Departments

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). Monoclonal gammopathy of undetermined significance (MGUS) is a precursor condition that could potentially lead to cancer and should be closely evaluated and monitored. Our myeloma specialists are dedicated to the care of these patients and see them as part of a MGUS Clinic. Stem Cell Transplant The Stem Cell Transplant Program at Smilow Cancer Hospital is a FACT accredited program that was started in 1994 and currently performs around 200 transplants yearly. We perform stem cell and bone marrow transplants for a variety of malignant and benign diseases in both pediatric and adult populations. There are two types of stem cell transplantation that we perform: Autologous transplant: involves using a patient’s own stem cells, whichare collected from their blood and frozen. Allogeneic transplant: involves receiving stem cells from another person, called a donor. A search

We offer coordinated, multidisciplinary clinical care for people with rheumatoid and other types of inflammatory arthritis, as well as osteoarthritis and a variety of autoimmune diseases, including lupus, scleroderma, myositis, and vasculitis. Our physicians are experts at diagnosing and treating more than 200 types of rheumatologic disorders, some of which are difficult to pinpoint. Rheumatic disorders affect the joints, muscles, and bones and often include autoimmune diseases that disrupt the body’s immune system by causing inflammation and breaking down connective tissue and related body structures. We work closely with other specialists at Yale including pulmonologists, nephrologists, gastroenterologists, cardiologists, allergists, neurologists, dermatologists, surgeons, and orthopaedists to care for complex rheumatic and autoimmune diseases. Specialized care is offered in the following areas: Antiphospholipid antibody syndrome Rheumatoid arthritis and other types of inflammatory arthritis Scleroderma and myositis Systemic lupus erythematosus Transition program for young adults Vasculitis State-of-the-art infusion sites at Yale New Haven Hospital and in the Yale New Haven Health Interventional Immunology Center in North Haven Full array of imaging and laboratory services Nationally recognized clinical research programs that are integrated with clinical care to offer the most advanced treatments to patients with arthritis and autoimmune diseases

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

The Yale Antiphospholipid Syndrome (APS) Program is an interdisciplinary collaboration to facilitate care, education, and research around APS, an autoimmune disorder that can be associated with other rheumatic diseases, including lupus. APS is a systemic disorder that can affect any organ or tissue. APS affects women more frequently than men and may cause problems during pregnancy, clotting or blood disorders, or may occur with other autoimmune conditions, such as lupus. We work with obstetricians, hematologists, rheumatologists, and other specialists to provide comprehensive care of all aspects of APS. Patient education is essential for any chronic condition, but especially for APS patients because it is a rare disorder that has only been recognized recently. We also educate physician colleagues to raise awareness of APS and work collaboratively with them to provide coordinated care.

As part of our Center of Excellence for Classical Hematology at Smilow Cancer Hospital, our hematologists provide a full spectrum of highly specialized care to patients with nonmalignant hematology disorders and participate in research to advance treatment options. The types of disorders cared for are varied and include thrombosis, anemia, bleeding and platelet disorders, and other hematological conditions and rare diseases. Our hematologists work closely with a specialized team of advanced practice providers (APPs) and nurses, in addition to our colleagues in Laboratory and Transfusion Medicine, in order to provide a multidisciplinary clinical focus. Community outreach and education are key components of the program in order to improve awareness and understanding of non-cancer blood disorders and train the next generation of physicians, APPs, and nurses. We offer treatment for: Thrombosis: blood clots blocking blood vessels Anemia: a lower-than-normal amount of healthy red blood cells Bleeding and platelet disorders: an abnormal decrease or increase in platelets or platelet dysfunction; abnormal bruising or bleeding; low or dysfunctional platelets Other hematological conditions: hemoglobin disorders, thalassemia, red cell enzyme or membrane disorders, low white blood cells Rare diseases: porphyria, PNH, mast cell disorders, eosinophil and histiocyte disorders, cold agglutinin disease

