Frontiers in Medicine

9:15–9:45 a.m.

Manipulating the Microbiome: Potential Future Applications, David F. Mercer, MD, PhD, FRCS(S), Nebraska Medicine

The human microbiota has attracted attention as one of the most intriguing and underexplored areas of medical research. While there have been several promising avenues for future development of the microbiome, microbial replacement therapies will likely become standard practice as we further understand the possibilities, limitations, and implications of the microbiome. This session will discuss human microbiome and the role of microbiota and its new clinical applications.

Learning Objectives:

1. Describe the influence of the gut microbiome on human physiology and health and its potential future applications.
2. Provide a state-of-the-art review of fecal microbial transplantation (FMT) as to its present FDA-approved indications and potential future applications.

9:45–10:15 a.m.

Hand Transplantation: Developing an Innovative Therapy, Linda C. Cendales, MD, Duke University Medical Center

The first successful hand transplantation took place in 1998 and since this time there have been close to 100 such operations performed. In 1999, Dr. Cendales, the only hand transplant surgeon in the U.S. trained in both hand and microsurgery and hand transplantation, helped organize the team that performed the first U.S. hand transplant. During this presentation, Dr. Cendales will provide an overview of the history of hand transplantation, which, like other forms of organ transplantation, is a major surgical procedure requiring lifelong immunosuppression to prevent rejection of the transplanted hand.

Learning Objectives:

1. Identify the steps followed to establish a hand transplant program.
2. Provide an overview of this highly complex procedure and the interprofessional team that are involved in the process.
3. Evaluate the future of hand transplantation as a therapeutic option after loss of one or both hands.
4. Discuss patient selection and current state of hand transplantation.

10:45–11:30 a.m.

Understanding Myeloma Genetics May Lead to Individualized Therapies, Brian Van Ness, PhD, University of Minnesota Cancer Center; Jenny Ahlstrom, Myeloma Crowd and CrowdCare Foundation

The treatment of multiple myeloma (MM) is complex because of rapid advances in stem-cell transplantation, medications, and better supportive care, all of which have led to improved patient survival. Overall, the care of patients should focus on treatment of the disease process and any associated complications. The diagnostic criteria for and management of MM in the updated 2016 NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) broadens the population of patients eligible for therapy by expanding the active myeloma category and also integrating novel therapies at all stages of the disease. Dr. Van Ness will review current and new therapeutic approaches for the treatment of MM and will address the challenges that exist in the treatment of this disease. He will also identify genetic approaches to characterize variations in tumor progression and will address how to determine the best therapy to maximize effectiveness and response for each individual patient.

Learning Objectives:

1. Describe current therapeutic approaches in the treatment of multiple myeloma (MM).
2. List some of the challenges that exist in the treatment of MM.
3. Identify genetic approaches to characterize variations in tumor progression and response.
4. Discuss ways of determining which therapies work best for each individual.
5. Describe the role of using genetics and bioinformatic tools to identify individual tumor signatures of response or resistance.

The Myeloma Crowd and CrowdCare Foundation were created by Jenny Ahlstrom after she was diagnosed with myeloma. On realizing that less than 5 percent of patients joined clinical trials, she started Myeloma Crowd Radio and began interviewing myeloma experts who share the latest research and open clinical trials in patient-friendly language in order to encourage participation in clinical trials. She has now held over 80 interviews with over a million listeners/readers. During this session, Ms. Ahlstrom will discuss how Myeloma Crowd believes that educated and involved patients can drive better outcomes for themselves, be part of the solution to better care, and accelerate the discovery of a cure for their own disease. 

Learning Objectives:

1. Understand the treatment and management of an MM diagnosis from a patient’s perspective.
2. State the vital role education plays in empowering patients to participate in their treatment pathway and optimize their care.
3. Explain the potential impact of participating in a clinical trial to enable patients with MM to receive the most current treatments while assisting in research for a cure.
4. Recognize the importance of receiving treatment from a myeloma specialist versus a general oncologist.

11:30 a.m.–12:15 p.m.

