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The Basic Immunology of ASCO

—a very committed lymphocyte

I just returned from ASCO, one of 23,000 committed lymphocytes percolating through the interstitial space of the New Orleans Convention Center. Like the other committed lymphocytes, I trafficked to the appropriate lymph nodes at the appropriate times, guided by my pocket program. As instructed by the program, I trafficked to the pharmacology node, breast cancer node, sarcoma node, neuro-oncology node, and so forth. I personally never track to the radiation therapy or surgery nodes, having little tropism for these areas.

As always, when I reached the designated node at the appointed hour, I met other committed lymphocytes with similar receptors. The drill was always the same. We'd interact in small groups to recall the days when we were pluripotent fellow lymphocytes and not terminally differentiated private practice, management, or clinical research clones. We'd also discuss the committed lymphocytes who had not made it to the node and gossip about who had apoptosed, who had become malignant, who had been helped, who had been suppressed, and so forth. Indeed, one motivation for attending the meeting is to avoid being the subject of these speculative discussions.

During the day in the interstitial space of the Convention Center, it was important to rest and repair DNA. Then committed lymphocytes would traffic to the Exhibit node, where enabling dendritic caffeine- and frozen yogurt-presenting Pharmaceutical cells could be counted on to restore the committed lymphocyte with all manner of offerings. It seems a lot of time is spent in the Exhibit node, since the traffic appears to be the greatest there and lymphocytes repeatedly home to the area with little relation to their underlying receptor phenotype.

At one point, all the committed lymphocytes, irrespective of their receptors are called to the spleen for the splenary sessions. Not much interaction between cells occurs here. Instead, about 20,000 committed lymphocytes sit back and do nothing for a few hours.

At the end of each day, we were forced from the interstitial space of the Convention Center into the general circulation of the city. Despite being much diluted in the general cell pool, the committed lymphocyte was still easy to recognize. This could be done at some distance by gross morphology (blue blazer and khaki pants in 94 degree weather with a tan ASCO bag) or more closely through more subtle clues (blue ASCO badge). For some reason, the committed lymphocyte never removes the ASCO badge for the entire period of the meeting. Apparently, the thinking is that if the badge is needed to get into the Exhibit node, it must be needed to get into bars and restaurants throughout the city. For this reason, the badge was ubiquitous on Bourbon Street and in the French Quarter irrespective of the time of day.

It's remarkable that the committed lymphocyte can circulate in the general circulation at these times without being recognized as foreign and being attacked or interfered with by endogenous host cells. Another immunologic mystery.

At meeting's end comes a time for reflection. What new programs and pathways have been absorbed during our days in the interstitial space, and how will they affect our behavior in the future? One lesson was obvious, whether one is a management, clinical practice, or research clone. It's the recurrent lesson of a large, well-attended clinical meeting. Book your room in San Francisco early!

Gregory A. Curt, M.D. —a very committed lymphocyte

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