Editor’s Note: This article first appeared in the Winter/Spring 2021 issue of Forward magazine, which is published twice a year by Fox Chase Cancer Center.
Bone Marrow Transplant, Cellular Therapies Offer Many Options
Every three minutes, someone in the United States is diagnosed with a blood cancer. These cancers, which include leukemia, lymphoma, multiple myeloma, and many others, account for nearly 10% of all new cancer cases, according to the Leukemia Research Foundation. The Leukemia and Lymphoma Society estimates that 1.3 million Americans are living with, or are in remission from, leukemia, lymphoma, or myeloma.
Luckily for patients in the Philadelphia area, Fox Chase Cancer Center has one of the leading programs in the country for the treatment of these conditions.
“Every week our staff sits down together and offers the best to our patients, whether it’s chemotherapy, radiation, immunotherapy, stem cell transplant, bone marrow transplant, cellular therapy, or a combination of all of them,” said Henry Chi Hang Fung, MD, FACP, FRCPE, chair of the Department of Bone Marrow Transplant (BMT) and Cellular Therapies at Fox Chase. Fung has more than 30 years’ experience working with thousands of patients undergoing transplants. Among many other honors, he is consistently listed by Castle Connolly and Philadelphia magazine as a top doctor in hematology and cancer.
The department, which was recently formed from the Fox Chase-Temple University Hospital Bone Marrow Transplant Program, treats patients with different types of blood cancers. It also provides bone marrow and stem cell transplantation and cellular therapies to patients with blood disorders and other life-threatening diseases with the goal of improving their long-term outcomes.
Fung said he is privileged to run the department because it offers unparalleled opportunities to work with state-of-the-art, life-saving technology. In 2018, the department unveiled a new 11,500-square-foot outpatient clinic. Together with the inpatient BMT unit, the $2 million facility occupies the entire fifth floor of the Patient Care Center at Jeanes Hospital, which is adjacent to Fox Chase Cancer Center and also part of the Temple system.
A Program of Distinction
In addition to the updated facility, Fung said the department is also distinguished by a collaborative approach that benefits patients. Before becoming a department in late 2020, the program earned the Blue Distinction Transplant – Bone Marrow/Stem Cell from Blue Cross Blue Shield. The distinction takes into account the program’s overall quality measures, which are developed with input from the medical community. The department has also been honored as a Cigna Lifesource Transplant Network program of excellence, an Optum Transplant Center of Excellence, and an Aetna Institutes of Excellence Transplant Hospital.
In addition to these distinctions, the department has been honored two years in a row for providing exceptional care and strong clinical outcomes for patients who received bone marrow or stem cell transplants by the Center for International Blood and Marrow Transplant Research. Fox Chase is the only cancer center in Pennsylvania to exceed BMT outcome expectations for patients for both 2019 and 2020, and the only center in four surrounding states—New Jersey, Delaware, Maryland, and Virginia—and Washington, D.C.
“It is the commitment of our physicians, nurses, and other clinical staff that brings us this success and recognition every year. It is a remarkable achievement, especially considering that our patients often have more advanced cases of blood cancer when they come to us than at many other programs in the country,” Fung said.
“This is very positive because our institution has recognized that this is one of the best clinical programs in the health system, and it has a very big potential to continue to grow and offer cutting-edge, novel treatments to our patients. These include different types of T cell and immunotherapies like CAR T, AlloCAR T, tumor-infiltrating lymphocytes, bi-specific antibodies, antibody drug conjugates, and others,” he added.
Recently, the BMT program was recognized by the Foundation for Reaccreditation of Cellular Therapy (FACT) at the University of Nebraska Medical Center. This is also the first time the program was accredited for immune effector cell therapy, making it the only adult center in Philadelphia that has this designation. FACT is an internationally-recognized accrediting body for hospitals and medical institutions offering stem cell transplant and cellular therapy; it indicates the accredited institution has met the most rigorous standards in every aspect of stem cell therapy.
