Recognized internationally for its breakthrough treatments for leukemia and other blood disorders,
City of Hope is one of the most successful treatment centers for leukemia in the country and has had some of the consistently best survival outcomes.
Listen as hematologist-oncologist Dr. Joseph Alvarnas explains that the focus of doctors and others at City of Hope is not just cancer remission, but to cure patients altogether.
Selected Podcast
Better Survival for Acute Leukemia Patients
Featured Speaker:
Joseph Alvarnas, MD
Joseph Alvarnas, M.D. is Associate Clinical Professor and Director of Medical Quality and Quality, Risk, and Regulatory Management Transcription:
Better Survival for Acute Leukemia Patients
Melanie Cole (Host): Recognized internationally for its breakthrough treatments for leukemia and other blood disorders, City of Hope is one of the most successful treatment centers for leukemia in the country and has had some of the most consistently best survival outcomes. My guest today is hematologist/oncologist, Dr. Joseph Alvarnas from City of Hope. Welcome to the show, Dr. Alvarnas. Tell us a little bit about acute leukemia. What is it, and what symptoms might someone have that would send them to see you to even get diagnosed with leukemia?
Dr. Joseph Alvarnas (Guest): Thank you very much for the opportunity to be with you today. Acute leukemia is a relatively rare disorder. A total of about 20,000 people are diagnosed annually in the United States with either acute myelogenous leukemia or acute lymphoblastic leukemia. To state it simply, there are many cells within the bone marrow that serve to make all the elements of our blood. The youngest cells that we can identify in the bone marrow are called blasts. In acute leukemia, these younger cells grow out of proportion and soon overtake the bone marrow and blood. And our bone marrow becomes filled with these relatively nonfunctioning cells that over time can take away our ability to fight off infection, drop our red blood cell count that allows us to carry oxygen to our bodies, and drop our platelets. That leads us to bleed. In acute leukemia, what people may experience is progressive fatigue and increasing risk of infection or fever, and people beginning to bruise easily or have bleeding, either under their skin or from their nose or from their mouth. These are the most common symptoms that people experience when they’re developing acute leukemia.
Melanie: How do you diagnose it?
Dr. Alvarnas: Well, the appropriate thing is for people to get expert care quickly. If someone goes to an emergency department or in an urgent care and gets a blood count, then the pathologist or the person reviewing that blood smear may see a series of abnormal cells or blasts present. It really takes an expert review by a pathologist, like a place at City of Hope, to diagnose an acute leukemia and differentiate it from another condition that may be less serious. For many people, this may also require a bone marrow aspirate or biopsy, where a physician may take a small amount of bone marrow, typically from the hipbone, so that we can really see from the place where all the blood is made what is actually going on.
Melanie: Once it’s diagnosed, what are some treatments available, and what is their survival rate? Let’s give the listeners some hope for acute leukemia.
Dr. Alvarnas: One of the things that we’ve seen is that we’ve become far more effective over time treating people with acute leukemia. The therapy of this set of diseases -- and it is a set of diseases of up to 30 different kinds of acute leukemias. In fact, they require treatment sometimes with intensive chemotherapy. So, patients will enter the hospital and may stay hospitalized initially for up to a month. Then, in order to treat the leukemia effectively, they may require a series of treatments over the coming six months with hospitalizations and with the need of supportive care. So, the care of someone with acute leukemia is quite comprehensive. One of the things that we can offer these days for some patients who may be at higher risk for the acute leukemia to not go away is a bone marrow or blood stem cell transplant, or may identify a brother or sister or an unrelated donor or even a unit of cord blood saved when a baby was born as potential stem cell source. So, with acute leukemia, being in an expert place where your doctor can understand the nature of the risk from the disease and tailor the therapy specifically for your needs, you’ll receive the most effective care. Typically, cure rates have ranged from about 30 to 40 percent for adults with acute leukemia; but in expert places, where bone marrow and blood stem cell transplants can be performed, cure rates may exceed 60 percent. The best way to understand your risk and what is the best therapy for you is by having a conversation with the physician who is expert in the care of patients with this kind of leukemia.
Melanie: Are there some factors that affect someone’s prognosis and how well they’ll do with these treatments?
Dr. Alvarnas: Well, I think there are a number of factors. We know that if people are compliant with their therapy, if they take their medications on time and in an appropriate way, they do better. We also know that getting care in a comprehensive cancer center or an expert center also allows patients to have access to more efficient and effective care from the beginning and also allows them to be able to receive therapy that is state of the art and speaks towards the newest and best attempts to cure this disease that exists anywhere.
Melanie: You spoke about stem cell transplants, possibly cord blood and even bone marrow transplants. Is it difficult to find a match if you do need one of these? And if you find somebody who’s willing to donate bone marrow, Dr. Alvarnas, is that a difficult thing? Is it painful?
