CONQUEST S U M M E R G
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It’s in your blood Patients count on life-sustaining donations
M I S S I O N The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
V I S I O N We shall be the premier cancer center in the world, based on the excellence of our people, our research-driven patient care and our science. We are Making Cancer History.
C O R E   VA L U E S Caring
By our words and actions, we create a caring environment for everyone.
Integrity
We work together to merit the trust of our colleagues and those we serve.
Discovery
We embrace creativity and seek new knowledge. On the Cover: In the family hammock in his backyard, leukemia patient Jeff Headley takes some time to enjoy his children (from left) Jordan, 5; Alyssa, 3; Justin, 8; and Jayden, 18 months. Â
Check out the Conquest Internet site at www.mdanderson.org/conquest
CONTENTS C O N Q U E S T
SUMMER 2008 F E AT U R E S
6 2 FRONTLINE Obesity Increases Risk of Cancers in Mice Empowering Natural Killer Cells
Preparing the Next Generation
Selecting and preparing the next generation of bright young scientists is a top priority for M. D. Anderson’s leaders as they strive to fulfill the institution’s research mission more rapidly.
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Symptom research
Honoring Sons, Recognizing Students
Bridging the Divide
Two grateful mothers team up to honor their sons, who were successfully
M. D. Anderson forms new research alliances
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Moving Forward Stacy Duff
Pediatric patient with large B-cell lymphoma dances into her future
treated for testicular cancer, while providing scholarships for graduate students to conduct promising research.
12 Targeting Cancer Before It Starts
With a deep, personal commitment to cancer prevention and risk assessment, the Dan Duncan family has given M. D. Anderson the largest gift ever received for its cancer prevention program and the second-largest gift in the institution’s 67-year history.
14 Roll Up a Sleeve to Give a Gift
Sgt. Jeff Headley, a veteran of the Houston Police Department, is just one of many patients who depend on M. D. Anderson’s Blood Bank.
CONQUEST SUMMER 2008
FRONTLINE Obesity Increases Risk of Cancers in Mice Evidence showing the benefits of calorie-restricting “Therefore, results of the epithelial skin cancer study diets builds as two teams of M. D. Anderson researchers discovered that low-fat and low-calorie diets in mice inhibited further development of precancerous growths in pancreatic and epithelial skin cancers.
Pancreatic Cancer Study “Our findings indicate that a restricted-calorie diet hinders development of pancreatic cancer, which could have implications for prevention and treatment of pancreatic tumors caused by chronic inflammation and obesity,” says senior author on the pancreatic study Stephen Hursting, Ph.D., professor in M. D. Anderson’s Department of Carcinogenesis and chair of the Division of Nutritional Sciences at The University of Texas at Austin. In the pancreatic cancer study, a special strain of mice was bred that spontaneously developed precancerous pancreatic lesions, says co-author Sue Fischer, M.D., professor in the Department of Carcinogenesis. Each mouse was fed one of the following diets: • A high calorie diet with 60 percent of calories from fat to produce obese mice; • A control diet with 10 percent of calories from fat to produce overweight mice; • A calorie-restricted diet with 30 percent fewer calories than control to produce lean mice. Mice receiving the calorie-restricted diet developed fewer and less severe pancreatic lesions after four months, while the mice on the obesity diet developed more severe lesions. Epithelial Cancer Study Epithelial cancers develop in the epithelium, the tissue that lines the surfaces and cavities of the body’s organs and account for 80 percent of all cancers.
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are broadly applicable to epithelial cancers in other tissues,” says John DiGiovanni, Ph.D., senior author on the skin cancer study and the director of M. D. Anderson’s Department of Carcinogenesis and the Science Park-Research Division in Smithville, Texas. Mice were given agents to make them develop papillomas (precancerous skin lesions) and were fed either a high-calorie diet, control diet or calorie-restricted diet. Mice on calorie-restricted diets formed significantly fewer papillomas than mice on the other diets. A separate study assessed the effects of these highand low-calorie diets on the development of papillomas, as well as the conversion of papillomas to squamous cell carcinomas (malignant skin cancers). It showed calorie intake affects the prevalence of papillomas, but it does not influence the rate at which papillomas become cancerous. Further research has identified two important signaling pathways within epithelial cells that mediate many of the effects of calorie restriction on tumor development. Joint Findings Previous research has suggested that a chronically positive energy balance (consuming more calories than are needed for the energy expended) can lead to obesity and increased risk of several cancers. On the other hand, DiGiovanni says, maintaining a negative balance (such as with a calorie-restricted diet) often decreases cancer risk. Hursting states that the impact of calorie intake on pancreatic cancer has not been well studied, and the mechanisms underlying the calorie-cancer connection are unknown. The findings of both studies provide the basis for additional research regarding the prevention of tumors caused by cancers related to diet and obesity. — Scott Merville
A team led by Chris Amos, Ph.D., and Margaret Spitz, M.D., has identified specific genes that increase lung cancer risk and which may explain how smoking and genetic factors interact to cause the disease.
John DiGiovanni, Ph.D., director of the Department of Carcinogenesis and of M. D. Anderson’s Science Park-Research Division, and graduate student Tricia Moore found that a calorie-restricted diet reduced precancerous skin lesions in mice. They also learned that calorie restriction inhibits two molecular pathways involved in tumor development. 3
CONQUEST SUMMER 2008
FRONTLINE Empowering Natural Killer Cells Killer Cells and Through mice and tissue studies, M. D. Anderson Natural Epigenetic Drugs researchers are discovering new ways to empower natural killer cells to fight leukemia, osteosarcoma and neuroblastoma, according to two presentations at the American Society of Pediatric Hematology/Oncology annual conference in May.
