Childhood survivors of BMTs need medical monitoring in adulthood

December 20, 2013 | by   

Improvements in hematopoietic cell transplants have been credited with increasing survival among patients undergoing the procedure by an estimated 10 percent per decade.

Childhood BMT survivors

More children than ever are surviving bone marrow transplants, but they often suffer long-term health problems. Photo credit: Photodisc

Yet, childhood survivors of the transplants, which are often referred to as bone marrow transplants (BMT), also are at a substantial risk of developing chronic and sometimes life-threatening medical conditions after transplantation.

In fact, nearly one in four will develop a severe or debilitating health condition (such as stroke or heart disease, another type of cancer or musculoskeletal problems) 15 years after transplantation.

At the American Society of Hematology (ASH) Meeting and Exposition in New Orleans in December, Saro Armenian, D.O., M.P.H.,  medical director of City of Hope’s Pediatric Survivorship Clinic, presented a report from the Bone Marrow Transplant Survivor Study (BMTSS).

“This study identified subgroups of survivors who may be at an especially high risk for these complications,” said Armenian, first author of the study. “This can inform current treatment strategies as well as screening practices for late effects in survivors seen in our clinics.”

The original BMT Long-term Follow-up Study cohort, begun in 2000, consisted of more than 2,500 children and adults who had received blood stem cell or bone marrow transplantation at City of Hope or the University of Minnesota between 1974 and 1998 and who had survived two or more years. The principal investigator for this National Cancer Institute-funded study was Smita Bhatia, M.D., M.P.H., director of the Center for Cancer Survivorship at City of Hope and the Ruth Ziegler Chair in Population Sciences.

In the new study presented at ASH, participants included 317 BMTSS patients who underwent hematopoietic cell transplantation (HCT) in childhood between 1976 and 1998 at one of the institutions. Their median age at transplant was 7.9 years, and at study participation was 19.9 years.

Forty-two percent of participants were female, 86.7 were non-Hispanic white, and 79 percent underwent allogeneic HCT (in which they received hematopoietic stem cells from a related or unrelated donor).

Two issues were identified as potentially chronic and or life-threatening for some of these survivors.

“Exposure to TBI was associated with a 1.3-fold risk of a chronic health condition, and a 2.6-fold risk of a severe/life-threatening/fatal condition compared to chemotherapy only,” Armenian said. Total body irradiation (TBI) was used in 61 percent of two-year survivors.

Chronic graft-versus-host disease (cGvHD) was reported in 26 percent of patients. Among allogeneic HCT recipients, cGvHD was associated with a two-fold risk of severe/life-threatening/fatal conditions compared to survivors without cGvHD.

Overall survival in this group was 80 percent at 10 years after HCT, Armenian reported. The main cause of death included primary disease (61 percent), secondary cancer (8 percent), cGvHD (6 percent), cardiopulmonary compromise (5 percent) and other causes, including infections and other organ toxicity (21 percent). Researchers also found that the cohort was at a 22-fold increased risk of premature death compared to age-and sex-matched general population.

Female participants, those treated with TBI, and autologous HCT survivors had the highest risk of premature death.

“This represents a broad assessment of multiple outcomes,” said Armenian. “It is important that the next generation of studies explore the reasons why certain complications occur in some individuals but not in others. Understanding this can set the stage for personalized care and long-term management,” Armenian said.

Smita Bhatia, the study’s senior author, agreed.

“Childhood HCT survivors carry a substantial burden of morbidity, years following completion of therapy, providing clear evidence for their close monitoring in a specialized setting targeting these high-risk complications,” said Bhatia.

Other City of Hope researchers participating in this study included Can-Lan Sun, M.D., Ph.D., director of survey research; Liton Francisco, staff scientist in outcomes research; Joseph Rosenthal, M.D., the Barron Hilton Chair in Pediatrics; and Stephen J. Forman, the Francis & Kathleen McNamara Distinguished Chair of Hematology and Hematopoietic Cell Transplantation.

