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
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.
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
Classical Hematology, also known as “benign” hematology, is the area of non-cancer-related blood disorders. Our hematologists provide a full spectrum of care to patients with non-malignant hematology disorders, and participate in research to advance treatment options for their patients. Educational and community outreach are also a priority to improve awareness and understanding of benign disorders.
The types of disorders that we care for include:
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.
Other less common disorders cared for by our Classical Hematology team include vascular anomalies such as Hereditary Hemorrhagic Telangiectasia, paroxysmal nocturnal hemoglobinuria (PNH), porphyria, iron overload such as hereditary hemochromatosis, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome, among others.
Smilow Multiple Myeloma and Gammopathies Program
Annually, approximately 32,000 new patients are diagnosed with multiple myeloma, a cancer of a type of white blood cell, or plasma cell. Overall survival in patients with myeloma has shown improvement in recent years, with new treatments approved by the FDA as recently as this year. Yale Cancer Center and Smilow Cancer Hospital, as part of the Smilow Multiple Myeloma and Gammopathies Program, have several clinical trials available for patients with myeloma.
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