A C E A C T I V I T Y

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1 HEAD A C E A C T I V I T Y Jointly sponsored by Robert Michael Educational Institute LLC and Postgraduate Institute for Medicine Supported in part with an educational grant from Celgene

2 CONTENTS Agenda Activity Overview Faculty Biography Barton Kamen, MD, PhD Accreditation & Credit Disclosures & Disclaimer Presentation Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis References Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis 1

3 HEAD AGENDA Welcome Hildy Dillon, MPH Senior Vice President, Patient Services The Leukemia & Lymphoma Society White Plains, New York Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis Barton Kamen, MD, PhD Chief Medical Officer The Leukemia & Lymphoma Society White Plains, New York Professor of Pediatrics and Pharmacology The Cancer Institute of New Jersey UMDNJ - Robert Wood Johnson Medical School New Brunswick, New Jersey Question-and-Answer Session Closing Remarks Hildy Dillon, MPH 2 Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis

4 ACTIVITY OVERVIEW TARGET AUDIENCE This activity has been designed to meet the educational needs of primary care physicians, nurse practitioners and registered nurses. ACTIVITY PURPOSE This virtual lecture is intended to assist healthcare professionals in understanding how to recognize the signs and symptoms of a hematological malignancy. STATEMENT OF NEED Abnormal blood counts can provide clues to an undiagnosed hematological malignancy. Many symptoms of blood cancers may be nonspecific, and signs such as anemia may be overlooked by patients and their physicians. Despite the lack of clear-cut signs or symptoms, such as bruising, stroke, bone pain or renal failure, the diagnosis of a blood cancer can be made by taking a careful patient history, performing a complete physical examination, obtaining a complete blood count with a peripheral smear and then obtaining a bone marrow aspirate. Because many blood cancers are curable and with some, such as acute myelogenous leukemia, earlier diagnosis may be crucial to therapeutic success, healthcare professionals should maintain a high level of clinical suspicion and be mindful of the urgency with which a diagnosis should be made and therapy initiated. EDUCATIONAL OBJECTIVES Cite the distinct signs and symptoms associated with hematological malignancies Describe methods of diagnosing hematological malignancies Explain the importance of pancytopenia or other blood count abnormalities as they relate to the diagnosis of hematological malignancies STATEMENT OF SUPPORT This educational activity is made possible by funding through The Leukemia & Lymphoma Society and in part with an educational grant from Celgene. This program is jointly sponsored by Robert Michael Educational Institute LLC and Postgraduate Institute for Medicine. FEE INFORMATION There is no fee for this educational activity. Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis 3

5 FACULTY BIOGRAPHY Barton Kamen, MD, PhD Chief Medical Officer The Leukemia & Lymphoma Society White Plains, New York Professor of Pediatrics and Pharmacology The Cancer Institute of New Jersey UMDNJ - Robert Wood Johnson Medical School New Brunswick, New Jersey Barton Kamen, MD, PhD, is the Executive Vice President and Chief Medical Officer of The Leukemia & Lymphoma Society (LLS) as well as Professor of Pediatrics and Pharmacology at the Cancer Institute of New Jersey at Robert Wood Johnson Medical School. Dr. Kamen has been a recipient of a Scholar Award from LLS, a Damon Runyon Walter Winchell Fellowship, a Burroughs Wellcome Clinical Pharmacology Award, and an American Cancer Society Clinical Research Professorship. He has authored approximately 250 peer-reviewed articles and book chapters, and is the current Editor-in-Chief of the Journal of Pediatric Hematology/Oncology. His main laboratory interests are centered around folate and anti-folate metabolism, drug development, treatment-associated neurotoxicity, and metronomic therapy for cancer. 4 Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis

