Inspired - Summer 2014 - University of Chicago Medicine

InspiredSUMMER 2014

A PHYSICIAN

PUBLICATION

FOCUS ON LEUKEMIA

PAGE 4

ATRA/ATO therapy targets acute promyelocytic leukemia

PAGE 6

Haplo-cord stem cell transplantation expands lifesaving treatment

ALSO IN THIS ISSUE

PAGE 1

First international trial for oligometastatic breast cancer

PAGE 3

Sleeve gastrectomy helps acclaimed chef lose weight, gain health

PAGE 10

Minimally invasive surgical resection for metastatic spinal cord compression

UCM_Inspired_7_v12.indd 1 6/24/14 3:32 PM

The University of Chicago Medicine

& Biological Sciences has been at the

forefront of medical care, research and

teaching for more than 90 years. Located

in historic Hyde Park on the South Side

of Chicago, the University of Chicago

Medicine & Biological Sciences includes:

Patient Care

» Bernard A. Mitchell Hospital

» Center for Care and Discovery

» Comer Children’s Hospital

» Duchossois Center for Advanced Medicine

» Numerous outpatient locations

throughout the Chicago area

Teaching Programs

» Pritzker School of Medicine

» Master’s and doctoral degree programs

» Postdoctoral programs

Research

» Medical and basic science units

Among our many honors and

acknowledgments: 12 Nobel laureates;

ranked 11th of all U.S. medical schools;

one of only 41 National Cancer

Institute–designated comprehensive

cancer centers; ranked fifth in nation

for National Institutes of Health grant

support per researcher.

University of Chicago Medicine & Biological

Sciences Executive Leadership

Kenneth S. Polonsky, MD, Dean of the

University of Chicago Biological Sciences

Division and the Pritzker School of Medicine,

and executive vice president for Medical

Affairs for the University of Chicago

Sharon O’Keefe, president of the

University of Chicago Medical Center

Jeffrey Glassroth, MD, dean for clinical

affairs, University of Chicago Medicine

T. Conrad Gilliam, PhD, dean for

basic science, Biological Sciences Division

Holly J. Humphrey, MD, dean for medical

education, Pritzker School of Medicine

INSPIRED iS PubliSHeD THRee TiMeS

a yeaR by THe univeRSiTy OF CHiCaGO

MeDiCine & biOlOGiCal SCienCeS.

editor: Anna Madrzyk

assistant editor: Gretchen Rubin

email us at: [email protected]

Design: TOKY Branding + Design

Contributing writers

Thea Grendahl Christou, Tanya Cochran,

John Easton, Kevin Jiang, Brooke O’Neill,

Gretchen Rubin and Matt Wood

Contributing photographers

David Christopher, Megan E. Doherty,

Carolina Hidalgo, Robert Kozloff,

Jean Lachat and Bruce Powell

aDDReSS

The university of Chicago Medicine

5841 S. Maryland Ave., Chicago, IL 60637

The university of Chicago Medicine

Comer Children’s Hospital

5721 S. Maryland Ave., Chicago, IL 60637

Telephone 1-773-702-1000

appointments 1-888-824-0200

Follow the University of Chicago Medicine

on Twitter at twitter.com/uChicagoMed or

visit our Facebook page at facebook.com/

uChicagoMed. You can read more about our

news and research at uchospitals.edu/news

and at sciencelife.uchospitals.edu.

This publication does not provide medical

advice or treatment suggestions. If you

have medical problems or concerns, contact

a physician, who will determine your

treatment. Do not delay seeking medical

advice because of something you read here.

For urgent needs, call 911 right away.

Read Inspired online at

uchospitals.edu/inspired.

We want to work with you to bring leading-edge therapies to patients facing cancer and other challenging diseases.

A diagnosis of

acute promyelocytic

leukemia (APL) used

to be an oncologist’s

nightmare. Life-

threatening

hemorrhaging at the outset typically

worsened even while initial treatment

was being administered. Today the

introduction of the combination of

all-trans retinoic acid and arsenic

trioxide (ATRA/ATO) for frontline

therapy has brought about remarkable

improvements in survival for patients

with this rare leukemia.

The story behind this tailored treatment

began at the University of Chicago Medicine

37 years ago, when our scientists identified

the chromosomal 15;17 translocation

responsible for APL. In the ensuing

decades, researchers here and worldwide

have conducted clinical trials leading to

and refining the ATRA/ATO treatment.

In this issue of Inspired, you will also

read about haplo-cord stem cell

transplantation, minimally invasive surgery

for cancer that has metastasized to the

spine and our new I131-MIBG therapy room

for treatment of high-risk neuroblastoma.

We want to work with you to bring

these and other leading-edge therapies

to patients facing cancer and other

challenging diseases. Let us know how

we can help.

aT THe FOReFROnT OF MeDiCine®

Dear Colleagues ,

KENNETH S. POLONSKY, MD

Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago

KENNETH S. POLONSKY, MDOLONSKY, MDOLONSKY

ON THE COVER: Design based on a photomicrograph of a blood smear from a patient with newly diagnosed acute promyelocytic leukemia (aPl). Cure rates for adults with low- and intermediate-risk aPl now exceed 90 percent with targeted therapy. See story on page 4.

image courtesy of Sandeep Gurbuxani, MD, PhD, assistant professor of pathology, the university of Chicago Medicine

UCM_Inspired_7_v12.indd 2 6/20/14 8:33 AM

PhysICIan referral lIne 1-800-824-2282 | UCHOSPITALS.EDU | UCHICAGOKIDSHOSPITAL.ORG » 1

Directed Therapy Shows Promise for Oligometastatic breast Cancer

The university of Chicago Medicine will lead the first international trials to randomize breast cancer patients with oligometastatic disease to treatments with curative intent. The trial studies (Br001 and Br002) are being conducted through the national Cancer Institutes’ nrg oncology and alliance cooperative groups.

oligometastasis — an intermediate state between cancer that has not spread at all and cancer that has spread extensively — was defined by physician-scientists here a decade ago. subsequently, they demonstrated that some patients with limited metastases could be cured with radiotherapy directed locally at the tumor.

