The Hematology Program at Smilow Cancer Hospital offers comprehensive diagnosis and treatment of blood cancers: lymphoma, leukemia, and myeloma. While the causes of these cancers remain unknown, great strides in treatment, some of which originated from Yale Cancer Center research, are improving survival rates.
The overall aim of treatment is to bring about a complete remission. Treatment approaches for blood cancers may include chemotherapy, radiation oncology, stem cell or marrow transplantation, or immunotherapy. Each patient receives an individual treatment plan, which includes standard care and/or clinical trials, which offer novel treatment options.
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).
Stem Cell Transplant
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.
Cutaneous T-Cell Lymphoma
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.
CAR T-Cell Therapy
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 Lymphoma
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.
Smilow Classical Hematology
- Thrombosis: When blood clots form abnormally in a blood vessel, they can obstruct blood flow. We provide consultation services for patients who have developed thrombosis, including those with hereditary disorders of coagulation and acquired disorders (e.g. antiphospholipid antibody syndrome). These disorders are generally treated with anticoagulant drugs.
- Anemia: There are multiple causes of anemia, including nutrient deficiency (iron and vitamin B12), hereditary issues such as sickle cell disease and thalassemia, inflammation, immune conditions, and others.
- Bleeding and platelet disorders: Several disorders can result in excess bleeding. We care for patients with hemophilia through the Yale Hemophilia Treatment Center, von Willebrand disease, platelet disorders, and other rarer hereditary and acquired bleeding disorders. There are several different sub-types of von Willebrand disease (vWD), and accurately determining the type is important for treatment.
Smilow Multiple Myeloma and Gammopathies Program
Hematology Center Members
Richard Edelson, MDDermatologyYale Medicine dermatologist Richard Edelson, MD, is the chair of the Department of Dermatology. Dr. Edelson cares for patients who have any number of skin conditions. He is a nationally recognized skin cancer expert. His groundbreaking research in the 1980s proved that a skin fungus once called “mycosis fungoides” is actually a cancer of the lymphocytes. He renamed the disease, which affects more than 10,000 people annually, cutaneous T-cell lymphoma (or CTCL). “If untreated, it can spread to the blood and to other internal organs,” says Dr. Edelson. “It is really important to me to help patients fight this cancer.” Using his research, he invented photopheresis, a treatment for advanced cases of CTCL. It’s a blood-filtering procedure in which blood is partially removed and treated in order to activate the immune system to fight the cancer. Photopheresis is often used with other conditions to bring balance to the immune system as well. A professor of dermatology at Yale School of Medicine, CTCL remains Dr. Edelson’s—and the department’s—central research interest today. At Yale, Dr. Edelson has also served as director of the Yale Cancer Center, deputy dean for clinical affairs, director of the Cancer Center’s Lymphoma Research Program, and a member of both the Yale-New Haven Hospital Board of Trustees and the Yale Medicine Board of Governors. Within the dermatology community, he is a member of the American Society for Clinical Investigation and the Association of American Physicians, and an honorary member of several international medical associations.
Francine Foss, MDMedical Oncology, Hematology & Oncology, Leukemia & LymphomaFrancine Foss, MD, professor of medicine in the Section of Medical Oncology at the Yale Cancer Center, is an internationally recognized clinician and clinical researcher with expertise in adult lymphomas and in stem cell allotransplantation. She has derived and tested therapies that have been used to treat thousands of cancer patients, and her research has potential to substantially impact the field of stem cell research, benefiting patients at Yale and around the world. Dr Foss has brought a nationally established clinical trials program to the Yale Cancer Center. In her previous post at Tufts New England Medical Center in Boston, she designed, initiated and directed multi-center national clinical trials which led to FDA approval of several novel therapies for lymphomas. One of these, Interleukin-2 conjugated to Diphtheria toxin, was the first FDA-approved fusion biologic drug to be approved for use in the United States. She also developed a treatment for patients undergoing allogeneic stem cell transplant that reduced the development of graft-versus-host disease. These findings led to the initiation of two National Cancer Institute-sponsored trials to confirm these results in patients with lymphoma and myelodysplastic syndrome. Dr Foss is a world expert in T cell Lymphomas. She has pioneered several novel therapies for T cell lymphomas and has led a number of national studies. She is currently overseeing a national registry for T cell lymphomas and is a founder and co-chairman of the T CELL Forum, the preeminent international T cell lymphoma research meeting. She is a founder of the United States Cutaneous Lymphoma Consortium and the Peripheral T cell Consortium. She has been a translational researcher in T cell Lymphomas and currently is collaborating with a number of laboratories at Yale to identify molecular targets in T cell Lymphoma.
Michael Girardi, MDDermatologyMichael Girardi, MD, is the director of Yale Medicine Dermatology’s ECP (Photopheresis) Immunotherapy Program, which is internationally recognized for developing the immunotherapy treatment photopheresis for advanced cutaneous T-cell lymphoma, graft-versus host disease and organ transplant rejection. “ What I enjoy about my job is using technology to relieve suffering and help people who sometimes feel hopeless ,” Dr. Girardi says. A professor of dermatology at Yale School of Medicine, Dr. Girardi also studies the development of skin cancer and works to discover new ways to prevent it. He recently received an innovation award as a co-developer of a new formulation for sunscreen that does not penetrate the skin. “I hope the technology will one day make sunscreens safer and more effective,” Dr. Girardi says. Preventing skin cancer is important to him on a personal level, too, after losing a family member to malignant melanoma as a child. “There is no doubt that the experience has stayed with me and has motivated me to help cancer patients in multiple ways,” he says. “Ultimately, having a positive effect on patients' lives is what matters the most to me.”
Lynn D. Wilson, MD, MPHTherapeutic RadiologyLynn Wilson, MD, MPH, vice chairman and clinical director of Yale Medicine’s Therapeutic Radiology Department, cares for patients with cutaneous lymphoma and breast cancer at Smilow Cancer Hospital at Yale New Haven. As a board-certified radiation oncologist, Dr. Wilson’s primary goal is to successfully treat his patients while limiting side effects from radiation treatment. “This can be best achieved through multidisciplinary collaboration among specialists focused on the patient,” he says. Through the use of specialized techniques, Dr. Wilson and his colleagues have been able to provide substantial pain relief (also called palliative care) for those in need, enhancing their quality of life. “Yale is both a national and international destination medical center for patients with cutaneous lymphoma,” he explains. “Our total skin electron beam therapy program is recognized as a major, national program anchored by a team with significant international expertise.” In addition to providing clinical care, Dr. Wilson is also a professor of therapeutic radiology and dermatology. He studies outcomes and treatment-related factors for patients receiving care for cutaneous lymphoma, lung and breast cancers. For example, new research reveals that there may be disparities in clinical outcomes for cutaneous lymphoma based on race. “This is a significant finding,” explains Dr. Wilson. “We are working toward understanding why this may be the case, so that we can address these issues for our patients.” Dr. Wilson serves on the board of trustees for the American Board of Radiology and is a member of the American Society for Radiation Oncology board of directors.
News from Hematology Program
Leukemia, Lymphoma, and Myeloma Trials
A Phase 1, Open-label, Dose Finding Study of CC-90009 in Subjects With Relapsed, Refractory Acute Myeloid Leukemia
A Phase 1b/2 Study of the ROR1-Targeting Monoclonal Antibody, Cirmtuzumab (UC-961), and the Bruton Tyrosine Kinase Inhibitor, Ibrutinib, in Patients With B-Cell Lymphoid Malignancies
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