Superfood recipes for a healthier holiday

December 18, 2013 | by   

City of Hope culinary ambassador and celebrity chef, Nathan Lyon, helps dish up the best superfood recipes for the holiday season. (Image courtesy of City of Hope)

We’re now in the home stretch of the holiday eating season, which means we still have plenty of opportunities to mix superfoods in with those holiday meals.

City of Hope researchers have found that superfoods contain compounds with the ability to fight and prevent cancer. The foods are healthful on their own, but incorporating them into favorite dishes and meals reminds us how powerful nature can be in keeping us healthy.

Mushrooms and pomegranates contain substances that help block the hormones that make breast cancer grow and spread. The substances also appear to fight prostate cancer. Blueberries can inhibit the growth and spread of triple-negative breast cancer, one of the most aggressive types of the disease. And cinnamon extract can interfere with a tumor’s ability to grow by blocking the tumor from forming blood vessels to feed it. » Continue Reading

Exploring cognitive decline after hematopoietic cell transplant

December 17, 2013 | by   

Hematopoietic cell transplant patients who undergo what’s known as myeloablative conditioning (that is, high-intensity chemotherapy and radiation) – and who have shorter telomeres (chromosome “end caps”) – may be at greater risk for cognitive impairment after transplant, City of Hope researchers have found.

Their study was presented earlier this month at the American Society of Hematology (ASH) Annual Meeting and Exposition in New Orleans in December. “Our goal was to understand the trajectory of their cognitive functioning after transplantation and also if there are some vulnerable subpopulations at increased risk of cognitive impairment,” said senior author Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences at City of Hope.

The study was featured during a news conference hosted by ASH.

» Continue Reading

How to give back: Couple who lost son now help others (w/VIDEO)

December 17, 2013 | by   

The fourth in a series about how to give, and give back, during the holiday season ...

Giving back during the holidays (or year-round) doesn’t have to come in the form of cash, toys or tangible gifts. In fact, it can be done at no cost: One way is by volunteering.

Local hospitals, animal shelters and other nonprofit organizations nationwide rely on volunteers to help run daily operations. At City of Hope, volunteers play a special role, bringing compassion, empathy and hope to patients and their families.

Gloria and Sal Gill know just how powerful this form of giving can be. The couple started volunteering at City of Hope after lymphoma claimed the life of their son in 1999. They wanted to give back to the institution that tried to save his life. They’ve now been working with City of Hope patients for almost 15 years.

Every Friday, the couple make their way to the cancer center where they help patients find their way around the hospital, file paperwork, answer phones and assist the staff in whatever they may need.

“Being amongst the patients is very inspiring,” Gloria said. “We get to learn new things every day and it feels good to help people.”

» Continue Reading

Leukemia diagnosis made Bishop J. Jon Bruno see his true impact

December 16, 2013 | by   

Bishop J. Jon Bruno will be one of 11 former City of Hope patients riding atop our float on New Year’s Day. Read other riders’ stories and learn more about the float, “Turning Hope and Dreams into Reality.”


After returning home from cancer treatment at City of Hope in May 2012, J. Jon Bruno was astonished to see his Pasadena, Calif., family room crowded with mail bags filled with more than 25,000 handwritten letters. “I read every one of them,” said 67-year-old Bruno, bishop of the six-county Los Angeles Episcopal Diocese.

Bishop J. Jon Bruno

Bishop J. Jon Bruno of the L.A. Episcopal Diocese, shown here with his family, didn’t realize his true impact until his diagnosis with leukemia. Now he views life a little differently. Photo courtesy of the Bruno family.

The charismatic, larger-than-life Bruno, who oversees 147 parishes and missions, 44 schools and 20 institutions, has become something of an institution himself.

The father of three and grandfather of seven – who was a professional football player and police officer before becoming an Episcopal priest then a bishop – has made the diocese a more “human-friendly place” through programs to feed the poor, stop gangs, wash the clothes of the homeless, house AIDS patients, collaborate with all religious faiths and, most controversially, support gay, lesbian and transgender rights.