The objectives of Br001 and Br002 are to determine if ablation, with either stereotactic body radiotherapy or surgical resection of all known metastases, significantly improves progression-free survival and overall survival in oligometastatic breast cancer patients.

“It is the hope that the outcome of this trial will be practice-changing for this subset of patients,” said radiation

oncologist steven J. Chmura, MD, PhD, the principal investigator for the trial.

The university of Chicago Medicine recently organized a multidisciplinary team of medical, surgical and radiation oncologists to evaluate and treat patients with oligo-metastases. The physicians work collaboratively to identify the most effective treatment — stereotactic body radiotherapy, chemotherapy, immunotherapy and/or surgery — for individual patients. The breast cancer trial, which begins later this year, is one of several prospective trials underway or in the planning stages.

uChicago Medicine researchers also are conducting extensive laboratory investigations to better understand the biological mechanisms of metastasis and oligometastasis. They have identified promising molecular biomarkers of oligometastasis, which may help determine which patients are most likely to benefit from aggressive metastasis-directed local therapies.

For more information or to refer a patient, please call 1-773-702-6860.

OLIGOMETASTASIS

The university of Chicago Medicine Comer Children’s hospital is the first medical center in Illinois to offer I131-meta-iodobenzylguanidine (MIBg) therapy for treatment of high-risk neuroblastoma.

neuroblastoma cells internalize the MIBg molecule. When the molecule is combined with radiolabeled iodine (iodine-131), the radioactive drug can carry radiation directly to tumor cells without harming normal cells. a single dose of I131-MIBg IV is given to patients over two hours on day 0. radiation is cleared through bodily fluids over several days, mainly excreted through the urine, during which time the patient must be hospitalized with a urinary catheter.

“I131-MIBg is one of the most active drugs identified to date for relapsed or refractory neuroblastoma,” said oncologist susan l. Cohn, MD, noting that the therapy has a 30 to 40 percent response rate in this setting. “Because of its efficacy in patients with relapsed disease, we are now evaluating I131-MIBg response in newly diagnosed high-risk disease.”

Comer Children’s hospital built a designated lead-lined room to safeguard families and

staff while children receive I131-MIBg therapy. During the three- to five-day exposure period, everything in the room — including the walls, floor and fixtures — is covered with plastic or paper. lead plates separate the patient bed from visiting staff and family.

nurses caring for patients undergoing I131-MIBg therapy follow strict guidelines to control their exposure to radiation. Parents are trained to be the primary caregivers during limited visits in the room, which become longer as the amount of radiation given off by the patient decreases. a closed-circuit TV monitoring system and iPads allow patients to communicate with family and staff.

The MIBg team at Comer Children’s hospital includes pediatric oncologists, advanced practice oncology nurses, nuclear medicine physicians and technicians, radiation safety experts, child life specialists and social workers.

For more information or to arrange a visit, please contact Susan Cohn, MD, [email protected], or Kelly Kramer, RN, MSN, CPNP, CPON, [email protected].

i131-MibG Therapy Room Opens at Comer Children’s Hospital

NEUROBLASTOMA

aT THe FOReFROnT OF CanCeR CaRe

Controlled primary lesion

Distant metastases/recurrences i131-MibG


2 » THE UNIVERSITY OF CHICAGO MEDICINE INSPIRED MAGAZINE | SUMMER 2014

Read moRe at

CancerConversations.uchospitals.edu

@UChicagoCancer

Read moRe at

ScienceLife.uchospitals.edu

@ScienceLife

The university of Chicago Medicine is the only u.s. site for an international multicenter trial testing an anti-inflammatory drug for pancreatic islet transplant in patients with brittle type 1 diabetes. The medication may improve islet survival during engraftment, allowing patients to achieve insulin independence sooner and avoid additional islet transplants. Piotr Witkowski, MD, PhD, director of pancreas and islet transplantation, is the principal investigator.

MOTHERS’ THERAPY

THwARTED

Despite evidence supporting the effectiveness of radiation therapy after breast-conserving surgery for women with breast cancer, women with young children seem less likely to be compliant. To understand the factors that affect compliance so that they may be addressed pre-emptively, university of Chicago researchers analyzed data from more than 21,000 women aged 20 to 64 who had breast-conserving surgery. Patients with at least one child younger than 7 years old were significantly less likely to receive radiation therapy than their counterparts with older or no children. “This underscores the importance of competing demands from child care as a barrier to complete breast cancer treatment,” said ya-Chen Tina shih, PhD, associate professor of medicine, an expert on health economics and senior author of the study published in the Journal of the National Cancer Institute.

CAFFEINE

AS ANESTHESIA

ANTIDOTE

Caffeine may be able to reverse the overall effects of anesthetics, according to university of Chicago Medicine researchers. The researchers injected caffeine, forskolin or theophylline — all of which increase neurotransmitter release — into rats that had been put under with isofluorane or propofol. all three drugs not only reduced waking times, but also made waking times similar in all animals. Caffeine performed the best, accelerating recovery time by more than 60 percent without significant blood pressure or heart rate change in the rats. “If you could wake up everybody reproducibly and quickly, and relieve the cognitive problems that are associated with anesthetics, it might change everyday medicine,” said aaron fox, PhD, professor of neurobiology, pharmacology, and physiology and an author of the study published in the Journal of Neurophysiology.

FRAGMENTED SLEEP AND CANCER

Poor-quality sleep marked by frequent awakenings can speed cancer growth, increase tumor aggressiveness and dampen the immune system, according to a university of Chicago Medicine study published in the journal Cancer Research. a team led by sleep expert David gozal, MD, professor of pediatrics, compared two groups of mice that had been injected with tumor cells. one cohort slept soundly while the other had their sleep disrupted. all mice developed palpable tumors, but masses from the mice with fragmented sleep were twice as large and far more aggressive than those from mice that slept normally. The difference appeared to be driven by tumor-associated macrophages (TaMs), a hallmark of the immune system’s response to cancer.