Umbilical Cord Blood and Leukemia Two clinicians have found a novel process that increases the number of NK cells in an umbilical cord and effectively uses them to kill human leukemia cells in mice. When given to mice with aggressive human leukemias, these NK cells reduced the circulating human acute lymphocytic leukemia and acute myelogenous leukemia cells by 60 percent to 85 percent. “Cord blood is a promising source of NK cells because they have enhanced sensitivity to stimulation, decreased potential to cause graft-versus-host disease and are available from cord banks throughout the country and world,” says Patrick Zweidler-McKay, M.D., Ph.D., assistant professor in the Division of Pediatrics from the Children’s Cancer Hospital at M. D. Anderson, who made the discovery along with co-investigator Elizabeth Shpall, M.D., professor in M. D. Anderson’s Department of Stem Cell Transplantation and Cellular Therapy. Graft-versus-host disease is a common side effect of patients receiving stem cell transplants, which results when the T cells in the transplanted blood react against the patient’s own cells. This disease can become fatal if it’s unable to be controlled. NK cells operate differently from T cells, leaving normal cells alone while targeting and killing the cancerous cells. Once the NK cells are put through this novel process, they can be transplanted to patients without prior chemotherapy. Zweidler-McKay predicts this type of transplant could be used for adults who have already had a transplant or for those adult and pediatric patients who aren’t candidates for other stem cell transplants due to blood counts or illness.
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A combination therapy has the potential to treat different types of childhood cancer, including osteosarcoma, certain leukemias and neuroblastoma, while possibly sparing young patients from more difficult therapies such as stem cell transplant or more toxic chemotherapy. Dean Lee, M.D., Ph.D., assistant professor in the Division of Pediatrics from the Children’s Cancer Hospital, has found that combining the epigenetic drug MS-275 with NK cells makes osteosarcoma cells more sensitive to NK cells while making the NK cells more lethal to the tumor. Though a rare pediatric cancer, osteosarcoma is the most common bone cancer found in children. “Traditional chemotherapy drugs kill any fast-growing cells like cancer, but they also kill healthy fast-growing cells like hair, bone marrow and mucous membranes, making the drugs very toxic,” says Lee, senior investigator on the study. “There’s a new class of drugs that takes cells that aren’t properly regulated and makes them behave. In our study, we found that these drugs make tumor cells more recognizable and vulnerable to natural killer cells.” The study also found similar responses from acute myelogenous leukemia and neuroblastoma, by combining NK with different inhibitors, NPI-0052 and Bortezomib. Additional research is being conducted on acute lymphocytic leukemia, the most common cancer in children, and medulloblastoma, the most common brain cancer in children. Lee hopes these findings will lead to a clinical trial for patients. “By applying what we’ve found from our study, we hope to improve our treatment for many cancers, but not by giving more NK cells or more toxic chemotherapy,” Lee says. “Instead, we want to marry the two therapies to improve each other and provide a more effective, less toxic treatment for our patients.” Funding for the study came from M. D. Anderson and the For Julie Foundation. — Sara Farris
Patrick Zweidler-McKay, M.D., Ph.D., and his colleagues are researching new ways to harness cells to target pediatric leukemia without harmful side effects, such as graft-versus-host disease. 5
Preparing the Next Generation by Mary Jane Schier
Recruiting and training the best graduate students to fulfill M. D. Anderson’s research mission more rapidly is a top priority for institutional leaders. “Nothing is more important than selecting and preparing the next generation of bright young scientists who will take advantage of the exciting opportunities emerging in cancer research,” notes Raymond DuBois, M.D., Ph.D., provost and executive vice president. Soon after assuming his position in June 2007, DuBois named a nine-member Graduate Education Committee to focus on enhancing recruitment of top-tier graduate students, reviewing academic standards and increasing faculty participation in graduate mentoring activities. The panel has evaluated all aspects of graduate education and recommended several ways for M. D. Anderson to be even more competitive globally in recruiting and teaching students interested in biomedical science careers. “We want to raise the bar in both the quality and scope of educational experiences for our students and our outstanding faculty. There is no greater need than having a passionate mentor or any greater reward than being one,” DuBois says.
Raising Awareness of Advanced Degrees As a part of The University of Texas System, M. D. Anderson has provided professional and public education programs that for many years have taught how to reduce the burden of cancer for people around the world. Its faculty and facilities have supplied substantial support to help train students at the UT Graduate School of Biomedical Sciences since the school started in 1963. The state’s Education Code was changed a few years ago to allow M. D. Anderson to award both undergraduate and advanced degrees. Beginning in 2002, the institution first shared in conferring doctor of philosophy and master of science degrees to students enrolled at GSBS, which it operates jointly with the UT Health Science Center at Houston. GSBS offices, classrooms and a student computer laboratory are located in M. D. Anderson’s George and Cynthia Mitchell Basic Sciences Research Building. “Since GSBS is a partnership between the two UT institutions, potential students may have some difficulty identifying specific research opportunities at M. D. Anderson. In fact, while we are well known as one of the top cancer centers in the world, few applicants to graduate school seem aware that we offer advanced degrees in biomedical research,” explains Gary Gallick, Ph.D., professor in the Department of Cancer Biology and chair of the Graduate Education Committee.
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[ Graduate Education ]
Michelle Barton, Ph.D., welcomes German college students (from left) Lena Haust, Hertlein Gillian, Katharina Genreith and Maria Boehme. They spent 10 weeks learning about research in M. D. Anderson laboratories.
