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Nebraska Medicine and Children’s Earn Accreditation for Joint Adult Congenital Heart Disease (ACHD) Program

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Program is One of the First in the U.S. to Earn ACHA Accreditation

In recognition of its expertise in serving adults with congenital heart disease (CHD), Nebraska Medicine and Children Hospital & Medical Center’s joint Adult Congenital Heart Disease program has received accreditation from the Adult Congenital Heart Association (ACHA), a nationwide organization focused on connecting patients, family members and healthcare providers to form a community of support and network of experts with knowledge of CHD.

Individuals with CHD, the most common birth defect diagnosed in one in 100 births, are living longer. There are now 1.4 million adults in the U.S. living with one of the many different types of congenital heart defects that range from simple to complex. The Nebraska Medicine/Children’s program annually treats around 1,500 ACHD patients from across the region at both institutions.

“Already home to Nebraska’s only board certified experts in ACHD, the program is now one of the country’s first to be nationally accredited in comprehensive care,” says cardiologist and congenital heart disease specialist Shane F. Tsai, M.D., the program’s medical director. “This distinction reflects our ability to provide extraordinary multidisciplinary services, and patients can feel confident that they are receiving the highest quality of care in the region.”


Shane Tsai, MD
The joint program received accreditation by meeting ACHA’s criteria, which includes medical services and personnel requirements, and going through a rigorous accreditation process, both of which were developed over a number of years through a collaboration with doctors, physician assistants, nurse practitioners, nurses and ACHD patients.

“This accreditation recognizes not only that we provide exceptional cardiac care, but also comprehensive expertise and support for ACHD patients at every stage,” explains pediatric and adult congenital cardiologist Jon Cramer, M.D. “We offer care for a teen’s transition to adult care, a pregnant patient in need of increased monitoring, unique OB/GYN care, specialized anesthesia services and all aspects of cardiac treatment and intervention. The ACHA acknowledges that this breadth of services leads to better patient outcomes and experiences.”

Ten (10) additional centers have earned the ACHA ACHD Accredited Comprehensive Care Center designation:

Ahmanson/UCLA Adult Congenital Heart Disease Center (Los Angeles, CA)

Adult Congenital Heart Program, Stanford University (Palo Alto, CA)

Adult Congenital Heart Disease Clinic at the University of Colorado Hospital (Denver, CO)

Boston Adult Congenital Heart (BACH) and Pulmonary Hypertension Program (Boston, MA)

University of Michigan Adult Congenital Heart Program (Ann Arbor, MI)

Washington University Adult Congenital Heart Disease Program (St. Louis, MO)

Cincinnati Children’s Adult Congenital Heart Disease Program (CCHMC) (Cincinnati, OH)

COACH: Columbus Ohio Adult Congenital Heart Disease & Pulmonary Hypertension Program (Columbus, Ohio)

Adult Congenital Heart Disease Program at University of Washington & Seattle Children’s Hospital (Seattle, WA)

Providence Adult and Teen Congenital Heart Program (PATCH) (Spokane, WA)

“There are now more adults than children in the U.S. with CHD,” says Mark Roeder, president and CEO of ACHA. “Accreditation will elevate the standard of care and have a positive impact on the futures of those living with this disease. Coordination of care is key, and this accreditation program will make care more streamlined for ACHD patients, improving their quality of life.”

Celebrating Elite National Quality Award, Again

Excellence Award from Vizient, Inc. for Quality Leadership Performance

Nebraska Medical Center is again honored to announce its recognition by Vizient, Inc., as a recipient of the 2017 Bernard A. Birnbaum, MD, Quality Leadership Award. The award recognizes Nebraska Medical Center for demonstrating superior quality and safety performance among more than 100 academic medical centers taking part in Vizient’s Quality and Accountability Study. Only twelve academic medical centers in the United States were recognized this year. Nebraska Medical Center is ranked eleventh and is the only health system in the region to earn this recognition.

“At Nebraska Medicine, the safety of our patients and the quality of care we provide to them comes above everything else,” says CEO Dan DeBehnke, MD, MBA. “To be recognized for something this important and for something we’re continually trying to improve upon validates the effort we’ve been making. Everyone who works here should be extremely proud of this honor, especially earning it for a second straight year.”


12 in the nation. Only 1 in Nebraska. National Leaders in Quality and Safety.*

This year, 107 academic medical centers and 161 community hospitals were included in the study. The study measured performance based on the Institute of Medicine’s six domains of care: safety, timeliness, effectiveness, efficiency, equity and patient centeredness. The composite scoring system uses patient-level performance data from a variety of sources, including the Vizient Clinical Data Base, the Vizient Core Measures Data Base, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

Nebraska Medicine – Bellevue also earned a spot on the community hospitals list, checking in at twelfth.