The Immunotherapy Adverse Events in Rheumatology Program treats patients who have adverse events—undesirable outcomes not related to underlying disease—due to immunotherapy or who have autoimmune conditions that may cause flare-ups, or a severe onset of symptoms, when receiving immunotherapy. Immunotherapy treatments—such as immune checkpoint inhibitors, CAR T-cell therapy, and cancer vaccines—use the body’s immune system to fight cancer. Approximately 20% to 25% of cancer patients will have rheumatological adverse events after receiving immunotherapy. Adverse events can include joint or muscle pain, joint swelling, muscle stiffness, vasculitis, dry eyes and mouth, and myositis, which can severely impact quality of life and be organ- or life-threatening. Our team seeks to ensure that patients’ immunotherapy treatment is not interrupted due to adverse events or autoimmune issues. The clinic treats patients in a timely manner, allowing them to start or resume immunotherapy as soon as possible to successfully treat their cancer. At the same time, adverse events are effectively treated to preserve the function of inflamed organs. We collaborate with oncologists to ensure that the treatment of these adverse events does not lessen the efficacy of the immunotherapy treatment. Strong communication and personalized patient management with referring physicians is one of the hallmarks of the program. The Yale Immunotherapy Adverse Events in Rheumatology Program has an outstanding research program that aims to understand the mechanisms of autoimmune disorders secondary to immune-based cancer therapy. We analyze human biospecimens obtained from eligible subjects from our center to identify molecular, transcriptomic, and cellular characteristics using cutting-edge genomic and immunologic technologies. The findings from humans are validated or further explored using various animal models in the laboratory of Sang Taek Kim, MD, PhD, director of the program. As the use of immunotherapy grows to address more types of cancer—and adverse events increase accordingly—Dr. Kim and his team will use data from the clinic and the laboratory to gain insights that lead to a deeper understanding of the predictive markers for adverse events, as well as the development of optimal treatment strategies.

We are internationally recognized for developing an immunologic treatment for advanced cutaneous T-cell lymphomas. Extracorporeal photochemotherapy (ECP), or photopheresis, is one of the safest and most effective treatments available for this type of cancer. Our experienced team of physicians and nurses administers photopheresis daily on an outpatient basis. We treat more than 1,000 patients each year. The procedure was first developed by Yale's Richard Edelson, MD.He and his team are pioneers and leaders in this technique, and continually conduct research to further improve ECP to help treat cancer and other disorders. During ECP, the patient’s blood is treated with a photosensitizing agent and exposed to specific wavelengths of light to eliminate cancerous cells from the blood and activate the immune system’s T-cells. With immune cells primed to fight off cancer, blood is then returned to the body. ECP is also effective for treating a number of inflammatory diseases.

Autoimmune encephalitis is a disease in which immune cells target particular areas of the brain to cause neurologic and psychiatric symptoms. While the symptoms vary, the experience of isolation is often uniform as individuals search for providers familiar with the diagnosis and treatment of the disease. The Yale Autoimmune Encephalitis Program brings together a team skilled in neuroimmunology, psychiatry, molecular biology, and allied specialties to provide patient-centered, cutting-edge treatment. Located within the Yale Interventional Neuroimmunology Center, the program offers immunotherapies and symptomatic treatments, and partners with physical therapists, speech-language pathologists, occupational therapists, and physical medicine and rehabilitation physicians to assist in the rehabilitation that is often required following autoimmune encephalitis. In addition, the program connects patients with a robust network of scientists to advance the treatment, diagnosis, and biologic understanding of the disease. We believe that care for individuals with autoimmune encephalitis begins at symptom onset and continues through the chronic phases of the disease. Early in the course of the disease, patients may require more extensive immunotherapy. However, as the disease progresses, a patient’s needs may shift to managing more long-standing neurologic and psychiatric manifestations. At the Yale Autoimmune Encephalitis Program, we guide our patients through illness from the initial diagnosis and treatment to long-term management. As the field evolves, we are committed to advancing our understanding of the disease and improving treatments for our patients. We work closely with a network of scientists and physicians to fuel discovery and advance therapeutics. Led by Tova Gardin, MD, MPP, a neuroimmunologist experienced in neurologic and psychiatric disease, the Autoimmune Encephalitis Program brings together clinicians, scientists, and allied specialties to provide holistic, person-centered care and to drive forward groundbreaking discoveries that serve our patients.

