'This is an extremely exciting period for the development of new treatments for leukaemia. As a result of research during the past 30 years, our understanding of the molecular and biological basis of leukaemia has developed enormously. This means that we can now tailor new drugs to target abnormalities in a more effective way, attacking the tumour without damaging the tissue. We can now treat many people in this way as outpatients, rather than having to admit them to hospital for complex, invasive therapies.
The Leukaemia Centre enables patients to have access to new therapies in a carefully controlled clinical environment. There is an enormous amount of potential for the development and improvement of therapies which can be unlocked by working more closely with the pharmaceutical and biochemical industries.'
Professor Charles Craddock, Professor of Haemato-oncology
Over the last ten years Birmingham has become established as a Centre of Excellence for the treatment of leukaemia. By working together scientists at the University of Birmingham and clinicians at the Queen Elizabeth Hospital (which is run by the University Hospital Birmingham NHS Foundation Trust) have made a major contribution to the international drive to improve the prospects for patients with leukaemia.
The University Hospital Birmingham in conjunction with the University of Birmingham, now has a very successful translational research programme. This ranges from basic laboratory research to the trialling of new drugs within the context of clinical studies. Patients in the Leukaemia Centre currently contribute to both of these areas of research. This will be added to by collaborating hospitals (see under Patient Care).
In conjunction with colleagues at Birmingham Children’s Hospital the Leukaemia Centre have published research outlining the way aspects of the immune system affect the success of stem cell transplants for leukaemia. Currently one of the world leaders in this particular field, this is one of the reasons the new haematology centre is aligned to those in New York and Paris in leading the way in the areas of new drugs, treatment and therapies.
We have a track record in introducing novel therapies early on in their development, always within the context of clinical trials. Examples of such agents include Imatinib (now an established therapy for chronic myeloid leukaemia), Dasatinib (also for chronic myeloid leukaemia and some forms of acute leukaemia) and Bortezomib (for the treatment of myeloma).
Our current portfolio of clinical trials include a phase II study of combined azacytidine and sodium valproate in older patients with acute myeloid leukaemia (AML) and are not fit for standard therapy. Another is a study of Imatinib therapy in the post stem cell transplant setting in the attempt to reduce relapse rates. This is the first time a tyrosine kinase inhibitor has ever been used in conjunction with a reduced intensity allograph and provides an important model for the combined use of immunotherapy and targeted therapies.
Based on the success of this we have initiated a new international competitive transplant studies using adjunctive treatment with Azacytidine for patients undergoing transplants with AML and lenalidomide for patients with Myeloma. The success of this model has led to the development of two new stem cell transplant studies using maintenance therapies of Azacytidine for patients with AML and lenalidomide for patients with Myeloma.
Working alongside the Institute of Cancer Studies, we have developed a new strategy for treating patients who have Cytomegalovirus (CMV) post transplant. CMV is common and relatively unproblematic in healthy people but is potentially lethal in immune compromised people particularly post transplant, current antiviral therapies are both toxic and expensive and require long term hospitalization. We have run two world first studies harvesting CMV immune cells from the transplant donor and giving them to the patient (adoptive immunotherapy) this process takes one day and has not been associated with any side effects. We are now in the process of setting up a larger randomized study to ascertain the efficacy of using this strategy.
We are supporting a study run by the University of Southampton using radio-labelled monoclonal antibodies as part of the conditioning regime prior to transplant. This strategy is used instead of standard total body irradiation, it allows an increased dose of radiation which targets the bone marrow and hence the patient’s disease site and eliminates the dose of radiation to other organs.
We are also involved with research projects working with the Institute of Cancer Studies, University Hospital Birmingham. These studies involve blood sample collection from patients, these samples are then studied in the attempt to ascertain causative factors of disease and potential targets for treatment such as adoptive immunotherapy and vaccine therapy.
Leukaemia, in all its forms, is one of the commonest cancers. Whilst real progress has been made in the treatment of childhood leukaemia there still remain major challenges in providing curative therapies in the majority of adults. There is therefore an urgent clinical need to develop new and more effective treatments for adults with leukaemia. Over the last 30 years there has been real progress in understanding the process by which leukaemia develops. This information has been used to develop new drug and transplant therapies which specifically target leukaemic cells sparing healthy ones. These new treatments are not only remarkably effective but also free of many of the side-effects associated with conventional chemotherapy. The challenge for the next decade is to extend the curative potential of these “magic bullets” to all patients with leukaemia.
