Every four minutes, someone is diagnosed with a hematologic cancer. Recognized internationally for its breakthrough treatments for leukemia, lymphoma, and myeloma, City of Hope is one of the most successful treatment centers in the country and has had some of the consistently best patient survival outcomes.
Listen as Dr. Stephen J. Forman, the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation, explains that the focus of doctors and others at City of Hope is not just cancer remission, but to cure patients altogether.
Selected Podcast
Hematologic Cancers: Better Treatments to More People Now
Featured Speaker:
Stephen J. Forman, M.D.
Stephen J. Forman, M.D., is an internationally recognized expert in leukemia, lymphoma and hematopoietic cell transplantation and is the program leader for City of Hope’s NCI-designated Comprehensive Cancer Center’s Hematologic Malignancies Program. He serves on the editorial boards of many scientific journals and was recently appointed to the Strategic Planning Advisory Committee of the California Institute of Regenerative Medicine. He is co-editor of Thomas’ Hematopoietic Cell Transplantation, a definitive textbook for scientists and health care professionals. Transcription:
Hematologic Cancers: Better Treatments to More People Now
Melanie Cole (Host): As a pioneer in advancing care for all hematologic cancers and blood-related disorders, City of Hope’s Department of Hematology and Hematopoietic Cell Transplantation leads the field as one of the largest and most successful transplant centers in the world. My guest is Dr. Steven Forman. He’s an internationally recognized expert in leukemia, lymphoma, and hematopoietic cell transplantation and he’s the program leader for City of Hope’s NCI-designated comprehensive cancer centers hematologic cancers program. Welcome to the show, Dr. Forman. Tell the listeners what are hematologic cancers.
Dr. Steven Forman (Guest): Hematologic cancers are those malignancies that people get that fall in the category of leukemia, lymphoma, and multiple myeloma. These are cancers that arise from the blood and bone marrow and the immune system. We have specific treatments for each of them, including stem cell transplantation where indicated. These are cancers that can be acute; maybe they come on rather rapidly. It can make somebody quite ill and require care sometimes emergently, while others are more indolent and are not as aggressive. I think getting the right treatment for the right disease is an important component of what we do.
Melanie: Dr. Forman, someone gets a diagnosis of a blood cancer, and it can be quite devastating and very scary. What do you tell them right off the bat to start them out on this journey and give them some hope?
Dr. Forman: I think the first thing to do is to give them accurate information about what the disease is because when we cancer in general, and even leukemia specifically, it’s very alarming. It’s very emotional. So we try to explain what it is that they have and, more importantly, what we’re going to do about it. I would say for almost all of the cancers of the blood and immune system, there is effective treatment. I think that when a person knows that they have the chance for either good therapy treatment or even cure, it goes a long way towards helping them partner with us to aid in getting them completely well and returning them to their home with their family and their friends, their community, which is what our goal is.
Melanie: Dr. Forman, City of Hope’s patient outcomes are among the best in the nation. Tell us a little bit about cell transplantation, what that involves for both the patient and the donor. Because people hear about bone marrow transplantation; they get scared, they’ve heard it’s painful. Tell us about it and kind of clear it up for everybody so it’s not so confusing.
Dr. Forman: So among the therapies that are done for treatment of cancers of the blood and the immune system is stem cell transplant, which is a way of basically replacing a person’s diseased bone marrow and diseased immune system with someone’s who is healthy. It’s a challenging procedure and requires the cooperation of not just family but many, many of our staff to to pull it off. The one that you’re asking about is when we use donor cells from matches that we determine either in the family or outside the family where we basically give a therapy that eliminates a person’s blood and immune system and then we replace it with cells derived from either a family donor or an unrelated donor. In essence, we convert a person’s blood and immune system into somebody else’s. It’s an organ transplant not unlike heart, lung, liver, kidney transplants, except this is the blood and immune system.
