September 28, 2023 • 52 mins
In a new episode of The Onco’Zine Brief, Peter Hofland talks with Jeffery Auletta, MD is Senior Vice President, Patient Outcomes and Experience, National Marrow Donor Program® (NMDP)/Be The Match®.
Be The Match® is a global leader in bone marrow transplantation. The organization conducts research to improve transplant outcomes provide support and resources for patients, and partner with a global network.
Unmet medical need
Every three or four minutes, someone in the United States is diagnosed with a hematological malignancy such as leukemia, a cancer of blood-forming tissues, including bone marrow.
For many patients, their only hope for a cure is a stem cell transplant. In the program, Hofland and Auletta talk about these unmet medical needs and about the new developments exploring the use of a standardized method of assessing measurable residual disease (MRD) before allogeneic hematopoietic stem cell transplantation (HCT) in patients with leukemia and how this provides valuable insight into MRD as a predictive tool to inform HCT decisions and individualize treatment to improve outcomes.
Hofland and Auletta also talk about the importance of people to join and register with Be The Match® as a bone marrow donor to bring hope to people in need.
About The Onco'Zine Brief
The Onco'Zine Brief is distributed in the United States via PRX (Public Radio Exchange). In the United Kingdom and Europe, the program is distributed via UK Health Radio (UKHR). And the program can be downloaded via most podcasts and streaming media services, including iTunes, Spotify, TuneIn, and iHeart Radio.
For more information about The Onco'Zine Brief or how to sponsor or support this public radio broadcast and podcast, visit to download our Media Kit, visit our Patreon page, or contact the sales team.
To sign up for The Onco'Zine Newsletter (open for residents of the United States only), text the word CANCER to 66866.
The Onco’Zine Brief is made possible, in part, by Java Original Coffee and Roastmasterz by Java Original Coffee.
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-onco-zine-brief--2786156/support.
Be The Match® is a global leader in bone marrow transplantation. The organization conducts research to improve transplant outcomes provide support and resources for patients, and partner with a global network.
Unmet medical need
Every three or four minutes, someone in the United States is diagnosed with a hematological malignancy such as leukemia, a cancer of blood-forming tissues, including bone marrow.
For many patients, their only hope for a cure is a stem cell transplant. In the program, Hofland and Auletta talk about these unmet medical needs and about the new developments exploring the use of a standardized method of assessing measurable residual disease (MRD) before allogeneic hematopoietic stem cell transplantation (HCT) in patients with leukemia and how this provides valuable insight into MRD as a predictive tool to inform HCT decisions and individualize treatment to improve outcomes.
Hofland and Auletta also talk about the importance of people to join and register with Be The Match® as a bone marrow donor to bring hope to people in need.
About The Onco'Zine Brief
The Onco'Zine Brief is distributed in the United States via PRX (Public Radio Exchange). In the United Kingdom and Europe, the program is distributed via UK Health Radio (UKHR). And the program can be downloaded via most podcasts and streaming media services, including iTunes, Spotify, TuneIn, and iHeart Radio.
For more information about The Onco'Zine Brief or how to sponsor or support this public radio broadcast and podcast, visit to download our Media Kit, visit our Patreon page, or contact the sales team.
To sign up for The Onco'Zine Newsletter (open for residents of the United States only), text the word CANCER to 66866.
The Onco’Zine Brief is made possible, in part, by Java Original Coffee and Roastmasterz by Java Original Coffee.
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-onco-zine-brief--2786156/support.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
This is the Youngazine Brief with PeterHoffland. In this episode of the Augustine
Brief, I talk with doctor JeffreyOletta. Doctor Aletta is Senior Vice President
Patient Outcomes and Experience and Chief ScientificOfficer of the National Marrow Donor Program,
(00:32):
be the Match and the Center forInternational Blood and Merit Transplant Research or CIBMTR
at the Medical College of Wisconsin.Doctor Aletta is also the Senior Director of
the Center for International Blood and MeritTransplant Research cro SERVICES. Now the Center
for International Blood and Merit Transplant Researchprovides a unique research of information and expertise
(00:54):
to the medical and scientific community,and some of this work goes back to
the early nineteen forties and nineteen fiftieswith experimental treatment for radiation sickness and the
development of new standards through leukemia,lymphoma, and sickle cell disease. Now
in nineteen seventy two, the workreally started to take off with the organization
when a handful of doctors from theUnited States, France, and the Netherlands
(01:18):
created an international Registry of Transplants inorder to see which therapies helped people the
most. Over time, the informalalliance grew to involve many more countries and
a formal research collaboration between the MedicalCollege of Wisconsin and the National Meridoma Program
be the match. Today, theInternational Blood and Merit Transplant Research Organization received
(01:42):
data from about three hundred and fiftymedical centers from around the world. Researchers
at the center have analyzed clinical outcomesof more than six hundred thousand patients who
underwent a bonemerit transplantation, and morerecently, the organization expanded its activities to
collect data from others therapies such assemeric androgen receptive T cells also known as
(02:04):
car T cell therapy. Without adoubt, research and development and the application
of cellular therapies have come a longway from their early beginnings. I'm Peter
Hoffland and this is the Youngest inBrief. The Youngest in Brief is developed
in collaboration with our online journal onCuisine, where you can find additional information
in the latest news about cancer,cancer diagnosis and treatment, and cancer prevention.
(02:28):
For more information on how to supportthis program, visit our website at
oncusine dot com. And if you'reliving in the United States and want to
receive our newsletter. Text the wordcancer to six six eight sixty six and
we will make sure that you'll receiveour newsletter, which includes an overview of
the latest news in oncology and hematology. This is the on Casine Brief.
(02:58):
For the latest news about cancer andcancer treatment, visit our online journal on
Gazine at www dot Oncassine dot com. On the phone with me is doctor
Jeffreyoletta. Doctor Oletta is Senior VicePresident Patient Outcomes and Experience and Chief Scientific
Officer of the National Marow Donor Programbed the Match and the Center for International
Blood and Merit Transplant Research or CIBMTRat the Medical College of Wisconsin. Doctor
(03:24):
Aletta is also the Senior director ofthe Center for International Blood and Merit Transplant
Research. Heare ro Services, DoctorAletta. Welcome to the Augustine Brave.
Thank you very much. Now,the National Merit Donor Program BEDA Match and
the Center for International Blood and MarrowTransplant Research recently published some very interesting news.
(03:45):
But before we come to talk aboutthat, tell me a little bit
more about yourself, about your background, how you got here, and about
the patients that you're trying to help. So I am a pediatric bomero transplant
physician. I'm also boarded in aninfectious disease, so that's my clinical background
and my research interests have spanned thingsfrom immunomodulation and immune reconstitution after transplant to
(04:09):
most recently, healthcare disparities in transplants. So I work at the National Marrow
Donor Program or an MDP, andthe NMDP is the nation's donor registry.
So what that means is we arethe national donor Registry where we provide stem
cell graphs for patients in need whodo not have a HLA or human leukocyte
(04:35):
nigen matched donor within the family.So these include patients who have a malignant
disease such as acute leukemia or anon malignant disease such as sickle cell disease,
and our registry provides the product forthose patients in need. And our
(04:57):
registry is based upon ultra bistic donorswho come forward provide a sample that gets
processed, which is the HLA partof the process, and that sample is
banked in our registry. And whena transplant center requires a donor, they
would contact the National Mirror Donor ProgramUS and we would come up with the
(05:23):
best HLA match for their patient.Now, HLA is a very diverse gene.
In other words, it is highlypolymorphic, meaning that the HLA genes
are based upon the ethnic diversity ofthe patient. So that's why you and
I have different immune systems, forexample, and therefore we recognize things that
(05:47):
are different. And so when wematch a patient with a donor, we
are matching them based upon the HLAlow side, and we do that through
the sample that the donor provides.As I mentioned before, those patients who
are ethnically diverse do have less ofa chance of having an HLA matched donor
(06:12):
in our registry based upon the geneticdiversity of their HLA. So what that
means is that those patients who arewhite Caucasians like myself have about a seventy
nine percent chance of finding an unrelateddonor versus a patient who is black or
African American who has a matching chanceof about twenty nine percent. And that
(06:39):
is largely because our registry is madeup of white Caucasian patients and we're trying
to increase the diversity of our registry, which is actually one of the most
diverse ones in the world in orderto provide a patient in need, namely
a patient who's ethnically diverse with anunrelated donor. So, when you look
(07:00):
at some of these challenges, onemajor barrier in the treatment of patients you
mentioned earlier includes patients diagnosed with leukemia, sickle cell anemia, or similar diseases.
How are you trying to address this? And in addition, how can
you be sure that everyone can equallyaccess your database or registry and benefit from
that. What are some of thethings that you're trying to change here?
(07:23):
Great question, Peter, So,there are many barriers to transplants and cell
therapy. In other words, thereare patients related barriers such as race and
ethnicity that I'd mentioned. There arealso socioeconomic barriers, insurance barriers for the
patient, and then there are alsophysician barriers another words, knowledge that the
(07:46):
physician has who is referring to atransplant center, they're patients, some referring
oncologists aren't necessarily up to date interms of what transplantal disease indications there are
That creates a barrier. And thenlastly, there are barriers at the transplant
program level in terms of center expertiseor capacity barriers, or even structural racism
(08:11):
still is one of these barriers.So the National MERIDIA program is addressing all
three of these types of non HLAbarriers at the patient level, educating the
referring oncologist, and then providing supportto the bomber transplant centers. So these
non HILA barriers we provide various servicesfor. So we have patient financial assistance
(08:37):
and education. For example, wehave patient support centers to navigate. We
have navigators who help patients through thetransplant journey. We have outreach programs.
