NEWS FROM. Roswell Park s LEUKEMIA SERVICE

Transcription

1 NEWS FROM Roswell Park s LEUKEMIA SERVICE

2 MEET THE LEUKEMIA TEAM The Leukemia Service at Roswell Park Cancer Institute (RPCI) is dedicated to quality patient care, innovative research, and the development of more effective treatments for all hematologic malignancies, including: Acute lymphoblastic leukemia (ALL) Acute myeloid leukemia (AML) Chronic myeloid leukemia (CML) Myelodysplastic syndrome (MDS) Myeloproliferative neoplasms (MPN) (above from left to right) Medical Oncology Meir Wetzler, MD, FACP RPCI s Leukemia Service takes a team approach to patient care. A leukemia physician oversees a team of fellows, nurse practitioners, physician assistants, pharmacists, social workers, a discharge-planning coordinator, psychologists, research coordinators, dieticians and physical and occupational therapists. Our nurse practitioner/physician assistant-run clinic in the Chemotherapy/Infusion Center is designed to see patients receiving outpatient chemotherapy or those who have low blood counts and are in need of transfusions. Clinical research conducted by our faculty and staff consistently translates into new therapeutic approaches and advances overall knowledge of the disease. Refer A LEUKEMIA PATIENT Hematologic Oncology Elizabeth Griffiths, MD James Thompson, MD Eunice Wang, MD Pathology Maurice Barcos, MD, PhD Bora Baysal, MD George Deeb, MD Mihai Merzianu, MD Vishala Neppalli, MD Petr Starostik, MD Paul Wallace, PhD We work continually to fortify existing partnerships with the community physicians who entrust their patients to RPCI. When you suspect or diagnose cancer in your patient, you want the best treatment and care available for that patient. At RPCI, we believe in a multidisciplinary team approach. As your patient s primary physician, you remain a key member of this team. We will work closely with you and keep you informed of your patient s treatment and progress. After treatment has been completed and your patient returns to your care, we will continue to provide assistance as needed. Tracy Roach Senior Patient Access Representative (716) With even a suspicion of cancer, your patient can call us and one of our referral professionals will walk him or her through the referral process, answer questions and set up an appointment with the cancer care specialist best suited to the case. Patients may be referred by a physician or may directly seek a consultation and treatment. The Patient Referral Office is open Monday through Friday, 8 am - 5 pm. Call ROSWELL ( ) to seek a consultation or second opinion, or to refer a patient.

3 PATHOLOGY THE FIRST PRIORITY Taking diagnosis to a new level At RPCI, a dedicated team of board-certified hematopathologists performs state-of-the-art, integrated diagnostic hematopathology essential to diagnosing and classifying hematolymphoid neoplasms according to the most recent WHO classification. Pathology is not just looking at cells under the microscope anymore, says George Deeb, MD, Assistant Professor, Director of Hematopathology and Department of Pathology & Laboratory Medicine; Associate Director, Laboratory of Clinical Flow Cytometry. The integrated diagnostic approach is based on comprehensive clinical, morphologic, immunophenotypic, cytogenetic, and molecular genetic studies of blood, bone marrow and extramedullary tissue samples. Our hematopathologists work closely with the leukemia clinical team and other ancillary laboratories at RPCI to expedite prompt, comprehensive assessments. The ancillary laboratories incorporate the following: bone marrow laboratory immunohistochemistry laboratory with wide arrays of markers available flow and image cytometry laboratory with a spectrum of comprehensive panels of markers to thoroughly characterize hematolymphoid neoplasms immunophenotypically cytogenetic laboratory with karyotypic analysis and large number of FISH probes for many types of genetic abnormalities molecular diagnostic laboratory with a plethora of PCR and sequencing-based analyses. GOING with the FLOW RPCI s Flow and Image Cytometry Facility recognized as one of the nation s first and finest analyzes cell samples for RPCI clinicians and researchers, leading health centers and many National Institutes of Health clinical studies. This unique facility specializes in leukemias and lymphomas, identifying specific cancer types and subtypes by determining the specific antigen expression of the tumor, using analyses with antibodies and laser-activated flow cytometry. This integrated diagnostic approach allows us to characterize the tumor s fingerprint, says Dr. Deeb, and provides the most accurate classification that is critical for planning treatment, predicting therapy response and survival, and detecting residual disease or early relapse in leukemia patients. Accurate diagnosis is critical for appropriate treatment. 10% of patients receive a different diagnosis after coming to RPCI, as a result of the specialized expertise of the Pathology team at RPCI. 3

4 novel targeted approaches for leukemia treatment "Because chemotherapy for leukemia has not changed significantly in recent years, there is a dire need for novel approaches," says Meir Wetzler, MD, FACP, Chief, Leukemia Service, Department of Medicine. Leukemia cells from individual patients have been shown to be biologically diverse. Targeted biological agents which block a specific molecular or genetic abnormality in select leukemia cells may improve outcomes for some leukemia patients without the severe side effects of chemotherapy. For this reason, each leukemia patient undergoes appropriate diagnostic tests to determine whether a targeted therapy is available for their disease subtype. Eligible patients can then access the latest and most recent treatment advances through clinical research studies at RPCI. About 50% of leukemia patients at RPCI are enrolled in a clinical trial. Trials include tyrosine kinase inhibitors for chronic myeloid leukemia and novel agents for FLT3-mutated acute myeloid leukemia and myelofibrosis with and without JAK2 mutations. A significant number of patients will receive standard induction treatment for their leukemia because they are not candidates for research studies, or for other reasons. Treatment is conducted in a state-of-the art inpatient unit at RPCI. The entire unit and its private patient rooms are High Efficiency Particulate-Free Air (HEPA)-filtered. A dedicated team of nurses attends to the patients needs. In addition, RPCI s Leukemia team works closely with the Blood and Marrow Transplant team to assess each patient s need and eligibility for transplant. Prior research at RPCI has indicated that low vitamin D levels are associated with poorer outcomes for acute myeloid leukemia. We are currently assessing the effect of vitamin D supplementation in this patient population. ROLE OF VITAMIN D ROSWELL ( )