The goal is not just to make the switch but to use that switch to eliminate the disease that the person had in the first place. Depending upon how extensive the disease is, that determines the intensity of the approach we use to do the replacement therapy. For the donor, for the most part, it is a procedure that involves taking a stem cell from the blood stream so that it’s not so different than donating blood or platelets. It’s a little bit more involved because one is on the machine a little longer. We collect the stem cells from the blood stream and then infuse them intravenously into the patient. The stem cells dramatically, in some ways, find their way into the right place in the bone marrow, set up shop, and begin to produce blood and immune cells as it did from the donor.
In some cases, we actually do go into the bone marrow of the donor, and that’s done in about a thirty-minute procedure in the operating room where we take marrow out and put it in, again, trying to get the stem cells to the right place which invariably always happens. That donor becomes, in essence, a family member. We have close to 11 million people in the United States who are on the registry, who have volunteered to be a donor should a patient need a transplant and not have a match within their family.
Melanie: Dr. Forman, how long does it take for the patient to notice a difference, or for you as a doctor to know if this treatment is working and that donor cells are working?
Dr. Forman: The first indication is, after the chemotherapy or radiation that the patient gets to prepare them for the transplant and we then put in the cells from the donor—it takes about two weeks—the blood counts which go down very low will begin to rise towards normal. When we see that happening, it’s a very good indication that there’s been a so-called “take,” or engraftment is the word that is used. Then we do some fairly elegant tests to prove that the cells are growing, not the patient’s but rather the donor’s stem cells given to the patient.
It gets as quirky as even though we do certain matching between patients and their donors, the blood group doesn’t have to match. If you were blood group A as a patient and your donor was blood group O, you’re going to switch over to blood group O for the balance of your life. We have converted you into the person who gave you the cells. But the rising of the counts is the best proof that the “take” has been there, and that will be the person’s blood and immune system for the rest of their life.
Melanie: Wow. That’s cool that you’re blood type actually changes from that. Now tell us a little bit about the group of cancers known as lymphoma. We hear about various celebrities that have come up with it, and there are a couple different types. Yes?
Dr. Forman: Yes. There are different types of lymphoma, and there are different types of leukemia. In lymphoma, it ranges from a disease that can be very indolent and sometimes does not even need much treatment at the beginning, to a disease that is highly aggressive and a person comes to you quite ill and needs to be hospitalized that day. It shows you that the word lymphoma can be somewhat all encompassing. The first thing we have to do is figure out what type of lymphoma the person has as that will dictate the treatment.
Increasingly, the treatment regimens are very specific for the type of cancer that the person has, and in this case lymphoma. So not all of lymphoma is treated the same. One thing that we spend a lot of time on here is just making sure that the diagnosis is correct. I think the number I saw recently as we correct or modify the diagnosis is about thirty percent of the time. So coming here or coming to any major cancer center, part of their job is really to make sure that what the person was told they have is in fact what they have because it does guide treatment. The therapy can vary from everything from antibody therapy against the cancer to full-fledged, full intensive chemotherapy to stem cell transplant. We try to figure out what is the most appropriate therapy for that particular moment for a patient. The last few years have just seen an explosion of new approaches, new therapies, and when I think back on what we were doing just ten years ago and what we’re doing now, I can see differences. I can see we’re doing better for people now than we did before, and it makes us hungry and aggressive to want to find out more to be able to do more.
The same thing applies to acute leukemia where you can have diseases that can be somewhat indolent and don’t need a lot of treatment, to diseases like acute leukemia that require basically hospitalization literally that day in order to be able to save somebody’s life.
Melanie: And, Dr. Forman, in just the last minute that we have left, tell us about the recently launched Hematologic Malignancies Institute and why people should come to City of Hope for their hematologic cancer care.
Dr. Forman: I think City of Hope has a rich history in both developing therapy for and taking care of people who have these somewhat unique diseases. I think when they come here they really have the whole repertoire of therapies at their disposal, and so they don’t have to go someplace else. So if you need a transplant, you can get a transplant. If you need standard therapy, you can get standard therapy. If you need investigational therapy, there’s a very deep and rich clinical trials network here, which really, because we have taken the ideas we have in our laboratory and put them into practice so that we can help patients who might need them.