We have what's called adjacent Carter clinicalTrial Search and Support, which allows patients
to access various clinical trials to seeif they're alterable for them and then also
(09:03):
get their questions answered regarding those clinicaltrials. So these are the non HLA
services that we provide to reduce patientbarriers. But we also are part of
the CIBMTR or the Center for Internationalwhat Ameri Transplant Research, which is a
collaboration between the NMDP and the MedicalCollege of Wisconsin. And within the CIBMTR,
(09:26):
we are doing both observational studies withour large database as well as prospective
clinical trials, and one of thoseclinical trials that's being sponsored by the National
Eurodonor Program is utilizing a mismatched unrelateddonor. So I explained how we wanted
to look at HLA matching. Butwhen you consider the genetic diversity of America,
(09:54):
which is only increasing because of multiplemultiple racial relationships and off bring,
we are reaching an inability to providea eight out of eight, which is
the number system of a well matchedunrelated donor for all patients in need.
Therefore, we need to hurdle orsupersede the HLA barrier, and we're doing
(10:18):
that with our prospective research utilizing amismatched unrelated donor. And we're doing that
by utilizing a chemotherapy drug called acycloposphamide and using that as graft versus host
disease prophylaxis. So, in otherwords, part of a complication of an
allogenetic or getting someone else's stem cellsis that someone else is a different immune
(10:45):
system from the patient's immune system,and so therefore we need to temporize that
donor immune system through something called prophylaxisor graph versus host disease prophylaxis, and
the field has utilized this in thesetting of happal identical transplant in other words,
(11:05):
fifty percent matching between donor recipient,and we're settying the mismatch unrelated donor
setting in terms of utilizing post transplantcyclofossamide. And thus far, our first
initial clinical trial called the fifteen MMUDtrial, was successful in terms of a
couple points. Number one, itwas able to provide a bone marrow graft
(11:30):
for about fifty percent of the patient'senrolled on the trial. In addition to
that, it showed a survival whichwas comparable to other donor sources, whether
that be a happalo identical donor ora well matched unrelated donor. And then
third it had an overall survival ofabout seventy five percent. So with those
(11:52):
three results which were favorable, wenow have what's called an access trial where
we're utilizing the mismatch undreaddited donors,this time using peripheral blood, which is
the most common graft source used inthe field, and then also seeing for
the first time enrolling some pediatric patientsas well. So that trial is ongoing
(12:16):
and it has enrolled quite nicely,but we are still waiting for the trial
to follow your crew. Let's takea break. This is the Youngest in
Brief. If you're just joining usin today's episode of the Youngest in Brief,
I'm talking with doctor Jeffrey Oletta.Doctor Oletta is Senior Vice Presidents,
Patient Outcomes and Experience and the ChiefScientific Officer of the National Merit Donor Program
(12:37):
Media Match and the Center for InternationalBlood and Merit Transplant Research or CIBMTR at
the Medical College of Wisconsin. DoctorOletta is also the Senior Director of the
Center for International Blood and Merit TransplantResearch CEO services. I'm Peter Hoffland and
this is the Youngest in Brief.Clinical trials allow researchers to introduce new hope
(13:07):
by providing participants access to cutting edgeand potentially life saving treatments. Speak with
your doctor and visit stand Up tocancerdot org slash Clinical Trials to learn more.
Together, we can stand up forall of us. This is the
(13:28):
young Gazine Brief with Peter Hoffland andwelcome back. This is the Youngest in
Brief. If you're just joining usin today's episode of the Youngest in Brief,
I'm talking with doctor Jeffrey Oletta.So when you look at some of
these issues. There are an awfullot of things to digest here. You
(13:50):
help patients in areas that are nonmedical issues, trying to solve one of
the most complex problems in medicine,that of treatment related disparities or health related
disparities, that make sure that everybodyhas access or can get access. You're
also providing the education for physicians tohelp them in this effort, and I
assume that you also try to makea case with insurance companies and make sure
(14:15):
that as many people as possible canhave access to treatment. And at the
same time you're dealing with the scientificand medical issues, right, correct.
I understand that what you're trying todo is offer a lot of hope for
these patients, and there is alot of good news in that area,
but there are also concerns. Youmentioned versus host disease. Today, versus
(14:39):
host disease remains I assume one ofthe biggest issues in hematology and stem cell
therapies. Right In addition to findinga good match in cell transplants, are
there other concerns that could limit thesuccess of cell transplants. Yes, so,
in general, the allogeneic or usingsomeone else's stem cells transplantation is limited
(15:03):
by a donor availability, so that'swhat we're dressing in terms of the mismatch
and related donor, but it's alsolimited by outcomes. And what I mean
by that is the top three reasonsfor patient demise after allogenetic stem cell transplant
have remained the same for decades,and that was our primary disease relapse in
(15:24):
the malignant setting, organ toxicity orgraph versus host disease, and then lastly
infection. So unfortunately, still intwenty twenty three, we're kind of using
a sledgehammer for allogenetics stem cell transplantwhen we really want to be able to
use chisels in order to kind ofgo after targeted disease such as cancer.
(15:48):
So that kind of goes and dovetailsinto the field of immune mediated cell therapies.
In other words, we can nowtake cells out of a patient who
has a particular form of leukemia orlymphoma, educate those T cells to recognize
(16:08):
certain protein expressions on the leukemia cellsor lymphoma cells, and infuse them back
into the patient so that those cellswill attack that specific cancer. That's called
chimeric anigen receptor CAR T cells,and so that has really been a game
(16:29):
changer in the field. So thatis addressing the relapse part. But we
do know that patients relapse for amultitude of reasons. In other words,
we look at things called immune escapemechanisms where those protein expressions on the cancer
cell are downmodulated or decreased on theexpression on the surface, and so therefore
(16:51):
these car T cells sometimes don't workor other forms of immune therapy. So
there are many different mechanisms of cancerimmun an escape that still result in primary
disease relapse. In addition to thatis the graph versus host disease and so
again I mentioned that that number eightout of eight, so it's really a
(17:12):
little bit of immunology lesson here.There are different types of classes for the
HLA class one in class two,and so we're measuring or matching rather at
a finite number of those particular alleles, and so there's a whole heck of
a lot that we're not matching on. So that gets into the term of
(17:33):
minor history incompatibility an egens, andso therefore that which we don't match has
the ability to provoke a graph versushost disease response in a transplant recipient,
and so I mentioned the post transplantscyclofossamide uses graph versus host disease prophylaxis,
so that has been highly successful interms of being able to kind of over
(17:57):
exceed or leap the HLA barrier,and so therefore that matching doesn't have to
be perfect. But in and ofitself that cycloposmide is a chemotherapeutic agent.
So despite it being relatively successful interms of preventing acute and long term or
chronic graph versus host disease, itcomes at the expense of toxicity, so
(18:22):
things like infection or things like bleedingfrom the bladder area, and also potentially
longer term toxicity like predisposition to therapyrelated leukemia. So the field is working
on different ways of utilizing or optimizingrather graph versus host disease prophylaxis, and
(18:45):
again turning towards cell therapy. Canwe take out certain cells from the graph
that we collect and infuse into thepatient, in other words, take out
those specific T cells that mediate graphhost disease, And there's success in terms
of doing that. So there's waysof depleting those particular cells. So that's
(19:07):
graph versus host disease optimization. Andthen last I mentioned infection. So we
do have pharmaceutical agents that we havein our armatorium now that we didn't have
ten years ago, a lot ofthe anti fungal drugs, for example.
And we are utilizing preventative ways anddiagnostic tests where we can detect infection before
(19:30):
it manifests clinically, such as byfever or chest X ray changes or CT
scans. So we're optimizing our infectionprevention and treatment. So by addressing the
top three reasons for patient demise,we are making headway where we didn't have
(19:51):
these tools in our tool chest before. But clearly those three reasons for patient
demise are still challenges today in twentytwenty three. Yeah, I can totally
imagine that now. One of thethings you mentioned earlier about the potential of
matching patients and donors is a magicalnumber of eight over eight matching points.
(20:11):
I understand that studies have now shownthat you can really match patients at a
different level a lower number than eightmatching points, going as low as five
or six matching points out of eight. Can you tell me a little bit
more about this, about the complexitiesinvolved and the benefits of working with not
fully matched patients and how that maywiden the potential for patients that now can
(20:34):
be effectively treated. This gets backto that fifteen MMUD study. So taking
a step back, we know thatthere are many patients who need a transplant
who don't get a transplant for lotsof different reasons. I mentioned some of
those non HLA reasons right in otherwords, low as socioeconomic status, don't
(20:55):
have insurance, aren't referred to atransplant center, those type of issues.
And then there are the HLA issues. And I mentioned that our registry is
primarily comprised of white, non Latinodonors who have a higher match rate than
a black African American for examples,that's seventy nine percent to twenty nine percent
that I mentioned. Going back tothat, a number of patients who have
(21:22):
a potential need for an allogeneic stemcell transplant per year is around fifteen to
sixteen thousand, and so we knowthat that number decreases for those two reasons
I mentioned, the non HLA barriersand the HLA barriers. And so this
study, this fifteen MMUD, thismismatched unrelated donor and what you're mentioning Peter,
(21:49):
is that that number we don't haveto be a perfect HLA match.
