Blood Cancer Is Smart. Research Is Smarter.

An update on the therapies available, their challenges and the research that Sylvester is conducting.

Advances in chemotherapy and immunotherapy have led to increases in survival rates for patients with leukemia, lymphoma and myeloma. As a National Cancer Institute-designated cancer center, Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, is at the vanguard of research and care for these blood cancers.

For decades, bone marrow/stem cell transplants were often performed when chemotherapy failed to keep patients in remission — and they still are for certain cancers. But there’s a new kid on the block: immunotherapy.

“We participated in the first trials, we have the most patients, and we have the most expertise in South Florida,” said Jay Spiegel, M.D., Sylvester hematology oncologist, Division of Transplant and Cellular Therapy, and assistant professor at the Miller School. “We have some of the best experience managing these complicated therapies, and we are positioned to deliver cutting-edge clinical trials.”

For some patients who relapse after chemotherapy, chimeric antigen receptor (CAR) T-cell therapy is an option. First approved in 2017, and now for aggressive large B-cell lymphoma in adults, acute lymphoblastic leukemia, follicular lymphoma and multiple myeloma, CAR T-cell therapy targets tumors more precisely than chemotherapy. A patient donates their own T cells through apheresis; the T cells are then genetically modified to target cancer. The process “turns a T cell into a heat-seeking missile,” said Dr. Spiegel. “It finds the cancer and kills it.”

CAR T Challenges

But CAR T-cell therapy has its challenges. “Currently, you have to collect a patient’s cells and often send them to a company that manufactures the CAR T product,” said Dr. Spiegel. Most patients live far from the cancer centers where CAR T-cell therapy is available, and it cures only around 40% of patients with aggressive lymphoma.

Successful Drug Research

“We’re researching why people relapse,” said Dr. Spiegel, noting that Sylvester is running allogeneic CAR T-cell therapy clinical trials, where cells are obtained from a donor. “Time is of the essence. If I can give you somebody else’s cells that are in the freezer, I can do that much quicker than the time it takes to manufacture a CAR T product from your cells.”

Wouldn’t a pill be better? That’s what Justin Watts, M.D., chief of the leukemia section, Division of Hematology at Sylvester, associate professor of medicine and Pap Corps Endowed Professor in Leukemia, is working on. “We’re getting better about doing CAR T quickly,” he said, “but it’s not as easy as taking a drug.” One recent development at Sylvester was a successful trial of an IDH 1 inhibitor called olutasidenib, which was approved in December 2022 for acute myeloid leukemia (AML).

“In around 2016, we put the first patient in the world on this trial,” Dr. Watts said. She was in her early 70s, with relapsed AML. Seven years later, she is still in remission. “The first person in the world to try a drug,” he said, “and she now picks it up at the local drugstore.”

Remission and Transplants

Of course, the goal is for patients to stay in long-term remission after initial chemotherapy. However, according to Craig Moskowitz, M.D., physician-in-chief at Sylvester and professor at the Miller School, for patients who relapse, the cure rate is nearly 65% with transplantation and nearly 80% for patients in remission at the time of the transplant.

“We along with our colleagues at Memorial Sloan Kettering Cancer Center have developed a program in this setting where 90% of patients are in remission at the time of transplant,” he said. “And this regimen is now being considered for a national study.”

Transplants can be toxic, Dr. Moskowitz said. Patients are hospitalized for a month, and infertility is very common. The general theme in Hodgkin lymphoma management is to maintain the cure rate with less toxicity with the availability of new agents.

Better Outcomes

“A lot of people think leukemia is a death sentence, but it’s not,” said Mikkael A. Sekeres, M.D. M.S., chief of the division of hematology at Sylvester and professor of medicine at the Miller School. “We have drugs that work so well for some with leukemia that they live as long as people who never had a diagnosis of leukemia at all.”

Survival for leukemia, according to Dr. Sekeres, has more than doubled over the past three decades. The key is getting the right diagnosis and the right treatment. There will never be a one-size-fits-all approach to treating cancer, he noted. The more researchers understand the complexity, the more they realize they need multiple targeted approaches.

“What’s great about an NCI-designated cancer center like Sylvester is that there are trials going on and we can design a treatment regimen,” Dr. Sekeres said. “You have doctors who have a specific cancer focus, so they know how to get an accurate diagnosis and they can identify the ideal treatment regimen for the person sitting in front of them.”

Tags: blood cancers, Dr. Craig Moskowitz, Dr. Justin Watts, Dr. Mikkael Sekeres, immunotherapy, Sylvester Comprehensive Cancer Center