Another aspect, I think, here, in addition to making the correct diagnosis and our pathology department which is also quite experienced, is that the nurses in this institution are very attuned to taking care of patients with cancer, and particularly patients with these diseases, in a very respectful and dignified way. I think one of the things we hate about cancer is that it’s a thief, not just of life but of the quality of people’s lives and their integrity. So for us, they are people who have cancer; they’re not cancer patients. I think the combination of a respectful environment with science that drives our compassion and our wanting to do a better job today than we did yesterday, I think, makes it a unique place for people to come here and know they’re going to be cared for well.
Melanie: Thank you so much, Dr. Steven Foreman. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.
Hematologic Cancers: Better Treatments to More People Now
Melanie Cole (Host): As a pioneer in advancing care for all hematologic cancers and blood-related disorders, City of Hope’s Department of Hematology and Hematopoietic Cell Transplantation leads the field as one of the largest and most successful transplant centers in the world. My guest is Dr. Steven Forman. He’s an internationally recognized expert in leukemia, lymphoma, and hematopoietic cell transplantation and he’s the program leader for City of Hope’s NCI-designated comprehensive cancer centers hematologic cancers program. Welcome to the show, Dr. Forman. Tell the listeners what are hematologic cancers.
Dr. Steven Forman (Guest): Hematologic cancers are those malignancies that people get that fall in the category of leukemia, lymphoma, and multiple myeloma. These are cancers that arise from the blood and bone marrow and the immune system. We have specific treatments for each of them, including stem cell transplantation where indicated. These are cancers that can be acute; maybe they come on rather rapidly. It can make somebody quite ill and require care sometimes emergently, while others are more indolent and are not as aggressive. I think getting the right treatment for the right disease is an important component of what we do.
Melanie: Dr. Forman, someone gets a diagnosis of a blood cancer, and it can be quite devastating and very scary. What do you tell them right off the bat to start them out on this journey and give them some hope?
Dr. Forman: I think the first thing to do is to give them accurate information about what the disease is because when we cancer in general, and even leukemia specifically, it’s very alarming. It’s very emotional. So we try to explain what it is that they have and, more importantly, what we’re going to do about it. I would say for almost all of the cancers of the blood and immune system, there is effective treatment. I think that when a person knows that they have the chance for either good therapy treatment or even cure, it goes a long way towards helping them partner with us to aid in getting them completely well and returning them to their home with their family and their friends, their community, which is what our goal is.
Melanie: Dr. Forman, City of Hope’s patient outcomes are among the best in the nation. Tell us a little bit about cell transplantation, what that involves for both the patient and the donor. Because people hear about bone marrow transplantation; they get scared, they’ve heard it’s painful. Tell us about it and kind of clear it up for everybody so it’s not so confusing.
Dr. Forman: So among the therapies that are done for treatment of cancers of the blood and the immune system is stem cell transplant, which is a way of basically replacing a person’s diseased bone marrow and diseased immune system with someone’s who is healthy. It’s a challenging procedure and requires the cooperation of not just family but many, many of our staff to to pull it off. The one that you’re asking about is when we use donor cells from matches that we determine either in the family or outside the family where we basically give a therapy that eliminates a person’s blood and immune system and then we replace it with cells derived from either a family donor or an unrelated donor. In essence, we convert a person’s blood and immune system into somebody else’s. It’s an organ transplant not unlike heart, lung, liver, kidney transplants, except this is the blood and immune system.
The goal is not just to make the switch but to use that switch to eliminate the disease that the person had in the first place. Depending upon how extensive the disease is, that determines the intensity of the approach we use to do the replacement therapy. For the donor, for the most part, it is a procedure that involves taking a stem cell from the blood stream so that it’s not so different than donating blood or platelets. It’s a little bit more involved because one is on the machine a little longer. We collect the stem cells from the blood stream and then infuse them intravenously into the patient. The stem cells dramatically, in some ways, find their way into the right place in the bone marrow, set up shop, and begin to produce blood and immune cells as it did from the donor.
In some cases, we actually do go into the bone marrow of the donor, and that’s done in about a thirty-minute procedure in the operating room where we take marrow out and put it in, again, trying to get the stem cells to the right place which invariably always happens. That donor becomes, in essence, a family member. We have close to 11 million people in the United States who are on the registry, who have volunteered to be a donor should a patient need a transplant and not have a match within their family.