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At its initial meeting, the committee decided that revamping the M. D. Anderson Internet site was crucial to help interested students learn about the institution and the large number of faculty conducting research. “We worked with our Internet support group to get a graduate research banner posted on the homepage with quicker links to describe M. D. Anderson and what our teaching faculty can offer students, plus a better link to the GSBS site,” says Stephanie Watowich, Ph.D., associate professor in the Department of Immunology and committee vice chair. Committee members also cited the need for sustained stipend support for graduate students, suggested numerous steps to recruit outstanding students and stressed that faculty should be recognized for their educational contributions. GSBS Dean George Stancel, Ph.D., a member of the Graduate Education Committee, says 486 degree-seeking students were enrolled as of mid-summer and about 100 new students are expected in September. The 580 graduate school faculty include 357 M. D. Anderson faculty members.
Expanding International Exchange Efforts One of the early Graduate Education Committee proposals now implemented involves a summer exchange program for promising international undergraduate students to learn about research opportunities at M. D. Anderson. Committee member Michelle Barton, Ph.D., associate professor in the Department of Biochemistry and Molecular Biology, coordinated planning for four German students who arrived in mid-June to spend 10 weeks in laboratories where faculty are conducting research in fields they are considering. She worked with Wolfgang Hillen, Ph.D., who chairs the Department of Molecular Microbiology at the University of Erlangen-Nurenberg, to select three students from that school and another one from the University of Heidelberg. “Many M. D. Anderson faculty have hosted students from other countries Raymond DuBois, M.D., Ph.D. on an informal basis. I hope our efforts with these four students will lead to more dedicated exchange programs. While showing visiting students how we conduct cancer research, I know many of our graduate students would enjoy spending time in some of our international colleagues’ laboratories,” Barton says. Barton, who joined M. D. Anderson in 2000, recalls wonderful mentors who helped chart her career and says she thrives on her own teaching activities. She also confides, “I learn new things every day from our students.” She credits John Latham, the GSBS student representative on the Graduate Education Committee, with “terrific suggestions” for communicating better with undergraduates who could be recruited. “College students live such different lives today. John is helping us understand how to reach them through creative weblinks, chat rooms, Facebook and other methods. We’re planning for future recruitment using these newer web-based tools,” Barton says. As M. D. Anderson expands its network of international sister institutions, more students are expected to be interested in exchange program opportunities.
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[ Graduate Education ]
Finding Sources of Support One continuing problem for all teaching activities, but especially graduate training, is a shortage of sustained support for students and faculty alike. “Graduate education represents a long-term investment. Our committee has recommended ways to assure M. D. Anderson will be more competitive in recruiting and preparing the best students,” says Watowich, who directs the Graduate Program in Immunology and serves on the GSBS Executive Committee. As a result of the Graduate Education Committee’s analysis, institutional funds have been increased to provide graduate students with stipends for their first two years. “Such stipends offer more security to students while they learn the ropes and decide on research to pursue. In the past, funds supported stipends for about 40 students for less than a year, after which our faculty who accept students must pay stipends from their research grants. However, with cutbacks in federal funds for many grants, we are all challenged to support our students,” Gallick says. Additional committee recommendations that DuBois says likely will be implemented include supplemental funds for graduate program directors, special education awards, support for as many as 15 faculty who provide exemplary training, and financial incentives for faculty to participate in educational activities at all levels. “I am extremely pleased with how rapidly the committee has proposed workable solutions for some big dilemmas and suggested how faculty can be more involved in aggressive student recruitment. We are working on plans to promote our graduate opportunities and also planning a campaign to raise up to $25 million in donor funds that would create an endowment for graduate education activities,” DuBois says. Other committee ideas being implemented include asking more faculty to contact their former undergraduate teachers and advisers as well as research peers at academic institutions in many countries. Several faculty leaders also have begun promoting M. D. Anderson’s graduate training through professional organizations and at conferences. “There’s nothing like personal contact to tell what M. D. Anderson has to offer in graduate research opportunities for our future scientists,” Gallick emphasizes.
Stephanie Watowich, Ph.D., and Gary Gallick, Ph.D., review updated Internet site information about graduate training opportunities.
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[ Graduate Education ]
Honoring Sons, Recognizing Students The gratitude of two Houston mothers, whose sons were successfully treated for testicular cancer, sparked an endowment that has raised $850,000 to help more than 50 graduate students conduct promising research, supervised by M. D. Anderson scientists.
by Mary Jane Schier
Their rationale: “There can be no answers without research, and there can be no research without funds to support dedicated scientists. The determination of those committed to the defeat of this dread disease will continue to inspire all of us …” When they formed the Andrew Sowell-Wade Huggins Endowed Scholarship Fund in 1991, Joann Sowell and Marcia Huggins Jahncke wanted to honor their sons and recognize students pursuing degrees at The University of Texas Graduate School of Biomedical Sciences. Five years later, they created Cancer Answers, a charitable organization that now includes scholarships in memory of KHOU-TV newsman Sylvan Rodriguez, who died in 2000 from pancreatic cancer. Since 2002, four sets of M. D. Anderson faculty and their graduate students have jointly received awards through the umbrella of Cancer Answers.