Bruno’s well-wishes came from a microcosm of all those he has supported: a college student he baptized as an infant, a middle-aged man he’d coaxed out of gang life as a teenager, an elderly couple he helped survive the death of their child decades before.

“I found out about things that I would have just called my job that I did as part of my calling. Lo and behold,” said Bruno, “they meant a lot to somebody else. I was amazed there was that kind of impact. I never noticed.”

One of the most memorable letters came from a Johns Hopkins professor of random theory. As an infant, she had fallen into an unattended swimming pool in Virginia – and Bruno had heard the splash. He scaled the fence, rescued the face-down baby and breathed life back into her. Nearly 40 years later, in a six-page letter, “she recounted all the things that wouldn’t have happened in the world if I hadn’t done that.” » Continue Reading

New Year’s resolution: Reduce cancer risk (the easy way)

December 15, 2013 | by   

In addition to toasting, feting and feasting, another tradition of the holiday season is taking stock of the year about to end, and making plans for the one about to begin.

Jeanette DePatie, a.k.a. "The Fat Chick," encourages people of all sizes to embrace exercise and its many benefits. She will join City of Hope for a tweet chat on getting started with fitness goals on Dec. 18 at 11 a.m.

Jeanette DePatie, a.k.a. “The Fat Chick,” encourages people of all sizes to embrace exercise and its many benefits. She will join City of Hope for a tweet chat on getting started with fitness goals on Dec. 18 at 11 a.m.

Often, these happen in the form of the New Year’s resolution, which often begins as a lofty good intention and becomes an afterthought before the calendar flips to February – especially those promises to ourselves to exercise more and drop a few (or a few dozen) pounds.

City of Hope scientists have linked exercise and healthy weight to a lower risk of diabetes and cancer. Leslie Bernstein, Ph.D., professor and director of the Division of Cancer Etiology at City of Hope, published her first paper linking physical activity to lower cancer risk nearly 20 years ago. Since then, study after study has backed up Bernstein’s findings, linking increased physical activity to a reduced risk of breast, colon, uterine and advanced prostate cancer.

Excess weight has been  linked to an increased risk of cancer, including breast cancer, colon and rectum cancer, endometrial cancer, kidney cancer, esophageal cancer and pancreatic cancer.

But where to begin?

That’s where Jeanette DePatie, a.k.a. The Fat Chick, comes in. The certified fitness instructor specializes in helping people of all sizes and ability levels take their first steps toward fitness. She’s joining with City of Hope in a tweet chat on Jan. 2. The topic: “New Year’s Resolutions That Won’t Make You Sick, Crazy or Dead.” » Continue Reading

Celebrate the season, healthfully, with a superfoods recipe

December 14, 2013 | by   

For many people, the holiday calendar is packed with parties, and superfoods – found by City of Hope scientists to have the potential to fight cancer – are an easy and good-for-you addition to a holiday menu.

Cancer-fighting mushrooms

Mushrooms have the potential to fight breast, prostate and lung cancer. Try them in this recipe. Photo courtesy of Katie Chin.

Take mushrooms, for example. Researcher Shiuan Chen, Ph.D., has found that white button mushrooms can help block hormones that cause breast cancer to grow and spread. Researchers are now studying this same hormone-blocking effect for prostate cancer. Further, a medicine derived from shiitake mushrooms is currently being tested for its ability to help the body boost the immune system to fight lung cancer.

Mushrooms even may help prevent fatty liver, slow down the formation of fat and reduce the incidence of metabolic diseases.

Chef and City of Hope culinary ambassador Katie Chin suggests a way to include mushrooms at holiday parties: Thai chicken lettuce cups. She shared the recipe from her latest cookbook, Everyday Thai Cooking, during our recent Community Science Festival at  City of Hope. It scored rave reviews from the Obama family when she visited the White House to talk about superfoods, she said. » Continue Reading

Study: Chemotherapy is enough in some advanced breast cancers

December 13, 2013 | by   

As treatment options expand, and researchers learn more about individual tumors, a critical component of cancer treatment becomes determining the most effective tool to treat an individual patient.

