How early referral improves outcomes for blood cancer patients

In just a few short years, the treatment landscape for hematologic malignancies has changed dramatically. New therapies, including CAR T cell therapies and bispecific antibodies, are extending lives and giving new options to patients with relapsed or refractory cancers.

As a longtime leader in cell therapy and bone marrow transplant, Penn Medicine is often the place where patients and providers turn once their disease has progressed. However, there are benefits to connecting with the Penn Medicine team earlier in the treatment journey for patients with potentially curable cancers like Hodgkin lymphoma, and for those who will require lifelong management of diseases like multiple myeloma.

Whether patients ultimately receive care at Penn Medicine or in their community hospital—or a combination of the two—an early referral can help ensure they start down the right treatment path.

“Decision-making for patients with blood cancers involves not only the medical factors but also patients’ goals,” says Alfred L. Garfall, MD. “The earlier we can meet patients and develop a relationship, the better we can help them meet their goals as their treatment progresses.” Dr Garfall is the Director of Autologous Hematopoietic Stem Cell Transplantation and Section Chief of Myeloma at Penn Medicine’s Abramson Cancer Center.

Confirming diagnosis and optimizing treatment

Referrals aren’t just for patients with few options left. Connecting early with Penn Medicine’s blood cancer program benefits patients in a myriad of ways.

Specialized experience

Treatment options for blood cancers are evolving quickly. More than a dozen new therapies have been approved by the FDA since 2017 for leukemia alone, and many of these had their origins at Penn Medicine. A nexus for talent and clinical investigation, Penn Medicine has recruited some of the nation’s top clinician-investigators to construct a program wherein virtually every subtype of cancer is represented by clinical expertise.

“While blood cancers collectively are common, they are really a collection of rare diseases,” Dr. Garfall says. “Penn Medicine has specialists who focus on individual blood cancer subtypes, bringing added expertise to diagnosis and treatment.”

Penn Medicine’s team includes specialists in leukemia, multiple myeloma, and lymphomas including B cell and T cell lymphomas, as well as experts dedicated to specific therapies like CAR T cell therapy and bone marrow transplant.

Confirming diagnosis

The expertise at Penn Hematology Oncology is evident in the realm of diagnosis, as well. Successful treatment for blood cancers depends on a precise diagnosis, which can be challenging to achieve. Lymphoma, for example, is a complicated and heterogeneous disease with approximately 50 subtypes. With specialists dedicated to different subclasses of blood cancer, along with pathologists with subspecialty expertise in blood cancers, Penn Medicine has the expertise to zero in on an accurate and timely diagnosis.

Better biopsies, better diagnoses

Some blood cancers, including specific types of lymphoma, require a large amount of tissue for accurate biopsies. Unfortunately, many patients initial needle biopsy is inconclusive, meaning a second procedure is needed for definitive diagnosis.

To reduce the number of invasive procedures, Penn Medicine’s surgical team sees patients quickly for initial surgical biopsies, using image-guided approaches to locate the biopsy site with the best odds of producing a definitive diagnosis. Tissue samples are assessed by in-house pathologists with expertise in hematologic malignancies to expedite diagnosis and treatment.

Advanced sequencing

Genetic and molecular sequencing are standards of modern cancer treatment, but molecular targets can change rapidly. Penn Medicine’s advanced sequencing capabilities allow providers to match patients to the most promising targeted therapies, including investigational treatments.

“Because we’re involved in so many trials, we have a heads up on the trends,” Dr. Garfall says. “In some cases, we test for genetic targets that aren’t in standard sequencing panels yet, because we know those targets are relevant to drugs being developed or being studied in clinical trials.”

Balancing risk

Even when a patient’s prognosis is good and the treatment plan seems straightforward, there is value to connecting with specialists early in the treatment process to minimize potential adverse effects of cancer therapy. In the case of Hodgkin lymphoma, for example, which often affects young people, radiation can affect a patient’s fertility and increase the risk of future heart damage or breast and thyroid cancers. Connecting with subspecialized radiation oncologists at Penn Medicine early in the treatment process can help tailor treatment plans to minimize these long-term risks.

Bone marrow transplant experts

For many blood cancers, bone marrow transplant offers the best chance for survival. Penn Medicine’s cellular therapy transplant program is large and well established, having performed more than 2,200 allogenic transplants and more than 5,500 autologous transplants to date.

Transplants can take 8 to 10 weeks of planning and must be carefully timed to occur when the patient’s health is stable and disease is still in remission. Early referral allows for that preparation to happen, says Alison Loren, MD, Chief of the Division of Hematology Oncology and Director of the Blood & Marrow Transplant, Cell Therapy & Transplant Program at Penn Medicine.

“There’s a lot of art to planning a bone marrow transplant,” Dr. Loren says. “By meeting patients soon after diagnosis, we can do testing early, identify donors, and have all the pieces in place so that when they hit that sweet spot for timing, we’re ready to go.”

Clinical trials

Early referrals that connect patients with clinical trial opportunities can provide access to promising new therapies. With nearly 100 active blood cancer clinical trials, including investigator-initiated trials and large multisite trials, Penn Medicine is at the forefront of new treatments for hematologic cancers in multiple areas of research:

• CAR T trials: Pioneered at Penn Medicine, the CAR T cell therapy tisagenlecleucel was initially approved for relapsed and refractory B-cell precursor acute lymphoblastic leukemia (ALL). Several additional CAR T therapies have now been approved to treat certain leukemias, lymphomas, and multiple myeloma in patients with relapsed and refractory disease. These therapies are now being tested in earlier-line settings in several clinical trials, across a range of blood cancer subtypes—and early referrals can help patients access those treatment opportunities.
• Cooperative group trials: By partnering with other leading academic medical centers across the United States, Penn Medicine can test new treatment strategies for patients with rare cancers.
• MyeloMATCH: Penn Medicine is a participant in the national Myeloid Malignancies Molecular Analysis for Therapy Choice (MyeloMATCH) trials, a group of precision medicine clinical trials for people with myelodysplastic syndromes or acute myeloid leukemia. The study uses rapid genetic sequencing to match patients to clinical trials testing therapies that target the specific mutations in their cancer.

Referrals and consultations

Early referral gives patients the time and support they need to understand their options and make confident decisions. Whenever possible, the blood cancer team partners with referring physicians so patients can receive care in their communities. Patients might receive chemotherapy or targeted therapies in their home hospital system, for instance, then come to Penn Medicine for cell therapy or clinical trials before transferring back to their home system for follow-up care and monitoring.

Designated as a Comprehensive Cancer Center by the National Cancer Institute and a member of the National Comprehensive Cancer Network, Penn Medicine’s Abramson Cancer Center is a world leader in patient care and research. Behind these titles is a multidisciplinary team of physicians who are eager to help patients receive the very best care.

To refer a patient to the Penn Medicine Division of Hematology and Oncology, call 877-937-7366 or refer a patient online.