“Being chosen an Andrew Sowell-Wade Huggins Scholar allowed me to complete a research project and strengthen my thesis,” says Brian Grabiner, who studies how a newly characterized protein may contribute to breast cancer development and lead to targeted therapies. Growing up in Buffalo, N.Y., Grabiner was encouraged to excel by parents who have doctorate degrees in sociology. After starting graduate school at State University of New York, he met Xin Lin, Ph.D., who had received his Ph.D. from GSBS in 1995. When Lin was recruited in 2004 to M. D. Anderson as an associate professor in the Department of Molecular and Cellular Oncology, Grabiner transferred to GSBS. “Dr. Lin is a great mentor. He has taught me so much more than all the fundamental methods needed to conduct research,” says Grabiner, who recently defended his thesis and will receive his Ph.D. this summer. In September, he begins a postdoctoral fellowship at the Whitehead Institute at MIT in Boston. Grabiner credits his grandfather, an engineer who died from bladder cancer, and cancer patients he has seen almost every day at M. D. Anderson with “inspiring me to work harder on research that can help save lives.”
Brian Grabiner (right) with Xin Lin, Ph.D. 10
Claudia Miller also is following in the footsteps of mentor Joya Chandra, Ph.D., an assistant professor in the Division of Pediatrics, who received a SowellHuggins Scholarship before earning her Ph.D. from GSBS in 1998. After postdoctoral fellowships at the Karolinska Institute and the Mayo Clinic, Chandra joined the M. D. Anderson faculty in 2002. “Claudia was my first graduate student here, so I feel like a proud parent about her success,” she says. “I’ve always been interested in science,” says Miller, whose father is a high school physics teacher in Brownsville, Texas. She received her master’s degree from GSBS in 2003 with Janet Price, D.Phil., associate professor in the Department of Cancer Biology at M. D. Anderson, as her adviser. Since working in Chandra’s laboratory, Miller has concentrated on translational research aimed at reducing the toxicity of leukemia drugs and designing better methods to increase survival. Receiving a Cancer Answers/Sylvan Rodriguez Scholarship was “very special because it recognizes both my research efforts and my community service in promoting science education in local schools,” says Miller, who anticipates getting her Ph.D. next year.
Claudia Miller (seated) and Joya Chandra, Ph.D.
Nicole Pinaire was considering several offers to play semiprofessional softball but chose cancer research instead. “I was passionate about softball, played in college at St. Louis University and also in Europe,” Pinaire remembers. “However, I was also fascinated with science.” After learning about M. D. Anderson’s partnership in operating GSBS, she enrolled in the graduate school in 2003 and later asked Timothy McDonnell, M.D., Ph.D., to be her mentor. McDonnell, who came to M. D. Anderson in 1991, is a professor and deputy chair of the Department of Hematopathology. He has been widely honored for research to define the molecular genetic alterations that cumulatively result in cancer formation and tumor progression. In addition to having taught several courses at GSBS, he also has directed 11 students who have completed advanced degrees. The two were selected as the 2007-2008 Sowell-Huggins Professor and Fellow in recognition of their research and McDonnell’s devotion to mentoring. “I am studying two genes that are impacted by the tumor suppressor gene p53, which is mutated in at least 25 percent of advanced prostate cancers. Because p53 is the gatekeeper gene that controls so many other genes, it is important to understand the mutations much earlier in the disease so we can develop ways to prevent its metastasis,” explains Pinaire, who hopes to receive her Ph.D. in 2009. “We are both grateful to the families of the two young men successfully treated for cancer,” McDonnell says. “It’s wonderful that they wanted to support research that will continue making a difference in the lives of patients around the world.” Timothy McDonnell, M.D., Ph.D., with Nicole Pinaire
Postscript
Wade Huggins owns a custom cabinetry company in Austin, Texas, where he lives with his wife, Amy, and three children. Andy Sowell is a commercial real estate broker who lives with his wife, Sherra, and two children in the Houston home where he grew up. Both men are active board members for Cancer Answers. 11
The Dan L. Duncan Family Takes Aim at Cancer Before It Starts
by DeDe DeStefano
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$35 Million Gift to M. D. Anderson Establishes the Dan Duncan Family Institute for Cancer Prevention and Risk Assessment
n an effort to prevent cancer in millions of people who might one day be diagnosed with it, the Dan L. Duncan Family Foundation has given M. D. Anderson $35 million to establish the Dan Duncan Family Institute for Cancer Prevention and Risk Assessment. The gift is the institution’s largest to the cancer prevention program and the second-largest gift in its 67-year history. At a press conference announcing the gift in M. D. Anderson’s Cancer Prevention Building, Jan Duncan expressed her family’s desire to see the disease prevented. “Our family’s personal experiences, coupled with the tragic loss of lives each day from the disease, has inspired us to make medical research, treatment and prevention a key component of our giving,” she says. “God has blessed us in many ways and He has given us the responsibility of using the gifts He has given us
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to help others. Our family can think of no greater joy than to be a part of preventing the pain, as well as the emotional, financial and physical challenges of this horrible disease.” The Duncan family’s gift will be used to mitigate cancer risk in individuals who might be at higher risk for developing the disease by assessing genetic risk factors and lifestyle habits, and then recommending a course of action for them. The Duncan family’s support also will enable M. D. Anderson to study the incidence and determinants of cancer in medically underserved and minority communities. A major element of the Duncan Family Institute will address cancer-related behavioral and genetic risk factors in medically underserved communities to better develop cancer prevention strategies and ultimately reduce cancer-related deaths in this rapidly growing segment of our population.