A new study finds that for surgery and radiation therapy may not have additional benefits for metastatic breast cancer patients who are responding well to chemotherapy.

A new study finds that surgery and radiation therapy may not have additional benefits for metastatic breast cancer patients who are responding well to chemotherapy.

Equally important to knowing when to perform a surgery is knowing when not to. Breast cancer experts debate the benefits of offering surgery and radiation to women with metastatic breast cancer – advanced-stage breast cancer that has spread to other parts of the body – who are already responding to chemotherapy.

A study presented this week at the San Antonio Breast Cancer Symposium aimed to settle the long-running dispute. The findings: For women with these kinds of breast cancers, surgery and radiation did not offer any additional benefits.

“We’ve actually been able to see drugs completely resolve small distant metastases and all that’s left is in the breast,” Courtney Vito, M.D., a surgical oncologist at City of Hope, told the Los Angeles Times in an interview. “Well, what do you do with those women?” » Continue Reading

Americans aware of HPV vaccine, but not its effectiveness

December 12, 2013 | by   

Many people have heard of the vaccine against human papillomavirus (HPV), but they often don’t know how well it works to lower the risk of cervical cancer, a new study has found. In fact, few people actually talk to their doctors about the vaccine.

Many are still unaware of the HPV vaccination's effectiveness for lowering the risk of cervical cancer.

Many are still unaware of the HPV vaccination’s effectiveness for lowering the risk of cervical cancer.

The study, which was funded by the American Cancer Society, was presented this month at the American Association for Cancer Research Conference on health disparities. It used 2012 and 2013 data from the National Cancer Institute survey on health trends.

The 1,400 people who participated were either in the age range for which the vaccine is recommended (9 to 27 years old) or had an immediate family member in that age bracket.

The researchers found that 70 percent of respondents were unsure how effective the vaccine was at preventing cervical cancer, with 78 percent of non-Hispanic blacks reporting uncertainty.

Only 25 percent of respondents said they had talked to their health-care providers about the HPV vaccine.

» Continue Reading

Why a secondary cancer after transplant? Grant may help find clues

December 11, 2013 | by   

Myelodysplastic syndrome, once known as “preleukemia,” is a disease of the blood and bone marrow that often attacks people who have survived initial cancer treatment. “Good Morning America” co-host Robin Roberts, for example, was diagnosed with the syndrome, known as MDS, in June 2012, five years after successfully undergoing treatment for breast cancer. She’s one of an estimated 12,000 Americans who are diagnosed with the syndrome each year.

DNA analysis

Smita Bhatia and Ravia Bhatia, researchers at City of Hope, have received a grant from the V Foundation for Cancer Research to study MDS. They’ll be using genomic tools to analyze mutations in DNA, as well as gene expression.

Two City of Hope researchers in particular are probing why patients who have undergone bone marrow transplants for lymphoma and other diseases are also vulnerable to being diagnosed with this deadly secondary cancer: Ravi Bhatia, M.D., director of the Division of Hematopoietic Stem Cell and Leukemia Research at City of Hope, and Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences and the co-leader of the Cancer Control and Population Sciences Program.

Now, the Bhatias have received a $600,000 grant over a three-year period from the V Foundation for Cancer Research to study why the disease develops and devise ways to treat and prevent this lethal complication.

“We are trying to understand the underlying mechanisms of how patients who have undergone successful treatment for lymphoma develop therapy-related leukemia,” Smita Bhatia explained.

“This is a brand-new cancer that develops in patients who have been treated for lymphoma or other diseases after getting an autologous transplant [in which a patient receives an infusion of his or her own purified stem cells]. And unfortunately,” she added, “unless it is treated with yet another transplant, such as an allogeneic transplant from another sibling or some unrelated donor, it can be fatal.” » Continue Reading