In addition to taking on the role of department chair, Fung is also a member of the Blood Cell Development and Function Program and the translational research disease groups for leukemia and myelodysplastic syndromes and lymphoma and chronic lymphocytic leukemia. He is also a member of the National Comprehensive Cancer Network’s Multiple Myeloma/Systemic Light Chain Amyloidosis/Waldenstrom’s Macroglobulinemia Panel.
In addition to conducting its own research, the department participates in research with the ECOG-ACRIN Cancer Research Group and the Bone Marrow Clinical Trials Network. Its researchers work collaboratively to bring the most promising discoveries from the laboratory into the clinical setting, where they can directly impact patients.
Fung is a well-known leader in the field of blood diseases and is internationally recognized for his clinical and scientific expertise in bone marrow and stem cell transplantation and cellular therapy. He came to Fox Chase from Rush University Medical Center in Chicago, where he was director of the Section of Bone Marrow Transplant and Cell Therapy and clinical leader of hematologic malignancies. He was also director of the Coleman Foundation Blood and Marrow Transplant Center, where he held the Coleman endowed chair.
A Benefit to Patients
One person who has benefitted from all this expertise and experience is Firas Saidi. In November 2019, Saidi, 49, of Huntingdon Valley, Pennsylvania, was diagnosed with multiple myeloma, a type of cancer that forms in the plasma cells and accumulates in the bone marrow, crowding out the healthy cells. Upon hearing his diagnosis, he was overcome with emotion.
“I had back pain that wasn’t going away for a couple of months before the diagnosis was official, but I had a feeling it might be multiple myeloma. That feeling got more intense as I saw the X-rays. Even though I was mentally ready, thinking something bad was about to be confirmed, it was just very different when I actually got the phone call to confirm my diagnosis,” said Saidi.
“I have a family, three kids, and my thinking was that I needed to start planning and that’s it. This is the end, and I need to plan for how my family will be taken care of,” he said.
The day after his diagnosis, Saidi met with Fung, who immediately started a treatment plan. Saidi said his worries gradually diminished the more he met with Fung and his team. They told Saidi that various treatments existed for multiple myeloma and that it was more of a chronic disease than the death sentence it was just a decade ago.
“Dr. Fung was very direct with me. He didn’t try to sugarcoat it. He very plainly told me, ‘This is what we’re going to try.’ I appreciated that,” said Saidi. “I also didn’t feel like I had to do anything really. I just had to show up and follow along with the appointments. Fox Chase has a great reputation, and I have all the trust in my treatment team.”
Saidi qualified for an autologous bone marrow transplant, one of several bone marrow and blood transplant procedures the department performs. It averages 100 to 150 such transplants each year. The department’s expertise in the procedure is one of the many assets that make Fox Chase an ideal place to be treated.
What is a Bone Marrow Transplant?
Bone marrow is the spongy tissue inside bones that contains stem cells. These cells can develop into red or white blood cells that carry blood through the body and help fight infections. When the marrow is affected by cancer or another blood disorder, the cells lose their ability to function properly.
A bone marrow transplant is similar to a blood transfusion. It involves infusing healthy stem cells into the body to replace damaged or diseased bone marrow. The first transplant in 1956 marked the beginning of standard life-saving care for patients with blood disorders. Bone marrow transplants have proven successful in treating certain types of cancer, including multiple myeloma, lymphomas, and leukemia, as well as other life-threatening blood disorders.
“For each of the diseases we offer transplants for, there are set circumstances where it’s an option,” said Michael Jay Styler, MD, a senior transplant specialist who works with Fung. “For example, with lymphoma, we only consider it if someone has relapsed or failed to go into remission with standard therapy. With myeloma the goal is different. We offer transplant as part of the initial treatment with the goal of achieving a deep reemission that predicts for prolonged survival and better quality of life.”