Research News

W I T koW s k I

Microscopic view of human pancreatic islets after isolation. islets are stained red with dithizone; acinar tissue remains yellow.

AT THE FOREFRONT


The university of Chicago Medicine’s Digestive Diseases Center is a multi-disciplinary network of physicians, researchers and allied health professionals. The name communicates the deep and broad level of services and the collaboration among the departments of medicine, surgery and pediatrics as they relate to digestive diseases.

Mitchell C. Posner, MD, chief of general surgery and surgical oncology, and medical

director of clinical cancer programs, and David T. rubin, MD, chief of gastroenterology, hepatology and nutrition, are the co-directors.

We are committed to providing

timely and optimal care for any

patient with a disease involving

the gastrointestinal tract.

THE DIGESTIVE DISEASES

CENTER IS COMPOSED OF THE

FOLLOwING SERVICE AREAS:

» Celiac Disease Center

» Center for Endoscopic Research

and Therapeutics

» Center for Esophageal Diseases

» Gastrointestinal Cancer Risk and

Prevention Clinic

» Center for Gastrointestinal Oncology

» Inflammatory Bowel Disease Center

» Center for Liver Diseases

» Pancreatic Disease Center

» Center for Small Bowel Disease

and Nutrition

» Center for the Surgical Treatment

of Obesity

» Basic, translational and

clinical research

GI Physician Connect:

1-844-UCGIDOC (1-844-824-4362)

Center for the Surgical Treatment of Obesity» All four major surgical options

for the treatment of obesity:

Roux-en Y gastric bypass,

adjustable gastric banding,

biliopancreatic diversion with

duodenal switch (DS) and

vertical sleeve gastrectomy

» Individualized,

multidisciplinary care

» Approximately 200 complex

laparoscopic bariatric procedures

in the last year

» Nationally recognized experts

in the treatment of super-obesity

(BMI>50)

» Regionally recognized referral

center for complications and

suboptimal outcomes following

procedures performed at

other institutions


Tailoring Obesity Surgery to the needs of acclaimed Chef a year ago, graham elliot — the nationally known chef and judge of fox’s “Master Chef” competitive cooking show — weighed almost 400 pounds. “I had hypertension, sleep apnea, gout, constant aches and pains,” elliot said.

“I was headed for disaster.”

elliot, 37, made an appointment with Vivek n. Prachand, MD, director of minimally invasive surgery and chief quality officer, Department

of surgery, at the university of Chicago Medicine, to discuss obesity surgery.

elliot fit the criteria for a duodenal switch, the surgical option that is often the best choice for patients with a BMI over 50 plus metabolic problems. But patients who have the procedure lose some of their capacity to process dietary fats. “This could interfere with his profession,” Prachand said. Multiple small tastings are central to elliot’s work.

so Prachand suggested a smaller operation, the gastric sleeve. This reduces the stomach to the size and shape of a small banana, but doesn’t interfere with nutrient uptake or digestion.

“It was a reasonable way to start,” Prachand said. “If it wasn’t sufficient, we could follow it with the rest of the duodenal switch later.”

after extensive evaluation, discussion and counseling, elliot underwent obesity surgery in July 2013. he was an ideal patient. he recovered quickly, changed the way he eats and became a role model for routine exercise.

Graham elliot keeps bananas

in the fridge to remind him just

how small his stomach is now.

four months later, he ran a respectable 5k. By Christmas, he no longer needed CPaP when he slept. By March 2014, his weight was below 250 pounds, his blood pressure nearly normal and his cholesterol levels much improved.

By april, his BMI was in the 27–29 range — overweight but not obese — and still falling.

“When you start out above 50,” Prachand said, “29 is fantastic. graham is where we want him to be right now. he’s motivated and committed to functional fitness.”

aT THe FOReFROnT

OF DiGeSTive DiSeaSeS

PraChanD

Po sner ruBIn

before after

AT THE FOREFRONT



acute promyelocytic leukemia (aPl) can cause hemorrhaging in the brain, gastrointestinal tract and other areas after starting remission induction chemotherapy.

“If we even suspect aPl, we start specific treatment immediately,” said hematologist/oncologist hongtao liu, MD, PhD.

at the university of Chicago Medicine, that means following a new frontline treatment supported by the latest clinical research. Patients immediately receive oral all-trans retinoic acid (aTra) along with intravenous infusions of arsenic trioxide (aTo). This differentiation therapy causes malignant cells to mature, circulate in the blood briefly and then die off like normal white blood cells. The combination counters cells’ arrest in maturation with less toxicity, fewer side effects and better outcomes than either chemotherapy alone or chemotherapy paired with aTra.

“aTra/aTo has turned out to be one of the best examples of targeted cancer therapies,” explained richard a. larson, MD, who directs the hematologic Malignancies Clinical research Program.

“The treatment has changed aPl from one of the most lethal leukemias to one of the most curable ones.” If treated quickly, larson said, nearly every patient with typical aPl enters remission.

In early 2014, author and speaker kim hammond of aurora, Ill., became fatigued and out of breath. Petechiae appeared on his chest. hammond’s diagnosis of aPl came just months after his son, Carter, 10, finished treatment for acute lymphoblastic leukemia at the university of Chicago Medicine Comer Children’s hospital. kim also chose uChicago Medicine for his treatment. he completes his therapy for the disease this fall and has an excellent prognosis. Carter’s cancer is in remission.

foCus on leukeMIa

Prompt, Tailored Treatment Produces Remission in aPl

2F

1

AT THE FOREFRONT

a multi-institutional

team of researchers,

including University

of Chicago medicine

pathologist Y. Lynn

Wang, md, Phd,

has pinpointed why

some patients with

chronic lymphocytic

leukemia (CLL) develop

resistance to ibrutinib,

a highly effective,

precisely targeted

new drug.