Now across those class one and classtwo HLA lowsi we can actually now be
less than that perfect match with theutilization of the post transplant cyclofossimide as graph
versus host disease prophylaxis. So thatstudy was able to enroll about fifty percent
(22:14):
of patients of ethnically diverse backgrounds whowould not be able to receive a well
matched unrelated donor because that just didn'texist for them. But with the post
transplant cyclophosphide in the setting of utilizinga mismatch unrelated donor, that has increased
nearly double the amount of being ableto provide a transplant for those patients in
(22:41):
need. So when you kind ofdo that rough arithmetic in your head,
if we start off with around fifteento sixteen thousand patients and kind of get
to various levels of reasons for whythose patients don't get down to transplant,
you think about roughly, in theUnited States of America there are around eight
(23:03):
to ten thousand transplants provided each year. That number is staggering in terms of
being able to provide a donor forall based upon a mismatch unreally the donor
or a happ loo identical donor.So those ethnically diverse patients are now being
able to receive a life saving allergenetictransplant because of our ability to hurdle the
(23:27):
HLA barrier with the post transplant cycloflossamide. Obviously, we have a lot of
work to do. I talked aboutthe three reasons why patients still die after
allogenetic transplants, but we are definitelymaking headway and the ability to provide a
donor for all through a mismatch unrelateddonor is really a game changer, and
(23:48):
again based upon increasing the amount ofethnically diverse patients who can receive a life
saving transplant. Let's take a break. This is the Youngest Sam Brief.
If you're just joining us in today'sthe Oogahine Brief. I'm talking with doctor
Jeffrey Oletta. I'm Peter Hoffland,and this is the o Gashine Brief.
(24:14):
Sarcoma ODDZO. You've never heard thatword before. For the forty people diagnosed
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Through awareness, advocacy, and research, the Sarcoma Foundation of America is
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(24:36):
the cure for sarcoma. For moreinformation on the work of the Sarcoma Foundation
of America, go to Cure Sarcomadot org. This is the young Gasine
Brief with Peter Hoffland and welcome back. This is the Youngest in Brief.
(25:04):
If you're just joining us in today'sepisode of the Youngest in Brief, I'm
talking with doctor Jeffrey Oletta. I'mPeter Hoffland and this is the Youngest in
Brief. One of the things youmentioned is the importance of donors because success
is based on matching patients with donors. Now you're using different ways to recruit
people to sign up to become adonor. But tell me a little bit
(25:26):
more about how important it is forpeople to either become a donor or to
consider being a donor. How andwhen are you becoming a donor? Because
I understand that there is some misconceptionsabout this, and one of those misconceptions
is the fact that many people believethat if you are going to the DMV
or MVD to renew your driver's license, there is an opportunity to become a
(25:51):
donor after life. But that's notwhat we're talking about here, right,
That's not the same thing as joiningbe the match as a donor. Tell
me a little bit more about that. So when you go to the BMV
and they ask if you'd like tobe an organ donor, they're asking if
you should have an accident and obviouslypass, would you like your organs to
be donated to another person? Andprobably the vast majority of us who are
(26:14):
on this podcast automatically have that imprintedon our driver's license. And what you're
getting at is we should have thatsame altruistic feeling about being a donor for
a patient in need as we dofor that donation of our organs. But
the issue is awareness, right.I don't think those in a podcast would
(26:37):
have appreciated that there is roughly aboutfifteen to sixteen thousand patients every year who
are diagnosed with a malignancy alone thatwould necessitate a stem cell transplant. And
then when you add other diseases ontop of it, like sickle cell disease.
It's really a significant amount of unmetneed that we have and part of
(27:02):
what the National Maridona Program is bringawareness to that unmet need. And what
we really would like is there tobe more people who get involved in our
registry. It's very simple to do. If interested, go to our website,
click on becoming a donor. Wesend you a packet which has a
swab. What you do is literallyswab the inside of your cheek a couple
(27:26):
of times, put it in thecontainer, and send it back to us.
And that is a very easy thingto do. It doesn't hurt at
all. I think that's one ofthe first misperceptions is that I can't do
that. Well, we're all puton this planet for a reason, and
one of those main reasons is tohelp out other people in need. And
(27:48):
I think that that's the message Iwant to be able to promote and as
the organization is that there are manypeople in need and we need you to
be part of our registry help thosepeople. So that's the first thing,
awareness and education of the problem.And the second part of your question is
you know, what does it meanwhen you become a donor, what is
(28:10):
the process, And yes, thereis a process. Obviously, we want
it to be safe for you asthe donor to give your stem cells to
another person, and so therefore youhave to go through some blood work to
make sure that you don't have anact of viral infection, for example,
and also that you go through aphysical exam to make sure that you're able
(28:32):
to withstand a process called apheresis,or the collection of your blood, and
then also potentially a bone marrow harvestwhere we would collect stem cells directly from
the bone marrow. And so that'skind of the initial check list with regards
to a pre donor workup. Andthen once you have passed those tests,
(28:56):
then it's up to you to actuallygive your stem cells in one of two
ways. One is through the aparesismachine that I mentioned. So what happens
with that is we give a drugthat stimulates your stem cells in your bone
marrow to leave the bone marrow andenter your blood stream. Then we collect
(29:18):
those stem cells through the aparesis machine. There's an ivy placed in one arm
where blood comes out, goes throughthe machine, spins up the cells,
collects them in the bag and sendsthe blood back to you in real time,
so there's no changes in blood pressure. And that process takes anywhere from
three to six hours, depending uponyour size and the size of the recipient.
(29:38):
And the other is a Boemer harvest, where you would go into the
operating room, gets the dated andthen have a needle placed in the back
area of your pelvis, and thenboomer would be extracted, put into a
bag, and then send off.Obviously there would be some discomfort with that,
(29:59):
but it goes way in a coupleof days and for the vast majority
of donors, as in like ninetynine percent of donors, they do absolutely
fine. And again, if Igo back to my statement of why we're
on this planet, you then havedone a remarkable job in terms of being
a potential hope for a patient whomay in fact have a disease that would
(30:25):
not otherwise be cured without the stemcells that you gave. So that's a
pretty good feeling in terms of beingable to do that. Now, early
in the program you refer to optimizingdonors. This is part of the whole
process of trying to make sure thatyou are getting the best donors to join
the registry because I understand not everybodycan be a donor. Tell me a
(30:47):
little bit about this. Yeah,the vast majority of people can, Peter.
So the main criteria is age,so age greater than eighteen years old,
because you have to consent for theprocess. The other thing is just
a willingness to go through the processthat I that I had mentioned. Now
there's going to be an upper limit. You know for those of us who
(31:08):
are you know, sixty years orabove. You know, the chances of
us of our stem cells being utilizedclinically are pretty low. So we tend
to gravitate towards wanting younger people becauseobviously they can stay in the registry longer
right as they advance an age.But also with regard to their stem cells
(31:30):
are for lack of a term,more vibrant than an older person stem cells.
And you know, just the agingprocess we all go through it,
we all get gray hair, samething happens to our stem cells. There's
a process of something like gray hairto a stem cell, so it's not
as active or robust. So again, anybody can become a domor in our
(31:56):
registry based upon age and based upondesire, and we strongly encourage more ethnically
diverse patients to be a part ofour registry because of the fact of the
dispirit HLA matching rates that I mentionedbased upon ethnicity, So we welcome all
(32:17):
persons of color, all persons ofethnicity to go through the donation process,
you know, get that swab tous and be a part of the registry,
because again, you know, it'sthose ethnically diverse patients that are most
challenged in terms of finding an allergenicor unrelated donor. And I guess it's
(32:38):
really important write to make sure thatyou can offer patients with different ethnicities the
opportunity to be treated and to makesure that people with different ethnicities are signing
up to become a donor. That'scorrect, yeah, for sure. And
again we're all Americans, right,but we all have different cultures and different
(32:59):
background and it's the diversity of Americathat makes America great. But from an
HLA matching standpoint, you're exactly spoton. It's easier to find unrelated donors
who are part of your own ethnicityand race than it is outside. And
so therefore that's why we welcome theethnically diverse donor to be a part of
(33:22):
our registry because it's for sure goingto enhance our ability to provide a product
to a patient in need of thesame race and ethnicity. Now you mentioned
deroll that you and your organization areplaying. You also mentioned de rolled the
donors and patients can have and ingeneral, how people who have not yet
(33:42):
signed up to be a donor canjoin me the match registry. Right,
But the medical profession, the doctors, ge oncologists, to hematologists to oncology,
nurses and many others who are involvedin treating patients also play an important
role. When we talk about referral, for example, and we look at
how important these process is of gettingpatients matched, how important is an early
(34:02):
referral to, for example, andtransplant center, because I guess that really
one of the questions of education andhelping physicians to also play their role includes
early referral. So how important issuch an early referral to a transplant center
to address the barriers you mentioned?Simple answer, it's vital to be referred
as early as possible to a transplantcenter, and there's multiple studies out there
(34:29):
to suggest and back that up.But it also kind of logically makes sense,
and that is, if you needa service that requires a specialist,
it's best to be referred as quicklyas possible to that specialist. And in
particular, the same holds for stemcell transplants. So when we look,
(34:51):
for example, at a patient whohas leukemia, so as a pediatric oncologist,
we give chemotherapy to patient to gettheir disease into a remission or an
inability to detect the cancer for examplein the bone marrow, and then based
upon the availability of a donor,then that pediatric patient would undergo an allergenic
(35:14):
stem cell transplant. So the issueis you want to be able to find
that donor as quickly as possible.So therefore you want to perform HLA typing
on a patient in need of aallergenetic stem cell transplant early on in order
to identify a potential donor. Butalso it's that critical timing to transplant.
(35:37):
So again I mentioned about stem celltransplants still kind of being a sledgehammer rather
than a chisel. Same thing appliesto chemotherapy. Yes, we have more
targeted chemotherapy that utilizes immunotherapy for example, or how cells signal on the inside
(36:00):
but we still are using sledge hammersof chemotherapy that have caused collateral damage like
damage to organs, cardiac or lungor potentially liver, and then increase risk
of long term side effects like growthand thyroid issues or even predisposed to other
leukemias. So the point is,you don't want to expose unnecessarily patients to
(36:24):
more sledgehammer chemotherapy if you can getthem the transplant faster so that spares toxicity
to that patient so that they canundergo a stem cell transplant. And so
therefore that relationship and that communication withthe community oncologist and the transplant center is
(36:45):
absolutely crucial, and we have aprogram called HLA today which facilitates that.