The gift also will allow M. D. Anderson to recruit additional researchers and clinicians to implement new or enhance current prevention programs and examine the effects of behavior and lifestyle choices on developing cancer. “Jan and Dan Duncan and their family are well known for their phenomenal efforts to eradicate a disease that affects millions of people,” says M. D. Anderson President John Mendelsohn, M.D. “We are extraordinarily grateful to them for teaming with M. D. Anderson to continue to pioneer new prevention methods. Their support will save countless people the pain and challenge of fighting cancer and will provide them the priceless gift of more time with their friends and family.”
Many Disciplines: One Target The Duncan Family Institute will be directed by Ernest Hawk, M.D., vice president for prevention and head of M. D. Anderson’s Division of Cancer Prevention and Population Sciences. It will bring research and experts together from many disciplines, including epidemiologists, behavioral scientists, biochemists, molecular biologists, computer and information scientists, clinical scientists and others to leverage and amplify the discoveries of each investigator and laboratory. The Duncan Family Institute will collaborate in related research with Baylor
From left: Dan Duncan, Jan Duncan, M. D. Anderson President John Mendelsohn, M.D., and State Rep. Ellen Cohen, representing Houston Mayor Bill White, admire a document proclaiming “Duncan Family Day” in honor of the Duncans’ generous gift. College of Medicine, Texas Children’s Hospital and other Houston institutions. “This is indeed an exceptionally generous gift, and we are humbled by the honor that the Duncan family has bestowed upon us. We are grateful for the trust it represents. And we’re
particularly in tune to the responsibility that it engenders,” Hawk says. “They have made a wise investment in my view. Cancer prevention is an area in desperate need. M. D. Anderson is an institution that’s known for world-class treatment, and this gift will help us to similarly be known for cancer prevention. Already in a research setting you see evidence of that, but we hope to disseminate that into the practicing care setting as well. “Every cancer patient has typically three realms of questions when they’re diagnosed,” Hawk continues. “The first is, ‘What does this mean for me?’ The second often is, ‘What does this mean for my family?’ That’s where prevention can play a very important role in providing answers to that question. And third, ‘How can I help others to ensure that they don’t follow the path that I’m on?’ That sort of intrinsic altruism is what brings us to work every day, what makes prevention terribly relevant.”
Philanthropy and Volunteering a Family Tradition Dan Duncan and his family have long supported M. D. Anderson through financial gifts and volunteer activities. Daughter Randa Duncan Williams has served on the University Cancer Foundation Board of Visitors since 2006 and is a former member of M. D Anderson’s Advance Team. “The Duncan family is proud of its long-standing relationship with M. D. Anderson, which is recognized the world over for its groundbreaking achievements in the fight against cancer,” Dan Duncan says. “With these additional resources, the talented doctors, researchers, administrators and employees of M. D. Anderson are poised to extend the institution’s tradition of innovative advances to the field of prevention, hopefully sparing future generations the ordeal of cancer treatment.” In a flat climate of federal funding, philanthropic gifts are increasingly important to help fund underserved areas, bridge the gap between grants and provide the seed money necessary to successfully compete for federal funding. “The Duncan family has supported M. D. Anderson for more than 25 years. Their unwavering commitment to the institution is helping us to continue to deliver the best possible outcome for our patients, who are the common denominator in all that we do,” says Patrick Mulvey, vice president for Development. “Their support throughout the years has provided our researchers the resources they’ve needed to successfully To learn more about the compete for grants and has helped move Duncans’ gift and view video of the event, go to findings into the clinics quickly. Through Conquest online at their generosity, lives will be touched for www.mdanderson.org/conquest. decades to come.”
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Roll Up a Sleeve to Give a Gift
by Julie Penne
Blood Bank Thinks Creatively to Meet Growing Patient Needs or platelets to ensure the best outcome,” says Jorge Cortes, M.D., professor in the Department of Leukemia and chair of M. D. Anderson’s Transfusion Committee. “Unlike saline or potassium, we cannot simply manufacture or order more units at will. With blood and platelets, we need human beings to come in and give so our patients can have what they need for a chance to survive. It is crucial to have the supply on hand every day.” Other patients with solid tumors may require between 15 and 60 units of blood for complex operations that involve multiple surgical teams. Still other patients receiving chemotherapy as treatment for a range of cancers may become anemic and require transfusions to rebound their blood counts and allow them to finish their full course at the optimal dosage. It is this innovative medical and supportive care and surgical expertise that makes the institution an international magnet for cancer care, and it also makes M. D. Anderson the nation’s — if not the world’s — largest transfusion hospital.
The legendary Blue Wall is alive — and pumping. For Sgt. Jeff Headley, a veteran of the Houston Police Department diagnosed with chronic myelogenous leukemia in 2005, backup from hundreds of his brothers and sisters in law enforcement has come in the form of donated platelets and whole blood units rather than assistance at a crime scene or on a call. While he’s used to getting and giving that kind of selfless support on the streets of Houston, Headley knows that for now he, along with hundreds of fellow patients, need their help with blood and platelet donations to keep a steady supply in the M. D. Anderson Blood Bank. The 34-year-old husband and father of four has relied on blood and platelet transfusions from the day after his bone marrow transplant in April 2008. Since then, Headley has returned almost weekly for blood and platelet infusions to keep his blood counts steady and his recovery on track. Were he on the giving side rather than the receiving end of this scenario, there is no doubt that he would be organizing the police department’s next blood drives. “Leukemia is a humbling and pride-plucking experience, but the support of the police department and everyone who gave blood and platelets in my name sustains me physically and emotionally,” says the broad-shouldered cop with the easy smile. “My family and I could only hope for such support for every other patient who comes through these doors.”
