Allogeneic Stem Cell Transplantation

Forum Chairs

Frederick R.
Applebaum
,
MD
Fred Hutchinson Cancer Center

Forum Description

The Forbeck Forum 2000 relates to the high dose drug therapy, treatment so toxic that it requires a bone marrow transplant to rescue the patient’s blood system. The graft of bone marrow can come from two sources. It is possible to harvest components of the blood system directly from the patient before therapy and give it back when treatment is completed. This is called autologous transplantation. The alternative (allogeneic transplantation) is to find an individual to make the donation of blood cells. This process has been difficult as finding an appropriate donor is not easy because tissues have to be matched with specific markers on the cell surface, otherwise rejection occurs. However, in the case of grafts of bone marrow cells it is now possible to undertake mis-matched grafts, making the procedure more useful. Allogeneic transplantation of bone marrow cells has some advantages. In some instances, cells in the graft can produce an immune response to attack the patient’s tumor cells. Unfortunately, this response can also affect normal tissues creating a very severe problem called graft versus host disease. In the past we have not been able to separate the anti tumor response from the cells that attach on the body, but now this situation is changing. It is likely that we will soon be able to manipulate allogeneic grafts to only kill the cancer cells, with an effectiveness which is greater than that achieved with drug therapy. This whole field is exploding as it now offers hope for the treatment of cancers which do not respond well to current therapies. Bringing together a group of scientists and clinicians to drive this process forward will be very exciting.

Forum Summary

The Forum focused on the topic of allogenic stem cell transplantation. Participants included experts in stem cell biology, scientists interested in experimental models of transplantation and tumor immunology, clinical researchers, and population scientists. The general mood of the meeting was one of considerable excitement and optimism. The mood was created by the general agreement that for perhaps the first time we now have the necessary knowledge and most of the tools to harness the enormous power of the human immune system in the fight against cancer.

Irv Weisman opened the meeting with an outstanding talk about the nature of the hematopoietic stem cell. In addition to elucidating many principles about the behavior of the stem cell relevant to clinical transplantation, Irv presented some extraordinary information about how hematopoietic stem cells can actually transform into liver cells and about how neural stem cells might be used to treat devastating neurological diseases.

Peter Landsdorp continued the discussion on stem cells presenting new data about how stem cells age, how we can monitor their health, and how this information might impact both the safety of transplantation and predict for the development of hematologic malignancies.

Crystal Mackall presented data about how the stem cell goes about forming a new immune system and what might be done to assist this process, which is a central issue to the health of patients following transplantation. Following marrow transplantation, there is a powerful immunologic effect of the graft against the patient’s malignancy. However, this effect is often accompanied by the development of graft-versus-host disease which can be a serious or even lethal complication of transplantation.

Robert Korngold, Bruce Blazar, and Paul Martin each presented different experimental approaches to overcome the difficult problem of graft-versus-host disease. All three presented exciting and encouraging data that will need to be pursued in clinical trials.

Megan Sykes and Richard Champlin provided clinical data describing the process of non-ablative transplants, an approach that is revolutionizing the process of allogenic hematopoietic stem cell transplantation. Contrary to conventional wisdom, investigators have found that it is possible to achieve complete engraftment of donor marrow without first treating patients with extraordinarily high and dangerous doses of chemotherapy. By achieving grafts with relatively non-toxic specific immunosuppression, transplantation is finding a much wider audience, both in terms of the age and health of the patient as well as the variety of diseases under treatment.

Stan Riddell and Richard O’Reilly presented exciting new information on how one can isolate immune competent cells with activity restricted to tumor and how this extraordinarily promising method of treatment is now being used clinically. John Goldman and Guido Tricot outlined the major questions that need to be addressed in the application of transplantation to several specific diseases, including chronic myelogenous leukemia and multiple myeloma.

Mary Horowitz provided information about the still surprisingly limited access that patients have to transplantation, and outlined a number of barriers to the wider application of transplantation and to the performance of the clinical trials necessary to continue the progress we have made in this field.

In addition to these uniformly outstanding scientific presentations, the three Forbeck scholars, Philip Beckhove, Francesco Galini and Catherine Ju-Ying Wu gave talks that were at almost the same level as the senior scientists. Their level of enthusiasm and accomplishment were a pleasure to witness.