In other words, we can providethat HLA kit to the patient in need
and his or her direct by aloefamily so that they can do that swab
process I mentioned and send off samplesto both the NMDP or to another reference
(37:09):
lab so that the community physician canget that HLA typing. And that's not
again on the checklist of getting atransplant, check off the box on HLA
typing to then be able to identifya donor sooner, and we know that.
Therefore, when you do that andhave the success of identifying a donor
(37:30):
sooner, that patient is exposed lessto toxicsity like additional chemotherapy, and can
get referred faster. So it's reallyimportant to actually know what transplantable disease indications
there are to perform that HLA typingand to get those patients to the transplant
(37:52):
center. And again, from aneducation standpoint, the NMDP can provide that
education to physicians, to community oncologistsor heematologists through our website where we can
list or where we have listed ourtranspontable disease indications. Let's take sure a
break and then we're back with doctorJeffrey Aletta. My name is Janey Jean.
(38:21):
I'm the chair of a computational biologydepartment at St. Ju Children's Research
Hospital. As a data scientist thatfeel so excited about seeing the potential impact
not only are the kids treated asSaint Jude, but across the world.
And I think this is a greatuse of the trust we got from our
donors finding cures saving children. Learnmore at Stjude dot org. This is
(38:58):
the Younger Zaine Brief with Peter Humhand welcome back in today's episode of The
Youngessine Brief. I'm talking with doctorJeffrey Oletta. I'm Peter Hofflin's and this
is the Youngestine Brief. Now,an early referral to a transplant center and
an early consultation is vital. Butwhat about the outcomes? Are the outcomes
(39:22):
in these cases also better? Yes, there's actually been several studies to suggest
that in the acute myloid leukemia settingand then also in the mild dysplastic syndrome
setting. So those patients who werereferred faster to a transplant center had better
outcomes, and a lot of thathas to do again with less exposure toxicity
(39:44):
so they could actually get the transplant, but also to capitalize on disease being
in remission because it's a finite periodof time before that disease no longer is
kept in check and in remission.So those are the two critical reasons for
earlier referral. So this would reallyhelp patients, right, especially if there
(40:05):
are potential candidates for a bone marrittransplant. This really emphasizes the role of
physicians to help patients as early aspossible. But even the role of patient
advocates is important, right, yeah, for sure. Now, one of
the complexities that you encounter is findinga match for all patients, and this
may include patients with differences in ethnicityand culture. But what about patients that
(40:28):
may be candidates but might be uninsuredor patients with low incomes. These patients
may have poor quality health care andseek health care less often, and when
they do seek health care, itis more likely to be for an emergency.
Right. These patients may not beable to afford certain treatments or their
insurance company may not cover those treatments. Other programs that can address this to
(40:50):
help patients to get treatments as earlyas possible. For sure, I'll touch
upon the NMDP, and then I'lltouch upon an initiative that we started.
The NMDP, through the generosity ofphilanthropic donors, has a foundation, and
again anybody can go to our websiteand if they're interested in terms of supporting
that effort, which provides patient financialassistance for those patients. And I mentioned
(41:15):
some of our support services in termsof patient navigation and education as well.
But fundamentally, Peter, this getsinto something that really has moved me over
the years in something that I'm reallyquite involved with now, and that is
healthcare disparities. And certainly there areothers who are involved in this field as
(41:37):
well. But when we think aboutthe United States of America again I talked
about this altruism in terms of becominga STEM cell donor, I think we
also need to have that altruism ofhelping out those who are less fortunate than
us. And there's lots of waysof doing this. But we know for
a fact that those ethnically diverse patients, they're under a represented in terms of
(42:00):
the population, but they're over representedin terms of poverty and uninsured status.
So therefore there are more persons ofcolor, particularly black and African Americans,
who don't have in health insurance,who are living at poverty. And when
we think about what that means,you know, there are roughly about three
(42:22):
hundred and thirty million people in theUnited States of America and in twenty twenty
one, they're about twelve percent wholived at or living at poverty levels and
about eight percent who didn't have healthinsurance. So doing the math on that,
it's about forty million people living inpoverty and about twenty seven million without
(42:44):
health insurance. So what is livingin poverty? You know, what does
that mean? Obviously we know whenwe see people living on the street that
that person's poor. But when welook at how our country is defining poor
people by their median income, thatnumber has to be double or triple of
forty million dollars. And for example, what I'm getting at is in twenty
(43:07):
twenty one, the poverty threshold forsomeone who is less than sixty five years
of age and lives in a twoperson and two children family is twenty seven
thousand, five hundred dollars. Imean, you know. So therefore,
if you're thirty thousand dollars in income, you weren't considered as part of that
(43:27):
forty million. So when we thinkabout that, that number now is staggering.
And we know that those persons whoget public health insurance, for example,
Medicaid, we know that though thatin and of itself is a poor
prognostic in terms of outcome for variousailments in medicine, but in particular for
(43:51):
example, stem cells transplant. Andit's not just being on medicaid, right,
it's what's this holistic theme called socialdeter termits of health, and that
is when a patient enters my office. In particular, seventy percent of their
health is determined outside of that medicalencounter. So things like socioeconomic factors,
(44:15):
physical environment, how they behave interms of their health, do they smoke
for example. Now, when weadd social determines of health on top of
a medical diagnosis, it's like adeluge of things that impact outcomes. And
so therefore I've had the privilege andpleasure to start an initiative called the Access
(44:40):
Initiative, and that is a collaborativewith the NMDP and the American Society of
Transplantation of Cell Therapy. So doctorStella Davies, who's a pediatric transplant physician
at Cincinnati Children's Medical Center and Iare the inaugural co chairs of this initiative.
And that initial initiative has at itsemission and vision to enhance access by
(45:05):
reducing barriers to stem cell transplant andcell therapy, and also to reduce health
care disparities, and really by focusingin on awareness of the problem poverty as
I just mentioned, and alshow racialinequity in terms of some of these examples.
So this is a ecosystem wide initiativeinvolving academic centers, transplants and celf
(45:28):
therapy, physicians, patient advocate organizations, pharmaceutical industry, and it's still at
its grassroots level, but you know, it started about a year ago.
But we have a website and apublication that people can can read if interested,
and we know that these are entrenchedproblems in our social system, so
(45:50):
it's going to take quite some timeto address them. But we had the
option to say it's someone else's problem, right, you know, it's Congress's
problem to enhance Medicaid coverage. It'syou know, the hospital's problem to give
more charity care. But we allneed to take that personal commitment and personal
responsibility that it's our problem in thiscountry and we have to take that amongst
(46:16):
ourselves and say we are a flickerof light, but together we are quite
the flame of change. And that'swhat we need to fundamentally do in the
United States of America. We needto reprioritize our resources into ourselves so that
these challenges which just aren't unique tostem cell transplant but are unique across lots
(46:38):
of different diagnoses. These things needa comprehensive collaborative approach in order to address
and to change over time. Inour journal Agrazine, we often publish articles
discussing disparities, and in this showwe also ask physicians about this. But
that seventy percent of a patient's healthis them but outside of a medical encounter,
(47:01):
outside of a medical consult with aphysician in the clinic, that really
stands out. But then we cando something about this, right, But
I understand that we can only dothis if we're willing to work together.
Only then we can be successful ineliminating the issues that you mentioned, right,
Yeah for sure. So when itcomes to research and transplant medicine,
(47:22):
the future may hold a lot ofgood news. There's a lot going on,
But equally important is and you mentionedthat earlier, is the fact that
everybody should be able to benefit fromthis approach and have access. Yeah for
sure, Doctor Jeffreyeletta, thank youso much for joining me today in the
Youngest in Brave. I think we'velearned a lot, but I'm sure that
(47:45):
we've only scratched the service of whatis important for sure, Preeter, and
thank you very much for having me. I just want to say in closing,
I can as stress how the worldtakes really from what really matters.
And with this profession, I've learnedso much and been privy to so many
(48:06):
different people and experiences, and Icould say that, you know, we
all have that opportunity of impact,right, I mean, I obviously as
a physician, I'm blessed to beable to do that at bedside, literally
laying my hands on someone else andhelping to make them better. But you
know, you don't have to bea physician or you know, a chief
(48:30):
scientific Director at the c IBMTR todo the same thing. And we all
have that ability to do something assimple as as swabbing our mouth to make
a difference in terms of someone's lifetime. So that hope, that four letter
word of hope is something that Ihope that this audience and can can message
(48:51):
to other people on the outside inorder to really make a difference in someone
else's life. Well, let's workon that. And again, doctor,
thank you so much for joining metoday. Great thanks, Peter. In
this episode of the Youngest in Brief, I spoke with doctor Jeffrey Aletta.
(49:12):
Doctor Aletta is Senior Vice President PatientOutcomes and Experience. He is also chief
Scientific Officer of the National marrow DonorProgram be the Match and the Center for
International Blood and Merit Transplant Research orCIBMTR. That's the Medical College of Wisconsin
and doctor Aletta is also Senior directorof the Center for International Blood and Merit
Transplant Research CRO Services. For moreinformation about becoming a donor, please visit
(49:38):
bedematch dot org Become a donor.For more information about the National myro Donor
Program, be the Match and theCenter for International Blood and Merit Transplant Research
or CIBMTR at the Medical College ofWisconsin, go to CIBMTR dot org.
