell alloimmunization should not be overlooked in patients receiving regular blood transfusion. RBC alloantibody detection on regular interval and antibody negative blood transfusion is strongly recommended in transfusion dependent hemato-onco patients.
Keynote Forum
Samuel Reynolds
Univeristy of Louisville School of Medicine, United States
Keynote: Keynote Speaker
Time : 11:15-12:00
Biography:
Samuel B Reynolds has completed his MD from the University of South Florida. He is currently in his first year of Internal Medicine residency training at the University of Louisville, School of Medicine. He has published numerous manuscripts in the field of both oncology and general medicine and plans to pursue advanced training in Hematology and Oncology following residency.
Abstract:
A 59 year-old male with no prior history of coagulopathy presented to the hospital with recurrent gastrointestinal bleeding. Diagnostic studies revealed creatinine of 3.13 g/dL, hemoglobin of 6 g/dL, platelets of 106,000/microliter and INR of 3.3, with bleeding gastric and duodenal ulcers on endoscopy. Mixing studies identified coagulation factor deficiency, low direct factor X and factor X activity <2%. Serum protein electrophoresis showed no monoclonal protein, but serum kappa/lambda free light chain ratio was elevated at 174.78. Bone marrow biopsy demonstrated 20-50% atypical plasma cells and absent high risk cytogenetics by FISH. Diagnosis was made as stage III multiple myeloma with acquired factor X deficiency. Treatment involved bortezomib, dexamethasone and factor X infusions, followed by melphalan autologous stem cell transplant. By day 40 post-transplant, patient achieved independence from factor X infusions. Bleeding occurs in up to 15% of patients with multiple myeloma, but is rarely the presenting symptom. Factor X deficiency, defined by Factor X activity <10%, develops in <5% of patients with plasma cell dyscrasias. Pathogenesis involves formation of complexes between para-proteins and clotting factor X, which are then cleared by the renal and reticuloendothelial systems. Presentation features bleeding in the brain, joints and mucosal surfaces. Laboratory workup typically shows elevated PT, aPTT and normal bleeding time. Mixing with normal plasma corrects factor X deficiency, and factor X assay demonstrates decreased antigenic and functional factor X. Based on retrospective data, induction chemotherapy followed by high-dose melphalan autologous stem cell transplant can successfully treat Factor X deficiency.
Keynote Forum
Thipaporn Jaroonsirimaneekul
Khon Kaen University, Thailand
Keynote: Speaker
Time : 12:00-12:30
Biography:
Thipaporn Jaroonsirimaneekul has completed her M.Sc. (Clinical Pathology), B.Sc.(Med.Tech) from Mahidol and Khon Kaen university, respectively. She is a medical technician specialist in All blood transfusion science; HLA, genotyping, serology, etc. At present, her position is the head of blood components preparation in Blood Transfusion Centre, faculty of Medicine, Khon Kaen University, Thailand
Abstract:
Introduction: Quality assurance of white blood cells (WBC) depletion require in QC blood products. Inline filter and automate centrifuge (Reveos-system) produce the leuko-depleted blood product in routine, therefore we need the new method for WBC counting, to assure the blood products.
Objective: To count WBC in leukocyte depleted red blood cell (LD-PRC) from inline filter or Reveos blood bag and leukocyte depleted pooled platelet concentrates (LD-PC).
Method: At least 1% were sampling from total units of LD-PRC (N=20) and LD-PC (N=12) in routine unit for WBC enumeration within 6-8 hours after collection. The WBC in samples was stain by fluorescent dye, use LED excitation and CCD detection technologies makes the WBC analysis result.
Result: Residual WBC in LD-PRC and LD-PC are 0.26+0.21 and 0.23+0.12x106 cells /unit (X+SD), respectively. The maximum WBC residual in both products are 0.47 and 0.35x106 cells/unit. The waiting time for results interpretation was almost 8 minutes per test.
Conclusion: The leuko-depleted blood product in blood transfusion centre, faculty of medicine, Khon Kaen University are accepted by standard of American Associated of Blood Transfusions (AABB) and European Standard, by the new standard of automatic residual leukocyte counting (rWBC-ADAM). And the technique was easy to use and effective in routine.
- Hematology Oncology | Blood Transfusion | Blood and Blood disorders | Bone Marrow Transplantation | Advanced Treatment and Research in Hematology | Artificial Intelligence techniques in Hematology Oncology | Pediatric Hematology
Location: Sydney, Austrlia
Chair
Thipaporn Jaroonsirimaneekul
Khon Kaen University, Thailand
Session Introduction
Thipaporn Jaroonsirimaneekul
Khon Kaen University, Thailand
Title: Enumeration of residual white blood cells in leuko-depleted blood products
Time : 12:00-12:30
Biography:
Thipaporn Jaroonsirimaneekul has completed her M.Sc. (Clinical Pathology), B.Sc.(Med.Tech) from Mahidol and Khon Kaen university, respectively. She is a medical technician specialist in All blood transfusion science; HLA, genotyping, serology, etc. At present, her position is the head of blood components preparation in Blood Transfusion Centre, faculty of Medicine, Khon Kaen University, Thailand
Abstract:
Introduction: Quality assurance of white blood cells (WBC) depletion require in QC blood products. Inline filter and automate centrifuge (Reveos-system) produce the leuko-depleted blood product in routine, therefore we need the new method for WBC counting, to assure the blood products.