Need Always Crucial Patients like Headley, who have leukemia and have undergone bone marrow transplants, may require up to 400 units of whole blood and platelets during the course of their treatment. New targeted therapies and refined transplants, while often effective as treatment for leukemia, lymphoma, myelodysplastic syndrome, myeloma and anemia, also have tremendously increased the need for blood products. “M. D. Anderson has a very large leukemia service and, at some point in treatment, every patient with acute leukemia will require blood See more of Jeff Headley’s story in Conquest online at www.mdanderson.org/conquest. 14
Drug Coverage Affects Blood Needs The last calendar year, M. D. Anderson transfused more than 160,000 units of blood. This year, that number may reach 170,000 and continue to go up. Blood Bank officials estimate the number of transfusions in the coming years could hit the 200,000 unit mark, especially when the expansion of the Albert B. and Margaret M. Alkek Hospital nears completion in 2011 with nearly 200 beds added, to be followed by another 200 new beds in 2013. In addition to increasing internal needs, external forces come into play as well. Last year, the Centers for Medicare and Medicaid Services ruled that it will not cover epoetin-alfa injection drugs to fight chemotherapy-induced anemia, except in very specific instances. Commonly known as Procrit and Epogen, these drugs have been administered to patients who needed assistance to build red blood cells. With the decision, patients are now given more blood transfusions rather than being saddled with a hefty bill at the pharmacy.
“Donating blood should be viewed as a community responsibility, like inoculating children, paying taxes, observing the rules of the road. Someday, it may be your loved one who needs a transfusion. Think now about paying it forward.” — Kathleen Sazama, M.D., J.D., professor in the Department of Laboratory Medicine and president of the Society for the Advancement of Blood Management
Shelly Grogin Schultz, who oversees the Neighbors in Need program, visits with patients and families every day about the tremendous need for blood products at M. D. Anderson and helps identify their champions who could sponsor a community blood drive.
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Roll Up a Sleeve to Give a Gift
“Transfusion medicine should be regarded as the fourth element of cancer treatment, alongside surgery, chemotherapy and radiation oncology,” says Benjamin Lichtiger, M.D., Ph.D., chair of the Department of Laboratory Medicine and medical director of the Blood Bank for the past 35 years. “Blood and platelets are vital to making these therapies effective for patients, and we must think of this supply like we do electricity: Every time we walk into the room and flip on the switch, the power is there. We’re continually thinking about how to ensure a proper and safe supply of blood and platelets for our patients.”
Shopping for Blood a Challenge But while the demand for blood is massive and constant, the supply often can be short and sporadic. Six months into 2008, M. D. Anderson’s Blood Bank has collected on site about 35,000 units — a little more than 20 percent of the total number of units transfused — leaving the center to shop for the remainder of the needed units at some 40 other blood collection centers in Texas and the United States. “Availability of blood products is our number one issue, and we continually look for new ways to recruit donors,” says Gary Griffin, manager of the M. D. Anderson Blood Bank. “Our goal is to have a three-day supply of blood on our shelves, but it is typically a 1 ½-day to two-day supply. We look for every opportunity to expand our donor base so we can keep our supply steady.” Griffin adds that the Blood Bank often experiences seasonal ebbs and flows, with donations down in the summer because of vacations. Likewise, there may be an increase in donations in the fall because high schools and colleges are back in session with blood drives, and families resume their routines. This summer, the Blood Bank reported an even greater deficit with floods in the Midwest and an early summer shortage of blood in the Northeast.
Neighbors in Need Early last summer, due to major blood shortages nationwide, M. D. Anderson was forced to cancel 22 surgeries in a twoweek period. It was during the time of this drastic move that an innovative new idea took hold, one that has not only brought in thousands of units of blood but also opened doors to new resources “People who are hesitant for blood. about donating blood need Known as the Neighbors to think about all that our in Need program, it consists of patients are going through trained staff from the Blood Bank every day. They need our who make daily visits to patients in help and donating blood is leukemia, lymphoma, bone mar- a way to help.” row transplant inpatient units and Jorge Cortes, M.D., clinics, as well as to patients who professor, Department are scheduled for surgeries. In each of Leukemia. case, they discuss the importance and urgency of blood products and how each might be able to contribute to keeping a strong supply on hand. While it can sometimes be a tough conversation to have with a patient and family who are facing so many other issues, Shelly Grogin Schultz, who oversees Neighbors in Need, has found that often people simply want to be asked to help. In his 35 years at M. D. Anderson, Benjamin Lichtiger, M.D., Ph.D., medical director of the Blood Bank, has seen the need for blood steadily increase, and he is confident that the need will continue to grow in the coming years. 16
“Of course, patients are never required to host a blood drive or commit to bringing in a specific number of units, but we talk about who among their support team might be willing to sponsor a blood drive,” Schultz says. “For patients who are from out of town, we contact their local blood collection center, and for our local patients, M. D. Anderson can do the drive. We ask for contact names of someone who will sponsor the drive, whether it be the patient’s church, union, school, employer, civic organization or neighborhood, and then we follow up and do the work to organize the drive.” As a result of the Neighbors in Need program, more than 700 leukemia and surgical patients have been contacted. From those contacts, 40 drives have been conducted by the M. D. Anderson Blood Bank and 76 drives sponsored by other blood centers beyond the Houston area. Houston-based “It is our responsibility to seek drives have yielded about 1,000 out every possible source for units and another 1,000 have blood for our patients.” been brought in from blood centers outside of Houston. Gary Griffin, manager, “Since Neighbors in Need M. D. Anderson Blood Bank started, we have not cancelled any surgeries,” Schultz says. “This is a terrific way for friends and family members to get involved and do something for their loved ones. Patients always hear people ask what they can do for them and giving blood is one of those heroic deeds. Plus, so many patients benefit.”