For more information about the studies presentedin this program, please go to our
(50:00):
online journal on cousine at ongussine dotcom. I'm Peter Hoffland and this is
the Younger Say Brief for us hereat the Youngest In Brief, we want
to thank you, our listeners,sponsors and advertisers for your ongoing support.
Your support makes it possible that youcan hear this program via POX Public Radio
Change and in the United Kingdom andmainland Europe via UK Health Radio. And
(50:22):
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Audible, Stitcher, SoundCloud, andnearly anywhere you can find a podcast.
For more information about supporting or sponsoringthe onus In Brief, visit our
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States and want to receive our newsletter, text the words cancer to six six
(50:45):
eight sixty six, that is sixtysix eight sixty six and we will make
sure that you will receive our newsletter, which includes an overview of the latest
news in oncology and hematology. Thankyou all and thank you for listening,
and join us again for our nextepisode. I'm Peter Hoffland and this is
(51:05):
the Youngest in Brief. The OngazineBrief is a global medical educational service from
the publishers of Ongasine and ADC Review, the Journal of Antibody Drug Conjugates.
Support for the Ongazine Brief comes fromour commercial lenderwriters and advertisers, and the
(51:29):
listeners to this station. For moreinformation about advertising, underwriting and sponsoring options,
visit Oncasine at www dot ongazine dotcom. Forward Slash podcasts. The
Ongazine Brief contains health and medicine relatedinformation and is provided for educational and entertainment
purposes only. The content in thisprogram is not intended as a substitute for
(51:50):
professional medical or health advice, anddoes not replace your doctor's advice and guidance.
Your doctor is the best person toanswer questions about your personal health if
you if here's something in this programthat doesn't agree with what your doctor has
told you, ask him or herabout it.
This is the Youngazine Brief with PeterHoffland. In this episode of the Augustine
Brief, I talk with doctor JeffreyOletta. Doctor Aletta is Senior Vice President
Patient Outcomes and Experience and Chief ScientificOfficer of the National Marrow Donor Program,
(00:32):
be the Match and the Center forInternational Blood and Merit Transplant Research or CIBMTR
at the Medical College of Wisconsin.Doctor Aletta is also the Senior Director of
the Center for International Blood and MeritTransplant Research cro SERVICES. Now the Center
for International Blood and Merit Transplant Researchprovides a unique research of information and expertise
(00:54):
to the medical and scientific community,and some of this work goes back to
the early nineteen forties and nineteen fiftieswith experimental treatment for radiation sickness and the
development of new standards through leukemia,lymphoma, and sickle cell disease. Now
in nineteen seventy two, the workreally started to take off with the organization
when a handful of doctors from theUnited States, France, and the Netherlands
(01:18):
created an international Registry of Transplants inorder to see which therapies helped people the
most. Over time, the informalalliance grew to involve many more countries and
a formal research collaboration between the MedicalCollege of Wisconsin and the National Meridoma Program
be the match. Today, theInternational Blood and Merit Transplant Research Organization received
(01:42):
data from about three hundred and fiftymedical centers from around the world. Researchers
at the center have analyzed clinical outcomesof more than six hundred thousand patients who
underwent a bonemerit transplantation, and morerecently, the organization expanded its activities to
collect data from others therapies such assemeric androgen receptive T cells also known as
(02:04):
car T cell therapy. Without adoubt, research and development and the application
of cellular therapies have come a longway from their early beginnings. I'm Peter
Hoffland and this is the Youngest inBrief. The Youngest in Brief is developed
in collaboration with our online journal onCuisine, where you can find additional information
in the latest news about cancer,cancer diagnosis and treatment, and cancer prevention.
(02:28):
For more information on how to supportthis program, visit our website at
oncusine dot com. And if you'reliving in the United States and want to
receive our newsletter. Text the wordcancer to six six eight sixty six and
we will make sure that you'll receiveour newsletter, which includes an overview of
the latest news in oncology and hematology. This is the on Casine Brief.
(02:58):
For the latest news about cancer andcancer treatment, visit our online journal on
Gazine at www dot Oncassine dot com. On the phone with me is doctor
Jeffreyoletta. Doctor Oletta is Senior VicePresident Patient Outcomes and Experience and Chief Scientific
Officer of the National Marow Donor Programbed the Match and the Center for International
Blood and Merit Transplant Research or CIBMTRat the Medical College of Wisconsin. Doctor
(03:24):
Aletta is also the Senior director ofthe Center for International Blood and Merit Transplant
Research. Heare ro Services, DoctorAletta. Welcome to the Augustine Brave.
Thank you very much. Now,the National Merit Donor Program BEDA Match and
the Center for International Blood and MarrowTransplant Research recently published some very interesting news.
(03:45):
But before we come to talk aboutthat, tell me a little bit
more about yourself, about your background, how you got here, and about
the patients that you're trying to help. So I am a pediatric bomero transplant
physician. I'm also boarded in aninfectious disease, so that's my clinical background
and my research interests have spanned thingsfrom immunomodulation and immune reconstitution after transplant to
(04:09):
most recently, healthcare disparities in transplants. So I work at the National Marrow
Donor Program or an MDP, andthe NMDP is the nation's donor registry.
So what that means is we arethe national donor Registry where we provide stem
cell graphs for patients in need whodo not have a HLA or human leukocyte
(04:35):
nigen matched donor within the family.So these include patients who have a malignant
disease such as acute leukemia or anon malignant disease such as sickle cell disease,
and our registry provides the product forthose patients in need. And our
(04:57):
registry is based upon ultra bistic donorswho come forward provide a sample that gets
processed, which is the HLA partof the process, and that sample is
banked in our registry. And whena transplant center requires a donor, they
would contact the National Mirror Donor ProgramUS and we would come up with the
(05:23):
best HLA match for their patient.Now, HLA is a very diverse gene.
In other words, it is highlypolymorphic, meaning that the HLA genes
are based upon the ethnic diversity ofthe patient. So that's why you and
I have different immune systems, forexample, and therefore we recognize things that
(05:47):
are different. And so when wematch a patient with a donor, we
are matching them based upon the HLAlow side, and we do that through
the sample that the donor provides.As I mentioned before, those patients who
are ethnically diverse do have less ofa chance of having an HLA matched donor
(06:12):
in our registry based upon the geneticdiversity of their HLA. So what that
means is that those patients who arewhite Caucasians like myself have about a seventy
nine percent chance of finding an unrelateddonor versus a patient who is black or
African American who has a matching chanceof about twenty nine percent. And that
(06:39):
is largely because our registry is madeup of white Caucasian patients and we're trying
to increase the diversity of our registry, which is actually one of the most
diverse ones in the world in orderto provide a patient in need, namely
a patient who's ethnically diverse with anunrelated donor. So, when you look
(07:00):
at some of these challenges, onemajor barrier in the treatment of patients you
mentioned earlier includes patients diagnosed with leukemia, sickle cell anemia, or similar diseases.
How are you trying to address this? And in addition, how can
you be sure that everyone can equallyaccess your database or registry and benefit from
that. What are some of thethings that you're trying to change here?
(07:23):
Great question, Peter, So,there are many barriers to transplants and cell
therapy. In other words, thereare patients related barriers such as race and
ethnicity that I'd mentioned. There arealso socioeconomic barriers, insurance barriers for the
patient, and then there are alsophysician barriers another words, knowledge that the
(07:46):
physician has who is referring to atransplant center, they're patients, some referring
oncologists aren't necessarily up to date interms of what transplantal disease indications there are
That creates a barrier. And thenlastly, there are barriers at the transplant
program level in terms of center expertiseor capacity barriers, or even structural racism
(08:11):
still is one of these barriers.So the National MERIDIA program is addressing all
three of these types of non HLAbarriers at the patient level, educating the
referring oncologist, and then providing supportto the bomber transplant centers. So these
non HILA barriers we provide various servicesfor. So we have patient financial assistance
(08:37):
and education. For example, wehave patient support centers to navigate. We
have navigators who help patients through thetransplant journey. We have outreach programs.
We have what's called adjacent Carter clinicalTrial Search and Support, which allows patients
to access various clinical trials to seeif they're alterable for them and then also
(09:03):
get their questions answered regarding those clinicaltrials. So these are the non HLA
services that we provide to reduce patientbarriers. But we also are part of
the CIBMTR or the Center for Internationalwhat Ameri Transplant Research, which is a
collaboration between the NMDP and the MedicalCollege of Wisconsin. And within the CIBMTR,
(09:26):
we are doing both observational studies withour large database as well as prospective
clinical trials, and one of thoseclinical trials that's being sponsored by the National
Eurodonor Program is utilizing a mismatched unrelateddonor. So I explained how we wanted
to look at HLA matching. Butwhen you consider the genetic diversity of America,
(09:54):
which is only increasing because of multiplemultiple racial relationships and off bring,
we are reaching an inability to providea eight out of eight, which is
the number system of a well matchedunrelated donor for all patients in need.