Objective: To count WBC in leukocyte depleted red blood cell (LD-PRC) from inline filter or Reveos blood bag and leukocyte depleted pooled platelet concentrates (LD-PC).
Method: At least 1% were sampling from total units of LD-PRC (N=20) and LD-PC (N=12) in routine unit for WBC enumeration within 6-8 hours after collection. The WBC in samples was stain by fluorescent dye, use LED excitation and CCD detection technologies makes the WBC analysis result.
Result: Residual WBC in LD-PRC and LD-PC are 0.26+0.21 and 0.23+0.12x106 cells /unit (X+SD), respectively. The maximum WBC residual in both products are 0.47 and 0.35x106 cells/unit. The waiting time for results interpretation was almost 8 minutes per test.
Conclusion: The leuko-depleted blood product in blood transfusion centre, faculty of medicine, Khon Kaen University are accepted by standard of American Associated of Blood Transfusions (AABB) and European Standard, by the new standard of automatic residual leukocyte counting (rWBC-ADAM). And the technique was easy to use and effective in routine.
Malinee Meesaeng
Khon Kaen University Thialand.
Title: Irradiated Blood for Transfusion Malinee Meesaeng, Khon Kaen University,
Time : 12:30-13:00
Biography:
Malinee Meesaeng is currently working in the field of Hematology and she pursued Degree at the Khon Kaen University Thialand.
Abstract:
Introduction: Blood and blood components are irradiated prior transfusion to prevent the proliferation of certain types of T lymphocytes that can inhibit the immune response and cause graft-versus-host disease. This procedure is necessary for transfusion recipients at risk for GVHD, including fetuses receiving intrauterine transfusions, select immunocompetent or immunocompromised recipients, patients undergoing hematopoietic transplantation, individuals receiving platelets selected for HLA or platelet compatibility, and individuals receiving units from blood relation.
Method: The data for blood components which requested irradiated was collected in 2017. All data are divided into diagnosis and type of components.
Result: 1,751 requested irradiated blood components were: pediatric, thalassemia, newborn, stem cells transplant, intra-uterine and other; 1001, 236, 264, 106, 31 and 113, respectively. Total of units for irradiated are 2.377 units (LDB=1.039 u, LPRC=609 u, SDP=617 u, RDP=65 u, LPPC=47 u), none of PRC.
Conclusion: Blood transfusion centre, faculty of medicine, Khon Kaen University can afford the irradiated blood components for patients in Srinagarind Hospital and another hospital in nearby area.
Nuanchan Mungkhunkhamchaw
Khon Kaen University, Thailand
Title: Pooled Cryoprecipitate Ready to use
Time : 14:00-14:30
Biography:
Nuanchan Mungkhunkhamchaw has completed her BSc (Transfusion Science) from Mahidol University, Thailand. She is the Supervisor in blood components preparation at Blood Transfusion Centre, Faculty of Medicine, Khon Kaen University, Thailand.
Abstract:
Introduction: The pooled component represents a source of concentrated FVIII:C, von Willebrand factor, fibrinogen, FXIII and fibronectin from primary cryoprecipitate components derived from units of fresh frozen plasma. Plasma should be selected from male donors or consideration should be given to screening female donors for HLA/HNA antibodies, as a TRALI risk reduction measure. For storage, cryoprecipitate pooled should be rapidly frozen to a core temperature of –25 ℃ or below within 2 hours of preparation.
Method: Cryoprecipitate was prepared by standard conventional method the male unit was selected for re-suspend cryoprecipitate 120-150 mL per pool. Five to six iso-blood group were pooled by connecting device within 5 minutes. The pooled cryoprecipitate were rapid frozen by -50 ℃ blast. The evaluated of pooled were determine for factor VIII and fibrinogen.
Result: Pooled cryoprecipitate from 5 units by A, B, O blood group were determination of factor VIII and fibrinogen found 109/282, 136/358 and 70/288, respectively. Six units pooled were found 113/342, 139/318 and 78.5/259, respectively. Pooled no group five units in plasma B and AB were found 143/400 and 114/400.
Conclusion: Pooled cryoprecipitate seem useful for routine. The yield of Factor VIII are acceptable in A, B and AB. Blood group O is recommend for better mix with other group and should be resuspend in plasma B or A.
