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Melanie Cole (Host): SLUCare hematologists and oncologists have an international reputation as experts in cancers of the blood, bone marrow, and lymph nodes as well as in bone marrow transplant. Our guest today is Dr. Carl Freter. He’s the Director and the Professor in the Division of Hematology/Oncology in the Department of Internal Medicine at Saint Louis University School of Medicine. Welcome to the show, Dr. Freter. Tell us about the Hematology/Oncology Department at SLUCare.

Dr. Carl Freter (Guest): Well, we offer full-spectrum cancer care to patients with any kind of cancer. We’re particularly proud of our Bone Marrow Transplant Program, which is one of the only transplant programs in our area that has an outpatient transplant facility. This is something that we’ve developed in the past two years through the hard work of Dr. Friedrich Schuening and, subsequently, the other members of the Bone Marrow Transplant Program here, including Mark Fesler. This allows our patients to basically not spend a period of time in a hospital room being taken care of but to be outpatients. They have to be close to us, and they have to have caregivers. But if all of that can be arranged, they can enjoy the luxury of not having to be in the hospital during a period of time for their bone marrow transplants or their stem cell transplants. We have found that patients love this option when they’re candidates for it. It really enhances their overall wellbeing in sort of every dimension: spiritually, medically. So this is something that I think is certainly the wave of the future that we’re offering here at SLU.

Melanie: Dr. Freter, you specialize in treating lymphoma, leukemia and other types of blood cancers. Tell us a little bit about leukemia. It’s something that instills fear in a lot of people, especially if children are involved. Tell us a little bit about leukemia.

Dr. Freter: Well, leukemia isn’t just one disease, although it does describe having too many white blood cells circulating in the blood, and that’s literally what the word “leukemia” means. But there are several different types of leukemia. I guess, first, the types of leukemia that occur in children mostly are what we call acute leukemia. That is, they tend to grow very rapidly and they need attention very rapidly. The good news is that over the past 15 to 20 years, curative therapy for childhood leukemia, the most common kind, has been developed and is regularly provided for children. Here at our partners at Cardinal Glennon Hospital, with which we also have a combined Bone Marrow Transplant Program—which is another thing we’re proud of in our program here at SLUCare. Other kinds of leukemias, particularly those that are in adults, can either be chronic leukemias, which tend to be actually a not-so-scary disease; actually, they are leukemias that tend to have a slow progression. Sometimes patients don’t require treatment for long periods of time, and they can be watched. Another type of leukemia that occurs in adults is called chronic myelogenous leukemia, and that’s a type of leukemia that used to instill fear. But now that we have -- one of the triumphs of modern oncology, simple oral medicines to treat that, to keep it under control and to keep it in remission, it’s become a less terrifying disease than it used to be. The last resort, we always have bone marrow or stem cell transplantation for that disease as well, which can be cured. The acute leukemias that occur in adults are rapidly progressive diseases. They do require very prompt attention. Patients usually have warning symptoms of fatigue, sometimes bleeding, sometimes infections that bring them to our attention and we have to act extraordinarily rapidly to first diagnose exactly what they have so we can offer the best cutting-edge treatment to them that exist and then, second, to put them into that treatment as quickly as possible. And so, we are generally able to do that if we really need to in just a matter of hours, after getting the patient here, sometimes flying by helicopter from some other remote location in Missouri. Some of those patients will need to have bone marrow, stem cell transplants to cure them with curative intent. Some will be cured by chemotherapy alone. For those who need transplants, we, again, can treat them seamlessly and move them into our transplant program when that’s appropriate, and they have the opportunity of having the outpatient transplants here that I was describing before. “Leukemia” is a scary term for a lot of people, but many leukemias are not so scary anymore. Some are not scary at all, even just because of their slow progression, and none of them are scary and that we have very good treatment for all of them.

Melanie: Dr. Freter, you were talking about the outpatient bone marrow transplant. Just give the listeners a quick synopsis of what that is like. Is there a donor? Can a family be a donor? Is it as painful as they’ve discussed in the past before, or is it all different now?

Dr. Freter: Well, I think the best answer to your question is it’s all different now. The first place, in terms of donors, the first place we look is in siblings of the person who’s affected by the leukemia. And so that’s brothers or sisters, and they’re most likely to be matched to the patient and able to be blood donors. The next place we often look is into larger industries of potential donors, and sometimes we find those. So that’s another source of donors. One of the things that we and others have been doing cutting edge work with is doing umbilical cord transplants, where the very early stem cells that are present in umbilical cords that are saved for this purpose can be used to do a bone marrow transplant in a person. That often is a source of cells or a donor, if you will, that makes a transplant possible these days. So there are many options in terms of donors. If you are a donor, it doesn’t involve doing lots of removing of bone marrow from bones like we used to do, I guess, in the bad old days. What it does involve is using [growth vectors] to make the stem cells come out in the circulation and then collect those. From the patient’s standpoint, pretty simple procedure where they have an IV in their arm and they’re connected to a machine that takes the stem cells out of the blood and then returns the blood back to the patient. It’s a lot like donating blood from the patient’s perspective, and so it’s not really a huge thing. We do screen our donors very carefully, and we make sure that they’re suitable, both from a medical standpoint, from the patient’s perspective and also their perspective. And so, that’s a process that we give a lot of attention to detail to in making sure that we have absolutely the best possible donors for each individual patient.

Melanie: That’s amazing. The outpatient, the bone marrow transplant clinic is the only one in the region, and it’s at SLUCare. So tell us, in just the last minute, Dr. Freter, why people should come to SLUCare for their cancer care.

Dr. Freter: I think people should come here, first and foremost, because we provide as advanced medical care for patients getting bone marrow transplants as anyone, and we’re very proud of that. We’re also very proud of our outpatient program, which we’ve already discussed. There’s another very important dimension to this, and that deals with why I came here to SLUCare, and that is just simply the people we have here. We have a very dedicated group of people who are very patient-focused, and we really view ourselves at the service of our patients. Our job is to get patients through, sometimes these prolonged typical procedures, with all of the grace, the dignity, and the lack of pain as possible. Our mission to do this is also to help the patient as holistically as possible but also the patient’s family, which is a big part of some of these bone marrow transplant procedures, working with them to get everybody through the procedure, including donors, as smoothly and easily as possible. We really want to minister to the social needs, the spiritual needs, the medical needs, the personal needs of our patients and really view this as a multi-dimensional approach to the complex human beings that our patients are and that we recognize them to be.

Melanie: Thank you so much, Dr. Carl Freter. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks so much for listening.