Carolinas HealthCare System
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Tailoring Leukemia Care to Each Patient

In the Summer of 2013, Carolinas HealthCare System’s Levine Cancer Institute opened its leukemia program as part of the Institute’s expanding Department of Hematologic Oncology and Blood Disorders. The leukemia program offers cutting-edge care for patients with acute and chronic leukemias, myelodysplastic syndrome, and myeloproliferative neoplasms.

With the opening of the region’s first and only blood and marrow transplant (BMT) unit in January 2014 and the introduction of new clinical studies, Levine Cancer Institute is now able to provide optimal and comprehensive care to leukemia patients throughout the Carolinas.

Jonathan Gerber, MD, director of the Institute’s leukemia program, and Michael Grunwald, MD, a leukemia specialist, both came to the Institute from Johns Hopkins University in July 2013 to oversee the development of the program.

Dr. Gerber and Dr. Grunwald wrote the following article:

Personalized Leukemia Care in the Carolinas

Additional Information

Learn more about the Institute, and its evolving hematologic oncology and blood disorders program.

Read the full study in the journal Blood.

Personalization has increasingly become a goal of leukemia treatment. Indeed, the early recognition that acute myeloid leukemia (AML) is a heterogeneous disease prompted efforts to risk-stratify patients. Current risk assessment is primarily based upon cytogenetic and molecular characteristics. These features help identify those patients who might benefit from consolidation with allogeneic BMT and provide promising targets for both current and future therapies.

Despite this progress, most patients with AML are not cured, and existing risk factors are still not able to prognosticate well for individual patients, particularly those in the favorable and intermediate risk groups. The leukemia stem cell (LSC) model has gained acceptance as a potential explanation as to why remission does not translate to cure for most patients with AML. Standard chemotherapy is often effective at wiping out the differentiated bulk of the leukemia, but emerging data suggest that the LSCs are more resistant.

The few surviving LSCs may be too few in number to detect by clinically available means; in such cases, the patient appears to be in complete remission. However, any remaining LSCs ultimately regenerate the leukemia, with resultant clinical relapse. As such, only those patients in whom the LSCs are fully eradicated would be predicted to attain cure.

Although most AML patients achieve complete remission after standard induction chemotherapy, with few exceptions we remain unable to predict who will ultimately be cured. A recently developed flow cytometry-based assay is proving promising in detecting LSCs and predicting which AML patients (who are otherwise in complete remission based on existing clinical parameters) are likely to relapse.

Assays such as this potentially offer another manner in which leukemia care can be personalized. Patients with persistent LSCs (and thus high risk of eventual relapse) can be assigned to more intensive therapy such as BMT or to a clinical trial.

LCI will soon be offering clinical trials with novel targeted agents for hematologic malignancies; additionally, we will have the ability—also via a clinical protocol—to assess for the presence of LSCs after treatment. This assay will allow us to assess which novel agents are active against the LSCs and thus have curative potential.

This ability to personalize therapies and administer them locally whenever feasible will ensure that LCI delivers the best care possible for patients with leukemia.” Dr. Gerber’s study, “A clinically relevant population of leukemic CD34+CD38¬¬¬- cells in acute myeloid leukemia” was published in Blood in 2012 and describes the leukemia stem cell assay that forms the basis for research efforts underway at Levine Cancer Institute.