Taking Care of Inventory In addition to finding creative ways to recruit donors, M. D. Anderson also continually looks for new ways to safeguard and maximize the precious supply. As a result of a number of quality initiatives, the Blood Bank discards only one-tenth of one percent of blood units collected. It also provides the freshest blood to patients with each unit sitting on the shelf no more than four to five days while the national maximum allowed is 42 days, Lichtiger says. Platelets often are infused in patients the day after collection. M. D. Anderson’s Transfusion Subcommittee, a group mandated by the Joint Commission, comprises representatives from the departments of Anesthesiology, Stem Cell Transplantation and Cellular Therapy, Surgical Oncology and Ambulatory Treatment Centers, as well as the divisions of Nursing and Pharmacy, who meet regularly to review guidelines and protocols for transfusion. The guidelines were developed about 12 years ago but are frequently reviewed to take into account new therapies and research.
Every morning, Gary Griffin, manager of M. D. Anderson’s Blood Bank, gathers his team to take count of the blood products on hand, donation and drive appointments scheduled, surgeries and transfusions planned and, then, begins calling blood banks across the nation to make sure the supply is there for patients’ needs. According to Lichtiger, the guidelines are “quite flexible and liberal,” taking into account a patient’s overall condition. “While each transfusion must meet pre-set medical criteria so we can justify the use of a unit of blood, we work with each physician to look at the overall health condition of the patient,” Lichtiger says. “The Blood Bank permeates every practice, every service at M. D. Anderson, and we collaborate every day with physicians to do what is right for patients. That is what donors should think about as they give: Each of them directly impacts a patient.”
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Bridging the Divide
A New Dawn for Cancer Research With two out of three adult cancer patients surviving their disease, researchers are finding they need to widen their focus beyond effective, lifesaving treatments. Surviving with poor quality of life and heavy symptom burden is increasingly unacceptable in a world in which 22.4 million people have survived cancer.
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by Sandi Stromberg
Patrick Dougherty, Ph.D., is searching for a better understanding of the biologic mechanisms that cause peripheral nerve damage.
Fatigue, cognitive deficit, sleep disturbance and neuropathic pain are just some of the side effects with which survivors must deal. Yet, historically, there has been little research to understand the biologic mechanisms that cause them, the patients who are most susceptible to developing them or what kind of interventions might alleviate them. “The problem is that many areas of importance to patients, especially side effects, have not been funded by the National Cancer Institute or the National Institutes of Health,� says Charles Cleeland, Ph.D., chair of the Department of Symptom Research at M. D. Anderson.
Paving way for new studies This situation has brought about new opportunities for cancer research: a recent alliance between a pharmaceutical company, AstraZeneca, and a research-oriented cancer center, M. D. Anderson, in which “the design of these studies has been a true collaborative effort,” says Cleeland, who is co-principal investigator on this multifaceted study. In the best of all worlds, these two entities would have joined hands long ago and worked in tandem to study and discover new treatments for cancer and the side effects of its treatments. However, collaborations between for-profit companies and non-profit institutions usually brought up the potential for conflict of interest.
So what has changed? “Today, in the face of limited federal funding and squeezes on the NIH’s budget, research grants, especially in the area of reducing or preventing symptoms, are harder to obtain than ever before. Collaborating with AstraZeneca allows us to continue working toward helping our patients. But rest assured, M. D. Anderson and The University of Texas System have put extensive safeguards and conflict-of-interest policies and committees in place to help carefully cultivate relationships with the pharmaceutical industry,” Cleeland says. “The development of strategic alliance relationships, such as this one between M. D. Anderson and AstraZeneca, also helps to combine the unique strengths of both partners to more effectively bring the newest drugs to patients faster,” says Robert Bast Jr., M.D., vice president of translational research at M. D. Anderson, who was instrumental in establishing the initial alliance to accelerate the evaluation and approval of anti-cancer drugs in 2006. “This research can now be extended to finding more effective supportive care for cancer patients and individuals dealing with the side effects of cancer,” Bob Holland, vice president for neuroscience at AstraZeneca agrees. “We are excited to begin this collaboration with M. D. Anderson, which is at the forefront of discovering new ways of assessing and addressing pain symptoms associated with cancer treatment. We hope the insights we gain from this alliance will ultimately lead to new treatment options that will improve the quality of life for cancer patients.”
thalidomide and bortezomib. If two or more of these agents are given in combination, the toxicity and potential for nerve damage increases. “For up to 40 percent of patients who experience this distressing problem, it may limit the amount of chemotherapy he or she can receive, and become a chronic pain problem for some smaller percent of those patients,” says Allen Burton, M.D., professor and clinical medical director of M. D. Anderson’s Pain Management Center. Together, he and Patrick Dougherty, Ph.D., professor in the Department of Anesthesiology and Pain Medicine, hope to identify neurobiologic differences between cancer patients who develop neuropathy and those who have little or no pain. This could give them a better understanding of the biologic mechanisms that cause this peripheral nerve damage, then help them design appropriate interventions. “If we can limit toxic effects on the nervous system and thereby give full chemotherapy regimens, we may increase a patient’s survival, and hopefully also eliminate the long-term chronic symptoms that survivors deal with,” say Dougherty, co-principal investigator with Cleeland on these studies.
