Yale Cancer Center

/Home/Leukemia Healthcare and Treatment Centers/Leukemia Health Care and Treatment Centers-US/Connecticut Leukemia Health Care and Treatment

Yale Cancer Center

333 Cedar Street, PO Box 208028
New Haven, Connecticut 06520

(203) 785-4191

Clinical Programs

Lymphoma, Leukemia and Myeloma

About the Program

At the Yale Lymphoma, Leukemia and Myeloma Program, services for the diagnosis and treatment of blood cancers offer the most comprehensive and advanced options in the region. Our services are designed to meet patients' physical, emotional and psychological needs. Physicians within the program are organized into a multispecialty team that discusses the treatment plans for patients until consensus is reached on the best management course for each individual patient.

Causes of these cancers remain unknown but advances in treatment, some of which came from research at Yale Cancer Center, are increasing survival rates. Our researchers continue to work on current promising therapies and are able to offer treatment for all phases and stages of lymphoma, leukemia, and myeloma - early, late and refractory.

The Blood Cancers We're Fighting
Lymphoma is the most common blood cancer and the third most common cancer of childhood. The annual incidence of lymphomas has nearly doubled over the last 3 years reaching 62,000 Americans. However, there have been rapid advances in the treatment of this disease and 80% of patients with Hodgkin's lymphoma can be cured.

Leukemia is a malignant cancer of the bone marrow and blood. Approximately 35,000 patients are diagnosed with leukemia annually. The relative adult five-year survival rate has more than tripled in the past 45 years, qualified by age, gender, race and type of leukemia. The leukemia death rate for children 0-14 years of age in the United States has declined 60 % over the past three decades, due to modern treatment advances.

Myeloma is a disease of another blood cell, the plasma cell. Annually, approximately 16,000 new patients are diagnosed with myeloma. Overall survival in patients with myeloma has shown a modest improvement since the 1970s, however, the mortality rate for people of African descent is more than double the rate for caucasians. Yale is a member of the Multiple Myeloma Consortium and is exploring novel treatment approaches to this cancer.

Diagnostic Expertise
Yale has an expert hematopathology diagnostic team capable of pathologic review of lymph nodes and bone marrow with in-depth molecular and cytogenetic analysis. Every diagnostic technique is available at Yale including: bone marrow examination, bone imaging, M protein analysis, cytogenetics, immunophenotyping, and FISH and PCR analysis. Diagnostic analysis also includes relevant genetic testing and the identification of markers of prognosis. The Yale Cancer Center maintains a tissue bank used for novel research studies in cancer treatment and prevention.

Standard Treatments and More
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. For maximum effectiveness, each patient receives an individual treatment plan, which includes standard care and/or clinical trials. In addition, patients may also benefit from complementary and alternative therapies offered at Yale Cancer Center.

In collaboration with Yale Cancer Center, patients benefit from specialized resources at Yale-New Haven Hospital, such as the state-of-the-art nuclear imaging technology, one of the largest total skin electron beam radiation oncology program worldwide, 3D conformal radiotherapy, intensity modulated radiation therapy (IMRT) and stereotactic radiosurgery at the Yale-New Haven Gamma Knife Center.

Specialized Cutaneous Lymphoma Expertise
There are a variety of treatment options available for cutaneous T and B-cell lymphoma and many patients are able to live relatively normal lives during and following therapy. Early diagnosis, cutting-edge treatment, and novel therapies provide a significant benefit to patients with cutaneous lymphomas at Yale Cancer Center and throughout the world.

Yale Cancer Center continues to make innovative advances in the diagnosis and treatment of cutaneous lymphoma through the focused efforts of a ground-breaking clinical research team. Their multispecialty approach to the treatment of patients with cutaneous lymphomas has led to the development of FDA approved treatments that are now the standard of care worldwide.

Transimmunization, an innovation related to extracorporeal photochemotherapy (ECP) which was the first FDA approved selective immunotherapy for any cancer, is currently being investigated in clinical trials at Yale Cancer Center. As the scientific and clinical successor of extracorporeal photochemotherapy, it has potential to replace ECP as the standard of care for patients with advanced forms of cutaneous T-cell lymphoma.