ReaD MORe aT

ScienceLife.uchospitals.edu


Today’s treatment for acute

promyeloctyic leukemia was built on

the University of Chicago Medicine’s

long history of world-class cancer

research. In 1972, the late Janet

D. Rowley, MD, became the first

to identify cancer as a genetic

disease, paving the way for effective

targeted therapies. Five years later,

Rowley, together with hematologist

Harvey M. Golomb, MD, and

pathologist James W.

Vardiman, MD, discovered

that APL results from a

structural rearrangement

of chromosomes 15 and

17 in bone marrow cells.

In the majority of patients, this

translocation causes the retinoic acid

receptor alpha gene on chromosome

17 to fuse with the promyelocytic

leukemia gene on chromosome

15. The resulting abnormal fusion

protein binds to DNA and causes

malignant cells to become arrested

in their normal maturation process.

The combined effect of ATRA/ATO

degrades the abnormal fusion protein

and re-initiates the normal pathway

for these abnormal white blood

cells to differentiate, mature

and then die off.

University of Chicago

Medicine researchers

participated in the

clinical trials that led to

and refined the ATRA/ATO

treatment and established it as

the frontline therapy.


AT THE FOREFRONT

Harvey M. Golomb, MD, and cells to differentiate, mature

and refined the ATRA/ATO

FISH IMAGE OF CHROMOSOME

TRANSLOCATION

Fluorescence in situ hybridization (FiSH) image confirming the presence of the PMl/RaRa rearrangement in a patient with acute promyelocytic leukemia (aPl). Fluorescently labeled Dna probes are designed to target the PMl locus on chromosome 15 (red probe) and the RaRa locus on chromosome 17 (green probe). The separate red signal corresponds to the PMl locus on the normal chromosome 15, while the green signal corresponds to the RaRa locus on the normal chromosome 17. The t(15;17) results in juxtaposition of the PMl and RaRa regions on the abnormal chromosomes, resulting in formation of two abnormal fusion (yellow) signals (shown by arrows).

| r IghT, ToP | Kim and Carter Hammond

| r IghT, BoT ToM | Hongtao liu, MD, PhD, leads rounds.

PROviDinG leaDeRSHiP in CanCeR CliniCal TRialS

a team from the university of Chicago Medicine Comprehensive Cancer Center has received a five-year, $3.9 million award from the national Cancer Institute to serve as a lead academic Participating site for the newly created national Clinical Trials network (nCTn).

uChicago Medicine received the best possible score in the highly competitive application process and is the only institution in Illinois chosen as a lead site.

The new network is designed to improve the speed and efficiency of cancer clinical trials, according to the national Cancer Institute. The nCTn will focus on early- and late-stage clinical trials for adults with cancer.

“our cancer center has a well-deserved reputation for high-impact clinical research and a deep and long-standing commitment to the former cancer cooperative groups that now comprise the nCTn,” said hedy lee kindler, MD, medical director of gastrointestinal oncology at the university of Chicago Medicine and lead principal investigator for the site. “This grant will enable us to provide outstanding multidisciplinary scientific and administrative leadership in the design and implementation of innovative and potentially practice-changing clinical trials within the nCTn.”within the nCTn.”



Haplo-cord Stem Cell Transplant Technique Expands Lifesaving Treatment Although millions of potential volunteer donors are listed on the National Marrow Donor Program (NMDP) registry, up to 50 percent of children and adults who need this type of transplant are unable to find a suitable match.

University of Chicago Medicine physician-scientists have successfully refined results for an alternative procedure known as haplo-cord transplantation. The technique combines the administering of haploidentical (HLA half-matched) related donor cells and a well-matched unrelated umbilical cord blood (UCB) unit. Haploidentical stem cells engraft quickly but only produce blood cells for a limited time. Nevertheless, they provide a bridge until replaced by lasting engraftment of UCB.

In a 2011 study published in Blood, UChicago Medicine researchers gave results for the first 45 adults in the U.S. to undergo

the procedure. The majority of patients experienced rapid engraftment of neutrophils and platelets, low incidences of graft vs. host disease and durable remissions.

“Separately, half-match and cord

blood stem cell transplantation have

many challenges, but we have shown

them to be effective together.”

JOHN M. CUNNINGHAM, MD

“Following these successes in adults, we began performing haplo-cord stem cell transplants on children and teens who had neither a related donor nor a match on the NMDP,” said John M. Cunningham, MD, director of hematopoietic stem cell transplantation at the University of Chicago Medicine Comer Children’s Hospital and a co-author on the study. Haplo-cord

transplant is offered only to patients for whom initial treatment has failed.

Daniela Lakosilova, then 17, had the novel treatment in fall 2012 after relapsing from acute lymphoblastic leukemia. Her half-matched stem cells came from her father.

While Lakosilova experienced GVHD and other complications after the transplant, her medical team successfully addressed each problem. The senior in high school kept up with her studies, attending school via FaceTime on an iPad. She graduated in the top 10 percent of her class and is now attending college.

“Daniela’s prognosis is outstanding,” Cunningham said, noting that her risk of relapse is very low now that she has passed the one-year mark. After two years, the risk of recurrence is less than 5 percent.

The University of Chicago Medicine was one of

the first medical centers in the country to offer haplo-

cord stem cell transplantation to adults and children.

ME

DIA

N P

ER

CE

NTA

GE

(U

NF

RA

CT

ION

AT

ED

CE

ll

S)

The evolution of haplo to cord engraftment during the

first six months after transplantation

Graph is a modification of a data report from the 2011 paper published in Blood.

First author: Hongtao Liu, MD, PhD, University of Chicago Medicine.HAPlOCORD

100

90

80

70

60

50

40

30

20

10

0

D30 - D60D7 - D14| ABoV e| John M. Cunningham, MD, director of hematopoietic stem cell transplantation at the University of Chicago Medicine Comer Children’s Hospital, and patient Daniela Lakosilova.

