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As we observe World Cancer Day, I’m reflecting on my own family’s experience with blood cancer.

Bold Goal, Bold Action

Galinpepimut-S therapy showed specific T-Cell immune responses for patients with acute myeloid leukemia in remission following second-line salvage therapy.

Galinpepimut-S Immunotherapy Has Preliminary Efficacy in Acute Myeloid Leukemia 

After a long and difficult journey, I finally published the book I set out to write as my legacy, overcoming cancer and the challenges of deafness.

Life After MDS and Accomplishing Your Goals

From the deaths of John Sykes and former Planned Parenthood President Cecile Richards to an update from Mike Peters, here’s this week’s cancer news. 

Whitesnake Guitarist John Sykes Died of Cancer, Mike Peters Starting CAR-T

CURE® highlights some top stories from the ASH Annual Meeting, focusing on B-cell acute lymphoblastic leukemia, multiple myeloma and other blood cancers.

Putting an Emphasis on Patient Collaboration in MPN Treatment

Dr. Richard “Rick" Winneker discussed advice that he would provide to patients faced with a myeloproliferative neoplasm (MPN) diagnosis, putting an emphasis in personalized care and active participation in the broader MPN community. He also goes on to emphasize the importance of consulting an MPN specialist to ensure optimal care.

, creating and managing programs, was recognized at the 

 for his dedication in uniting the patient, physician and pharmaceutical communities together in creating awareness for MPN research.

In an interview, Winneker sat down with CURE and shared his expert insights on patient care, as well as expanded on the importance of participation in groups like the MPN Research Foundation to ensure a high prioritization of research and collaboration across the field. Read more from the interview below.

The first thing I do when I meet a patient, rather than giving them advice right away, is ask them how they're doing. I want to understand what they're experiencing because I know it can be so different from one patient to the next. [However], my advice usually is: if possible, try to see an MPN specialist, if not directly, but perhaps a second opinion or a consultation of some kind. They're the ones that are really closely following this rapidly emerging field, [therefore] you want to make sure that you're experiencing the best possible outcomes that you can.

Secondly, I would say be your own best advocate. Not only that, [but] join the MPN Research Foundation. Work with us and be part of that solution that we're trying to bring forward. We want to hear from patients about what they care about most, in terms of what we should be doing next. See the right people and join us. I think that would be my message.

Transcript was edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to 

subscribe to CURE®’s newsletters here.

Dr. Prithviraj Bose discusses patient characteristics to potentially optimize selection of the available JAK inhibitors for patients with myelofibrosis.

Dr. Prithviraj Bose Discusses Patient Characteristics for Treatment Selection

Several patient characteristics — spleen size, symptom burden and blood counts, among others — are taken into consideration when deciding upon the best JAK inhibitor to treat myelofibrosis, a type of myeloproliferative neoplasm (MPN).

Dr. Prithviraj Bose, professor in the department of leukemia at The University of Texas MD Anderson Cancer Center in Houston, spoke with CURE onsite at the Society of Hematologic Oncology 2024 Annual Meeting, to discuss these factors to potentially optimize selection of the available JAK inhibitors for patients with myelofibrosis.

There is a lot of different patient characteristics one looks at. So, one looks at the size of the spleen, one looks at the burden of symptoms, and one looks at the blood counts. So, this is a unique cancer where treatment is not by … stage of the cancer, or, it's not very algorithmic in terms of what is front line, what is second line, what is third line. So it's really based on the need of the patient.

Now, again, generally, I will say of the four [Food and Drug Administration-]approved JAK inhibitors — again, JAK inhibitors are all we have approved in myelofibrosis — I think ruxolitinib (Jakafi), 

, can all be used in frontline [setting], but I think what really happens is that it's either ruxolitinib or momelotinib, with momelotinib being favored if the patient is anemic, and otherwise ruxolitinib. I will say the majority [of patients] get ruxolitinib because it is so good for spleen and symptoms, and it has a survival benefit that's been shown [in clinical data].

In the second line, I think it goes back more to what I was saying about the clinical presentation. If you have good counts, large spleen, by all means, go with fedratinib. If you have, anemia, predominant presentation where that's what you're trying to improve the most, momelotinib, I think, is your best choice. If the platelets are super low, which is rare to happen in [the] front line [setting], much more common in second and later lines, if it less than 50 [platelets per microliter of blood], absolutely pacritinib. That has the best data, and it has good efficacy there. So I think … you cannot set exact rules, but these are just some pointers.

Spleen size, blood counts and symptom burden are some of the factors cancer teams take into account when selecting which of the four JAK inhibitors to treat patient with myelofibrosis.

Patient Characteristics Guide Decision Making for JAK Inhibitors in Myelofibrosis

For patients with MDS, close monitoring by doctors may help determine the appropriate timing to undergo stem cell transplants before the disease worsens.

