The Blood & Marrow Transplantation Center

Transcription

1 The Blood & Marrow Transplantation Center We were one of the first centers in the world to routinely offer patients blood and marrow transplantation (BMT). What Sets Us Apart High-volume center performs about 150 transplants per year. Better-than-predicted outcomes for patients receiving allogeneic transplants. Access to clinical trials, both cooperative group and investigator-initiated. A full menu of services, from Caregiver Orientation to Long-Term Survivorship Clinic. Prompt evaluation, within one week of referral (24 hours for critical cases). Partners In Practice medical information for physicians by physicians

2 Specialized Multidisciplinary Care RPCI s BMT Center brings together a multidisciplinary team of specialists in transplant, radiation, surgery, infectious disease, dentistry, cardiology, and pulmonary, renal, and gastrointestinal medicine, as well as nutrition and psychosocial support. Nursing staff are specialty-trained in the management and care of immune-compromised BMT patients. OUR TEAM INCLUDES: Transplant physicians Advanced practice practitioners (nurse practitioners and physician assistants) Transplant unit nurses Transplant coordinators Infectious disease physicians Dedicated specialty physician consults Dietitians Clinical pharmacists Psychologists Medical social workers Nurse case managers Physical and occupational therapists Respiratory therapists Dentists Financial counselors Pastoral Care staff A Center Designed for Safety and Comfort RPCI can accommodate more than 20 BMT inpatients at one time. Private patient rooms feature High-Efficiency Particulate-free Air (HEPA) filtration to protect against airborne infections, a private bathroom, TV with DVD player, and a convertible easy chair so a loved one can stay overnight. Visitors (usually two at a time) are welcome 24 hours a day, seven days a week, and may relax, do laundry, or fix a snack in the adjacent solarium. Outpatients are seen in a dedicated BMT outpatient center in the hospital. Patient advocates Team members collaboratively develop a comprehensive treatment plan for each patient, meeting daily to review patient progress and status. 2

3 Comprehensive Transplantation Treatment Our BMT Center provides both autologous transplantation, using the patient s own hematopoietic stem cells harvested from peripheral blood or bone marrow, and allogeneic transplantation, using a donor s peripheral blood, bone marrow, or cord blood. Our dedicated facility also provides these Specialized Transplant Services: Reduced-intensity conditioning and non-myeloablative transplant, which can make transplant possible for eligible patients up to age 80, depending on patient fitness Onsite collection and processing of blood and marrow World-class flow cytometry and laboratory support services Unrelated donor BMT Cord blood transplant for patients who do not have a fully matched donor, either related or unrelated Haplo-identical related BMT for patients who do not have a fully matched donor Promising new methods of predicting and controlling transplant complications, including treatment side effects and Graft-versus-Host Disease Quality Management Program to ensure consistent high quality in clinical care, cell collection and processing at every stage of the transplant process ADULT PATIENTS RPCI offers BMT for eligible adult patients between ages 18 and 80 for these diseases: Acute lymphocytic leukemia Acute myeloid leukemia Aplastic anemia and other marrow-failure syndromes Chronic lymphocytic leukemia Chronic myelogenous leukemia Non-Hodgkin lymphoma Hodgkin lymphoma Multiple myeloma Myelodysplastic syndrome Myeloproliferative neoplasms, including myelofibrosis Selected solid tumors (malignant), such as testicular cancer Hemoglobinopathies, including sickle cell disease and thalassemia PEDIATRIC PATIENTS RPCI offers BMT for eligible pediatric patients between ages 4 and 18 for these diseases: Hemophagocytic lymphohistiocytosis (HLH) Leukemia Lymphoma Aplastic anemia, Fanconi anemia, and other marrow-failure syndromes Myelodysplastic and myeloproliferative disorders Sickle cell disease Thalassemia Malignant brain tumors Neuroblastoma 3