AT THE FOREFRONT

D180D100

FoCUS oN LeUkeMIA2



american association for Cancer Research

forty members of the university of Chicago Medicine Comprehensive Cancer Center participated in the annual meeting of the american association for Cancer research (aaCr) in san Diego in april. The theme of this year’s meeting, “harnessing Breakthroughs — Targeting Cures,” reflects the commitment among the cancer research community to advance research findings from the laboratory bench to the cancer patient’s bedside with an accelerated pace and personalized approach.

In a meet-the-expert session, Mark J. ratain, MD, discussed the strategies and challenges of cancer pharmacogenomics. lucy a. godley, MD, PhD, chaired a methods workshop that provided practical information on the latest techniques in epigenetic research. kenan onel, MD, PhD, chaired and presented his latest work in a session on “radiation and Breast Cancer: linking genetics, epidemiology and Biology.” In addition, the aaCr poster sessions included 54 presentations by university of Chicago Medicine researchers.

american Society of Clinical Oncology

The american society of Clinical oncology (asCo) annual meeting brought more than 25,000 oncology professionals to Chicago this spring to discuss the most recent advances in clinical oncological scientific research. This year’s conference theme was

“science and society.” Many university of Chicago Medicine Comprehensive Cancer Center members had oral and/or poster presentations showcasing their latest findings, including Mitchell Posner, MD; Irving Waxman, MD; everett Vokes, MD; ravi salgia, MD, PhD; olufunmilayo olopade, MD; Iris romero, MD, Ms; gini fleming, MD; Tanguy seiwert, MD; Thomas gajewski, MD, PhD; Mark lingen,

DDs, PhD; Justin kline, MD; Victoria Villaflor, MD; ralph Weichselbaum, MD; Jonas de souza, MD; hedy kindler, MD; Diane yamada, MD; scott eggener, MD; William Dale, MD, PhD; swati kulkarni, MD; Mark ratain, MD; Christopher Daugherty, MD; yusuke nakamura, MD, PhD; Tara henderson, MD, MPh; Walter stadler, MD; Theodore karrison, PhD; Blase Polite, MD; richard larson, MD; russell szmulewitz, MD; elizabeth Blair, MD; Wendy stock, MD; susan Cohn, MD; habibul ahsan, MD, MMedsc; rita nanda, MD; Todd Zimmerman, MD; hongtao liu, MD, PhD; olatoyosi odenike, MD; ya-Chen Tina shih, PhD; Michael Maitland, MD, PhD; sonali smith, MD; kenan onel, MD, PhD; rena Conti, PhD; Peter o’Donnell, MD; eileen Dolan, PhD; Chadi nabhan, MD; hans schreiber, MD, PhD; Dezheng huo, MD, PhD; amittha Wickrema, PhD; Michael Bishop, MD; and Manish sharma, MD.

american Society of Pediatric Hematology/Oncology

research from university of Chicago Medicine Comer Children’s hospital physicians John M. Cunningham, MD; susan l. Cohn, MD; samuel l. Volchenboum, MD, PhD, Ms; James laBelle, MD, PhD; navin Pinto, MD; and Tara henderson, MD, MPh, was presented at the american society of Pediatric hematology/oncology (ashPo) annual meeting in Chicago in May.

Digestive Disease Week

university of Chicago Medicine faculty led courses and presented their research and clinical updates during Digestive Disease Week (DDW) in Chicago in early May.

David T. rubin, MD, directed the american gastroenterological association spring postgraduate course attended by 2,900

participants. rubin also gave the inaugural scott Zarrow Memorial lecture in honor of a patient who died of colorectal cancer. The lecture focused on new approaches to cancer prevention in inflammatory bowel disease. uzma siddiqui, MD, led a hands-on workshop on endoscopic retrograde cholangiopancreatography (erCP).

In all, there were more than 40 invited lectures and presentations from the Digestive Diseases Center, demonstrating uChicago Medicine’s ongoing excellence in these disciplines. “Casein kinase 2 (Ck2) inhibition limits damage-induced and immune-mediated colitis by distinct mechanisms” from the lab of Jerrold r. Turner, MD, PhD, was featured as one of the top abstracts of the meeting. other presentations of note included:

“histological normalization in ulcerative colitis: a new treatment outcome” (Britt Christensen, MD); “Microbes, not technique, cause anastomotic leak” (John C. alverdy, MD), and “Transcriptional response to 1,25(oh)2 Vit D in the human colon: differences by ethnicity and CrC affection” (sonia kupfer, MD).

Society of General internal Medicine

numerous university of Chicago Medicine physicians and trainees led workshops, gave oral presentations and presented posters during the society of general Internal Medicine (sgIM) annual scientific meeting in san Diego in april. among the areas covered were health disparities; quality of care and quality improvement; patient safety; and innovations in medical education.

highlights included a workshop by Deborah Burnet, MD, Ma, titled “effective Time Management for gIM leaders,” and the plenary session, “over a Decade of Duty hours: Who Do Patients say is Most Involved in Their hospital Care,” presented by Vineet arora, MD, MaPP; Micah T. Prochaska, MD; Jeanne farnan, MD, MhPe; and David Meltzer, MD, PhD.

COnFeRenCe DiGeST



| fro M lefT | nita Karnik lee, MD, MPH; Meaghan Tenney, MD; ernst lengyel, MD, PhD; and S. Diane yamada, MDexPerT Care,

ClInICal TrIals for oVarIan CanCer



AT THE FOREFRONT

With the majority of ovarian cancer cases still found at an advanced stage, patients need access to comprehensive care: aggressive tumor debulking, IV and intraperitoneal chemotherapy, targeted therapies that prolong time to progression, clinical trials and a multidisciplinary team of specialists in gynecologic oncology.

at the university of Chicago Medicine, the ovarian cancer team integrates surgical and medical care with ongoing clinical, basic and translational research. our researchers are investigating the biology of ovarian cancer metastasis and exploring new drugs for its treatment. In recent years, they characterized two new targets in ovarian cancer that led to clinical trials and developed a novel method for finding new drugs.