‘Tempo’ of MDS Helps With Timing for Stem Cell Transplants 

During the treatment process for patients with myelodysplastic syndromes (MDS), the time in which patients receive stem cell transplants matters, an expert told CURE® at the Society of Hematologic Oncology Annual Meeting.

However, many patients will have already met with an MDS specialist who has consistently monitored their disease over time, said Dr. Sergio A. Giralt.

Giralt is a professor of medicine at Weill Cornell Medical College and attending physician in the Adult Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center, both in New York.

Throughout the treatment process, Giralt noted that patients and their doctors begin to understand the “tempo of the disease” after months or years with MDS. By doing so, the team is able to determine whether there are progressive cytopenias (consistently low blood cell counts, including red blood cells, white blood cells and platelets).

He emphasized that certain potential progressive abnormalities in the body may lead to higher-risk MDS.

“Before that happens, one should intervene because this is the time when the patient’s going to be youngest and their disease is going to the be the weakest,” Giralt explained.

Regarding transplant eligibility in patients with MDS, he emphasized that patients’ fitness may weigh more than their age. Before deciding on whether transplants are an option, patients take some assessments — including a physical examination — to help doctors determine eligibility.

Well, for many patients, they've already established care with an MDS specialist and a transplant specialist who've monitored these patients for many months or years, and the tempo of the disease, one can see whether there is progressive cytopenias or progressive acquisition of other molecular abnormalities, or increase of high-risk molecular abnormalities, or development of cytogenetic abnormalities that suggest that this disease is going to evolve rapidly into a more higher risk [disease], and that before that happens, one should intervene because this is the time when the patient's going to be youngest and their disease is going to be the weakest.

More important than age is a patient's fitness, and this is determined by a comprehensive geriatric assessment and a full physical exam and assessment by the transplant center physician.

Patients with blood cancer who undergo CAR-T cell therapy should monitor for fever and signs of respiratory distress, an expert said. 

After CAR-T Cell Therapy, Monitor for These Symptoms at Home 

Patients with blood cancers who undergo CAR-T cell therapy will typically stay in the hospital or cancer clinic for a few weeks after therapy so clinicians can monitor for potentially dangerous side effects, such as cytokine release syndrome (a type of overreaction of the immune system) and neurotoxicity.

CAR-T cell therapy, according to the American Cancer Society, is a type of treatment that involves extracting patients’ cells, engineering and growing their immune T cells to find and fight cancer and then re-infusing those new T cells back into the patient.

What Is CAR-T Cell Therapy, and What Can Patients With Cancer Expect?

Once patients return home, there are also symptoms that they and their loved ones should keep an eye out for, such as fever or signs of upper respiratory infections, explained Dr. Nausheen Ahmed.

Ahmed, who is a hematologist-oncologist at the University of Kansas Cancer Center, recently discussed what patients need to know after coming home from CAR-T cell therapy.

There are some patients [who] may have low blood counts, especially neutrophil counts. Our patients will be familiar with that [if] they’re neutropenic. Those patients are at a higher risk of decompensation from any infection. So any fever would be something to report promptly, and ideally get treatment for. Sometimes it might mean IV antibiotics, sometimes it might mean admission. We, at our treatment centers, prefer to avoid the ER so if there's any kind of infrastructure to bypass the ER, that would be great. That's number one.

Then other things can happen such as pneumonia and recurrent respiratory infections. Those have to be promptly reported to the … community oncologist so that they can decide whether the patient needs any other type of medications, antimicrobials for prophylaxis (prevention of conditions) and treatment, whether the patient needs immunoglobulin infusions to help with your immune system, or if there's any other unusual infection that they're worried about … They should be able to either have the patient come back to the treatment center for a visit, or the or the community oncologist can collaborate with the treatment center to see if there's any other testing that needs to be done.

An oncology nurse discusses what patients should know before BiTE therapy, and what they can do if they do not have a social support system. 

Social Support Is Key During BiTE Therapy for Blood Cancers

The use of bispecific T cell engagers (also known as BiTE) therapies has been increasing to treat patients with blood cancers. However, there are side effects and other factors to consider when deciding on the treatment type, explained Kathy Mooney.

Mooney, clinical program director at Johns Hopkins Hospital and Johns Hopkins Health System, sat down with CURE® at the 49th Annual Oncology Nursing Society Congress to discuss BiTE therapies.

“It’s an intense model of care, especially in the beginning. Its frequent dosing [and] there are harsh side effects that the patients need to be aware of,” Mooney said. Common side effects from BiTE therapy include neurotoxicity (nervous system damage) and cytokine release syndrome, when there is an influx of inflammatory molecules, called cytokines, in the bloodstream. 

Cytokine release syndrome can be serious and life-threatening

Educated Patient® Multiple Myeloma Summit BiTE and Future Myeloma Directions Presentation

“So, ensuring that they have good social support is probably key to the initial step-up dosing,” Mooney said. Social support is important because it can help look for signs of side effects, transportation assistance and communication with doctors.

Step-up dosing means that a small amount of the drug will be administered at first, and the dosage increases as the treatment progresses.

