Drew Binsky is a young travel vlogger who has one professional ambition: to visit every country in the world by June 2020. As of March 2020, he had toured 191 of the 195 United Nations–designated sovereign countries. He had almost reached his goal, but the global COVID-19 pandemic halted his travel. His YouTube videos focus on each destination’s topography, demography, culture, and food, and he has logged thousands of miles in his herculean effort. His inspiring story made me wonder: Wouldn’t it be fascinating to visit every country in the world to learn about the local medical care, and in particular, the state of hematology? In fact, ASH has many global initiatives that serve as good starting points for your journey.
If you travel to Brazil, Chile, Paraguay, Peru, or Uruguay, you will learn about amazing progress of the International Consortium on Acute Promyelocytic Leukemia (IC-APL), now the International Consortium on Acute leukemia (ICAL). APL is an uncommon but highly curable subtype of acute myeloid leukemia (AML) that launched several global initiatives. Disparities in outcomes in low-resource countries prompted the ASH International Members Committee to establish IC-APL in 2004. This network of North American and European clinicians and investigators, together with colleagues in low-resource countries, implemented a standard-of-care diagnostic and therapeutic protocol for patients with newly diagnosed APL adapted to local circumstances. The objectives were to improve outcomes, establish standards in clinical and laboratory procedures, encourage participation in clinical trials, and promote scientific collaborations. While the early death rate in Brazil was historically 32 percent (Jácamo RH et al. Haematologica. 2007;92:1431-1432), with adherence to a common protocol, the early death rate has decreased to approximately 11 percent, and the overall survival increased from 50 percent to 80 percent (Rego EM et al. Blood. 2013;121:1935-1943). ICAL has now embarked on a protocol for newly diagnosed APL with oral arsenic, ATRA, and minimal chemotherapy. The consortium is also conducting a randomized trial for AML exploring postremission strategies, and as of October 2020, almost 400 patients have been recruited.
Visit one of several Caribbean countries (Bahamas, Barbados, Jamaica, Tobago, and Trinidad) and you will learn about the Children’s International Consortium on Acute Leukemia (C-ICAL). This is a clinical network developed together with the SickKids Caribbean Initiative to establish a standard-of-care treatment protocol for acute lymphoblastic leukemia, improve patient care, encourage development of clinical trials, and promote the exchange of scientific ideas.
Travel to Africa and you will be impressed with the progress made by the Consortium on Newborn Screening in Africa, which reflects the major commitment by ASH to address many issues surrounding sickle cell disease (SCD). This network was convened to demonstrate the effectiveness of newborn screening and early interventions. Participating countries include Ghana, Kenya, Liberia, Nigeria, Tanzania, Uganda, and Zambia. The goal is to screen 10,000 to 20,000 babies each year in each country and to provide babies living with SCD with the best care. Screening and treatment have started in Nigeria and Ghana.
Return to Latin America and you will be interested to learn about the Latin American Registry in Aplastic Anemia, established in 2017 with many of ASH’s partner hematology societies (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Paraguay, Peru, Uruguay, and Venezuela). The goal of the initiative is to develop a registry of patients with aplastic anemia, standardize therapeutic strategies, encourage clinical trials, and promote global investigation.
You can travel almost anywhere in the world and appreciate ASH’s numerous global outreach programs designed primarily for education of hematologists and related health care professionals. The Clinical Research Training Institute in Latin America is directed toward early- to mid-career hematology faculty working in Latin America to promote the design and conduct of clinical trials. ASH and the European Hematology Association (EHA) have teamed up to create the ASH-EHA Translational Research Training in Hematology program — a yearlong mentoring program for early-career investigators that begins with a weeklong intensive course teaching biostatistics, genetics, molecular biology, and clinical trial design. The International Outreach Initiative provides educational materials to hospitals and universities in low-resource countries to address local needs in hematology. The Visitor Training Program provides funding for up to 12 weeks of training for hematologists or hematology-related health care professionals to train in a specific hematology topic at the institution of an ASH member. Despite the pandemic, this year ASH has worked closely with partner societies to identify relevant topics for the popular Highlights of ASH in Latin America, Asia Pacific, and the Mediterranean to provide online education. Highlights of ASH are themselves highlights of ASH’s global initiatives! There are international editions of Blood with various features translated into the local language (Spanish, Portuguese, Italian, Japanese, and Chinese).
We must continue to reach outward far and wide and continue to invest resources in global programs. There are many other countries in the world to visit and colleagues with whom to collaborate and learn. Drew Binsky’s videos are compelling and educational; ASH’s global initiatives are, too. We have the opportunity and responsibility to continue to extend our reach to improve the diagnosis and treatment of patients, thereby fulfilling our mission to conquer blood disorders worldwide.