Dr. Alvarnas: Well, starting with your last question first, I am a tremendous coward, but I’m actually enrolled in the National Marrow Donor program as a volunteer donor. Donating stem cells these days is not a difficult proposition. In fact, for many donors, the cells may be taken from their blood using a machine that filters out the stem cells. I think that isn’t a barrier. What we’ve seen over the last decade is in fact greater access to donors for much more diverse variety of patients. About one in three people have an appropriate matched donor. We’re talking about immunological matching, not ABO red type matching. This is quite a bit different. Many other people though who don’t have a potential donor can draw upon a pool of more than 10 million unrelated volunteer donors that are available through the National Marrow Donor program, and this way, we can, for the vast majority of individuals affected by acute leukemia, find a donor that’s appropriately matched.
Melanie: What about some new advances? What’s on the horizon for acute leukemia?
Dr. Alvarnas: Well, I think there are a couple of things which I find tremendously exciting. On the transplant side, we’re now able to offer transplants using less intensive chemotherapy. Reduced intensity transplants, in fact, are able to extend the usefulness of transplants not just to people who are young but people who may be in their 60s or 70s who are affected by this disease. One of the innovations is that therapy has become more accessible and relevant for those who need it most. On the other hand, when I look at some of the things going on at City of Hope, we’re looking at new T-cell therapies, which can in fact target leukemia cells and lymphoma cells. In this case, what’s done is a T-cell is taken from either the person or from a donor and gene-engineered to be able to deliver specialized care—that is, we actually can target the T-cell against the leukemia or lymphoma cell so that it can augment all that chemotherapy has achieved beforehand. This way, we’re harnessing the power of the immune system and into the power of chemotherapy. Thirdly, we’re working in collaboration with other partners to be able to bring new chemotherapy drugs that are specifically targeted at leukemia in novel ways that had never existed before. This is a wonderful time to be at a place like City of Hope because we’re looking at the future of medicine written anew. It’s absolutely extraordinary, and it provides patients and their families to benefit from novel forms of new therapies, effective therapies that would have been unimaginable even 10 years ago.
Melanie: Dr. Alvarnas, in just the last minute or two—this is such fascinating and exciting information you’re giving today—please tell listeners why they should come to City of Hope for their leukemia or blood disorders care.
Dr. Alvarnas: Well, I think that first it’s how we care that makes a difference. As you walk through the gate here, literally, there’s a gate that says, “What profit is there in saving the body if in the process we forfeit the soul?” We look at people as living, breathing individuals with families and lives around them. What we do begins with the respect for that person and his desire to return them to wholeness. On the other hand, we couple that desire to respect the person with the best technology, the newest treatments, and the most dedicated healthcare professionals anywhere to deliver what I believe is the best care in the world.
Melanie: Well, thank you so much, Dr. Joseph Alvarnas. 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. Thank you so much for listening.
Better Survival for Acute Leukemia Patients
Melanie Cole (Host): Recognized internationally for its breakthrough treatments for leukemia and other blood disorders, City of Hope is one of the most successful treatment centers for leukemia in the country and has had some of the most consistently best survival outcomes. My guest today is hematologist/oncologist, Dr. Joseph Alvarnas from City of Hope. Welcome to the show, Dr. Alvarnas. Tell us a little bit about acute leukemia. What is it, and what symptoms might someone have that would send them to see you to even get diagnosed with leukemia?
Dr. Joseph Alvarnas (Guest): Thank you very much for the opportunity to be with you today. Acute leukemia is a relatively rare disorder. A total of about 20,000 people are diagnosed annually in the United States with either acute myelogenous leukemia or acute lymphoblastic leukemia. To state it simply, there are many cells within the bone marrow that serve to make all the elements of our blood. The youngest cells that we can identify in the bone marrow are called blasts. In acute leukemia, these younger cells grow out of proportion and soon overtake the bone marrow and blood. And our bone marrow becomes filled with these relatively nonfunctioning cells that over time can take away our ability to fight off infection, drop our red blood cell count that allows us to carry oxygen to our bodies, and drop our platelets. That leads us to bleed. In acute leukemia, what people may experience is progressive fatigue and increasing risk of infection or fever, and people beginning to bruise easily or have bleeding, either under their skin or from their nose or from their mouth. These are the most common symptoms that people experience when they’re developing acute leukemia.
Melanie: How do you diagnose it?
Dr. Alvarnas: Well, the appropriate thing is for people to get expert care quickly. If someone goes to an emergency department or in an urgent care and gets a blood count, then the pathologist or the person reviewing that blood smear may see a series of abnormal cells or blasts present. It really takes an expert review by a pathologist, like a place at City of Hope, to diagnose an acute leukemia and differentiate it from another condition that may be less serious. For many people, this may also require a bone marrow aspirate or biopsy, where a physician may take a small amount of bone marrow, typically from the hipbone, so that we can really see from the place where all the blood is made what is actually going on.