However, for patients who do not have strong social support at home, Mooney said that does not mean the BiTE therapies are out of the question. She advised these patients to be open with their care teams if this is the case. Assistance programs exist, such as those that can help with lodging or transportation. Additionally, for these patients, maybe it is best to receive BiTE therapy in the inpatient (hospital) setting, rather than outpatient (in a clinic outside of the hospital), Mooney said.

It's an intense model of care, especially in the beginning, it's frequent dosing [and] there are harsh side effects that the patients need to be aware of. So ensuring that they have good social support is probably key to the initial step-up dosing. We need to make sure that they are safe, and that they can be transitioned quickly to care areas when they need that and have somebody looking out for them for any of those signs and symptoms that may occur.

Some of these options are also … long treatment. There's no end date for the treatment. So making sure they're aware that this is going to be an intense therapy for many months, many weeks, and making sure they feel comfortable with the ability to continue that care [is important].

Lauren Yakelis  in an interview with CURE

Nurse Says CAR-T Cell Therapy is a ‘Mind-Blowing’ Advancement

In the ever-advancing cancer space, more types of treatments have been available, notably CAR-T cell therapy.

“When I first started my career, we were giving a lot of chemotherapy [and] a lot of bone marrow transplants,” Lauren Yakelis said during an interview.

Yakelis is an oncology nurse at Ochsner Medical Center in New Orleans and was a 2024 

. She noted that now, new treatments have “evolved” in the cancer space, including CAR-T cell therapy.

“That's mind-blowing to me that your own body is now fighting the cancer cells and reproducing and killing the cancer,” she said.

Blood Cancer Expert Talks CAR-T Cell Therapy Risks, Benefits

CAR-T cell therapy typically treats patients with certain blood cancers, the National Cancer Institute explains. For patients eligible for CAR-T cell therapy, doctors take T-cells from patients’ blood. They then add a specific gene that binds to a certain protein on the cancer cells to destroy them. After many CAR T cells have grown, patients receive the therapy via an infusion.

Food and Drug Administration approved Carvykti

 (ciltacabtageneautoleucel; cilta-cel) for certain patients with relapsed or refractory multiple myeloma. The approval came following results from the phase 3 CARTITUDE-4 trial.

Yakelis sat down with CURE® at the 2024 Extraordinary Healer® Award event and discussed the advances in cancer treatment during her career.

Just recently is when I realized this is why I chose oncology. When I first started my career, we were giving a lot of chemotherapy, a lot of bone marrow transplants, which are cool. But and I knew that in the next 40 to 50 years in my career, I would see all the new treatments that evolved in cancer therapy. So now CAR-T cell therapy is something I've never seen where you take your own T-cells in your body, your own immune system and you engineer those cells to go fight the cancer.

That's mind-blowing to me that your own body is now fighting the cancer cells and reproducing and killing the cancer. Patients are 30 days on the line after we do their first scan and they're in remission. It's mind-blowing, so to see where we've come, this is why I chose oncology because I just want to help people regain their life and their quality of life and live longer with their families.

Transcript has been edited for clarity and conciseness.

For patients with blood cancers, CAR-T cell therapy has been a “mind-blowing” advancement for treatment in the cancer space.

Conference

Physical therapy early on and speaking up can help patients with blood cancer be more prepared for a hematopoietic stem cell transplant. 

Frailty Can Lengthen Post-Transplant Hospital Stays

Patients with blood cancer who are frail tend to have longer hospital stays after undergoing hematopoietic stem cell transplant, highlighting the importance of patients discussing their health with their care teams and working with doctors, such as physical therapists to improve their functioning, explained Kayla Giannetti, a nurse practitioner in the department of hematology and medical oncology at the Cleveland Clinic.

Giannetti and her team recently conducted research examining the effects of frailty — which includes components such as cognitive health, time to get up and go, falls, weight loss and others — on transplant outcomes. Findings showed that frailty did not affect a patient’s ability to undergo a transplant or their survival outcomes after the procedure, though it was associated with significantly longer hospital stays.

In an interview, Giannetti offered advice for patients who may be frail and plan to undergo a hematopoietic stem cell transplant. In short, patients should consult physical therapy early on in the process, and always be sure to speak up to their care team about questions or concerns that they have.

The main thing that I would encourage patients to really do is move … and do speak up.

If physical therapy is there, that can be consulted early on — the earlier, the better. And it sounds a little bit simplified, but … even if your goal is to get up from the bed to the chair, that makes a big difference in your overall physical health.

I tell people your psychosocial [and] your cognitive health, it's just important. So knowing when to ask questions [is also important]. Speak up if you don't understand something about your medications, that's an important thing to really have your provider, your nurse and your care team, slow down and explain it to you more deeply.

Consulting physical therapy early on and speaking up to the health care team can help patients with blood cancer be more prepared for a hematopoietic stem cell transplant, an expert said. 

Blood Cancers

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