November 22, 2002
A Closer Look at the Hematologic Malignancies Program
Dr. Soiffer and patient Heather Huth
The Hematologic Malignancies program at DFCI is, in many ways, the direct descendant of work begun by Institute founder Sidney Farber, MD. And as it has grown, it has become — in its mix of caregivers, basic scientists, and administrators, its sources of funding, and emphasis on bench-to-bedside research — a microcosm of the cancer center as a whole.
Sidney Farber's initial breakthrough came in the area of leukemia, a cancer of bone marrow tissue that produces white blood cells. The Hematologic Malignancies Disease Center cares for adult patients with leukemia, along with other "non-solid" tumors such as multiple myeloma and lymphoma. It also operates a bone marrow transplantation service.
The program includes two research divisions, with distinct but complementary roles. One, headed by Kenneth Anderson, MD, focuses on laboratory studies; the other, led by Robert Soiffer, MD, is responsible for patient-based research. Their common purpose is clinical research, which uses basic science discoveries as the raw material for new treatments and diagnostic tests.
"The idea is to have a seamless effort from basic laboratory studies to clinical trials of new therapies," says James Griffin, MD, chair of Medical Oncology and longtime leader of the Institute's leukemia program. "We want to continue to be a place where patients seek out access to the latest treatments."
Evidence that that is occurring can be found in enrollment figures for clinical trials. More than twice as many patients are participating in Hematologic Malignancies trials as in any other DFCI department. Last year, more than 700 patients took part in clinical research studies for leukemia, multiple myeloma, and lymphoma — up from about 400 in 1999.
That orientation toward research, plus a reputation for excellent patient care, explains why Dana-Farber and its partner Brigham and Women's Hospital (which provides inpatient treatment) have become one of the largest centers for bone marrow and stem cell transplantation in the world. The procedures represent, in many cases, the most powerful treatments available for cancers of the bone marrow or lymph system, as well as certain non-cancerous blood conditions.
DFCI and BWH provide not only traditional transplants — in which patients receive intense doses of chemotherapy followed by infusions of bone marrow or stem cells to "rescue" their blood supply — but also newer approaches known as reduced-intensity transplants. Often called "mini transplants," these procedures involve much lower doses of drugs and an infusion of disease-fighting cells from a compatible donor. The aim is to spare patients the harsh effects of high-dose chemotherapy and the need for months of germ-free isolation required of conventional transplant patients.
Mini transplants are conducted as clinical trials, and although it's too soon to compare their effectiveness to traditional transplants', doctors have found that patients tolerate the lower doses of chemo well and that, in many cases, donor cells grow well in their new hosts.
Along with this work, researchers are exploring ways of preventing and treating graft-versus-host disease, a potentially severe condition suffered by some transplant recipients. They're also conducting studies of newly developed cancer vaccines and of transplant patients' quality of life.
A matter of precision
The complexity of transplants warrants a level of attention, coordination, and professional and personal availability by caregivers rivaling that of any other medical procedure. That Dana-Farber and Brigham and Women's have grown to such prominence in the field — with 250 adult transplants performed last year — demonstrates how fully they have mastered its intricacies. The "allogeneic" branch of the program — which performs transplants with donated marrow — is one of the largest and most experienced in the world, and continues to grow.
"Well over half the inpatients on the Longwood side of Dana-Farber/Partners CancerCare are people with hematologic malignancies," Soiffer notes. "One of our greatest strengths as a care center is our multidisciplinary approach: patients are seen by a team of doctors, nurses, researchers, nurse practitioners, dietitians, and social workers dedicated to the needs of each individual. And as a research center, we're able to provide patients with innovative forms of treatment and access to new technology."
To follow Hematologic Malignancies' evolution over the past 15 years, it helps to visualize a changing organizational chart. Research and treatment of these cancers have always been a mainstay at Dana-Farber, but in the early 1990s work in this area began to expand rapidly. In 1993, the Institute combined its leukemia, lymphoma, and bone marrow transplant programs into a single unit, the Division of Hematologic Oncology, under the direction of Lee Nadler, MD. When DFCI reorganized its research structure in 1996, Hematologic Oncology was absorbed into the Department of Adult Oncology (now Medical Oncology) but continued to function as a unit. This year, its research functions were brought into two overlapping divisions under Griffin's leadership.
The program's quarters are split between its research labs on the fifth floor of the Dana and Mayer buildings, clinic areas on Dana 1, physicians' and nurses' offices on the Dana quarterdeck, and clinical research support staff in the Longwood Galleria. Its team of doctors, nurses, basic scientists, postdoctoral students, research technicians, clinical research coordinators, nurse practitioners, and administrators numbers well over 200.
A balance of research and clinical work, and a habit of viewing basic science and patient care as mutually reinforcing, explain why Hematologic Malignancies is so adept at procuring "program project grants" from the National Cancer Institute covering several research studies with a common theme. According to Administrative Manager Amy Emmert, its investigators currently hold seven such grants — in bone marrow transplantation, multiple myeloma, lymphoma, and leukemia research — accounting for more than $9.5 million of annual funding.
"The extent of our research can be seen in the 135 peer-reviewed scientific reports that Hematologic Malignancies investigators published last year, or in the program's large representation at American Society of Hematology meetings," Emmert remarks.
The same blending of lab and clinic is evident in the program's sources of revenue. Virtually every staff member is supported by independent research funding — whether from the National Institutes of Health, industry, foundations, or private philanthropy — and by funds earmarked for clinical services.
"Dana-Farber scientists have made crucial advances in our understanding of the basic biology of hematological cancers," Ken Anderson asserts. "The impetus of our bench-to-bedside research is to directly apply these advances to improve diagnosis, prognosis, and treatment of these diseases."
Beyond the lab
Hematologic Malignancies staff say that even if their own work is confined to either the clinic or laboratory, the sense of teamwork is pervasive. As Glenn Stern, the administrative manager of the basic science section, says, "It's a pleasure to work with people who have such passion for what they do. Everyone is so focused on pushing back the barriers to better treatments for patients. Even for people working in basic research labs, that's what's on their minds."
For staff involved in clinical trials, the quest for new therapies and techniques is always front-and-center. Nurse practitioner Richard Boyajian, RN, MS, sums it up: "The cancer treatments we have today are the result of clinical trials that took place in the past."
Story by Robert Levy
