← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Dr. Douglas Graham, Chief of the Aflac Cancer and Blood Disorders Center
00:19:24
Loading summary
Transcript14 lines
- [00:00]
A
Welcome to the Becker's Healthcare Podcast. I'm Chris Sosa, your host, and I'm thrilled to be joined today by Dr. Douglas Graham. He is chief of the Aflac Cancer and Blood Disorder center at Children's Healthcare of Atlanta. Doug, thank you for joining us today.
- [00:14]
B
Thanks. It's great to be part of the podcast today.
- [00:16]
A
Wonderful. Doug, we're having you on the program today to discuss pediatric cancer sickle cell disease treatment research, where it's going, and what's exciting you about it. So, so off the top, though, could you please just introduce yourself and tell us a bit about your background?
- [00:32]
B
Yeah, absolutely. So, Chris, I originally from North Carolina. That's where my training was. Undergraduate at Wake Forest. And then I went to medical school in Chapel Hill, where I completed my MD and PhD there. And then I moved to Colorado. So I was in Denver for 19 years as part of the faculty there at Children's Hospital of Colorado. I am a physician scientist. So I. I have a research lab looking for new treatments for pediatric leukemia in particular, but also I'm a pediatric leukemia doctor. So after being in Colorado for 19 years, I transitioned a little bit of my role to, in addition to being a leukemia physician, to have a more administrative role as the chief of the AFLAC Cancer and Blood Disorder center in Atlanta. And I have been here now 10 years.
- [01:22]
A
Doug, I want to follow up with that. Just what drew you to being a leukemia doctor in particular?
- [01:30]
B
Well, that is a fantastic question, and I often get asked, is it something that is a difficult career to work with children in cancer? I'll tell you that part of my interest in cancer came from my research interest as I was doing my PhD research, it was in the field of cancer research and understanding what causes normal cells to turn cancer cells and how do we develop new treatment for cancer. But really the passion came as I was in the clinic in dealing with families that were going through the crisis of having to hear the words that your child has cancer. Oftentimes, even though we couldn't explain why a child has cancer, we could say, we know the next step forward to be able to try to make your child healthy again. Over the last several decades, there's been remarkable progress with leukemia. I was born in the 1960s, and at the time, if you were a child diagnosed with leukemia in the 1960s, there was almost no hope for a cure. As a matter of fact, there was even debate around that time whether or not we would even treat children who have leukemia with chemotherapy. So we progressed from there to now in Today's world, about 80% of children with all childhood cancer we can cure as an overall cure rate, and specifically within leukemia, some of the cure rates are as high as 90 to 95% of children with leukemia. So there's a lot of promise and hope and really just a lot of reward, I would say, in working with families and being entrusted with the care of their children.
- [03:13]
A
Well, Doug, thankfully there are people like you who are doing this hard work, this research. Obviously, you're not the only one. But to go from the numbers that you just said up to 99%, 90 to 95%, that's great. I'm sure you're numbers. You hope those numbers will get higher every single day. And that's part of what we're here to talk about. So, Doug, the next question I have for you is simply what are some of the milestones that you've reached at the Aflac Cancer and Blood Disorder center, and what effect have they had on children's health, whether it's in the Atlanta area or beyond?
- [03:44]
B
One of the things that is remarkable about the Aflac Cancer and blood Disorder center is our partnership with the Aflac company. I don't really know of anywhere else in the country where there's anything quite like what we have with the partnership we have with Aflac. But this has been a 30 year partnership. We're having our 30th birthday celebration this year. We have been funded by the Aflac company 30 years ago because of a unique patient that we cared for within our center. And this was a young girl who developed leukemia. And we were able to give the therapy that was necessary for the leukemia at the time, for the upfront therapy. But then the child relapsed, and when the child relapsed, she needed a bone marrow transplant. We did not have the expertise at that time to provide a bone marrow transplant at Atlanta. So we had to send our patient to Seattle, so outside of the state of Georgia to receive the care and then come back to us. So we approached the Aflac company about, would you join us in a vision so that someday every child that's diagnosed with cancer in the state of Georgia we could care for in Georgia. We wouldn't have to send any kids outside of Georgia for any reason. As a matter of fact, we would like to be a referral center, a place that could be a safety net for other kids that are in the southeast to receive care that they would need. That started the journey 30 years ago. And now the Aflac company over this time span has given us $190 million of investment to be able to make us one of the top centers in the country. And the remarkable thing about it is that in part, it comes from the company, but it also is an engagement with all of the aflac field force workers all across the country. So every month, more than 15,000 of the field force workers contribute monthly from their paycheck to the athletic cancer and blood disorder center. This has allowed tremendous growth, growth in expertise of our faculty, for example. So 25, 30 years ago, we had 18 faculty that were specialists in hematology, oncology, and bone marrow transplant, and today we have over 130. So this really gives us experts in any kind of disease that you would have in the field, and that we have really top national experts that are right in Atlanta. And we no longer have any reason to be able to send children outside of Atlanta to receive accelerated care. As a matter of fact, we now have become a regional referral center. And if you look back over the last five years, we have seen patients from 45 different states that have sent patients to us for their care. I say also that we have had a unique opportunity because we are the only children's hospital