Hematology Program

Yale hematopathologists employ the complete range of diagnostic tools available, including bone marrow examination, bone imaging, M protein analysis, cytogenetics, immunophenotyping, and FISH and PCR analysis, as well as genetic testing and the identification of markers that guide prognosis.

Additionally, patients have access to caregivers who help them cope with the physical, emotional, and psychological issues related to these cancers. Advanced practice nurses and social workers assist with education, general information, and practical issues of travel and accommodation assistance.

The blood cancers we are fighting:

• Lymphoma is the most common blood cancer, affecting 81,000 Americans each year. While its rates continue to rise, there have also been rapid advances in treatment, and the current 5-year survival rate for all people diagnosed with Hodgkin lymphoma is 87%.
  
• Leukemia is a malignant cancer of the bone marrow and blood, diagnosed in 60,000 Americans each year. It is the most common cancer in children and teens. The leukemia death rate for children ranging from birth to age 14 in the United States has declined 60% over the past three decades, due to treatment advances. 
• Myeloma is a disease of the plasma cell, and affects approximately 34,000 new patients annually. Overall survival in patients with myeloma has shown improvement in recent years, with treatments recently approved by the Food and Drug Administration (FDA). 

In an effort to destroy abnormal cancerous cells in leukemia, lymphoma and multiple myeloma, stem cell transplants are often used. Yale is the only center in Connecticut offering allogeneic transplant, a transplant using compatible donor stem cells. Autologous stem cell transplant helps to rebuild bone marrow that’s injured or destroyed during high-dose drug therapies used to treat some cancers. An allogeneic stem cell transplant involves receiving stem cells from a compatible donor, potentially a family member.

To see how Yale Cancer Center compares to Transplant Centers in the United States reporting more than 50 allogeneic transplants during the last reporting period (2014 – 2015), view this table.

Extracorporeal photochemotherapy (ECP), the first FDA-approved selective immunotherapy for any cancer, has been continually refined and improved by the cutaneous lymphoma clinical research team at Yale. This is the current standard of care for patients with advanced forms of cutaneous T-cell lymphoma. 

The novel treatment transimmunization, a promising innovation related to ECP, was investigated in clinical trials at Yale Cancer Center, and has the potential to replace ECP as the standard of care.

Chimeric antigen receptor (CAR) T-cell therapy reprograms a patient’s own T-cells to target tumor antigens. CAR T-cell therapy has shown complete remission rates of 80 to 90% in patients with B-cell acute lymphoblastic leukemia and multiple myeloma, and 40% in patients with aggressive B-cell non-Hodgkin’s lymphomas who have failed multiple prior lines of treatment. The groundbreaking therapy is currently only available in Connecticut at Smilow Cancer Hospital. 

As part of the program, oncology clinical social workers help patients and families manage the stress associated with therapy. Patients and family members are provided with ongoing clinical social work support including listening, counseling, educating, advocating, and referring them to resources and services.

T cell lymphomas have a number of different subtypes, and the hematology team at Smilow Cancer Hospital has expertise in profiling patient’s tumors to determine the specific genetic mutations so treatment can be tailored. Novel monoclonal antibodies, targeted therapies, and inhibitors are all in study through clinical trials providing multiple options to patients. 

Myelodysplastic syndromes (MDS) are a group of diverse bone marrow disorders in which the bone marrow does not produce enough healthy blood cells. A diagnosis is usually made using a bone marrow biopsy, and there are typically not any early signs or symptoms. At Smilow, patients are treated based on their individual clinical and genetic features. Certain patients can be cured with aggressive treatment with chemotherapy followed by stem cell transplant using stem cells from a donor.

As a leader in the treatment of hematologic cancers, Yale is a regional resource for difficult and challenging cases, with a large number of referrals coming from other hematologists and oncologists throughout New England. We work closely with the physicians at Yale Cancer Center both to provide primary care to patients referred for bone marrow transplant who are determined to be better served by nontransplant treatments, and to provide rapid referral of those patients who are candidates for stem cell transplant.

Our services are designed to meet each patient’s physical, emotional, and psychological needs. Our physicians form a multispecialty team that discusses and agrees upon the best course of treatment for each individual patient. Our care includes state-of-the-art expertise from laboratory medicine and hematopathology. Blood banking, phlebotomy, and pheresis services are part of our excellent care for hematologic disorders. Our nurse specialists, focusing on hematology/oncology patients, are essential participants in the health care team.

Special services offered by our section include:

• Bone marrow aspiration and biopsy
• Diagnosis and management of difficult hematologic disorders
• Outpatient and inpatient chemotherapy treatment
• Molecular analysis of hematologic disorders