Therefore, we need to hurdle orsupersede the HLA barrier, and we're doing
(10:18):
that with our prospective research utilizing amismatched unrelated donor. And we're doing that
by utilizing a chemotherapy drug called acycloposphamide and using that as graft versus host
disease prophylaxis. So, in otherwords, part of a complication of an
allogenetic or getting someone else's stem cellsis that someone else is a different immune
(10:45):
system from the patient's immune system,and so therefore we need to temporize that
donor immune system through something called prophylaxisor graph versus host disease prophylaxis, and
the field has utilized this in thesetting of happal identical transplant in other words,
(11:05):
fifty percent matching between donor recipient,and we're settying the mismatch unrelated donor
setting in terms of utilizing post transplantcyclofossamide. And thus far, our first
initial clinical trial called the fifteen MMUDtrial, was successful in terms of a
couple points. Number one, itwas able to provide a bone marrow graft
(11:30):
for about fifty percent of the patient'senrolled on the trial. In addition to
that, it showed a survival whichwas comparable to other donor sources, whether
that be a happalo identical donor ora well matched unrelated donor. And then
third it had an overall survival ofabout seventy five percent. So with those
(11:52):
three results which were favorable, wenow have what's called an access trial where
we're utilizing the mismatch undreaddited donors,this time using peripheral blood, which is
the most common graft source used inthe field, and then also seeing for
the first time enrolling some pediatric patientsas well. So that trial is ongoing
(12:16):
and it has enrolled quite nicely,but we are still waiting for the trial
to follow your crew. Let's takea break. This is the Youngest in
Brief. If you're just joining usin today's episode of the Youngest in Brief,
I'm talking with doctor Jeffrey Oletta.Doctor Oletta is Senior Vice Presidents,
Patient Outcomes and Experience and the ChiefScientific Officer of the National Merit Donor Program
(12:37):
Media Match and the Center for InternationalBlood and Merit Transplant Research or CIBMTR at
the Medical College of Wisconsin. DoctorOletta is also the Senior Director of the
Center for International Blood and Merit TransplantResearch CEO services. I'm Peter Hoffland and
this is the Youngest in Brief.Clinical trials allow researchers to introduce new hope
(13:07):
by providing participants access to cutting edgeand potentially life saving treatments. Speak with
your doctor and visit stand Up tocancerdot org slash Clinical Trials to learn more.
Together, we can stand up forall of us. This is the
(13:28):
young Gazine Brief with Peter Hoffland andwelcome back. This is the Youngest in
Brief. If you're just joining usin today's episode of the Youngest in Brief,
I'm talking with doctor Jeffrey Oletta.So when you look at some of
these issues. There are an awfullot of things to digest here. You
(13:50):
help patients in areas that are nonmedical issues, trying to solve one of
the most complex problems in medicine,that of treatment related disparities or health related
disparities, that make sure that everybodyhas access or can get access. You're
also providing the education for physicians tohelp them in this effort, and I
assume that you also try to makea case with insurance companies and make sure
(14:15):
that as many people as possible canhave access to treatment. And at the
same time you're dealing with the scientificand medical issues, right, correct.
I understand that what you're trying todo is offer a lot of hope for
these patients, and there is alot of good news in that area,
but there are also concerns. Youmentioned versus host disease. Today, versus
(14:39):
host disease remains I assume one ofthe biggest issues in hematology and stem cell
therapies. Right In addition to findinga good match in cell transplants, are
there other concerns that could limit thesuccess of cell transplants. Yes, so,
in general, the allogeneic or usingsomeone else's stem cells transplantation is limited
(15:03):
by a donor availability, so that'swhat we're dressing in terms of the mismatch
and related donor, but it's alsolimited by outcomes. And what I mean
by that is the top three reasonsfor patient demise after allogenetic stem cell transplant
have remained the same for decades,and that was our primary disease relapse in
(15:24):
the malignant setting, organ toxicity orgraph versus host disease, and then lastly
infection. So unfortunately, still intwenty twenty three, we're kind of using
a sledgehammer for allogenetics stem cell transplantwhen we really want to be able to
use chisels in order to kind ofgo after targeted disease such as cancer.
(15:48):
So that kind of goes and dovetailsinto the field of immune mediated cell therapies.
In other words, we can nowtake cells out of a patient who
has a particular form of leukemia orlymphoma, educate those T cells to recognize
(16:08):
certain protein expressions on the leukemia cellsor lymphoma cells, and infuse them back
into the patient so that those cellswill attack that specific cancer. That's called
chimeric anigen receptor CAR T cells,and so that has really been a game
(16:29):
changer in the field. So thatis addressing the relapse part. But we
do know that patients relapse for amultitude of reasons. In other words,
we look at things called immune escapemechanisms where those protein expressions on the cancer
cell are downmodulated or decreased on theexpression on the surface, and so therefore
(16:51):
these car T cells sometimes don't workor other forms of immune therapy. So
there are many different mechanisms of cancerimmun an escape that still result in primary
disease relapse. In addition to thatis the graph versus host disease and so
again I mentioned that that number eightout of eight, so it's really a
(17:12):
little bit of immunology lesson here.There are different types of classes for the
HLA class one in class two,and so we're measuring or matching rather at
a finite number of those particular alleles, and so there's a whole heck of
a lot that we're not matching on. So that gets into the term of
(17:33):
minor history incompatibility an egens, andso therefore that which we don't match has
the ability to provoke a graph versushost disease response in a transplant recipient,
and so I mentioned the post transplantscyclofossamide uses graph versus host disease prophylaxis,
so that has been highly successful interms of being able to kind of over
(17:57):
exceed or leap the HLA barrier,and so therefore that matching doesn't have to
be perfect. But in and ofitself that cycloposmide is a chemotherapeutic agent.
So despite it being relatively successful interms of preventing acute and long term or
chronic graph versus host disease, itcomes at the expense of toxicity, so
(18:22):
things like infection or things like bleedingfrom the bladder area, and also potentially
longer term toxicity like predisposition to therapyrelated leukemia. So the field is working
on different ways of utilizing or optimizingrather graph versus host disease prophylaxis, and
(18:45):
again turning towards cell therapy. Canwe take out certain cells from the graph
that we collect and infuse into thepatient, in other words, take out
those specific T cells that mediate graphhost disease, And there's success in terms
of doing that. So there's waysof depleting those particular cells. So that's
(19:07):
graph versus host disease optimization. Andthen last I mentioned infection. So we
do have pharmaceutical agents that we havein our armatorium now that we didn't have
ten years ago, a lot ofthe anti fungal drugs, for example.
And we are utilizing preventative ways anddiagnostic tests where we can detect infection before
(19:30):
it manifests clinically, such as byfever or chest X ray changes or CT
scans. So we're optimizing our infectionprevention and treatment. So by addressing the
top three reasons for patient demise,we are making headway where we didn't have
(19:51):
these tools in our tool chest before. But clearly those three reasons for patient
demise are still challenges today in twentytwenty three. Yeah, I can totally
imagine that now. One of thethings you mentioned earlier about the potential of
matching patients and donors is a magicalnumber of eight over eight matching points.
(20:11):
I understand that studies have now shownthat you can really match patients at a
different level a lower number than eightmatching points, going as low as five
or six matching points out of eight. Can you tell me a little bit
more about this, about the complexitiesinvolved and the benefits of working with not
fully matched patients and how that maywiden the potential for patients that now can
(20:34):
be effectively treated. This gets backto that fifteen MMUD study. So taking
a step back, we know thatthere are many patients who need a transplant
who don't get a transplant for lotsof different reasons. I mentioned some of
those non HLA reasons right in otherwords, low as socioeconomic status, don't
(20:55):
have insurance, aren't referred to atransplant center, those type of issues.
And then there are the HLA issues. And I mentioned that our registry is
primarily comprised of white, non Latinodonors who have a higher match rate than
a black African American for examples,that's seventy nine percent to twenty nine percent
that I mentioned. Going back tothat, a number of patients who have
(21:22):
a potential need for an allogeneic stemcell transplant per year is around fifteen to
sixteen thousand, and so we knowthat that number decreases for those two reasons
I mentioned, the non HLA barriersand the HLA barriers. And so this
study, this fifteen MMUD, thismismatched unrelated donor and what you're mentioning Peter,
(21:49):
is that that number we don't haveto be a perfect HLA match.
Now across those class one and classtwo HLA lowsi we can actually now be
less than that perfect match with theutilization of the post transplant cyclofossimide as graph
versus host disease prophylaxis. So thatstudy was able to enroll about fifty percent
(22:14):
of patients of ethnically diverse backgrounds whowould not be able to receive a well
matched unrelated donor because that just didn'texist for them. But with the post
transplant cyclophosphide in the setting of utilizinga mismatch unrelated donor, that has increased
nearly double the amount of being ableto provide a transplant for those patients in
(22:41):
need. So when you kind ofdo that rough arithmetic in your head,
if we start off with around fifteento sixteen thousand patients and kind of get
to various levels of reasons for whythose patients don't get down to transplant,
you think about roughly, in theUnited States of America there are around eight
(23:03):
to ten thousand transplants provided each year. That number is staggering in terms of
being able to provide a donor forall based upon a mismatch unreally the donor
or a happ loo identical donor.So those ethnically diverse patients are now being
able to receive a life saving allergenetictransplant because of our ability to hurdle the
(23:27):
HLA barrier with the post transplant cycloflossamide. Obviously, we have a lot of
work to do. I talked aboutthe three reasons why patients still die after
allogenetic transplants, but we are definitelymaking headway and the ability to provide a
donor for all through a mismatch unrelateddonor is really a game changer, and
(23:48):
again based upon increasing the amount ofethnically diverse patients who can receive a life
saving transplant. Let's take a break. This is the Youngest Sam Brief.
If you're just joining us in today'sthe Oogahine Brief. I'm talking with doctor
Jeffrey Oletta. I'm Peter Hoffland,and this is the o Gashine Brief.
(24:14):
Sarcoma ODDZO. You've never heard thatword before. For the forty people diagnosed
with sarcoma every day, it isa life changing word because sarcoma is cancer.
Through awareness, advocacy, and research, the Sarcoma Foundation of America is
bringing hope to the families whose liveshave been turned upside down by a cancer
they had never heard of until diagnosis. Please jou instand the fight to find
(24:36):
the cure for sarcoma. For moreinformation on the work of the Sarcoma Foundation
of America, go to Cure Sarcomadot org. This is the young Gasine
Brief with Peter Hoffland and welcome back. This is the Youngest in Brief.