in a large metropolitan city of 6 or 7 million people. This makes us one of the largest volume pediatric cancer centers in the country. We see more than 500 new cancer diagnoses a year, making us one of the very largest in terms of number of cancer patients that we see. We are the number one clinical volume for pediatric hematology patients with blood diseases like sickle cell disease or thalassemia, for example, or hemophilia. In part driven by the fact that we have more than 2100 unique sickle cell patients that we care for. Then our other component of our program is our bone marrow transplant program, which is also one of the largest five centers in the country in terms of volume. I think those together, the partnership that we've had, have allowed us to recruit exceptional faculty to expand the programs that we need to, to care for the large volume of patients that we have. But also the last component of it is the innovation, the innovative programs that we've been able to capitalize on. We can talk more about that, but we have some programs that are present in Atlanta that may only be present in one or two or three places in the country outside of Atlanta. So we're very fortunate to receive the support that we have to provide the exceptional care that we want to provide to our children.
- [07:58]
A
That's quite an impressive rate of growth, Doug. And I'm sure you hope that that continues. I also want to talk to you about the future, specifically some of the most promising pediatric cancer treatments that you guys at the Aflac Cancer and Blood Disorder center are working on that may be affecting other health systems as well.
- [08:22]
B
If you think about where we have come in terms of cure for cancer, if we haven't 80% cure for all pediatric cancer as a whole, that's fantastic, fantastic progress. And we've done that as really a group across the country in collaborating with clinical trials to be able to advance the treatments. That still leaves 20% of patients that we're not curing every year. If we think about that in Atlanta, if we have 500 new cancer diagnoses, we might have 400 of those that go on to be survivors. But. But there's still 100 patients for which we need much better treatment. And I would say better treatment in two ways. We need more effective therapies, therapies that will, that will close the gap on this 20%. But the second thing that we need to do is to have less toxic treatments, more. More treatments that are going to have fewer side effects. And so even though our cure rates are high, studies have shown that if you look at pediatric cancer survivors, that virtually every pediatric cancer survivor by the age of 50 is going to have some chronic health condition. So there will be problems, issues related to heart function or lung function or thyroid function. There may be learning challenges in school. There could be fertility preservation issues. So the goal that we have as we look forward to the future are more targeted therapies that are effective and are less toxic. And so we are doing that in a couple different ways. The first way that we are trying to address having more targeted therapies, therapies that are really only hitting the cancer cells more specifically and less of the normal cells, is we do that through programs such as precision medicine programs in our cancer center and in other centers across the country. We now have the ability to understand on a genetic level what might be driving individual cancer. So it's not, for example, that all the leukemias are the same in the patients we see, but there might be unique drivers for each leukemia patient, and that might help us figure out better treatment plans, is a better prognosis and a better treatment plan that's directly tailored for that patient. There are more than 20,000 genes in a normal cell or leukemia cell. And what would have taken forever to be able to figure out and dissect all the different genes in a cancer cell, we now can, in just a matter of days sequence all the genes in a cancer cell, and we can figure out how those genes are different from the normal cell. This allows us to figure out, if we decipher a specific genetic lesion, Is there a drug that can be targeted for that? Is there a specific drug that can help that patient? So in that way, the future is bright and that the understanding that we have and advances we have in molecular medicine Are helping us tailor certain types of therapies for patients and also help us understand in some patients, are there ways that they may metabolize chemotherapy differently. So we might even adjust some of the way that we give chemotherapy agents Based on some genetic information we obtain from the patient. The second thing, which is an exciting advancement, Besides the precision medicine and the use of targeted therapies, Is really, I would say, the coming of age of using immunology, Using your own immune system to help fight cancer. So we have begun in the field of pediatric oncology, and I would say adult oncology as well, to learn tricks, to be able to ramp up and rev up your immune system to help you fight cancer, to turn on the immune system, Specifically as an aid to cancer fighting, There are medicines that we can give that can turn on the immune system, and that can help. And another way is that we can take immune cells from a patient, so outside of the body, and train those immune cells to detect cancer cells, such as leukemia cells, and then give them back to that patient. And so you're using cells as drugs as well. And an example of this is this type of therapy that I'm discussing is called CAR T cell therapy. So CAR T cell therapy has changed the path for many patients that have failed other therapies. And so in the past, a decade ago, before the advent of CAR T cell therapy, There may have been patients that we have said, well, we've really run out of options of what we can do for you. But now, through these cellular therapies, such as CAR T cell therapy, we can now say we have another option and a very effective option to now cure patients using immune cells and cells, in this case, that we derive from that particular patient, to help fight the cancer and achieve cures in a way we could not have done in the past. Those are what I would say is promising to be able to close the gap on this 20%. How do we reach a goal sometime that we have a therapeutic option for every patient that we see that has childhood cancer?
