ONS Connect - March 2008 - (Page 12)

Facts About Leukemia and Lymphoma Leukemia • U.S. estimated cases in 2007 – Acute lymphocytic leukemia (ALL): 5,200 – Chronic lymphocytic leukemia (CLL): 15,340 – Acute myeloid leukemia (AML): 13,410 – Chronic myeloid leukemia (CML): 4,570 – Other: 5,720 • Leukemia represents 30% of all childhood cancers. • The disease occurs 10 times more often in adults than children. • ALL accounts for 73% of leukemia in children. • AML and CLL are more common in adults than children. Lymphoma • U.S. estimated cases in 2007 – Hodgkin lymphoma: 8,190 – Non-Hodgkin lymphoma (NHL): 63,190 • Rates for NHL have nearly doubled since the early 1970s. American Cancer Society. (2007). Cancer facts and figures 2007. Atlanta, GA: Author. with transplantation, “targeted immunotherapy and natural killer cell research are helping to provide safe and effective ways to treat relapse with transplant,” Parran says. “Graft-versushost disease is also under investigation with groundbreaking T regulatory cell research to decrease post-transplant immune reactions and improve overall survival.” Another innovation in which the BMT program at Minnesota has been a driving force is that of umbilical cord blood transplantation. “Cord blood transplant has decreased the need to use bone marrow as a source of transplant and has unique benefits such as rapid availability, absence of donor risk, absence of donor attrition, low risk of transmissible disease, low risk of acute graft-versus-host disease, and availability to patients of ethnic and racial minority descent for whom adult marrow and donors often cannot be identified,” Parran explains. “We have accomplished over 700 cord blood transplants since 2000.” Types of Transplantation The Dana-Farber Cancer Institute (DFCI) initially was established as the Children’s Cancer Research Foundation in 1947 by Dr. Sidney Farber as the first research program in chemotherapy for children with cancer. Farber and his team were the first scientists to attain temporary remission of acute lymphocytic leukemia in children and in the 1980s to pioneer autologous BMT for childhood leukemia. In 1969, the institute’s charter was expanded to provide services to adult patients as well (Dana-Farber Cancer Institute, n.d.). Mildred Pasek, RN, OCN®, MM, ONS member and DFCI stem cell transplant research nurse, says that the distinguishing features of DFCI’s program are its size and age; the availability of autologous, related, and unrelated transplants; the research programs in graft-versus-host prophylaxis and treatment as well as mismatched, doublecord transplants; the vaccine program; and the novel mobilizing agents the program has developed for autologous transplantation. In 2006, DFCI performed 190 allogeneic, 157 autologous, and 20 cord blood transplants. “Our patient population shifts based on the types of research protocols in which we are participating,” Pasek explains. “For example, we currently are seeing more patients with chronic lymphocytic leukemia due to an allogeneic transplant-with-vaccine program that we are conducting.” At times, they have also seen more patients requiring nonmyeloablative allogeneic transplants. “Nonablative therapy is important for patients who have had a lot of previous therapy, including a prior autologous transplant.” Pasek also notes an “increase in patients who have myelodysplasia, probably from treatment for a previous cancer such as breast cancer or a hematological malignancy, as the survival from these other diseases increases.” “We had been one of the few centers in New England that did unrelated transplants,” Pasek says, but “a trend we are seeing in the region is that smaller centers are starting unrelated [allogeneic] programs also.” This can create a challenge for patients who wish to take advantage of the years of transplant experience at DFCI if DFCI is not in their insurance network. Pasek finds that her role over the years has evolved to encompass financial aspects of care. “We work with the patient and the insurer, but it can cause delays,” Pasek says. “This can result in patients who are sicker and emotionally as well as financially depleted when they come to us.” Dealing with financial Concerns Increasing payer denials and the availability of research funding are issues 12 ONS CONNECT March 2008

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ONS Connect - March 2008 Contents Editor's Note Just In From Then to Now A Year in the Life—Month Three Web Connect Capitol Connection Notice Nursing Now Recognize Hepatic Sinusoidal Obstruction Syndrome in Patients With Cancer Caregiver Care Elasticity of Cells May Help Researchers to Identify Cancer Calendar of Events ONS Congress Your Thoughts and Comments Are a Valued Decision-Making Resource Staying On Top

ONS Connect - March 2008

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