4 RPCI s BMT Outcomes for Multiple Myeloma Patients Between , Roswell Park s BMT program performed 112 first autologous peripheral blood stem cell transplants (PBSCTs). All 112 patients (100%) were alive 100 days after PBSCT, and 94% were alive one year after PBSCT. Total Number of BMTs Number of BMTs per Year Allo Auto Calendar Year Our Patient Outcomes A high-volume center, RPCI performs about 150 transplants per year For the fourth consecutive year, one-year survival outcomes for patients receiving allogeneic transplants through RPCI s BMT Center were shown to be significantly better than would be expected for the patient population treated. Outcomes were evaluated on the basis of data from 168 U.S. transplant centers, published by the Center for International Blood and Marrow Transplant Research (CIBMTR), for transplants performed between The risk-adjusted one-year survival rate for transplant patients at RPCI was much better than predicted. The CIBMTR assigned the RPCI program to the highest possible risk category, indicating that RPCI s BMT cases for the period were among the most complex and difficult in the nation. Early referral is essential For an estimated 15% of patients evaluated by our team, referral comes late, resulting in increased mortality or the inability to undergo transplant. Preparation for transplant can take weeks time to find a suitable donor (or collect the patient s own stem cells), gain insurance approval, identify caregivers for post-transplant care, and prepare the patient. Talk to one of our patient access specialists at If your patient is currently under treatment or in remission, referral for BMT evaluation is important. Your patient can begin preliminary steps, donor search and collecting and storing stem cells. This expedites treatment should your patient require a transplant in the future. Tracy Roach Patient Access Coordinator Sarah Riggie Senior Patient Access Representative

5 Lifetime Lifeline: Roswell Park s BMT Long-Term Survivorship Clinic Our BMT Center is one of few to offer a long-term clinic for specialized follow-up care and monitoring for disease recurrence, secondary malignancy, treatment-related complications, and Graft-versus-Host Disease (GvHD). The clinic is open to all RPCI transplant patients as a first priority. Patients who received transplants at other centers may also be evaluated at the long-term clinic. The Long-Term Clinic provides: Clinical recommendations for the unique complications that can result after BMT, including: Premature bone loss (osteopenia and osteoporosis) Dental problems and mouth sores Cataracts Thyroid changes Cardiac problems, hypertension, hypercholesterolemia Pulmonary problems Infertility Lack of stable engraftment Side effects of corticosteroid use Skin changes Alopecia Nausea, vomiting, or diarrhea It is expected that all patients will continue to see their primary care physicians and referring oncologists for general care. RPCI keeps patients physicians apprised of their patients health during the transplant process and beyond. Specialty referrals for gastrointestinal, renal, pulmonary, and dermatologic problems Dental health monitoring and recommendations for long-term dental care Bone density surveillance of patients receiving glucocorticoid therapy, who are high risk for premature osteoporosis Re-immunization tracking for patients who have undergone allogeneic BMT Appointments in the Long-Term Clinic are scheduled for Fridays. Call and follow the prompts for Annual Clinic. 5

6 Supportive Care RPCI surrounds patients and their families with a strong system of support before, during and after transplant. Our Psychosocial Oncology and interfaith Pastoral Care departments help patients cope with the anxiety and stress of diagnosis and treatment. Medical psychologists, social workers, chaplains, and spiritual advisors are available at any hour for urgent needs. Our program includes: Helping patients cope with the anxiety and stress of diagnosis and treatment Cancer Pain Management Service (CPMS) develops a customized pain-management plan for every patient, drawing on the expertise of physicians, anesthesiologists, nurses, physical and occupational therapists, psychologists and social workers. Options include both medical and invasive procedures, biofeedback, relaxation training, and physical therapy. RPCI upholds the high standards of the National Comprehensive Cancer Network s painmanagement protocols. BMT Caregiver Orientation prepares patients and their caregivers for every aspect of the transplant, including: post-transplant medical needs; finances; coping strategies for emotional, physical, and sexual issues related to BMT; spirituality; and unique problems experienced by BMT caregivers. The patient and family receive a personalized care manual for later reference. Financial counselors and Medicaid advocates help patients understand their insurance coverage, including participation in clinical trials. They work with third-party payers to secure authorizations and serve as advocates for patients, including patients from outside the U.S. RPCI does not deny services to the uninsured. For more information: Psychosocial Oncology Department, Case managers and social workers help with such issues as day-to-day household management, and travel and lodging for out-of-town patients, who will be away from home for several months during and post-transplant. Support groups are open to patients, family members, and caregivers at all stages of the transplant process. For information: Psychosocial Oncology Department, RPCI Resource Center for Patients and Families offers free cancer-related publications, access to computers/ Internet, and connection to reliable information about cancer diagnosis and treatment. The Center also houses a lending library of books, laptops, DVDs, and a boutique of free wigs, hats, and scarves. 6

