My dear colleagues,
Shakespeare, in All’s Well That Ends Well, counsels that we should “Love all, trust a few, do wrong to none.” [ Act I.i] As I write this, my last column as your president, I realize that there is no ending approaching (despite the portents and rumblings) but that this column is an appropriate occasion for reflection about the current and future of our Society.
I have tried in the past year to live by the words of the above quote. Love. I can say after this past year that my love for this Society and all it represents is deeper, as is my appreciation for its diverse, talented and dedicated membership. Our members face some of the most challenging diseases and difficult clinical scenarios in modern medicine and perform small and large miracles daily. Trust. I have absolute trust in ASBMT volunteer leaders who so wonderfully represent all of you, from the leaders of our SIGs, task forces and committees to the Board of Directors, Executive Committee and other volunteer scientific and editorial leaders. Do wrong to none. As Hippocrates also advised, I am often mindful to do no wrong to this proud organization. While taking chances, I believe we have succeeded in leaving it more secure and better poised to face its future.
What have we accomplished in the past year? While the best answer is “not enough” I am pleased that we did some measurable good. As we mark our silver anniversary in Salt Lake City, we will reflect on the progress of the past quarter century while trying to glimpse our future. In the past year, ASBMT members have contributed scientifically to new FDA approvals across the spectrum of hematopoietic transplantation and adoptive immunotherapy. One example of our impact is the remarkable achievement of seeing each of last year’s Tandem17 Late Breaker abstracts yielding publications in the NEJM, with all three presentations reflecting practice-changing studies. Critically, our members led scientific and clinical studies that led to approvals of engineered T cell therapies for pediatric acute leukemia and adult lymphoma. We performed studies that resulted in the first human gene therapies, the first antiviral agent for CMV prophylaxis after HCT, the first approval of a drug to treat graft-versus-host disease and a critical affirmation of autologous transplantation as a treatment for systemic sclerosis.
I am happy to say that the Society has embraced not only the scientific foundations of these transforming advances, but also reacted to their seismic impacts. This has included taking a leading position in defining clinical standards for immune effector cell therapies and also helping to create the infrastructure for coding, regulatory safety and reimbursement. By developing a formal health policy program within the ASBMT, we have better advocated for our clinicians and our patients to increase their access to a broader range of cell therapies. Significant challenges still need to be addressed as these therapies are unprecedented in cost and as reimbursement frameworks have not yet evolved to create sustainable health systems. This means that patients who could be cured by these therapies are not yet guaranteed the access and coverage they deserve. But I am proud of our ongoing efforts with our partners (including CIBMTR, FACT, ISCT, Be The Match, ASH, ASCO and others) to address the many challenges that remain.
In addition to our nascent health policy efforts, I am happy to report that our ASBMT leadership has been working hard behind the scenes to create a new management framework that should prepare us for the next 25 years. Following careful self-reflection, we decided to transition to new association management and recently finalized an arrangement with SmithBucklin, a leading association management company who will provide new resources and directions to support our membership and our broad efforts. We are grateful to our staff at Executive Administration, Inc (EAI) for their dedicated service in the past year including their gracious support for this critical transition.
This past fall, our Board also began a critical strategic planning process that will be completed later this year once critical members of our new management team are in place. This will result in a redefinition of our vision and goals and will help define the structure, tactics and financial commitments needed to ensure our continued growth and impact. I am very pleased that John DiPersio, an accomplished and thoughtful scientist and clinician, will lead the ASBMT as your next president during this critical process. The input of members with diverse interests and needs will be critical, and we look forward to hearing from you as we redefine our scientific, clinical and policy priorities.
While we have made progress, I recognize how much work remains to be done. Despite the approvals I mentioned above, we are still far from reliable cures, either through HCT or T cell therapies, for most patients we see. Even the approvals for CMV prevention and GVHD therapy have been meaningful but incomplete advances leaving need for further progress. Profound uncertainty remains about basic questions of conditioning intensity and graft choice and how to selectively suppress alloreactivity while limiting relapse. While we have made great scientific progress, we must also admit too few of these advances have translated to daily practice. While we have established SIGs focused on palliative and supportive care, health economics and infectious diseases, these and other areas of research remain underdeveloped despite their importance. We have also done little to strengthen a collapsing funding environment for basic science. And while there are some encouraging signs (e.g., a record number of ASBMT New Investigator Award applications) I remain concerned about the numbers of clinicians and especially scientists who will replace our aging membership and carry our torches forward.
With these caveats, I am sincerely optimistic about the future of hematopoietic transplantation and cellular therapy, and the critical role of the ASBMT in advancing science and patient care in these disciplines. It has been the greatest privilege of my career to serve as your president, and I am profoundly thankful for your support and for the lasting friendships I’ve made in your service. I look forward to continuing to support our talented Executive Committee and Board in the coming year, including our new board members Vice-President Pavan Reddy and new Board Members Stephanie Sarantopoulos, Bipin Savani and John Koreth.
As the Bard also reminded us in Macbeth [Act V.v], “Life’s but a walking shadow.” I’m confident that all of us in the ASBMT will use our relatively brief hour upon the stage to make the world of cellular therapies a better place, for our members, our communities and most of all our patients.
With appreciation,
Krishna