Impact of Personalized Medicine for  the Practice of Hematopathology Adam Bagg MD Professor Director, Hematology University of Pennsylvania Kojo S.J. Elenitoba‐Johnson MD Henry C Bryant Endowed Professor  Director of Molecular Diagnostics University of Michigan  Megan S. Lim MD PhD Professor  Director of Hematopathology 1 University of Michigan   2011 College of American Pathologists. Materials are used with the permission of the faculty. Disclosures None 2 Course Objectives • Be familiar with concepts of personalized medicine in the  context of hematopathology • Understand the appropriate diagnostic and prognostic value  of specific molecular tests in the evaluation of hematopoietic  neoplasms • Appreciate how novel genetic alterations in myeloid and  lymphoid neoplasms impact patient management.  3 Agenda Topic Speaker Time I. Introduction Lim 5’ II. Principles of personalized medicine and evolution of Elenitoba- 40’ molecular hematopathology Johnson -Overview of commonly used molecular technologies in hematopathology -Update in new technologies including array CGH, next generation sequencing III. Approach to myeloid neoplasms in the era of Bagg 65’ personalized medicine -Chronic myeloid leukemia -Acute myeloid leukemia IV. Approach to NHL in the era of personalized medicine Lim 60’ -Aggressive B-cell lymphomas -Splenic Lymphoma -ALCL IV. Summary and Closing Lim 10’ 4 Impact of Personalized Medicine for  the Practice of Hematopathology Kojo S.J. Elenitoba‐Johnson MD Henry C Bryant Endowed Professor  Director of Molecular Diagnostics Laboratory University of Michigan  5  2011 College of American Pathologists. Materials are used with the permission of the faculty. Personalized medicine and evolution of molecular hematopathology 1. Principles of personalized medicine 2. Evolution of molecular diagnostics 3. Update in new technologies including array CGH, next-generation sequencing 6 Concepts of Personalized Medicine Personalized Medicine (2013) 10(1), 13-15 7 Personalized Medicine Definition Form of medicine that uses information about a  person’s genes, proteins, and environment to  prevent diagnose and treat disease  National Cancer Institute http://www.cancer.gov/ Not a new concept “The new language of genomics, as applied to  medicine, is less a revolution than an evolution“        Steele 2009 Personalized medicine: something old, something new.  Pers Med 6:1‐5 8 Genetic testing for personalized medicine  in hematopathology Diagnosis Prognosis Treatment Response to Prediction of Disease Classification treatment response monitoring Pre-symptomatic Pharmacogenomics risk assessment 9 Evolution of Molecular Diagnostics  in Hematopathology New therapies Gleevec approved by •Combination FDA of small molecules Cytogenetics PCR FFPE tissues REAL classification WHO classification 1980 1985 1988 1990 1994 2001 2008 2015 … Morphologic Introduction of Rapid growth in evaluation immunopathology, molecular genetic flow cytometry application Clinical sequencing for immunohistochemis detection of structural try alterations/mutations 10