Within the Leukaemia Centre itself approximately 300 patients are seen in the Haematology clinics every week. Patients suffer from malignant diseases of the Haematopoietic (blood-forming) system. These diseases include leukaemia (in all its forms), lymphoma, multiple myeloma, myelodysplastic syndromes, as well as other less common disorders. Typically, patients attend every three to four weeks but it can be as often as three times per week. Because of the debilitating nature of leukaemia and it’s treatments patients can experience tiredness, loss of energy and have a reduced immune system leaving them susceptible to illness and infection. Some patients, therefore, will not feel able to travel to the new Leukaemia Centre to take part in clinical trials and new drugs treatments. Cure Leukaemia is starting to fund haematology research nurses in other Midlands hospitals which will give all patients the same opportunities in addition to our research programmes being extended.
Some Leukaemia Facts
■ 25,000 new cases of leukaemia or related disorders develop every year in the United Kingdom.
■ Approximately 7,000 adults in the West Midlands currently have leukaemia.
■ The chance of developing leukaemia increases with age and it is especially common in adults.
■ Chemotherapy and stem cell transplantation has the capacity to cure a growing number of adults but curative treatments are still not available for many patients.
■ New treatments for adult leukaemia are becoming available. A recently developed drug, Imatinib (Glivec) designed to inhibit the abnormal gene which causes chronic myeloid leukaemia has been remarkably successful and is associated with few of the side-effects of chemotherapy. This breakthrough serves as a model of how future drugs can be targeted against other forms of leukaemia for which effective treatments do not currently exist.
■ Stem cell transplants are highly effective treatments for many patients with leukaemia but can only be safely used in younger patients because of their side-effects. Recent work from a number of centres across the world has shown that it is now possible to transplant older patients.
Ground-breaking work in Birmingham is developing new approaches by which transplants can be delivered more safely so that more patients with leukaemia can benefit from their curative potential.
Patient Profile - Introducing Pete Warren
37 year old Pete Warren was diagnosed with Leukaemia in the summer of 2003. He has been treated by leukaemia consultants at both the Walsgrave Hospital in Coventry and the Leukaemia Centre in Birmingham. Pete has offered to share his story in the hope that it may help others. No names or details have been changed in the following text – this is reality.
'I was first diagnosed with Leukaemia in the summer of 2003. I didn’t know what the heck it was and didn’t even know how to spell it! I was treated at Coventry using chemotherapy which got me into remission. I went back to work and got married, went travelling, but to cut a long story short in the summer of 2006, I was told that the chemo that got me into remission had also damaged my own bone marrow. The only option was a bone marrow transplant.
After a long search a perfect match was found. My donor was to be a woman from America. This was my first introduction to the Leukaemia Centre at the Queen Elizabeth Hospital in Birmingham & the Bone Marrow Transplant team. After a couple of weeks of conditioning, which involves very strong chemotherapy & radiation treatment to kill off your own bone marrow, I had a stem cell transplant in October 2006 from my very unselfish and kind donor. I stayed in for another 3 weeks then went home so the stem cells could make themselves at home in me!
Then in November 2006 I developed a cough which turned out to be a form of pneumonia from a virus in the graft. I was admitted to the intensive care unit where without sounding dramatic my life was literally hanging in the balance! It was thanks to Professor Charlie Craddock, his excellent team and the regime of drugs that Cure Leukaemia has researched & provide, that I managed to get through it & get home again.
After that I had many frequent trips over to the Leukaemia Centre 3 or 4 times a week while they were monitoring me closely. I was lucky in that I started visiting outpatients when the new clinic had just opened. Although it is obviously a place you don’t want to be, the surroundings are pleasant and comfortable and as relaxed as they can be in the circumstances.
The staff and counsellors have managed to put me back together both physically and emotionally and I see myself as one of the lucky ones who survived and made it through this traumatic and life changing journey. There are many who didn’t.'
'Thank you for your time in reading my story. Pete.'