- Hematology Oncology | Blood Transfusion | Blood and Blood disorders | Bone Marrow Transplantation | Advanced Treatment and Research in Hematology | Artificial Intelligence Techniques in Hematology Oncology | Pediatric Hematology
Location: Syndey, Australia
Chair
Thipaporn Jaroonsirimaneekul
Khon Kaen University, Thailand
Session Introduction
Shaoguang Li
University of Massachusetts Medical School, United States
Title: Targeting Chronic Myeloid Leukemia Stem Cells
Biography:
Shaoguang Li has obtained his PhD degree from Tulane University, USA and completed his postdoctoral studies at Harvard Medical School. He is currently a Professor at University of Massachusetts Medical School, USA. He has published some seminal work related to leukemia stem cells in highly competitive journals such as Nature Genetics, JCI, PNAS, Blood, Leukemia, etc.
Abstract:
Cancer stem cells in many hematologic malignancies and some solid tumors are associated with cancer initiation and insensitivity to chemotherapy and need to be eradicated for achieving a cure. A successful cancer therapy relies on targeting critical signaling genes that play a key role in the maintenance of cancer stem cell survive and proliferation. Thus, it will be important to fully understand the molecular mechanisms by which cancer stem cells survival and proliferate. Toward this goal, a physiological cancer stem cell disease model is required for identifying and testing genes/pathways that play an essential role in functional regulation of cancer stem cells and can be targeted for eradicating these stem cells. Human chronic myeloid leukemia (CML) induced by the BCR-ABL oncogene is derived from a stem cell, serving as a good disease model for studying the molecular biology of cancer stem cells. In CML, BCR-ABL tyrosine kinase inhibitors including imatinib mesylate (Gleevec) are highly effective in controlling chronic phase CML, but they fail to eradicate leukemia-initiating cells or leukemia stem cells (LSCs) in CML mice and patients. Clinically, a complete and sustained molecular remission (undetectable levels of BCR-ABL transcripts) is difficult to attain even after a complete cytogenetic remission achieved through imatinib treatment. It has become clear that BCR-ABL kinase inhibitors can effectively kill highly proliferating leukemia cells but are incapable of eradicating LSCs for cure. An anti-LSC strategy needs to be developed. Our laboratory has been focusing on understanding the biology of LSCs in CML to identify key genes that regulate survival and proliferation of LSCs, helping us to develop new therapeutic strategies by targeting LSCs.
Yu-Chen Enya
University of Queensland Diamantina Institute, Australia
Title: Activation of FcγR-dependent responses to therapeutic antibodies by Nurse Like cells requires PI3Kδ
Biography:
Yu-Chen Enya Chen is pursuing her PhD degree at University of Queensland. She has published a review paper as first author in BBA Cancer Review 2017 (Chen et al.). Her PhD project so far has presented an interesting study towards the understanding of the antibody resistant of patients with progressive chronic lymphocytic leukemia disease.
Abstract:
Antibody therapies for treating chronic lymphocytic leukemia (CLL) remain a challenge for many CLL patients who are insensitive to antibody treatment. A high percentage of CLL patients that are resistant to the current combination therapy of chemotherapeutics and immune-therapeutics have always been a clinical challenge. Understanding the mechanisms driving disease progression and treatment resistance is key to improving patient outcomes. Many studies including our own laboratories have shown that resistance to therapeutic antibodies against CLL is due to the survival signals from the monocyte derived macrophages (MDMs) and also an acquired resistance of monocyte derived macrophages to participate in FcγR-dependent anti-tumor responses. However, the FcγR-dependent signaling pathway in macrophages has not been well studied. Our recently published data suggested that SYK and BTK are involved downstream of FcγR-dependent signaling pathway. In this study we investigate the involvement of PI3K isoforms as they have been known to be an important pathway regulator for cellular function in various immune cells such as T cells, B cells and NK cells as well as in cancerous cells. To examine the expression and involvement PI3K isoforms in contributing to FcγR-dependent ADCC by MDMs, we used different inhibitors to specifically target each PI3K isoform at a time to investigate the effect on ADCC responses by MDMs. Examination of PI3K expression showed that PI3Kα, β and δ are expressed in MDM whereas PI3Kγ is below the limit of detection. We also reported that the PI3Kδ-selective inhibitor, idelalisib and the pan PI3K inhibitor BKM120 (Buparlisib) were able to inhibit ADCC in response to the CD20-targeting therapeutic antibody, obinutuzumab. Similarly, both buparlisib and idelalisib were able to inhibit AKT phosphorylation at concentrations that also inhibited ADCC. This is the first report to show that PI3Kd is involved in FcgR signaling in MDMs from CLL patients or in MDMs from any tumor type. Based on these findings we conclude that PI3Kd is a critical effector molecule for anti-tumor responses to therapeutic antibodies in CLL.