(25:04):
If you're just joining us in today'sepisode of the Youngest in Brief, I'm
talking with doctor Jeffrey Oletta. I'mPeter Hoffland and this is the Youngest in
Brief. One of the things youmentioned is the importance of donors because success
is based on matching patients with donors. Now you're using different ways to recruit
people to sign up to become adonor. But tell me a little bit
(25:26):
more about how important it is forpeople to either become a donor or to
consider being a donor. How andwhen are you becoming a donor? Because
I understand that there is some misconceptionsabout this, and one of those misconceptions
is the fact that many people believethat if you are going to the DMV
or MVD to renew your driver's license, there is an opportunity to become a
(25:51):
donor after life. But that's notwhat we're talking about here, right,
That's not the same thing as joiningbe the match as a donor. Tell
me a little bit more about that. So when you go to the BMV
and they ask if you'd like tobe an organ donor, they're asking if
you should have an accident and obviouslypass, would you like your organs to
be donated to another person? Andprobably the vast majority of us who are
(26:14):
on this podcast automatically have that imprintedon our driver's license. And what you're
getting at is we should have thatsame altruistic feeling about being a donor for
a patient in need as we dofor that donation of our organs. But
the issue is awareness, right.I don't think those in a podcast would
(26:37):
have appreciated that there is roughly aboutfifteen to sixteen thousand patients every year who
are diagnosed with a malignancy alone thatwould necessitate a stem cell transplant. And
then when you add other diseases ontop of it, like sickle cell disease.
It's really a significant amount of unmetneed that we have and part of
(27:02):
what the National Maridona Program is bringawareness to that unmet need. And what
we really would like is there tobe more people who get involved in our
registry. It's very simple to do. If interested, go to our website,
click on becoming a donor. Wesend you a packet which has a
swab. What you do is literallyswab the inside of your cheek a couple
(27:26):
of times, put it in thecontainer, and send it back to us.
And that is a very easy thingto do. It doesn't hurt at
all. I think that's one ofthe first misperceptions is that I can't do
that. Well, we're all puton this planet for a reason, and
one of those main reasons is tohelp out other people in need. And
(27:48):
I think that that's the message Iwant to be able to promote and as
the organization is that there are manypeople in need and we need you to
be part of our registry help thosepeople. So that's the first thing,
awareness and education of the problem.And the second part of your question is
you know, what does it meanwhen you become a donor, what is
(28:10):
the process, And yes, thereis a process. Obviously, we want
it to be safe for you asthe donor to give your stem cells to
another person, and so therefore youhave to go through some blood work to
make sure that you don't have anact of viral infection, for example,
and also that you go through aphysical exam to make sure that you're able
(28:32):
to withstand a process called apheresis,or the collection of your blood, and
then also potentially a bone marrow harvestwhere we would collect stem cells directly from
the bone marrow. And so that'skind of the initial check list with regards
to a pre donor workup. Andthen once you have passed those tests,
(28:56):
then it's up to you to actuallygive your stem cells in one of two
ways. One is through the aparesismachine that I mentioned. So what happens
with that is we give a drugthat stimulates your stem cells in your bone
marrow to leave the bone marrow andenter your blood stream. Then we collect
(29:18):
those stem cells through the aparesis machine. There's an ivy placed in one arm
where blood comes out, goes throughthe machine, spins up the cells,
collects them in the bag and sendsthe blood back to you in real time,
so there's no changes in blood pressure. And that process takes anywhere from
three to six hours, depending uponyour size and the size of the recipient.
(29:38):
And the other is a Boemer harvest, where you would go into the
operating room, gets the dated andthen have a needle placed in the back
area of your pelvis, and thenboomer would be extracted, put into a
bag, and then send off.Obviously there would be some discomfort with that,
(29:59):
but it goes way in a coupleof days and for the vast majority
of donors, as in like ninetynine percent of donors, they do absolutely
fine. And again, if Igo back to my statement of why we're
on this planet, you then havedone a remarkable job in terms of being
a potential hope for a patient whomay in fact have a disease that would
(30:25):
not otherwise be cured without the stemcells that you gave. So that's a
pretty good feeling in terms of beingable to do that. Now, early
in the program you refer to optimizingdonors. This is part of the whole
process of trying to make sure thatyou are getting the best donors to join
the registry because I understand not everybodycan be a donor. Tell me a
(30:47):
little bit about this. Yeah,the vast majority of people can, Peter.
So the main criteria is age,so age greater than eighteen years old,
because you have to consent for theprocess. The other thing is just
a willingness to go through the processthat I that I had mentioned. Now
there's going to be an upper limit. You know for those of us who
(31:08):
are you know, sixty years orabove. You know, the chances of
us of our stem cells being utilizedclinically are pretty low. So we tend
to gravitate towards wanting younger people becauseobviously they can stay in the registry longer
right as they advance an age.But also with regard to their stem cells
(31:30):
are for lack of a term,more vibrant than an older person stem cells.
And you know, just the agingprocess we all go through it,
we all get gray hair, samething happens to our stem cells. There's
a process of something like gray hairto a stem cell, so it's not
as active or robust. So again, anybody can become a domor in our
(31:56):
registry based upon age and based upondesire, and we strongly encourage more ethnically
diverse patients to be a part ofour registry because of the fact of the
dispirit HLA matching rates that I mentionedbased upon ethnicity, So we welcome all
(32:17):
persons of color, all persons ofethnicity to go through the donation process,
you know, get that swab tous and be a part of the registry,
because again, you know, it'sthose ethnically diverse patients that are most
challenged in terms of finding an allergenicor unrelated donor. And I guess it's
(32:38):
really important write to make sure thatyou can offer patients with different ethnicities the
opportunity to be treated and to makesure that people with different ethnicities are signing
up to become a donor. That'scorrect, yeah, for sure. And
again we're all Americans, right,but we all have different cultures and different
(32:59):
background and it's the diversity of Americathat makes America great. But from an
HLA matching standpoint, you're exactly spoton. It's easier to find unrelated donors
who are part of your own ethnicityand race than it is outside. And
so therefore that's why we welcome theethnically diverse donor to be a part of
(33:22):
our registry because it's for sure goingto enhance our ability to provide a product
to a patient in need of thesame race and ethnicity. Now you mentioned
deroll that you and your organization areplaying. You also mentioned de rolled the
donors and patients can have and ingeneral, how people who have not yet
(33:42):
signed up to be a donor canjoin me the match registry. Right,
But the medical profession, the doctors, ge oncologists, to hematologists to oncology,
nurses and many others who are involvedin treating patients also play an important
role. When we talk about referral, for example, and we look at
how important these process is of gettingpatients matched, how important is an early
(34:02):
referral to, for example, andtransplant center, because I guess that really
one of the questions of education andhelping physicians to also play their role includes
early referral. So how important issuch an early referral to a transplant center
to address the barriers you mentioned?Simple answer, it's vital to be referred
as early as possible to a transplantcenter, and there's multiple studies out there
(34:29):
to suggest and back that up.But it also kind of logically makes sense,
and that is, if you needa service that requires a specialist,
it's best to be referred as quicklyas possible to that specialist. And in
particular, the same holds for stemcell transplants. So when we look,
(34:51):
for example, at a patient whohas leukemia, so as a pediatric oncologist,
we give chemotherapy to patient to gettheir disease into a remission or an
inability to detect the cancer for examplein the bone marrow, and then based
upon the availability of a donor,then that pediatric patient would undergo an allergenic
(35:14):
stem cell transplant. So the issueis you want to be able to find
that donor as quickly as possible.So therefore you want to perform HLA typing
on a patient in need of aallergenetic stem cell transplant early on in order
to identify a potential donor. Butalso it's that critical timing to transplant.
(35:37):
So again I mentioned about stem celltransplants still kind of being a sledgehammer rather
than a chisel. Same thing appliesto chemotherapy. Yes, we have more
targeted chemotherapy that utilizes immunotherapy for example, or how cells signal on the inside
(36:00):
but we still are using sledge hammersof chemotherapy that have caused collateral damage like
damage to organs, cardiac or lungor potentially liver, and then increase risk
of long term side effects like growthand thyroid issues or even predisposed to other
leukemias. So the point is,you don't want to expose unnecessarily patients to
(36:24):
more sledgehammer chemotherapy if you can getthem the transplant faster so that spares toxicity
to that patient so that they canundergo a stem cell transplant. And so
therefore that relationship and that communication withthe community oncologist and the transplant center is
(36:45):
absolutely crucial, and we have aprogram called HLA today which facilitates that.
In other words, we can providethat HLA kit to the patient in need
and his or her direct by aloefamily so that they can do that swab
process I mentioned and send off samplesto both the NMDP or to another reference
(37:09):
lab so that the community physician canget that HLA typing. And that's not
again on the checklist of getting atransplant, check off the box on HLA
typing to then be able to identifya donor sooner, and we know that.
Therefore, when you do that andhave the success of identifying a donor
(37:30):
sooner, that patient is exposed lessto toxicsity like additional chemotherapy, and can
get referred faster. So it's reallyimportant to actually know what transplantable disease indications
there are to perform that HLA typingand to get those patients to the transplant
(37:52):
center. And again, from aneducation standpoint, the NMDP can provide that
education to physicians, to community oncologistsor heematologists through our website where we can
list or where we have listed ourtranspontable disease indications. Let's take sure a
break and then we're back with doctorJeffrey Aletta. My name is Janey Jean.
(38:21):
I'm the chair of a computational biologydepartment at St. Ju Children's Research
Hospital. As a data scientist thatfeel so excited about seeing the potential impact
not only are the kids treated asSaint Jude, but across the world.
