Special to the Journal
AUGUSTA, Ga. – Georgia Regents University cancer researchers are expanding the reach of an easy-to-use algorithm that could keep 30 percent of patients with a rare but deadly form of leukemia from dying within the first month of diagnosis.
The GRU Cancer Center and Dr. Anand Jillella, Associate Cancer Center Director for Clinical Affairs and Chief of the Section of Hematology/Oncology at the university’s Medical College of Georgia, have received a $1.67 million grant over the next five years from The Leukemia & Lymphoma Society to expand the project throughout Georgia and South Carolina.
Along with its project partners—Emory University in Atlanta, the Medical University of South Carolina in Charleston, Northside Hospital in Atlanta and Upstate Oncology Associates in Greenville—the GRU Cancer Center will use the funding in hopes of decreasing early death rates in patients with acute promyelocytic leukemia.
Studies at Stanford University, the Swedish Adult Leukemia Registry and a U.S. Surveillance, Epidemiology and End Results program analysis demonstrate that almost 1 in 3 patients with APL die within a month of diagnosis. Patients with APL develop an abnormally high level of immature white blood cells (promyelocytes) in their bone marrow, resulting in a shortage of healthy red and white blood cells and platelets.
But Jillella likens this new approach to national initiatives that helped prevent heart attack-related death by reducing door-to-balloon times. In APL, he focused on condensing the existing complex, multiple-page standard of care into a simple, one-and-a-half-page algorithm (easily emailed or faxed to physicians) to help prevent delays in diagnosis and treatment; bleeding; side effects of treatment; and infection—all identified as major causes of early death in APL.
“Similar to heart attack patients in the first minutes after diagnosis, those with APL who can be treated quickly, aggressively and proactively within the first month after diagnosis have better outcomes,” he said. In fact, none of 12 APL patients in a GRU pilot study died after use of the new protocol.
Led by leukemia experts at the partner centers, the grant will focus on:
· Educating hematologists/oncologists throughout Georgia and South Carolina to better recognize APL, leading to rapid diagnosis and, if needed, transfer to an experienced treatment center;
· Simplifying the treatment algorithm at these hospitals;
· Providing 24/7 experts to guide hematologists at outlying hospitals from diagnosis through the 30-day initial management period.
Investigators particularly hope to target smaller centers to improve care in outlying areas. “Because this is such a relatively uncommon cancer, one simple misstep in the early stages of treatment could lead to increased morbidity or mortality,” said Dr. Vamsi Kota, medical oncologist at the GRU Cancer Center and a study co-investigator. “What we’re hoping to achieve is a system-wide approach, where physicians everywhere will follow the exact same steps every time.”
While the high early death rate of APL is widely known, this project is the first large-scale population-wide study in the country testing an intervention to decrease APL’s death rate. “If it is successful, this project will have global implications,” said Jillella.
“This is actually a very treatable cancer,” added Kim Cheely, Oncology Nurse Manager at the GRU Cancer Center. “But the biggest obstacle has been the complications that patients can get early on. We’ve really developed the very best recipe for managing patients’ disease.”
An aggressive education program for oncologists in the catchment area began in January, with patient enrollment slated to begin in July. Project results will be reported and published in 2017.
“As a cancer center that conducts research, our role is to enhance cancer care for citizens here in Georgia and South Carolina, and, ultimately, around the world—through projects that advance the standard of care for cancer,” said Dr. Samir N. Khleif, Director of the GRU Cancer Center. “This study exemplifies the accomplished work performed by our physician-scientists every day.”