OVARIAN CANCER RESEARCH

AT THE UNIVERSITY OF CHICAGO

MEDICINE FOCUSES ON:

» understanding metastasis

» Imaging for early detection

» Drug discovery

» ovarian cancer prevention

» genetic and protein studies

OTHER CARE RESOURCES FOR

wOMEN wITH OVARIAN CANCER

» Psycho-oncology supportive care for patients with cancer

» sexual health clinic for cancer patients and survivors

» specialized oncology clinic for older adults

Gynecologic Oncology Surgical Team

S. DIANE YAMADA, MD

section Chief, gynecologic oncology

ERNST LENGYEL, MD, PHD Chairman, obstetrics and gynecology

NITA KARNIK LEE, MD, MPH

MEAGHAN TENNEY, MD

Our ovarian cancer

physician-scientists

are members of

the internationally

recognized

University of

Chicago Medicine Comprehensive

Cancer Center, a National Cancer

Institute (NCI)–designated cancer

research center.


HAS MORE CLINICAL

TRIALS available to patients with

advanced stage ovarian cancer than

other institutions in Illinois.

OuR CanCeR RiSK CliniC

OFFeRS SCReeninG, GeneTiC

TeSTinG anD COunSelinG.

ernst lengyel, MD, PhD, right, chairman of obstetrics and

gynecology, performs a procedure.

60–70 PERCENT OF

PATIENTS at the University of Chicago

Medicine are optimally debulked,

with 1 centimeter or less residual

tumor remaining after surgery.

THE UNIVERSITY OF CHICAGO MEDICINE wILL BE THE LEAD

SITE FOR A PHASE 2 TRIAL of metformin in conjunction with

chemotherapy followed by metformin maintenance therapy in

advanced stage ovarian, fallopian tube and primary peritoneal

cancer. Metformin has been associated with decreased cancer

risk and improved survival for other cancers.

The ovarian cancer team

discusses and plans optimal

treatment regimens for

individual patients at the

weekly multidisciplinary tumor

board conference.

S. Diane yamada, MD, section chief of gynecologic oncology, talks with a patient.

The ovarian cancer

program is a lead

academic site for nRG

Oncology, an nCi-

supported cooperative

group that develops

and runs leading clinical

trials for gynecologic

and other cancers.



Surgical Resection for Metastatic Spinal Cord Compression Keeps Patients Ambulatory for Longer

Innovations to radiation, chemotherapy and other treatments are extending function, quality of life and survival time for many patients battling metastatic prostate cancer. Surgery is playing a more significant role in the management of cancer that has spread to the spine, the most common musculoskeletal site of metastasis for prostate, lung and breast cancer.

Five to 14 percent of cancer patients will develop metastatic spinal cord compression, with approximately 20,000 new cases in the U.S. every year. In most cases, the metastases causing the compression are located anterior to the spinal cord, in the vertebral body.

University of Chicago Medicine neuro-surgeon Edwin Ramos, MD, an expert in oncological and complex spine surgery, performs minimally invasive decompression and spinal stabilization surgery as part of the medical center’s multimodal management for patients with metastatic spine tumors.

In early spring, a scan taken during Tim Collins’ treatment for prostate cancer revealed a spinal cord tumor at the T4 vertebra. The 61-year-old had pain that radiated from his back around to the front of his chest, but thought he had pulled a muscle.

“The tumor was severely compressing the spinal cord and destroying stabilizing structures in Collins’ spine,” said Ramos.

“Without surgical treatment, the condition would have progressed quickly to paralysis.”

Operating through a 5-centimeter incision, Ramos debulked the tumor. He then separated it from the spinal cord, which would allow for higher radiation doses earlier in the postoperative period. Using titanium screws and rods, he reconstructed the spine to restore stability in the compromised area.

The primary endpoint after surgery is to keep the patient ambulatory, Ramos said.

“In selected patients with symptomatic spinal cord compression, a randomized trial showed that surgery followed by radiotherapy was superior to radiotherapy alone in preventing paralysis,” Ramos said. “In addition, patients maintain muscle strength and continence as well as reduce steroid and analgesic use.”

Collins, a semi-retired sales executive, was up and walking the day after surgery and back to work the next week. He was able to move expeditiously on to his next phases of treatment — radiation and chemotherapy — and take a vacation to Florida in between.

| LEFT | A Spinal cord compression from metastatic prostate adenocarcinoma arising from the left T4 lateral and posterior spine elements. B Postoperative CT image shows the decompression and resection cavity after tumor debulking and separation from the spinal cord. C Instrumentation was placed percutaneously (2cm incisions) to restore spinal stability.

A

B

C

Tim Collins

AT THE FOREFRONT

Edwin Ramos, MD, discusses the role of

surgery in the management of metastatic spine tumors on Learning at the Forefront, our new online educational channel, launching in July.

learning.uchospitals.edu



NIR URIEL, MD, MSC, an authority on heart failure, heart transplantation and clinical management of circulatory assist devices, has been appointed associate professor of medicine and medical director of the heart failure program at the university of Chicago Medicine. uriel previously was director of research for the mechanical circulatory support program at Columbia university.

DAVID T. RUBIN, MD, a nationally recognized authority on digestive disease, investigational therapies and medical ethics, has been named section chief of gastroenterology, hepatology and nutrition at the university of Chicago Medicine. rubin, professor of medicine, is co-director of the Digestive Diseases Center.

MARSHALL CHIN, MD, MPH, the richard Parrillo family Professor of healthcare ethics in the Department of Medicine, is the new president-elect of the society of general Internal Medicine (sgIM) for the 2014– 15 year. Chin is associate chief and director of research in the section of general Internal Medicine.

