LEUKEMIA SERVICERoswell Park’s NEWS

FROM

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 hematolymphoidneoplasms 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.

MEET THE LEUKEMIA TEAM

The Leukemia Service at Roswell Park Cancer Institute(RPCI) is dedicated to quality patient care, innovativeresearch, and the development of more effectivetreatments for all hematologic malignancies, including:

RPCI’s Leukemia Service takes a team approach to patient care. A leukemia physician oversees ateam of fellows, nurse practitioners, physician assistants, pharmacists, social workers, adischarge-planning coordinator, a psychologist and research coordinators. Our nursepractitioner/physician assistant-run clinic in the Chemotherapy/Infusion Center is designed tosee patients receiving outpatient chemotherapy or those who have low blood counts and are inneed of transfusions.

Clinical research conducted by our faculty and staff consistently translates into new therapeuticapproaches and advances overall knowledge of the disease.

At RPCI, a dedicated team of board-certified hematopathologists performsstate-of-the-art, integrated diagnostic hematopathology—essential todiagnosing and classifying hematolymphoid neoplasms according to themost recent WHO classification.

“Pathology is not just looking at cells under the microscope anymore,” saysGeorge Deeb, MD, Assistant Professor, Director of Hematopathology andDepartment of Pathology & Laboratory Medicine; Associate Director,Laboratory of Clinical Flow Cytometry. “The integrated diagnostic approachis based on comprehensive clinical, morphologic, immunophenotypic,cytogenetic, and molecular genetic studies of blood, bone marrow andextramedullary tissue samples.”

Our hematopathologists work closely with the leukemia clinical team andother ancillary laboratories at RPCI to expedite prompt, comprehensiveassessments. The ancillary laboratories incorporate the following:

PATHOLOGY Taking diagnosis to a new level

of patients receive adifferent diagnosis after coming to RPCI,

as a result of the specialized expertise of the Pathology team at RPCI.3

A LEUKEMIA PATIENTWe work continually to fortify existing partnerships with thecommunity physicians who entrust their patients to RPCI.

When you suspect or diagnose cancer in your patient, you want the best treatment and care available forthat 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 yourpatient’s treatment and progress. After treatment has been completed and your patient returns to yourcare, we will continue to provide assistance as needed.

With even a suspicion of cancer, your patient can call us and one of our referral professionals willwalk him or her through the referral process, answer questions and set up an appointment with thecancer 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 1-800-ROSWELL (1-800-767-9355) to seek a consultation or second opinion, or to refer a patient.

Tracy RoachSenior Patient Access Representative(716) 845-5902

Refer

(above from left to right)

Medical OncologyMeir Wetzler, MD, FACP

Hematologic OncologyElizabeth Griffiths, MDJames Thompson, MD

Carlos Vigil, MDEunice Wang, MD

PathologyMaurice Barcos, MD, PhD

Bora Baysal, MDGeorge Deeb, MDMihai Merzianu, MDVishala Neppalli, MDPetr Starostik, MDPaul Wallace, PhD

PsychologyMegan Pailler, PhD, MA

GOING with the FLOWRPCI’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.

THE FIRST PRIORITY

“This integrated diagnostic approach allows us to characterizethe tumor’s fingerprint,” says Dr. Deeb, “and provides the mostaccurate classification that is critical for planning treatment,predicting therapy response and survival, and detecting residualdisease or early relapse in leukemia patients.”

10%

Acute lymphoblastic leukemia (ALL)

Acute myeloid leukemia (AML)

Chronic myeloid leukemia (CML)

Myelodysplastic syndrome (MDS)

Myeloproliferative neoplasms (MPN)

Accurate diagnosis is critical for appropriate treatment.