- [13:53]
A
Doug, I'm very impressed. Let me just say this. The picture painting of how these therapies Work is just incredibly easy for me to follow and I'm not anywhere close to an MD, PhD. So I appreciate you putting in this in such a way that makes me super excited about where all these therapies are going. And no doubt your patients and communities feel the same, looking even further into the future. So what are the afflate cancer and blood disorder centers? What are your next steps in advancing your mission and what are you going to need to accomplish your goals?
- [14:30]
B
Well, I'll tell you as we discuss these therapies, I mentioned cell therapy. Our mission will continue to advance upon expanding options for cell therapy. So we have great options for cell therapy for leukemia patients in the car. T cell therapy. Our team and other teams across the country are looking for how do we use that technology and expand it to other types of cancers that are solid tumors, for example. So right now we're trying to develop the same kind of cellular therapy for brain cancer and for tumors such as neuroblastoma that we're testing. We are so excited to be in the new hospital, the new Arthur M. Blank Hospital right in Atlanta that we have moved into. It has 446 beds. 98 of the beds are for the Aflac cancer and blood Disorder Center. State of the art facility allows us to deliver the exceptional care that we want to provide in state of the art fac. But the other thing that that the Arthur Blank Hospital has are GMP laboratories. So these are good manufacturing practices, laboratories that allow us now for the first time ever to manufacture these cell therapies that I'm talking about. So prior to moving into this hospital, any cell therapy trial that we would want to conduct would have had to be in collaboration with a pharmaceutical company or with another center. But now that we have the manufacturing capability right in the hospital, we actually can think of new ideas for cell therapy and for gene therapy for our patients and manufacture these products right in the hospital to give even quicker delivery and to come up with new ideas and next generation ideas. In addition to the cell therapy. I mentioned gene therapy and I do want to touch on that for just a second as well. Gene therapy has changed the way that we even think about cures for some of our children. And this used to just a few years ago would have been, wouldn't it be nice, for example, if we had a way that we could cure children with sickle cell disease? Well now today is the day, Today is the day that we can do that. There's gene therapy trials, there have been gene therapy trials that we participated in over the last few years, that allowed as a community across the country for us to develop an effective gene therapy product for patients with sickle cell disease. So we now are in the process of enrolling patients to receive this new gene therapy treatment right here in Atlanta. As a matter of fact, we already have over 60 patients on the wait list to receive gene therapy for sickle cell disease. So we're in a new era of offering cures for patients for sickle cell disease that we never could have done in the past using gene therapy. I'll say that this complements, though, another kind of therapy that we've been involved with for a number of years already within our center, and that's the use of bone marrow transplant for patients with sickle cell disease. In our center, we have transplanted more than 150 patients with sickle cell disease already. Many of them have been able to have transformed lives and be able to have a curative option. We hope that the gene therapy would be a next generation for that, and we'll have some advantages of having not as many of the side effects potentially that a patient would have that undergoes a bone marrow transplant. But in addition, this idea of gene therapy is being extended to other types of diseases as well within our center. So we have already treated this year a patient with gene therapy for beta thalassemia and for that disease. We have more than 26 patients that are already on a waiting list for this therapy as well. Then finally, we have contributed significantly to gene therapy for hemophilia. As a matter of fact, one of our faculty at the Aflac Cancer and Blood Disorder center came up with the new gene therapy product for hemophilia that was just tested internationally in India and has been so successful in this therapy that it was just published just in the last couple months in the New England Journal of Medicine. And reporting the early success of that trial.
- [18:53]
A
Doug, I can't imagine the amount of hope that comes out of the center that you're working for every single day. Thank you so much for being on the podcast today. Hopefully this will not be the last time that we share with our audience. Your insights on everything. Your expertise is incredible. So thank you again, and until next.
- [19:15]
B
Time, thank you so much and enjoy the conversation. Dane, look forward to future conversations with you as well.