Systemic Lupus Erythematosus (SLE, or lupus) is an autoimmune disease in which the immune system causes inflammation in the joints, skin, kidneys, lungs, and other internal organs. Yale Medicine’s lupus program provides unparalleled access to rheumatologists who are experts in the care and treatment of patients with lupus, as well as the most up-to-date information to promote patients’ well-being. Our rheumatologists coordinate care with experts in a wide range of other specialties to provide comprehensive, multifaceted evaluation and treatment plans. Lupus researchers are also an important part of our program, with the goal of advancing the treatment and understanding of this complex disease. Our program is directed by Fotios Koumpouras, MD, who has conducted extensive research on lupus, serves as principal investigator for several active clinical trials in SLE at Yale, and developed and is principal investigator for the Yale Rheumatology BioRepository. Many patients of Dr. Koumpouras and other Yale Medicine rheumatologists travel long distances for their expertise and understanding of lupus, and with telemedicine, they can continue their treatment at Yale even if they live far away. With sites on the Yale New Haven Hospital (YNHH) Saint Raphael Campus and the YNHH Interventional Immunology Center at North Haven, the Yale Lupus Program provides comprehensive evaluation and treatment of patients, and education about the disease for patients and their family members. The program provides multidisciplinary evaluations by rheumatologists and experts in a wide range of specialties, including dermatology, nephrology, maternal-fetal medicine, neurology, pulmonary medicine, and cardiology. The program also features: A state-of-the art Infusion Center for administration of the most up-to-date therapies. A Lupus Wellness Program . Lupus can be a complicated condition to understand, and education is the first step in empowering people to be an active part of their treatment decisions and improve the quality of their life. A Transition Program for young adults with lupus that works toward each person’s individual goals, emphasizing education and shared decision-making. One of the unique aspects of our lupus program is a combined Rheumatology–Dermatology Clinic —the first of its kind in Connecticut—where our renowned experts in those two fields work together to provide diagnosis, second opinions, and treatment planning. Rashes or skin lesions may be among the first symptoms of lupus, and dermatologists are often the first doctors to see signs of the disease. Overall, 66% of people with lupus will develop some form of skin disease. By seeing patients together, our experts in dermatology and rheumatology combine resources for a more integrated and holistic approach to this complex illness. In another interdisciplinary collaboration, Dr. Koumpouras is working with Yale Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences to study and

Our program consists of dedicated experts and support staff committed to providing cutting-edge care to patients with disorders including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Other conditions that we treat include sarcoidosis, autoimmune mediated liver injury, cholestasis of unknown etiology, lupus, cholangitis, secondary cholangitis, and overlap syndromes. The program offers effective and personalized treatment for patients with these rare liver diseases. Our doctors are specialists in these conditions, with expertise in interpreting biopsy scans, medications, and more. Patients also have access to our clinical trials, any of which offers new treatment options otherwise unavailable to the general public. We are partnered with the Yale School of Medicine Liver Center, one of only four National Institutes of Health-sponsored liver research centers in the United States, and the only center in Connecticut that offers comprehensive patient care for individuals with autoimmune and cholestatic liver diseases. Our team includes three autoimmune and cholestatic liver disease program experts. Together, they provide care that integrates basic, translational, and clinical research. Our combined expertise allows us to discuss and treat difficult cases from many angles. The research conducted by the program is mainly patient driven and aimed at finding solutions that patients can benefit from. The key to effective therapy is collaboration—we work closely with specialists in adult and pediatric gastroenterology, advanced endoscopy, transplant hepatology, transplant surgery, pathology, diagnostic and interventional radiology, gastrointestinal surgery, rheumatology, endocrinology, and medical and surgical oncology within the Yale Medicine system to provide any additional support that patients may need.