5 For healthcare professionals, quality cancer care tends to be defined by clinical outcomes particularly those that impact patient mortality, morbidity and cost of care and rooted in evidence-based medicine and best practices. Blood Marrow AND OUR 50% 45% 40% 43.5% 39.4% Acute Myeloid Leukemia (AML) 5-Year Observed Survival Cases Diagnosed, Transplant P R O G R A M Percentage 35% 30% 25% 20% 34.9% 27.4% 26.9% 22.9% 23.7% 20.8% 22% 19.3% 15% A CENTER OF EXCELLENCE 10% 5% 0% Year Post-Diagnosis RPCI National Cancer Data Base The Blood and Marrow Transplant (BMT) Program at RPCI performs approximately 100 to 120 blood and marrow transplants each year, treating patients with hematologic disorders including acute and chronic Chronic Myeloid Leukemia (CML) 5-Year Observed Survival Cases Diagnosed, leukemias, aplastic anemia, Hodgkin and non-hodgkin lymphoma, multiple myeloma, myelodysplastic syndrome, and selected solid tumors. RPCI s BMT unit was designed for patient safety and comfort. The entire BMT unit and its 14 private patient rooms are HEPA-filtered. This maintains the highest Percentage % 73% 68.4% 61.4% 61.4% 54% 57.9% 49.2% 54.2% 45.7% protection against airborne pathogens. The nursing 20 staff is specially trained in the management and care 10 of immunocompromised BMT patients, who have 0 special needs Year Post-Diagnosis RPCI National Cancer Data Base The statistical data presented here has been benchmarked against data collected by SEER, NCDB, Press Ganey and NCCN. 5

6 From bench to bedside translational research at RPCI Translational research, which aims to bring new discoveries to the clinic to help patients as quickly as possible, is the hallmark of the investigative efforts of RPCI s Leukemia Team. It begins in the laboratory, where researchers define an aberration within a cell and strive to correct it, an endeavor that has led to the development of many medications we use today. RPCI researchers are investigating a number of pathways in leukemia, and this work has already led to several clinical studies for RPCI patients. Currently we are investigating: The role of signal transducer and activator of transcription in leukemogenesis; cellular and humoral immune response to leukemicassociated antigens; and cytogenetics in AML and ALL The role of angiogenesis and hypoxia in promoting acute leukemia; and the genetic analyses of leukemias. The etiology of MDS and unexplained anemia (UA) of aging; the role of mitochondrial DNA (mtdna) mutations in immunosenescence; and the role of mtdna mutations in the development of MDS and UA. Epigenetic changes in leukemia and myelodysplastic syndromes, and novel therapeutics for elderly patients with Acute Myeloid Leukemia Novel therapies for hematologic malignancies; oxidative stress mechanisms in hematologic malignancies; and erythropoiesis and hypoxia. Results from our clinical trials have raised new questions, leading to new bench research, called retro-translational research ROSWELL ( )

7 Support every step way of the INTEGRATING PSYCHOSOCIAL SUPPORT INTO EVERY PATIENT S CARE Adjusting to diagnosis and coping with treatment is difficult for most cancer patients, but those with acute leukemia often face unique challenges. Any cancer diagnosis is a shock, but with leukemia, there is often a need to begin treatment quickly. Patients and families are left with very little time to adjust, says Teresa Johnson, LCSW, Medical Social Worker. RPCI offers extensive psychosocial services for leukemia patients, including support at the time of a new diagnosis, psychosocial assessment, counseling for patients and their families, and a caregiver orientation and networking program for family members of all newly diagnosed leukemia patients. As a comprehensive cancer center, says Ms. Johnson, we are committed to meeting each patient s needs with focus on their social, emotional and spiritual well-being. Our psychosocial oncology services, while beneficial to many cancer patients, are often essential for those with leukemia. PSYCHOSOCIAL ONCOLOGY SERVICES Supportive counseling Educational and orientation programs to help patients and their families understand the disease and its treatment Assistance in navigating the Family Medical Leave Act (FMLA), sick leave and disability Help with lodging, transportation or language/interpreter needs Connections to financial assistance programs and other community resources Hematologic Procurement Facility This facility allows RPCI to collect and bank tissue samples from all patients with hematologic malignancies. We study these samples to better understand characteristics of individual patients disease, and this leads to new findings and the development of better clinical studies for leukemia patients. Assistance with advance care planning, palliative care and/or hospice as needed 7

8 Setting the National Standards Roswell Park Cancer Institute plays a key role in developing the National Comprehensive Cancer Network (NCCN) guidelines that specify the best ways of preventing, detecting and treating specific types of cancer. The NCCN guidelines, based on scientific data, are the most widely used standards for cancer care. These RPCI physicians are members of NCCN guideline panels. Meir Wetzler, MD, FACP, Chief, Leukemia Section, Department of Medicine; Assistant Research Professor, Department of Immunology; serves on the Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia Panels. James Thompson, MD, Assistant Professor of Oncology, Department of Medicine; Assistant Member, Department of Immunology; serves on the Myelodysplatic Syndromes Panel. Eunice Wang, MD, Assistant Professor, Department of Medicine; Assistant Member, Tumor Immunology Program; serves on the Acute Myeloid Leukemia Panel. = NCCN Cancer Centers RPCI Visit for more information (5/4/12)