DIANE SPERLING LAUDERDALE, PHD, professor and chair of the Department of health studies, was elected president-elect of the society for epidemiological research. she is a fellow of the american College of epidemiology.

wILLIAM A. MCDADE, MD, PHD, associate professor of anesthesia and critical care and deputy provost for research and minority issues for the university of Chicago, was elected president of the Illinois state Medical society.

MONICA B. VELA, MD, associate dean for multicultural affairs at the university of Chicago Pritzker school of Medicine, received the 2014 herbert W. nickens Minority health and representation in Medicine award from the society of general Internal Medicine. The award recognizes exceptional commitment to cultural diversity in medicine.

SUSAN L. COHN, MD, professor of pediatrics and a leading authority on neuroblastoma, has been named dean for clinical research at the university of Chicago Medicine & Biological sciences. In this role, she will direct the strategy and operations of the office of Clinical research. she also is director of clinical sciences in the Department of Pediatrics and co-leader of the Clinical Trials Cluster at the university of Chicago’s Institute for Translational Medicine.

JOHN C. ALVERDY, MD, the sara and harold lincoln Thompson Professor and executive vice chair of the Department of surgery, has been named president-elect of the surgical Infection society. alverdy will assume the presidency in april 2015.

GOKHAN MUTLU, MD, was appointed section chief of pulmonary/critical care medicine. Mutlu, professor of medicine, previously was an associate professor at northwestern university.

BARRY G.w. ARNASON, MD, the James nelson and anna louise raymond Professor of neurology, received the 2014 John Dystel Prize for Multiple sclerosis research, awarded jointly by the national Multiple sclerosis society and the american academy of neurology. The prize recognizes outstanding contributions to research in the understanding, treatment or prevention of multiple sclerosis.

DAVID MELTZER, MD, PHD, associate professor of medicine and section chief of hospital medicine, is the 2014 recipient of the John M. eisenberg excellence in Mentoring award from the agency for healthcare research and Quality (ahrQ). Meltzer is recognized for his long-standing dedication to the professional development of trainees as leaders in clinical care, quality improvement and medical education.

LUCIA B. ROTHMAN-DENES, PHD, professor of molecular genetics and cell biology, has been elected a member of the national academy of sciences, one of the highest professional honors a scientist can achieve. rothman-Denes is best known for pioneering a novel system to study how bacterial viruses take over the molecular processes of their hosts.

MARCUS R. CLARK, MD, professor of medicine and pathology, and section chief of rheumatology, has been elected to the association of american Physicians for his leadership in research in autoimmune disease focused on B cell biology. he co-directs the gwen knapp Center for lupus and Immunology research and directs the uChicago Medical scientist Training Program.

JOHN MAUNSELL, PHD, one of the world’s foremost experts on the neuroscience of vision, perception and attention, was elected to the american academy of arts and sciences. he is a professor of neurobiology and the inaugural director of the grossman Institute for neuroscience, Quantitative Biology and human Behavior at the university of Chicago.

MELISSA GILLIAM, MD, MPH, professor of obstetrics/gynecology and pediatrics and associate dean for diversity for the Biological sciences Division, was honored by the Chicago urban league with an Innovator award for her leadership in cross-disciplinary collaborations.

recipients of 2014 fellowships from the John simon guggenheim foundation included LAINIE ROSS, MD, PHD, the Carolyn and Matthew Bucksbaum Professor of Clinical Medical ethics, professor of pediatrics, medicine and surgery, and an associate director of the Maclean Center for Clinical Medical ethics; and JOSEPH w. THORNTON, PHD, professor in the Departments of ecology and evolution and human genetics.

R. TAMARA KONETZKA, PHD, associate professor in the Department of health studies, received the article-of-the-year award from academyhealth, the leading professional organization for health services research. her article, “shipping out Instead of shaping up: rehospitalization as an unintended effect of Public reporting in nursing homes,” was published in the Journal of Health Economics.

SAMUEL G. ARMATO III, PHD, associate professor of radiology and chair of the Committee on Medical Physics, was elected a fellow of the american association of Physicists in Medicine in recognition of his distinguished contributions to medical physics.

BERNARD ROIZMAN, SCD, has been named a fellow of the national academy of Inventors. he is the Joseph regenstein Distinguished service Professor of Virology in the Departments of Microbiology and Molecular genetics and Cell Biology.

MARDI GOMBERG-MAITLAND, MD, MSC, associate professor of medicine and director of the pulmonary hypertension program, has been appointed by the Patient-Centered outcomes research Institute (PCorI) one of the first 13 members of its new advisory Panel on rare Disease.

JOHN M. CUNNINGHAM, MD, professor of pediatrics, physiology, and stem cell biology, has been named physician-in-chief of the university of Chicago Medicine Comer Children’s hospital and interim chair of the Department of Pediatrics.

IRA BLUMEN, MD, professor of medicine, section of emergency medicine, received the Medical Director of the year award from the air Medical Physician association in recognition of his contributions and achievements in the field of aeromedical transport and as medical director of the university of Chicago aeromedical network (uCan).

INSPIRED TO DiSCOveR,

TeaCH & Give baCK



Chicago breast and lymphedema Symposium

SEPTEMBER 12–13, 2014

Fairmont Hotel

200 N. Columbus Drive, Chicago

Colon, Rectum and beyond: innovations in Management of inflammatory bowel Disease, Colorectal Cancer and Pelvic Floor Disorders

OCTOBER 10, 2014

7:30 AM–3:30 PM

American College of Surgeons

633 N. St. Clair St., Chicago

SAVE THE DATE

Women’s Health Symposium

NOVEMBER 8, 2014

University of Chicago Gleacher

Center, 450 N. Cityfront Plaza

Drive, Chicago

This educational event will provide participants with the latest multidisciplinary update on ovarian, cervical and breast cancer, fertility and reproductive endocrinology and other women’s health topics. For more information, please contact Anthony Turner, [email protected].