The participants were unanimous in their belief that it should be possible in the near future to isolate a relatively pure population of hematopoietic stem cells, to transfer them from a healthy donor to the patient, and to educate the immune system of the donor to attack and in many cases eradicate the patient’s malignancy. As demonstrated by the investigators at this forum, this can now be done in relevant animal models of human disease and all the tools are now available to apply these principles to patients.

The participants of the meeting also emphasized some of the barriers to the performance of such large cooperative studies. One such barrier id the lack of generally agreed upon endpoints for such trials. To this end, all participants were excited and gratified to learn of the Forbeck’s willingness to support a Forum to be co-chaired by Dr. Horowitz and Dr. Martin to define such endpoints. This news was a fitting ending to an exciting two days which began with the definition of the true stem cell and concluded with a discussion of how this technology can and should be used to the benefit of tens of thousands of individuals each year. All participants were deeply grateful to the Forbeck Foundation for allowing us to have these terrific several days.

Foundation Supports Follow Up Meeting
During the 2000 Forbeck Forum, the Foundation received a request from participant Dr. Mary Horowitz regarding the need for a meeting to deal with specific issues relating to Clinical Trials in Hematopoietic Stem Cell Transplantation. The Foundation agreed to fund a 1-day meeting in February, 2001 in Keystone, CO, tailgating to another meeting no bone marrow transplantation. Paul Martin, also a Forum 2000 participant, was a co-organizer of the meeting. (This is reported under the section ‘Focus Meetings’).

Venue & Travel Information

Hilton Head Island

Travel Forms

TRAVEL FORMS DUE:
November 1, 2000
submit travel form

Travel Policy

Please familiarize yourself with our policies and procedures for travel. We truly appreciate you taking the time to participate in this meeting. As you make your plans, please remember that we are a nonprofit organization dependent on donations and volunteers. We do NOT pay for upgrades, change fees, incurred costs resulting from a flight change, transportation to or from your local (home side) airport, meals or other incidentals.

  • Travel Confirmation will be sent out within 1 week of the meeting. This will include a hotel confirmation number, if there is one, and airport transfer details. We have to wait until we receive almost everyone’s travel to book airport transfer. Due to frequent airline changes, we wait until the week of the meeting to send this out.
  • Airport transfer is provided by Foundation staff, volunteers or arranged shuttle at specific times. If you opt to utilize Foundation airport transportation on your travel form, please be patient in receiving this information. We will send it to the week of the meeting.
  • Speaker agenda is not sent out prior to the meeting. It will be provided upon arrival in the meeting packet. We do not tell people when they are speaking because we expect everyone to attend all sessions. Sessions are all day Friday and Saturday.
  • REMINDER: We do not reimburse for home side airport transfer or incidentals while traveling. We will not honor miscellaneous receipts sent for these expenses.
  • Spouses are welcome to come with you at their own cost but are not allowed to attend the meeting. Please no children.

What the Foundation Pays

Accommodations and meals are provided by the foundation during the meeting. Airfare will be covered only if booked through our travel agent. The Foundation will also cover airport transportation on the meeting side at the designated shuttle times. You can select not to utilize Foundation arranged transportation at your own expense when completing the travel form. Once your travel form is received your accommodations and airport transfer will be confirmed. Please let us know of any food allergies or other information we should be aware of on the travel forms.

  • If you would like your airfare covered by the Foundation, you must book with our travel agent. Note we do not cover upgrades, changes, late bookings, etc.
  • Flights must be booked at least 30 days prior to the meeting to confirm your accommodations and airport transfer.
  • As a nonprofit we utilize volunteers and other methods to maximize our efforts (or our donor support) when making accommodations and arranging ground transportation. Ground transportation will be provided upon your arrival either by a foundation volunteer or arranged shuttle. You will be provided airport transportation information the week of the meeting. We do not reimburse for home side airport transfer or incidentals while traveling.

Abstracts

Abstracts are due 30 days prior to the start of the meeting to allow enough time to prepare the meeting book.

The abstracts should be only one or two paragraphs outlining the theme of your presentation and should reflect the objective and spirit of the meeting (see above). Abstracts will be circulated about one week before the meeting. The meeting organizer will start requesting them a month before the meeting.

abstracts DUE:
November 1, 2000
submit abstract

Meeting Structure

The meeting structure has been developed over years of experience.

