Shanghai Revisited: An Environment of Hope
May 21, 2012
A return visit to Asia by the IMF team of me, Susie Novis and Senior Global Analyst Dan Navid this past week was an exhilarating blur of activities that instructed, impressed and touched us deeply.
On Thursday morning we visited the sponsoring institution--Shanghai Changzheng University Hospital--with Prof. Jian Hou, head of the Myeloma Unit. Dr. Weijun Fu, one of Prof Hou's assistants, showed us the laboratory facilities. On this amazing tour we saw the SPEP/UPEP and IFE testing laboratory, then the outpatient clinic organizations.
The testing lab was in the basement and reached by an elevator packed with sick patients and family members. In the corridor we were greeted by a large picture of an electrophoresis (SP) gel (SPEP), commemorating the famous professor who established this pioneering unit in Shanghai.
Here, samples for testing arrive in a drop-off box: reports on tiny pieces of white paper are sent to the patient's chart or mailed back to the referring outlying hospital by regular post. In addition to the electrophoresis laboratory, we saw the whole range of clinical pathology laboratories plus the Blood Bank --- all with gleaming new equipment of every conceivable type.
Hundreds of Patients Lined Up for Appointments
The outpatient area of the hospital looked like New York's Grand Central Station. Literally hundreds of patients lined up for appointments in a frantic lobby area, where patients also picked up prescriptions (free with SS#) at the huge pharmacy sections.
A very efficient dedicated testing area consisted of a series of rooms in which myeloma patients had their blood tested and their bone marrow sampled (right there off the clinic), and received an immediate morphology review and FISH (chromosome) testing. About half a dozen MDs cope with 30 to 40 patients daily.
On Friday morning we headed to a Howard Johnson's Hotel--strange to see in China, but a so-called "5-star" property. There we reviewed our cooperative agreement with China - the China Health Promotion Foundation (CHPF), with whom educational activities are authorized and planned. We discussed potential upcoming activities with the leading myeloma experts in China, Prof. Wen-Ming Chen from Beijing and Prof. Hou from Shanghai.
Asian Patients Are Younger and Have Different Disease Patterns
MD investigators flew in from seven countries (Hong Kong, Taipei, Japan, Korea, Singapore, Thailand, Taiwan) to participate in our Asian Myeloma Network (AMN) meeting, which followed. Prof. Kim (on behalf of Prof. Lee and the Korean team) presented the results of our database project, which has been accepted in abstract form for presentation at both ASCO and EHA in 2012.
At the meeting there was much interested discussion about the results comparing Asian with U.S. (Mayo Clinic, for example) and European datasets. Of note, Asian patients are younger and have different disease patterns, such as more frequent plasma cell leukemia, extra medullary disease, as well as IgD type myeloma. Despite limited access to many diagnostic facilities and therapies - including, for example, auto-transplant (ASCT) in China - in many of the countries the overall survival was a very respectable 52 months. This is not too dissimilar from general outcomes elsewhere.
Plans for new clinical trials in Asia were then discussed, with specific protocol suggestions resented by Dr. Wee Joo Chng from Singapore. Active discussion ensued. There are different issues for drug access and approval in each country. Nonetheless, potential protocols in both the frontline and relapse settings were favorably received and it seems likely that with incorporation of the feedback and suggestions agreement will be reached to initiate new Asian trials - a first in the region.
Follow-up plans were made. A very enthusiastic and positive meeting.
A Lot of Contacts and Discussions Occur...Before Too Much Toasting Has Happened!
Friday evening was the opening ceremony for the 2nd Chinese Myeloma/Lymphoma Congress hosted by Prof. Hou. The 1st Congress was held in Beijing last year, hosted by Prof. Chen. This 2nd opening ceremony was a lively affair, including a gymnastic performance (think Cirque du Soleil) and the normal "toasting," which involves everyone going from table to table meeting prominent invited guests/speakers and toasting with Great Wall of China red wine. It seems that this is when a lot of contacts and discussions occur - especially before too much toasting has happened!
After an exhausting day we slept soundly to be up for an early start. I gave the lead-off lecture at 8 a.m. back at the Howard Johnson's Hotel. I was followed by a number of international guests, including Dr. Douglas Joshua (an IMWG member) from Sydney, Australia. At the first coffee break we were very excited to meet five of seven Chinese physicians who will be travelling to Los Angeles in August to participate in a tailored two-week educational course hosted by the IMF. The group includes four women. All attendees are very excited about this opportunity, which the IMF is in the midst of planning
Very Emotional and Sometimes Difficult or Tragic Stories
The final event was the Patient Forum at Changzheng Hospital on Sunday morning. Over 120 Chinese patients attended the event, held in a transformed lobby area using one wall as a huge screen with multiple TV panels. I co-hosted with Dr. Fu, and one of his colleagues gave an excellent lead-off "Myeloma 101" talk illustrated with really beautiful, up-to-date slides.
This was followed by what started off as a "free for all" of questions, with everyone keen to have their question answered first. This is when Susie stepped in to restore a degree of order to the chaos by taking questions row by row. Through an interpreter and with the help of Dr. Fu, over two hours of questions ensued. We heard very emotional and sometimes difficult or tragic stories. Everyone did their best to come up with helpful advice as well as what was equally important - the support coming from reaching out in an environment of hope.
Numerous contacts were made. There will be many e-mail follow-ups. Again, it was an exhausting day, but an incredibly rewarding day for all.
After what seemed like a blur of activity it was time to catch a direct flight back to LAX. Pondering great plans for the future, we took off at 9:35 p.m. from Shanghai and arrived in Los Angeles at 6:10 p.m. the same day - before we took off! We saved a day on our way back, which we certainly needed for our recovery!