7 Our Research Expands Treatment Options About 40% of our BMT patients are enrolled on investigator-initiated or cooperative group clinical trials. RPCI is an active member of: Transplant Committee of the Alliance for Clinical Trials in Oncology Foundation (The Alliance formerly Cancer and Leukemia Group B) Blood and Marrow Transplant Clinical Trials Network Chronic Graft-versus-Host Disease Consortium Pediatric Blood & Marrow Transplant Consortium Children s Oncology Group Search open clinical trials at roswellpark.org/clinical-trials A few examples of our current research An NIH-funded Genome-Wide Association Study (GWAS) on 3,500 donor- and recipient-unrelated donor pairs undergoing allogeneic transplant With the Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, and collaborators at the University of Southern California and University of Chicago Translational research: an investigation of the utility of Toll-Like Receptor (TLR) agonists in pre-clinical hematopoietic stem cell mobilization and immune modulation, to be translated into clinical BMT applications With Cleveland BioLabs A pilot study of reduced-intensity transplant to determine if a novel conditioning regimen will lead to better outcomes in allogeneic transplant With the RPCI Radiation Oncology Department Accreditations/ Distinctions/Memberships RPCI S BLOOD AND MARROW TRANSPLANT PROGRAM HOLDS THESE DISTINCTIONS: Certified for more than a decade by the Foundation for the Accreditation of Cellular Therapy (FACT) as meeting or exceeding global standards in patient care and laboratory services Core member, Blood and Marrow Transplant Clinical Trials Network (BMT-CTN) of the National Institutes of Health Certified by the National Marrow Donor Program (NMDP) as a Transplant, Collection, and Apheresis Center Designated as a transplant center by the Alliance for Clinical Trials in Oncology (The Alliance), formerly the Cancer and Leukemia Group B (CALGB) Designated a Blue Distinction Center for Complex and Rare Cancers and for Blood and Marrow Transplant by the BlueCross BlueShield Association. Member of the National Comprehensive Cancer Network (NCCN) A study examining novel approaches to the evaluation and treatment of chronic Graft-versus-Host-Disease (GvHD) With Stanford University Medical Center Mining RPCI s rich database of BMT data We maintain a comprehensive database of critical information about the approximately 2,000 transplants performed to date at RPCI. The database is managed by a clinical epidemiologist who monitors our outcomes to develop new protocols, improve clinical care, and identify better ways to manage long-term survivors. RPCI S BMT PHYSICIANS ARE MEMBERS OF: The American Society of Blood & Marrow Transplantation (ASBMT) The American Society of Hematology (ASH) The American Society of Clinical Oncology (ASCO) The American Association for Cancer Research (AACR) 7

8 Meet the Team Medical Oncology 1 Philip McCarthy, MD Director, BMT Program 2 George Chen, MD 3 Maureen Ross, MD, PhD 4 Barbara Bambach, MD, Pediatric BMT 5 Meghan Higman, MD, PhD, Pediatric BMT Epidemiology 6 Theresa Hahn, PhD Transplant Program Administrator 7 Stephen Schinnagel, MS Immunology 8 Xuefang Cao, MD, PhD 9 Michael Nemeth, PhD 10 Elizabeth Repasky, MD Molecular & Cellular Biology 11 Joseph T. Y. Lau, PhD Pathology 12 Joanne Becker, MD 13 Paul Wallace, PhD Advanced Practice Practitioners 14 Molly Aungst, NP 15 Justine Bertolo, NP 16 Eric Breitwieser, PA 17 Michelle Burgess, PA 18 Melissa Everett, PA 19 Jennifer Grimmer, NP 20 Amber Kobel, RN, MSN Transplant Coordinators 21 Dana Cipolla, RN, BSN 22 Karen Dubel, RN, CHTC 23 Patricia Lipka, RN, BSN, CHTC 24 Colleen Warren, RN, AAS 25 Lora Yoerg, RN, BSN Early referral is essential About 15% of patients who come to Roswell Park to be evaluated for BMT cannot undergo transplant, because they were referred too late. Preparation for transplant takes time. Even if your patient is currently in treatment or in remission, immediate referral is advised so everything will be in order if BMT is needed in the future. WE CAN T LET CANCER WIN THAT S WHY ROSWELL PARK WILL NEVER STOP FIGHTING Elm & Carlton Streets Buffalo, New York RPMD ( ) To refer a patient, contact: Tracy Roach, Patient Access Coordinator, or Sarah Riggie, Senior Patient Access Representative (8/14) A National Cancer Institute-Designated Comprehensive Cancer Center A National Comprehensive Cancer Network Member A Blue Distinction Center for Complex and Rare Cancers A Blue Distinction Center for Transplants An ANCC Magnet - Designated Hospital