50%

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

Perc

enta

ge

3 4 521

Acute Myeloid Leukemia5-Year Observed Survival

Cases Diagnosed in 1998-2002

43.5%

39.4%

27.4%

34.9%

26.9%

22.9%20.8%

23.7%22%

19.3%

RPCI National Cancer Data Base

Year Post-Diagnosis

Chronic Myeloid Leukemia (CML)5-Year Observed Survival

Cases Diagnosed, 1998-2002

90

80

70

60

50

40

30

20

10

0

Perc

enta

ge

3 4 521

Chronic Myeloid Leukemia5-Year Observed Survival

Cases Diagnosed in 1998-2002

73%

78.9%

61.4%

68.4%

61.4%

54%

49.2%

57.9%54.2%

45.7%

RPCI National Cancer Data Base

Year Post-Diagnosis

Acute Myeloid Leukemia (AML)5-Year Observed Survival

Cases Diagnosed, 1998-2002

4 5

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.

approachesforleukemia

novel targeted

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.

OU

R

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

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

protection against airborne pathogens. The nursing

staff is specially trained in the management and care

of immunocompromised BMT patients, who have

special needs.

BloodMarrow

TransplantAND

P R O G R A M

The statistical data presented here has been benchmarkedagainst data collected by SEER, NCDB, Press Ganey and NCCN.

For healthcare professionals, quality cancer care tends to be defined byclinical outcomes—particularly those that impact patient mortality, morbidityand cost of care—and rooted in evidence-based medicine and best practices.

A CENTER OFEXCELLENCE

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

forleukemiatreatment

approachesnovel targeted

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.

76

Currently we are investigating:

• The role of signal transducer and

activator of transcription in

leukemogenesis; cellular and humoral

immune response to leukemic-

associated 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.

From bench to bedside—translational research at RPCI Support

INTEGRATING PSYCHOSOCIAL SUPPORT INTO EVERY PATIENT’S CARE

way

everystepofthe

Adjusting to diagnosis and coping with treatment is difficult

for most cancer patients, but those with acute leukemia

often face unique challenges. “Certain factors about

leukemia, such as the very short time between diagnosis

and treatment, extended hospitalization and duration of

care, put a significant strain on patients and their families,”

says Megan Pailler, PhD, Medical Psychologist.

RPCI offers extensive psychosocial services for leukemia

patients, including support at the time of a new diagnosis,

psychological assessment, psychotherapy for patients and

their families, and a caregiver orientation program for

family members of all newly diagnosed leukemia patients.

“As a comprehensive cancer center, this is what sets us

apart,” says Dr. Pailler. “We treat the whole person, not just

the cancer. Psychosocial services are fully integrated into

the treatment and care patients receive here.”

In addition, the Social Work Department offers leukemia

patients a number of services to support them and their

families throughout treatment.

Patients don’t have the time to prepare or plan for a long

hospital stay. Our Social Services, while beneficial to many

cancer patients, are often essential for those with leukemia.

• Educational and orientationprograms to help patientsunderstand their disease and its treatment

• Assistance in navigating theFamily Medical Leave Act(FMLA), sick leave and disability

• Help with lodging, transportationor language/interpreter needs

• Connections to financialassistance programs and othercommunity resources

• Assistance with advance careplanning, palliative care and/orhospice as needed

SOCIAL WORK AND PSYCHOLOGY

SERVICES

This facility allows RPCI to collect and bank tissue samples from all patients with hematologic malignancies. We study these samples to betterunderstand characteristics of individual patients’ disease, and this leads to newfindings and the development of better clinical studies for leukemia patients.

HematologicProcurement Facility

24981 (1/6/12)

RPCI

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.

= NCCN Cancer Centers

Setting the National Standards

Meir Wetzler, MD, FACP, Chief, Leukemia Section,Department of Medicine;Assistant ResearchProfessor, Department of Immunology; serves on the ChronicMyelogenous Leukemiaand Acute LymphoblasticLeukemia Panels.

Visit www.nccn.org for more information.

James Thompson, MD, Assistant Professor ofOncology, Departmentof Medicine; AssistantMember, Departmentof Immunology;serves on theMyelodysplaticSyndromes Panel.

Carlos Vigil, MD, Assistant Professor,Leukemia Service,Department of Medicine;serves on the Cancer-and Chemotherapy-Induced Anemia Panel.

Eunice Wang, MD, Assistant Professor,Department of Medicine;Assistant Member, TumorImmunology Program;serves on the AcuteMyeloid Leukemia Panel.