19th annual endoscopic ultrasonography live 2014

NOVEMBER 14–16, 2014

University of Chicago Medicine

Center for Care and Discovery

5700 S. Maryland Ave., Chicago

University of Chicago Medicine

physicians are available to present

in-office CME courses in greater

Chicagoland and Northwest Indiana.

For information, please contact

Uchenna Hicks, uchenna.hicks@

uchospitals.edu.

Register for CME events at

cme.uchicago.edu

CME& eDuCaTiOnal OPPORTuniTieS

PHYSICIAN RELATIONS

CAROL MARSHALL

Director 1-773-702-9205 carol.marshall@ uchospitals.edu

AMBER NAIK

Assistant Director 1-773-230-5236 [email protected]

DEMETRIA AVANT

Regional and Western Suburbs 1-773-717-0458 demetria.avant@ uchospitals.edu

MIKE DELAROSA

Northwest Indiana 1-773-230-8496 michael.delarosa@ uchospitals.edu

ANTHONY TURNER

South and Southwest Suburbs 1-773-729-0822 anthony.turner@ uchospitals.edu

DIONNE MEEKINS-MICHAUD

North and Northwest Suburbs

1-773-717-0457 dionne.michaud@ uchospitals.edu

BROOKE HERNANDEZ

Pediatrics, All Regions 1-773-573-9500 [email protected]

The master affiliation agreement between the university of Chicago Medicine and franciscan alliance creates a unique relationship between a prominent academic medical center and a leading regional health system.

The move brings together two health care systems “that share both a dedication to excellence in patient care and a desire to develop new models of care in a rapidly changing health care marketplace,” said kenneth s. Polonsky, MD, Dean of the university of Chicago Biological sciences Division and the Pritzker school of Medicine and executive vice president for Medical affairs for the university of Chicago.

The agreement focuses on the university of Chicago Medicine and franciscan alliance’s northwest Indiana facilities, including Crown Point, Michigan City, Dyer, hammond and Munster.

The affiliation provides for the joint development and implementation of clinical, research and educational initiatives. “By combining the world-class tertiary and quaternary care and research capabilities of the university of Chicago Medicine with franciscan alliance’s extensive network of community-based hospitals and ambulatory centers, we will enhance patient care locally and provide seamless access and continuity for patients needing care at any level,” said kevin leahy, franciscan alliance’s president and chief executive officer.

bringing university of Chicago Medicine expertise to northwest indiana

Please contact your dedicated liaison by phone or email with any request. We are here to serve you.


“fare’s funding decisions are informed by its strategic research plan, with the overarching goal of investing in research that will lead to safe, effective new treatments — and ultimately a cure — for food allergy,” said John lehr, Ceo of fare. “fare’s support of Dr. nagler’s work illustrates the success of this approach.”

nagler’s work is encouraging to families with loved ones who have suffered from sometimes life-threatening food allergies.

Denise and David Bunning know this all too well. When their two sons were young, they experienced numerous life-threatening reactions to certain foods, including milk, eggs, tree nuts, shellfish and beef.

now young adults, the Bunnings’ children still need to be vigilant about food and carry a shot of epinephrine in case of allergic reaction. “every reaction is a game of russian roulette, hoping the drug stops the problem before a patient stops breathing,” said Denise Bunning.

so the Bunnings are staunch supporters of nagler’s work. In collaboration with fare, the north suburban residents previously established the Bunning food allergy Professorship, held by nagler, to advance research on, treatment for and education about children’s food allergies.

“Dr. nagler’s insight into the bacteria in the gut may offer a solution to many affected by allergic disease, not just food allergy,” Bunning added. “We are thrilled and hopeful for the work she continues to do for the entire food-allergic community.”

For more information or to support food allergy research at the University of Chicago Medicine, please contact Kate Azizi at [email protected].

With an increasing number of children affected by food allergies, research being conducted at the university of Chicago Medicine is raising hope of finding a way to protect the body against allergic sensitization to food.

at the helm of that research is university of Chicago immunologist Cathryn nagler, PhD, who recently received a five-year, $1.95 million grant from the national Institutes of health, along with additional funding from food allergy research & education (fare).

nagler has identified a new strain of “good” intestinal bacteria that may protect the body against food allergies. The research, while in its early stages, could lead to new formulations that might prevent food allergy in infants or enhance the protection provided by other promising new treatments for food allergy, such as oral immunotherapy.

“The Centers for Disease Control and Prevention has documented an 18 percent increase in the prevalence of food allergies in children under 18 between 1997 and 2007,” nagler said. “environmental stimuli are changing the composition of the microbiota (the vast collection of microbes that inhabit our bodies), and in genetically susceptible individuals, this can predispose to food allergies.”

The university is positioned to be a leader in microbiome research. Its state-of-the-art, germ-free mouse facility has been a catalyst for significant multidisciplinary partnerships among university of Chicago researchers, including eugene Chang, MD, David T. rubin, MD, and Bana Jabri, MD, PhD, who focus on inflammatory bowel disease and celiac disease.

reaching this point would not have been possible without multidisciplinary collaboration and philanthropic support from various donors, added nagler.

ClOSeR TO a CuRe FOR FOOD

alleRGieS

Cathryn nagler, PhD

| lefT | visitors from Food allergy Research & education, from left, Mary Poland, Mackay Gunn and Jennifer Dues, meet with senior research technician anuradha nadimpalli during a tour of immunologist Cathryn nagler’s lab.



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LeArNINg At the ForeFroNt

Coming soon: Learning at the Forefront, our new online learning channel. Content includes lecture presentations by University of Chicago Medicine physicians, procedure videos, and links to our physician directory, upcoming events and science blogs.

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LeArNINg At the ForeFroNt

John M. Cunningham, MD, on Evolving Approaches to Stem Cell Transplantation for the Hemoglobinopathies


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Inspired - Summer 2014 - University of Chicago Medicine