There are two different kinds of bone marrow/stem cell transplants: allogeneic and autologous. In an allogeneic transplant, healthy bone marrow/stem cells come from a matched or partially matched donor or umbilical cord blood. In autologous transplants, the bone marrow and stem cells are derived from the patient themselves. The bone marrow is harvested from the hip bone and stem cells are collected from peripheral blood though a procedure called apheresis.
The type of transplant and stem cell source a patient receives is determined by factors such as age, diagnosis, stage of disease, and overall health. These transplants may be used with chemotherapy alone or in combination with different levels of total body irradiation.
The Future of Treatment
Fung attributes much of the department’s excellence to the dynamic and nuanced care the center is able to provide, as well as its history of leading the way with emerging therapies. One such example is a new certification Fox Chase received to offer a therapy called brexucabtagene autoleucel.
The treatment, also known by the brand name Tecartus, is the first cell-based gene therapy approved by the Food and Drug Administration (FDA) for the treatment of patients with mantle cell lymphoma, a type of B-cell non-Hodgkin lymphoma that affects the immune system.
Tecartus, a chimeric antigen receptor (CAR) T-cell therapy, was approved for adults with mantle cell lymphoma who have not responded to or who have relapsed following other kinds of treatment. According to its developer, Kite Pharmaceuticals, the treatment works by first separating white blood cells from a patient’s blood. The T-cells are then sent to a lab where they are modified into CAR T cells that are later infused back into the patient’s body during a 30-minute intravenous infusion administered at an authorized treatment center.
“This is probably one of the most promising therapies for patients with mantle cell lymphoma, including those with a type of disease called P53-mutated mantle cell lymphoma,” said Fung, who served as an investigator on the clinical trial that led to FDA approval. “When patients failed these treatments, even after having durable responses, we had nothing to offer them. The responses we are seeing with Tecartus are like nothing we have seen in the history of mantle cell lymphoma.”
Fung and his team were also co-investigators on a study that was the basis for the recent FDA approval of axicabtagene ciloleucel, also known by its brand name Yescarta, which is also made by Kite Pharmaceuticals. It is the first CAR T-cell therapy approved for indolent follicular lymphoma, a form of indolent non-Hodgkin lymphoma, in patients who have relapsed after two or more lines of systemic therapy.
As Fox Chase continues to expand the BMT department with therapies like Tecartus and Yescarta that will benefit blood cancer patients, the effectiveness of immunotherapy in treating other hematologic malignancies is also being explored. Ongoing clinical trials include investigations into multiple myeloma, chronic lymphocytic leukemia, and follicular lymphoma.
“There has been an explosion of new drug development for cancer, especially in our field, over the last several years,” said Styler. “The pace of that development seems to be accelerating. As they come out, most of them tend to be better tolerated and more specifically geared toward some aspect of the cancer, which makes more and more patients eligible to receive those types of therapy.”
Fox Chase and Temple University Hospital continue to make strides in the battle to improve treatment opportunities for patients with blood cancer and blood disorders. The BMT department at Fox Chase partners with other institutions to offer the same patient care outside of Temple University Hospital-Jeanes Campus.
Fox Chase partners with St. Luke’s University Health Network-Anderson Campus in Easton, Pennsylvania, to provide blood cancer care to patients closer to home to avoid multiple trips to Philadelphia, which is 80 miles away. Fung and his team work collaboratively with colleagues at St. Luke’s to provide the highest quality of care to patients who are referred from the system’s 12 hospitals and more than 300 outpatient sites. For example, patients can undergo blood and marrow transplant and cellular therapy at Fox Chase and have pre- and post-transplant care at St. Luke’s. Additionally, this partnership and the access it provides allows patients to participate in a wider range of clinical trials.
Fung said he believes much of the center’s continued success will be due to a robust quality improvement program that provides it with continuous feedback. “My philosophy is that we should work together to make an informed decision about what is best for the patient. We can always do better,” said Fung.
The first bone marrow transplant in 1956 marked the beginning of standard life-saving care for patients with blood disorders.