Reducing the symptom burden “We are hopeful that the knowledge gained from this collaboration will enable us to design and validate new pain research models that can then be used to effectively test novel therapies in a preclinical setting,” says Andy Dray, chief scientist in the CNS and Pain Research Area at AstraZeneca. While this research could lead to new treatments to prevent pain and thereby extend the therapeutic value of current chemotherapies, it also could help in the development of new chemotherapies with less severe, pain-related side effects. Other parts of the project will study such treatment-related symptoms as cognitive deficit, fatigue and sleep disturbance, and explore potential common biologic mechanisms that may underlie these distressing symptoms. “Our collaboration with AstraZeneca presents a unique opportunity to study ways of making cancer therapy much more tolerable,” Cleeland says. “Our overarching goal is to reduce the symptom burden of survivorship.”
Filling a critical need One of the foremost side effects to be studied under the terms of this agreement is chemotherapy-induced neuropathy, a common problem for patients receiving certain kinds of chemotherapy, such as paclitaxel, docetaxel, cisplatin, oxaliplatin, vincristine,
In the fall issue, the series continues with the testing of new approaches to controlling multiple treatment-related symptoms.
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Moving Forward: Stacy Duff by Gail Goodwin
The going got really tough in 2005 for Stacy Duff and her family. Stacy’s dad was called to serve in Iraq. The family’s home burned to the ground. Then in February 2006, Stacy was diagnosed with large B-cell lymphoma.
Moira and husband Jas Podgurski
Any of these circumstances would be enough to bring most
This busy young woman enjoys drawing, shopping and spending
families to their knees, but the Duffs handled it all with aplomb.
time with her family and friends. Obviously a talented artist, Stacy
Now, two years later, the family is at home together in a new
has four pieces of art in M. D. Anderson’s Children’s Art Project
house, and Stacy, age 19, has completed her cancer treatment and
2008 Holiday Collection. “Mr. Claus,” “Nativity” and “Stocking”
is studying business management at the University of Houston-
are all greeting cards with related products based on the designs,
Downtown.
and her “Lamb” is the “L” in the Alphabet Train book.
Another byproduct of her cancer treatment came when Stacy’s
Stacy’s talents don’t end with art. She is light on her feet —
wish was granted by the Make-A-Wish Foundation. A limosine
she loves dancing and ice skating — and in addition to a brain
drive to a pet store, a shopping cart full of dog necessities and Darla,
for business, she has an eye for fashion. Stacy has an idea about
a silky terrier, were all included in the wish — and now the Duffs
how to combine these talents, too. With ambitions to own an art
are a family of five.
gallery, she wants to have her own clothing line for women, men and children of all sizes. Oh, and she has set her sights on “at least one” Oscar.
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The University of Texas System Board of Regents
affiliations
H. Scott Caven, Jr., Houston Chair
Centro Oncológico M. D. Anderson International España, Madrid, Spain
Vice Chair
M. D. Anderson Clinical Care Center in the Bay Area
James Richard Huffines, Austin Robert B. Rowling, Dallas Vice Chair
John W. Barnhill, Jr., Brenham James D. Dannenbaum, Houston Paul Foster, El Paso Printice L. Gary, Dallas Janiece M. Longoria, Houston Colleen McHugh, Corpus Christi Benjamin L. Dower, Dallas Student Regent
Francie A. Frederick General Counsel
The University of Texas System Administration
Kenneth I. Shine, M.D. Chancellor Ad Interim
The University of Texas M. D. Anderson Cancer Center EXECUTIVE COMMITTEE
John Mendelsohn, M.D. President
Thomas W. Burke, M.D.
Executive Vice President and Physician-in-Chief
Raymond N. DuBois, M.D., Ph.D. Provost and Executive Vice President
M. D. Anderson Cancer Center Orlando, Orlando, Florida
M. D. Anderson Radiation Treatment Centers in Bellaire, Fort Bend, Katy and The Woodlands, Texas; and Albuquerque, N.M. Christus Spohn Stem Cell Program affiliated with M. D. Anderson Cancer Center Outreach, Corpus Christi, Texas Conquest is published quarterly by The University Cancer Foundation Board of Visitors on behalf of The University of Texas M. D. Anderson Cancer Center. All correspondence should be addressed to the Division of Public Affairs -Unit 229, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, 713-792-0658. E-mail: sfstromb@mdanderson.org. Articles and photos may be reprinted with permission.
Stephen C. Stuyck, Vice President for Public Affairs Sarah Palmer, Associate Vice President for Communications Executive Editor: David Berkowitz, Director of Publications and Creative Services Managing Editor: Sandi Stromberg, Program Manager of External Publications Writers: DeDe DeStefano, Sara Farris, Gail Goodwin, Scott Merville, Julie Penne, Mary Jane Schier, Sandi Stromberg Designer: Michael Clarke Photographers: John Everett (pages 12, 13), Kevin McGowan (page 20), Ricardo Merendoni (pages 7, 9,), Wyatt McSpadden (pages 3, 5, 10, 11, 15, 16, 17, 18), F. Carter Smith (cover, table of contents, page 8)
Leon J. Leach
Executive Vice President
The University Cancer Foundation Board of Visitors OFFICERS
Ernest H. Cockrell Chair
Marc J. Shapiro
For information on supporting programs at M. D. Anderson Cancer Center, please contact Patrick B. Mulvey, Vice President for Development, 713-792-3450, or log on to the Development Office Internet site at www.mdanderson.org/gifts. For information on patient services at M. D. Anderson, call askMDAnderson at 1-877-MDA-6789, or log on to www.mdanderson.org/ask
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