  • Participants have approximately 45 minutes, depending on the number of participants, for their presentation and discussion. The presentation is meant as a conversation start and should last about twenty minutes briefly covering background information and areas that are new or need further input. This should be structured in such a way as to lead to a lively discussion. Participants are encouraged to interrupt to ask questions or start discussions.
  • A MAXIMUM of 5 slide equivalents per presentation is allowed (Power point slides should not contain more than one graph or gel per slide and no more than 5 bullet points to stress the points being made by the presenter.) We appreciate cooperation with the spirit of this guideline. Handouts are welcome but should be distributed before sessions.
  • Everyone is expected to actively participate in every session and discussions.
  • The time spent at the meeting is relatively short, so please be familiar with papers received prior to the meeting.
  • It is very important that you commit to all sessions of the 2 days of meetings.

Forbeck Scholars Participation

Scholars are selected for each Forbeck Forum. These are outstanding junior clinical or post-doctoral fellows selected based on the quality and relevance of science.

  • Scholars present for 30-45 minutes, depending on the number of participants
  • The same presentation rules apply for scholars
  • After the Forum you are selected to attend, you will attend three years of Scholar Retreats held in Lake Geneva, WI. If you attend a Fall Forum, you will attend the Spring Retreat. If you attend a Spring Forum you will attend a Fall Retreat.
  • Scholars are selected by the Foundation Scientific Advisory Board and peer reviewers selected from past Forbeck Scholars.

General Program

The outline below illustrates a typical program schedule. You will receive a complete schedule, including speaking times, the Thursday the meeting starts.

Arrival Day
1:00 PM Arrivals
6:00 PM Cocktails (opt'l)
7:00 PM Dinner
Meeting Day 1
7:00 AM Breakfast
8:00 AM Scientific Sessions
12:00 PM Lunch
1:30 PM Scientific Sessions
6:00 PM Cocktails & Dinner
Meeting Day 2
7:00 AM Breakfast
8:00 AM Scientific Sessions
12:00 PM Lunch
1:30 PM Scientific Sessions
6:00 PM Cocktails & Dinner
Departure Day
7:00 AM Breakfast
8:00 AM Departures

Frequently Asked Questions

Below are some of our most Frequently Asked Questions. If you have something new to ask, please feel free to contact us.

  • Travel Confirmation will be sent out within 1 week of the meeting. This will include a hotel confirmation number, if there is one, and airport transfer details. We have to wait until we receive almost everyone’s travel to book airport transfer. Due to frequent airline changes, we wait until the week of the meeting to send this out.
  • Airport transfer is provided by Foundation staff, volunteers or arranged shuttle at specific times. If you opt to utilize Foundation airport transportation on your travel form, please be patient in receiving this information. We will send it to the week of the meeting.
  • Speaker agenda is not sent out prior to the meeting. It will be provided upon arrival in the meeting packet. We do not tell people when they are speaking because we expect everyone to attend all sessions. Sessions are all day Friday and Saturday.
  • Frequently airport transfer is provided by volunteers. Please be patient on receiving this information. Airport transfer will be sent out prior to arrival.
  • REMINDER: We do not reimburse for home side airport transfer or incidentals while traveling. We will not honor miscellaneous receipts sent for these expenses.

Forum Participants

Bart
Barlogie
,
MD
University of Arkansas
Bruce
Blazar
,
MD
University of Minnesota
Richard
Champlin
,
MD
MD Anderson Cancer Center
John
Goldman
,
MD, FRCP
Imperial College School of Medicine
Mary M.
Horowitz
,
MD
Medical College of Wisconsin
Robert
Korngold
,
PhD
Jefferson Medical College
Peter
Landsdorp
,
MD, PhD
The Terry Fox Laboratory
Crystal
Mackall
,
MD
National Institutes of Health
Paul
Martin
,
MD
Fred Hutchinson Cancer Research Center
Richrd J.
O'Reilly
,
MD
Memorial Sloan-Kettering Cancer Center
Stanley
Riddell
,
MD
Fred Hutchinson Cancer Research Center
Megan
Sykes
,
MD
Columbia University
Guido
Tricot
,
MD, PhD
University of Arkansas for Medical Science
Irv
Weissman
,
MD
Stanford University

Forum Scholars

Philip Beckhove, MD, PhD
National Center for Biotechnology Information
Francesco Galimi, MD, PhD
University of Sassari Medical
Catherine Ju-Ying Wu, MD
Dana-Farber Cancer Institute