The scientific basis of Transimmunization is the ability to stimulate the development of dendritic cells. Transimmunization is a more efficient means by which to bring these dendritic cells in contact with target cancer cells, before they are returned to the body to stimulate an anti-tumor immune response. Extracorporeal photochemotherapy (photopheresis), which has been continually refined by the cutaneous lymphoma clinical research team at Yale, is currently being used to treat patients with CTCL in over 250 centers throughout the world and has been administered over 300,000 times.

Hematology
Yale Hematology has been a leader in the care of hematologic malignancies for several decades. Hematology plays an important role in the continuity of care of patients from inpatient induction therapy, through outpatient consolidation and maintenance chemotherapy, to long-term follow-up following completion of treatment. Yale's hematologists play a unique role as a regional resource for difficult and challenging cases, with a large number of referrals coming from other hematologists and oncologists in the physician community throughout Connecticut and New England. They work closely with the physicians in the Bone Marrow Transplant service, both to provide primary care to patients referred for transplant that are deemed to be better served by non-transplant modalities, and to provide rapid referral of those patients who are candidates for stem cell transplant.

The Yale Transplant Advantage
Yale is a member of the National Marrow Donor Program and has been accredited as a major transplant center by the FACT transplant accreditation committee.

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. The number of allogeneic transplants performed annually at Yale Cancer Center has doubled in the last four years.

Bone marrow transplants and autologous transplants have been performed at Yale since 1988. Led by Dennis Cooper, MD, the Allogeneic Bone Marrow and Stem Cell Transplantation program at the Yale Cancer Center was one of the first cancer centers to use the procedure to successfully treat cancer patients.

New clinical trials are available for patients who have not been successfully matched with a donor and are at high risk for relapse. Available in only a handful of cancer centers in the country, Yale Cancer Center is currently performing:

* Haploidentical transplants, which allow patients to be transplanted with mismatched or half-matched donor stem cells from a family member with whom they have only one haplotype (set of genes) in common.
* Non-myeloablative or reduced intensity transplants, which is a technique that uses a less intense treatment to prepare a patient for transplant and alternatively relies on the donor's immune cells combined with newer agents to fight the cancer. Of the 42 patients treated at Yale Cancer Center, 75% were over 55. Previously these patients would not have been eligible for transplant. Lead physician is Stuart Seropian, MD.

Stem cell allotransplantation can cause a side effect called Graft-Versus-Host disease in 40-50% of patients who receive transplant. Yale researchers have long been considered leaders in developing novel techniques to eliminate this disease. Advances include:

* The discovery that dendritic, or immune cells, are necessary in causing graft-versus-host disease. The deletion of T-cells from the donor stem cells removes the incidence of graft-versus-host but may also decrease the effectiveness of the transplant. Lead physician is Warren Shlomchik, MD.
* The introduction of intravenous infusions of autologous immature dendritic cells before an allogeneic transplant reduced the incidence rate from the average of 40-50 % to only 15 %. These findings, initially revealed through a study of 104 patients, are currently being confirmed through a national Phase II trial. Lead physician is Francine Foss, MD.

Patient-centered Program Design
Patients at Yale Cancer Center have the advantage of easy access to a disease-based multispecialty team with special interest and clinical expertise treating lymphoma, leukemia, and myeloma. Physicians in medical oncology, hematology, neuro-oncology, and radiation oncology meet regularly to discuss each patient's care and to develop a comprehensive treatment plan unique for each patient.

Patients and referring physicians can be assured of continuity of care. Referring physicians receive a summary of the transplant procedure and most patients return to their physician within two months of a stem cell transplant. Local referring physicians are welcome to and often participate in the Lymphoma Tumor Board to discuss the history and care of their patient with Yale physicians. Coordination continues with home care and supportive oncology, both integral parts of the treatment plan. Yale Cancer Center has an extensive second opinion practice and collaborates with out-of-area physicians to coordinate patient care locally.

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.

©2009 Yale Cancer Center