And I think this is a greatuse of the trust we got from our
donors finding cures saving children. Learnmore at Stjude dot org. This is
(38:58):
the Younger Zaine Brief with Peter Humhand welcome back in today's episode of The
Youngessine Brief. I'm talking with doctorJeffrey Oletta. I'm Peter Hofflin's and this
is the Youngestine Brief. Now,an early referral to a transplant center and
an early consultation is vital. Butwhat about the outcomes? Are the outcomes
(39:22):
in these cases also better? Yes, there's actually been several studies to suggest
that in the acute myloid leukemia settingand then also in the mild dysplastic syndrome
setting. So those patients who werereferred faster to a transplant center had better
outcomes, and a lot of thathas to do again with less exposure toxicity
(39:44):
so they could actually get the transplant, but also to capitalize on disease being
in remission because it's a finite periodof time before that disease no longer is
kept in check and in remission.So those are the two critical reasons for
earlier referral. So this would reallyhelp patients, right, especially if there
(40:05):
are potential candidates for a bone marrittransplant. This really emphasizes the role of
physicians to help patients as early aspossible. But even the role of patient
advocates is important, right, yeah, for sure. Now, one of
the complexities that you encounter is findinga match for all patients, and this
may include patients with differences in ethnicityand culture. But what about patients that
(40:28):
may be candidates but might be uninsuredor patients with low incomes. These patients
may have poor quality health care andseek health care less often, and when
they do seek health care, itis more likely to be for an emergency.
Right. These patients may not beable to afford certain treatments or their
insurance company may not cover those treatments. Other programs that can address this to
(40:50):
help patients to get treatments as earlyas possible. For sure, I'll touch
upon the NMDP, and then I'lltouch upon an initiative that we started.
The NMDP, through the generosity ofphilanthropic donors, has a foundation, and
again anybody can go to our websiteand if they're interested in terms of supporting
that effort, which provides patient financialassistance for those patients. And I mentioned
(41:15):
some of our support services in termsof patient navigation and education as well.
But fundamentally, Peter, this getsinto something that really has moved me over
the years in something that I'm reallyquite involved with now, and that is
healthcare disparities. And certainly there areothers who are involved in this field as
(41:37):
well. But when we think aboutthe United States of America again I talked
about this altruism in terms of becominga STEM cell donor, I think we
also need to have that altruism ofhelping out those who are less fortunate than
us. And there's lots of waysof doing this. But we know for
a fact that those ethnically diverse patients, they're under a represented in terms of
(42:00):
the population, but they're over representedin terms of poverty and uninsured status.
So therefore there are more persons ofcolor, particularly black and African Americans,
who don't have in health insurance,who are living at poverty. And when
we think about what that means,you know, there are roughly about three
(42:22):
hundred and thirty million people in theUnited States of America and in twenty twenty
one, they're about twelve percent wholived at or living at poverty levels and
about eight percent who didn't have healthinsurance. So doing the math on that,
it's about forty million people living inpoverty and about twenty seven million without
(42:44):
health insurance. So what is livingin poverty? You know, what does
that mean? Obviously we know whenwe see people living on the street that
that person's poor. But when welook at how our country is defining poor
people by their median income, thatnumber has to be double or triple of
forty million dollars. And for example, what I'm getting at is in twenty
(43:07):
twenty one, the poverty threshold forsomeone who is less than sixty five years
of age and lives in a twoperson and two children family is twenty seven
thousand, five hundred dollars. Imean, you know. So therefore,
if you're thirty thousand dollars in income, you weren't considered as part of that
(43:27):
forty million. So when we thinkabout that, that number now is staggering.
And we know that those persons whoget public health insurance, for example,
Medicaid, we know that though thatin and of itself is a poor
prognostic in terms of outcome for variousailments in medicine, but in particular for
(43:51):
example, stem cells transplant. Andit's not just being on medicaid, right,
it's what's this holistic theme called socialdeter termits of health, and that
is when a patient enters my office. In particular, seventy percent of their
health is determined outside of that medicalencounter. So things like socioeconomic factors,
(44:15):
physical environment, how they behave interms of their health, do they smoke
for example. Now, when weadd social determines of health on top of
a medical diagnosis, it's like adeluge of things that impact outcomes. And
so therefore I've had the privilege andpleasure to start an initiative called the Access
(44:40):
Initiative, and that is a collaborativewith the NMDP and the American Society of
Transplantation of Cell Therapy. So doctorStella Davies, who's a pediatric transplant physician
at Cincinnati Children's Medical Center and Iare the inaugural co chairs of this initiative.
And that initial initiative has at itsemission and vision to enhance access by
(45:05):
reducing barriers to stem cell transplant andcell therapy, and also to reduce health
care disparities, and really by focusingin on awareness of the problem poverty as
I just mentioned, and alshow racialinequity in terms of some of these examples.
So this is a ecosystem wide initiativeinvolving academic centers, transplants and celf
(45:28):
therapy, physicians, patient advocate organizations, pharmaceutical industry, and it's still at
its grassroots level, but you know, it started about a year ago.
But we have a website and apublication that people can can read if interested,
and we know that these are entrenchedproblems in our social system, so
(45:50):
it's going to take quite some timeto address them. But we had the
option to say it's someone else's problem, right, you know, it's Congress's
problem to enhance Medicaid coverage. It'syou know, the hospital's problem to give
more charity care. But we allneed to take that personal commitment and personal
responsibility that it's our problem in thiscountry and we have to take that amongst
(46:16):
ourselves and say we are a flickerof light, but together we are quite
the flame of change. And that'swhat we need to fundamentally do in the
United States of America. We needto reprioritize our resources into ourselves so that
these challenges which just aren't unique tostem cell transplant but are unique across lots
(46:38):
of different diagnoses. These things needa comprehensive collaborative approach in order to address
and to change over time. Inour journal Agrazine, we often publish articles
discussing disparities, and in this showwe also ask physicians about this. But
that seventy percent of a patient's healthis them but outside of a medical encounter,
(47:01):
outside of a medical consult with aphysician in the clinic, that really
stands out. But then we cando something about this, right, But
I understand that we can only dothis if we're willing to work together.
Only then we can be successful ineliminating the issues that you mentioned, right,
Yeah for sure. So when itcomes to research and transplant medicine,
(47:22):
the future may hold a lot ofgood news. There's a lot going on,
But equally important is and you mentionedthat earlier, is the fact that
everybody should be able to benefit fromthis approach and have access. Yeah for
sure, Doctor Jeffreyeletta, thank youso much for joining me today in the
Youngest in Brave. I think we'velearned a lot, but I'm sure that
(47:45):
we've only scratched the service of whatis important for sure, Preeter, and
thank you very much for having me. I just want to say in closing,
I can as stress how the worldtakes really from what really matters.
And with this profession, I've learnedso much and been privy to so many
(48:06):
different people and experiences, and Icould say that, you know, we
all have that opportunity of impact,right, I mean, I obviously as
a physician, I'm blessed to beable to do that at bedside, literally
laying my hands on someone else andhelping to make them better. But you
know, you don't have to bea physician or you know, a chief
(48:30):
scientific Director at the c IBMTR todo the same thing. And we all
have that ability to do something assimple as as swabbing our mouth to make
a difference in terms of someone's lifetime. So that hope, that four letter
word of hope is something that Ihope that this audience and can can message
(48:51):
to other people on the outside inorder to really make a difference in someone
else's life. Well, let's workon that. And again, doctor,
thank you so much for joining metoday. Great thanks, Peter. In
this episode of the Youngest in Brief, I spoke with doctor Jeffrey Aletta.
(49:12):
Doctor Aletta is Senior Vice President PatientOutcomes and Experience. He is also chief
Scientific Officer of the National marrow DonorProgram be the Match and the Center for
International Blood and Merit Transplant Research orCIBMTR. That's the Medical College of Wisconsin
and doctor Aletta is also Senior directorof the Center for International Blood and Merit
Transplant Research CRO Services. For moreinformation about becoming a donor, please visit
(49:38):
bedematch dot org Become a donor.For more information about the National myro Donor
Program, be the Match and theCenter for International Blood and Merit Transplant Research
or CIBMTR at the Medical College ofWisconsin, go to CIBMTR dot org.
For more information about the studies presentedin this program, please go to our
(50:00):
online journal on cousine at ongussine dotcom. I'm Peter Hoffland and this is
the Younger Say Brief for us hereat the Youngest In Brief, we want
to thank you, our listeners,sponsors and advertisers for your ongoing support.
Your support makes it possible that youcan hear this program via POX Public Radio
Change and in the United Kingdom andmainland Europe via UK Health Radio. And
(50:22):
you can also download our program viapodcast and stream media including iTunes, Spotify,
Audible, Stitcher, SoundCloud, andnearly anywhere you can find a podcast.
For more information about supporting or sponsoringthe onus In Brief, visit our
website at on Cousine at ongazine dotcom. If you're living in the United
States and want to receive our newsletter, text the words cancer to six six
(50:45):
eight sixty six, that is sixtysix eight sixty six and we will make
sure that you will receive our newsletter, which includes an overview of the latest
news in oncology and hematology. Thankyou all and thank you for listening,
and join us again for our nextepisode. I'm Peter Hoffland and this is
(51:05):
the Youngest in Brief. The OngazineBrief is a global medical educational service from
the publishers of Ongasine and ADC Review, the Journal of Antibody Drug Conjugates.
Support for the Ongazine Brief comes fromour commercial lenderwriters and advertisers, and the
(51:29):
listeners to this station. For moreinformation about advertising, underwriting and sponsoring options,
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Ongazine Brief contains health and medicine relatedinformation and is provided for educational and entertainment
purposes only. The content in thisprogram is not intended as a substitute for
(51:50):
professional medical or health advice, anddoes not replace your doctor's advice and guidance.
Your doctor is the best person toanswer questions about your personal health if
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