6 ACCREDITATION & CREDIT PHYSICIAN CONTINUING EDUCATION ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and Robert Michael Educational Institute LLC (RMEI). PIM is accredited by the ACCME to provide continuing medical education for physicians. CREDIT DESIGNATION Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. INTERNATIONAL PHYSICIANS International physicians completing this activity will receive a certificate documenting participation in an activity designated for AMA PRA Category 1 Credit. International physicians should contact their respective licensure and certification bodies for information on use/conversion of AMA PRA Category 1 Credit(s) TM. NURSE PRACTITIONERS CONTINUING EDUCATION Nurse practitioners should contact their respective licensure and certification bodies for information on use/conversion of AMA PRA Category 1 Credit(s) TM. NURSING CONTINUING EDUCATION Approval for nurses has been obtained by The Leukemia & Lymphoma Society s National Office under provider number CEP 5832 to award 1.5 continuing education contact hours through the California Board of Registered Nurses. Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis 5

7 DISCLOSURES & DISCLAIMER DISCLOSURE OF CONFLICTS OF INTEREST Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity: Dr. Barton Kamen has no affiliations with commercial interests to disclose. The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CE activity: The Leukemia & Lymphoma Society Hildy Dillon, MPH, has no affiliations with commercial interests to disclose. Robert Michael Educational Institute LLC Sherri Kramer, MD, has no affiliations with commercial interests to disclose. Postgraduate Institute for Medicine Jan Hixon, RN, BSN, MA, has no affiliations with commercial interests to disclose. Linda Graham, RN, has no affiliations with commercial interests to disclose. Trace Hutchison, PharmD, has no affiliations with commercial interests to disclose. Jan Schultz, RN, MSN, CCMEP, has no affiliations with commercial interests to disclose. DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. PIM, Robert Michael Educational Institute LLC (RMEI), The Leukemia & Lymphoma Society (LLS) and Celgene do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, RMEI, LLS and Celgene. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. DISCLAIMER Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient s conditions and possible contraindications on dangers in use, review of any applicable manufacturer s product information and comparison with recommendations of other authorities. 6 Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis

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30 REFERENCES Abel GA, Friese CR, Magazu LS, Richardson LC, Fernandez ME, et al. Delays in referral and diagnosis for chronic hematologic malignancies: a literature review. Leuk Lymphoma. 2008;49: Chee CE, Bjarnason H, Prasad A. Superior vena cava syndrome: an increasingly frequent complication of cardiac procedures. Nat Clin Pract Cardiovasc Med. 2007;4: Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26: Haas AR. Recent advances in the palliative management of respiratory symptoms in advanced-stage oncology patients. Am J Hosp Palliat Care. 2007;24: Haematological Malignancy Diagnostic Service. Available at: Accessed August 7, Jaffe ES, Harris NL, Stein H, Vardiman JW (eds.). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Hematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; Lichtman MA. Battling the hematological malignancies: the 200 years war. The Oncologist. 2008;13: Robbins SL. Textbook of Pathology. Philadelphia: WB Saunders; Rosen PJ, Wender RC, Kadkhoda H, Kober SL. Measuring the ability of primary-care physicians to diagnose and manage patients with hematologic malignancies. Blood (ASH Meeting Abstracts). 2007;110. Abstract Thomson A, Miles A. Manual of Surgery. Volume One: General Surgery. 6th edition. London: Henry Frowde and Hodden & Stoughton; Wheeless CR III, et al. (eds.) Wheeless Textbook of Orthopaedics. Available at: Data Trace Internet Publishing, LLC; Accessed August 7, Blood Count Abnormalities and Other Clues to a Blood Cancer Diagnosis 30

31 Mission Statement The Leukemia & Lymphoma Society s mission: Cure leukemia, lymphoma, Hodgkin s disease and myeloma, and improve the quality of life of patients and their families For information on leukemia, lymphoma and myeloma, call The Leukemia & Lymphoma Society s Information Resource Center at (800) or visit The Leukemia & Lymphoma Society 1311 Mamaroneck Avenue White Plains, NY VL