Melanie: Once it’s diagnosed, what are some treatments available, and what is their survival rate? Let’s give the listeners some hope for acute leukemia.
Dr. Alvarnas: One of the things that we’ve seen is that we’ve become far more effective over time treating people with acute leukemia. The therapy of this set of diseases -- and it is a set of diseases of up to 30 different kinds of acute leukemias. In fact, they require treatment sometimes with intensive chemotherapy. So, patients will enter the hospital and may stay hospitalized initially for up to a month. Then, in order to treat the leukemia effectively, they may require a series of treatments over the coming six months with hospitalizations and with the need of supportive care. So, the care of someone with acute leukemia is quite comprehensive. One of the things that we can offer these days for some patients who may be at higher risk for the acute leukemia to not go away is a bone marrow or blood stem cell transplant, or may identify a brother or sister or an unrelated donor or even a unit of cord blood saved when a baby was born as potential stem cell source. So, with acute leukemia, being in an expert place where your doctor can understand the nature of the risk from the disease and tailor the therapy specifically for your needs, you’ll receive the most effective care. Typically, cure rates have ranged from about 30 to 40 percent for adults with acute leukemia; but in expert places, where bone marrow and blood stem cell transplants can be performed, cure rates may exceed 60 percent. The best way to understand your risk and what is the best therapy for you is by having a conversation with the physician who is expert in the care of patients with this kind of leukemia.
Melanie: Are there some factors that affect someone’s prognosis and how well they’ll do with these treatments?
Dr. Alvarnas: Well, I think there are a number of factors. We know that if people are compliant with their therapy, if they take their medications on time and in an appropriate way, they do better. We also know that getting care in a comprehensive cancer center or an expert center also allows patients to have access to more efficient and effective care from the beginning and also allows them to be able to receive therapy that is state of the art and speaks towards the newest and best attempts to cure this disease that exists anywhere.
Melanie: You spoke about stem cell transplants, possibly cord blood and even bone marrow transplants. Is it difficult to find a match if you do need one of these? And if you find somebody who’s willing to donate bone marrow, Dr. Alvarnas, is that a difficult thing? Is it painful?
Dr. Alvarnas: Well, starting with your last question first, I am a tremendous coward, but I’m actually enrolled in the National Marrow Donor program as a volunteer donor. Donating stem cells these days is not a difficult proposition. In fact, for many donors, the cells may be taken from their blood using a machine that filters out the stem cells. I think that isn’t a barrier. What we’ve seen over the last decade is in fact greater access to donors for much more diverse variety of patients. About one in three people have an appropriate matched donor. We’re talking about immunological matching, not ABO red type matching. This is quite a bit different. Many other people though who don’t have a potential donor can draw upon a pool of more than 10 million unrelated volunteer donors that are available through the National Marrow Donor program, and this way, we can, for the vast majority of individuals affected by acute leukemia, find a donor that’s appropriately matched.
Melanie: What about some new advances? What’s on the horizon for acute leukemia?
Dr. Alvarnas: Well, I think there are a couple of things which I find tremendously exciting. On the transplant side, we’re now able to offer transplants using less intensive chemotherapy. Reduced intensity transplants, in fact, are able to extend the usefulness of transplants not just to people who are young but people who may be in their 60s or 70s who are affected by this disease. One of the innovations is that therapy has become more accessible and relevant for those who need it most. On the other hand, when I look at some of the things going on at City of Hope, we’re looking at new T-cell therapies, which can in fact target leukemia cells and lymphoma cells. In this case, what’s done is a T-cell is taken from either the person or from a donor and gene-engineered to be able to deliver specialized care—that is, we actually can target the T-cell against the leukemia or lymphoma cell so that it can augment all that chemotherapy has achieved beforehand. This way, we’re harnessing the power of the immune system and into the power of chemotherapy. Thirdly, we’re working in collaboration with other partners to be able to bring new chemotherapy drugs that are specifically targeted at leukemia in novel ways that had never existed before. This is a wonderful time to be at a place like City of Hope because we’re looking at the future of medicine written anew. It’s absolutely extraordinary, and it provides patients and their families to benefit from novel forms of new therapies, effective therapies that would have been unimaginable even 10 years ago.
Melanie: Dr. Alvarnas, in just the last minute or two—this is such fascinating and exciting information you’re giving today—please tell listeners why they should come to City of Hope for their leukemia or blood disorders care.
Dr. Alvarnas: Well, I think that first it’s how we care that makes a difference. As you walk through the gate here, literally, there’s a gate that says, “What profit is there in saving the body if in the process we forfeit the soul?” We look at people as living, breathing individuals with families and lives around them. What we do begins with the respect for that person and his desire to return them to wholeness. On the other hand, we couple that desire to respect the person with the best technology, the newest treatments, and the most dedicated healthcare professionals anywhere to deliver what I believe is the best care in the world.
Melanie: Well, thank you so much, Dr. Joseph Alvarnas. 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. Thank you so much for listening.