The Cantera: An Epic Learning Ring Cycle for Young Haematologists

On Friday, June 8, 2018, I received an email from Prof Massimo Federico inviting me to serve as a coach for the 7th Cantera workshop sponsored by Fondazione Italiana Linfomi (FIL) and the European Hematology Association (EHA). He explained that this special course “takes inspiration from the famous Spanish Cantera of the Barcelona football club” which is a well-known soccer school that was created for training young players and developing local new champions. He added “The coach is asked to give at 20 to 30 minutes talk in each session in order to have most of the time left to discussion and questions. Spending almost all the time together, having dinners together and a restricted number of participants allow to create an informal, friendly atmosphere that help the young hematologists to take advantage of this unique experience”. Of course, my answer was “I am honored to be invited” as I thought this was a very unique teaching and mentoring opportunity. I also thought this will be a nice time to visit Italy, and enjoy some leisure time, and enjoy the Italian food and wine. Somehow, I missed from the invitation that I was expected to give 7 individual lectures in 2 days, followed by 2 additional sessions where the trainees will form small teams and present their proposed projects to the coach and judges. My idea of having some leisure time on the sideline of the event rapidly evaporated.

To give 7 individual lectures to highly intelligent young hematologists while keeping them interested and engaged without boring them, and without repeating some of the slides, is one of the most challenging thing I had in my professional career. My task was even more challenging as the focus of my Cantera was on precision medicine, rather than lecturing on different disease subtypes. While each lecture should “stand alone” on its own, there were many concepts and data that can easily be shared across several lectures that can improve the understanding and glue all lectures in one theme. To solve this dilemma, I had to borrow from the genius of Richard Wagner's “The Ring of the Nibelung”, a cycle of 4 epic operas that are masterfully linked to each other, but frequently performed as individual operas. To link all operas in one thematic cycle, Wagner used musical motifs (in my case they were key slides) that he repeated occasionally throughout the cycle that reminded the audience of previous events or characters.

The program was very intense, with short coffee breaks during the day, and ended up with nice group dinners. Eighteen young hematologists from 6 countries in Europe and South America participated. Topics that were covered included clinical trial endpoints, circulating tumor DNA, precision medicine in the era of combination therapy, precision medicine in the era of immune therapy, and novel clinical trial designs. There was plenty of time for discussions and exchange of ideas, as the lectures were designed to be short. Discussions continued during the breaks and over dinner, which blended with some cultural and social interactions. Given the diverse background and nationalities of the trainees, it was fascinating to compare different approaches across different countries and regions.

The last 2 sessions were devoted for the trainees, as they were tasked to form small groups and propose future projects based on what they have learned during the course. Four groups presented very interesting proposals investigating the role of non-coding RNAs in DLBCL, novel immune checkpoint inhibitor-based therapy in primary mediastinal B cell lymphoma with biomarker analysis, using circulating tumor DNA to guide selection of patients with relapsed Hodgkin lymphoma for stem cell transplant in second remission, and evaluating the dynamics of circulating tumor DNA in patients with T-cell lymphoma. The projects were presented in an open session to the entire group and were evaluated by a panel of judges, which included professors Martin Dreyling, Roberto D’Amico, Antonino Carbone, together with Martina Manni (assistant coach), Massimo Federico, and the EHA representative Francesco Cerisoli. While the judges felt that all 4 proposals were of high quality, they selected the Hodgkin lymphoma and the T cell lymphoma projects and recommended them for official support by EHA and the International T cell project.

Overall, the Cantera was an outstanding opportunity for exchanging new ideas and sharing cutting edge information in a relaxed format. Kudos to Professor Federico for having this vision, and for creating a forum that will inspire the next generation of academic hematologists and will plant seeds for building future international collaborations based on mutual respect and friendship.