Melanie: Dr. Forman, how long does it take for the patient to notice a difference, or for you as a doctor to know if this treatment is working and that donor cells are working?
Dr. Forman: The first indication is, after the chemotherapy or radiation that the patient gets to prepare them for the transplant and we then put in the cells from the donor—it takes about two weeks—the blood counts which go down very low will begin to rise towards normal. When we see that happening, it’s a very good indication that there’s been a so-called “take,” or engraftment is the word that is used. Then we do some fairly elegant tests to prove that the cells are growing, not the patient’s but rather the donor’s stem cells given to the patient.
It gets as quirky as even though we do certain matching between patients and their donors, the blood group doesn’t have to match. If you were blood group A as a patient and your donor was blood group O, you’re going to switch over to blood group O for the balance of your life. We have converted you into the person who gave you the cells. But the rising of the counts is the best proof that the “take” has been there, and that will be the person’s blood and immune system for the rest of their life.
Melanie: Wow. That’s cool that you’re blood type actually changes from that. Now tell us a little bit about the group of cancers known as lymphoma. We hear about various celebrities that have come up with it, and there are a couple different types. Yes?
Dr. Forman: Yes. There are different types of lymphoma, and there are different types of leukemia. In lymphoma, it ranges from a disease that can be very indolent and sometimes does not even need much treatment at the beginning, to a disease that is highly aggressive and a person comes to you quite ill and needs to be hospitalized that day. It shows you that the word lymphoma can be somewhat all encompassing. The first thing we have to do is figure out what type of lymphoma the person has as that will dictate the treatment.
Increasingly, the treatment regimens are very specific for the type of cancer that the person has, and in this case lymphoma. So not all of lymphoma is treated the same. One thing that we spend a lot of time on here is just making sure that the diagnosis is correct. I think the number I saw recently as we correct or modify the diagnosis is about thirty percent of the time. So coming here or coming to any major cancer center, part of their job is really to make sure that what the person was told they have is in fact what they have because it does guide treatment. The therapy can vary from everything from antibody therapy against the cancer to full-fledged, full intensive chemotherapy to stem cell transplant. We try to figure out what is the most appropriate therapy for that particular moment for a patient. The last few years have just seen an explosion of new approaches, new therapies, and when I think back on what we were doing just ten years ago and what we’re doing now, I can see differences. I can see we’re doing better for people now than we did before, and it makes us hungry and aggressive to want to find out more to be able to do more.
The same thing applies to acute leukemia where you can have diseases that can be somewhat indolent and don’t need a lot of treatment, to diseases like acute leukemia that require basically hospitalization literally that day in order to be able to save somebody’s life.
Melanie: And, Dr. Forman, in just the last minute that we have left, tell us about the recently launched Hematologic Malignancies Institute and why people should come to City of Hope for their hematologic cancer care.
Dr. Forman: I think City of Hope has a rich history in both developing therapy for and taking care of people who have these somewhat unique diseases. I think when they come here they really have the whole repertoire of therapies at their disposal, and so they don’t have to go someplace else. So if you need a transplant, you can get a transplant. If you need standard therapy, you can get standard therapy. If you need investigational therapy, there’s a very deep and rich clinical trials network here, which really, because we have taken the ideas we have in our laboratory and put them into practice so that we can help patients who might need them.
Another aspect, I think, here, in addition to making the correct diagnosis and our pathology department which is also quite experienced, is that the nurses in this institution are very attuned to taking care of patients with cancer, and particularly patients with these diseases, in a very respectful and dignified way. I think one of the things we hate about cancer is that it’s a thief, not just of life but of the quality of people’s lives and their integrity. So for us, they are people who have cancer; they’re not cancer patients. I think the combination of a respectful environment with science that drives our compassion and our wanting to do a better job today than we did yesterday, I think, makes it a unique place for people to come here and know they’re going to be cared for well.
Melanie: Thank you so much, Dr. Steven Foreman. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks for listening.