Hepatitis C Virus (HCV): Treatment Guidelines to Screen and Diagnose for Optimal Management, Paul Kwo, MD, Indiana University

Chronic infection with the HCV primarily harms the liver, with liver cancer being a well-known consequence in some individuals — especially those who already have cirrhosis. Recent advances in the number and types of medications available to treat hepatitis C provide more options to consider when deciding on a treatment plan. Until a few years ago, there were only a few drugs approved by the FDA to treat hepatitis C, but newly available drugs have revolutionized treatment. These advances have made treatment regimens shorter in duration, less difficult to tolerate and more effective. This session will discuss the most recent evidence-based treatment guidelines to screen, diagnose and manage patients with HCV. Potential barriers to care will also be identified, as well as the latest pharmaceutical interventions for the treatment of HCV.

Learning Objectives:

1. Discuss the most recent evidence-based treatment guidelines to screen, diagnose and manage patients with HCV.
2. Describe the indications, rates of viral eradication and adverse reactions of the latest pharmaceutical interventions for the treatment of HCV.
3. Identify potential patient barriers to care through the use of direct-acting antivirals, including cost, fear of side effects and concern about treatment duration.

2:30–3:15 p.m.

Evolving Concepts in Cancer Immunotherapy: Prospects for a Cure, Matthew A. Lunning, DO, University of Nebraska Medical Center

In the last few decades, immunotherapy has become an important part of treating some types of cancer. Different types of immunotherapy include monoclonal antibodies, cancer vaccines, chimeric-antigen receptor (CAR) T-cell therapy and immune-checkpoint inhibitors. This session will describe the various types of immunotherapy and outline their clinical applications. The underlying principles of tumor immunology and immunotherapy will be discussed, as well as the appropriate selection of patients and the therapeutic effectiveness of immunotherapy to ultimately improve patient outcomes.

Learning Objectives:

1. Define immunotherapy and distinguish it from chemotherapy.
2. State key principles of tumor immunology and immunotherapy.
3. Analyze recent research and clinical applications of cytokines, cancer vaccines, T-cell-checkpoint inhibitors, adoptive immunotherapy, and biomarkers.
4. Recognize the importance of interdisciplinary management and improve communication with patients and colleagues about adherence to immunotherapeutic protocols and end points for therapy after achieving remission.

3:15–4:00 p.m.

Incompatible Kidney Transplantation: National Strategies and Outcomes, Dorry Segev, MD, PhD, Johns Hopkins University

The considerable shortage of organ donors and increasing number of patients with end-stage renal disease has led to an extended waiting time for potential renal-allograft recipients. ABO-incompatible kidney transplantation was previously considered to be an absolute contraindication for patients with end-stage kidney disease (ESKD) due to hyperacute rejection related to blood-type barrier. With the need to expand the donor pool and minimize shortage of kidneys for transplantation, ABO-incompatible kidney transplantation (ABOi KT) was introduced. Another way to offset the extended waiting time and shortage of organ donors is Kidney Paired Donation (KPD) as a transplant option for candidates who have a living donor who is medically able, but cannot donate a kidney to their intended candidate because the two individuals are physiologically incompatible.
This session will discuss the various approaches to matching and allocation in KPD and identify strategies for transplantation across blood barriers in ABO-incompatible kidney transplantation.

Learning Objectives:

1. Discuss the various approaches to matching and allocation in KPD.
2. Identify strategies for kidney transplantations across blood barriers.

4:00–5:00 p.m.

Age Over 70: Heart Transplant or Ventricular-Assist Device (VAD)? Joseph G. Rogers, MD, Duke University Medical Center; and Jeffrey Teuteberg, MD, University of Pittsburgh Medical Center

Dramatic advances in VAD design and patient management have made mechanical circulatory support an attractive therapeutic option for the growing pool of elderly heart failure patients. There are three major indications for the use of VADs: 1) as a bridge to transplantation; 2) as a lifelong support alternative for patients deemed ineligible for heart transplantation, or so-called destination therapy; and 3) as a bridge to myocardial recovery. One of the most controversial issues in the field of patient selection for advanced heart failure is age. Many health care professionals are reluctant to list “elderly” candidates for transplant though the cutoff age varies. In contrast, there is no absolute age cutoff for VADs, and older patients may have easier access to mechanical pumps than to donor organs. During this session, two experts will debate the point/counterpoint for VAD-versus-heart transplant for this patient population. The criteria for patient selection for transplant and VADs, long-term survival and quality of life will be compared.

Learning Objectives:

1. Debate the pros and cons of heart transplant versus VAD for patients over 70 years of age.
2. Compare the indications for and differences in long-term survival and quality of life for elderly patients with heart transplant versus mechanical circulatory support.