“The entire Nebraska Medicine system strives to provide our patients with the highest quality, safest, most efficient and compassionate care available,” says Michael Ash, MD, chief transformation officer. “Earning this Vizient Quality Leadership Award alongside other elite national academic medical centers shows just how devoted everyone who works here is to providing serious medicine and extraordinary care every day.”

Here is the list of academic medical centers honored with the 2017 Bernard A. Birnbaum, MD, Quality Leadership Award:
Mayo Clinic Hospital – Rochester
NYU Langone Health
Froedtert & the Medical College of Wisconsin- Froedtert Hospital
Rush University Medical Center
Penn State Health Milton S. Hershey Medical Center
University of Utah Health
UCHealth University of Colorado Hospital
Lehigh Valley Health Network
University of Texas Medical Branch at Galveston
The University of Kansas Hospital
Nebraska Medicine
Oregon Health & Science University Hospital (OHSU)

Dr. Wisecarver elected president of ASCP


James Wisecarver, M.D., Ph.D.

James Wisecarver, M.D., Ph.D., has been elected president of the American Society for Clinical Pathology (ASCP). Dr. Wisecarver, who will serve a one-year term, assumed the presidency at the ASCP annual meeting held Sept. 6-8 in Chicago.

Dr. Wisecarver serves as the vice chair for clinical affairs for the UNMC Department of Pathology/Microbiology and director of the Human DNA Identification Laboratory at UNMC. He also serves as medical director of the clinical laboratories at UNMC’s clinical partner, Nebraska Medicine.

Dr. Wisecarver received his medical degree from UNMC in 1986 and a doctorate in physiology from Creighton University in 1978. He completed a residency in combined anatomic and clinical pathology at UNMC and then joined the department of pathology and microbiology in 1990.

His involvement in ASCP has included serving on the Council on Continuing Education, and later on the board of governors of the ASCP Board of Registry (now Board of Certification).
While serving on the board, he helped organize a new examination committee to develop the molecular biology examination and the associated credential that is now being offered through the

ASCP Board of Certification. He also organized and presented molecular diagnostics workshops offered through ASCP and the United States and Canadian Association of Pathology.

“Dr. Wisecarver’s strategies for optimizing laboratory test utilization are recognized nationally,” said Steven Hinrichs, M.D., the Stokes-Shackelford Professor of Pathology and Chair at UNMC. “We are extremely fortunate to have Dr. Wisecarver as a member of our faculty and his expertise in laboratory science is reflected in the high quality of our services.”

Revolutionary Cancer Care that’s the Right Care for Your Patient

When you have a patient who has been diagnosed with cancer, you want to make sure he or she is not only receiving the best and most cutting-edge care, but also the right care. Roger Belohlavy is a case in point.

Belohlavy was critically ill. All treatments for his acute lymphoblastic leukemia had failed. Until he came to Nebraska Medicine. The therapy he received here is one of the most cutting-edge treatments now available to fight his type of cancer.

Belohlavy qualified for a clinical trial using an immunotherapy called CAR T-cell therapy. The treatment targets cancer cells by homing in on specific molecular changes seen primarily in those cells and then engineering a patient’s own immune cells to recognize and attack the cancer. The therapy saved Belohlavy’s life. Twenty-eight days after the infusion, Belohlavy was declared cancer-free.

The development of new cutting-edge cancer treatments like immunotherapy is just one of the many treatments the specialists and researchers at Nebraska Medicine are developing to win the battle against cancer. Personalized cancer therapies based on a person’s DNA also are play a growing role in diagnosis and treatment and Nebraska Medicine researchers and clinicians are at the forefront of these advances bringing the latest clinical trials and breakthroughs to our patients.

Nebraska Medicine provides the most comprehensive cancer care in the region using the most advanced and innovative treatments. It is one of only sixty nine National Cancer Institute (NCI)-designated cancer centers in the United States. NCI-designated Cancer Centers are recognized for their scientific excellence and commitment to cancer treatment and research that focuses on the development of more effective approaches to cancer prevention, diagnosis and therapy.

Patients come from across the state and around the world to see many of the internationally renowned cancer specialists at Nebraska Medicine, many of whom have dedicated training in specialty areas of cancer. This includes areas such as breast cancer, lymphoma and leukemia, multiple myeloma, ovarian and cervical cancer and thyroid cancer. This ensures our patients receive the most advanced and up-to-date care and treatment.

Nebraska Medicine is also making cancer care more personal and accessible than ever with cancer clinics available at Bellevue, Village Pointe and Nebraska Medical Center.

Our new multidisciplinary breast cancer clinic at Village Pointe streamlines appointments for the patient and brings a multidisciplinary team of breast cancer experts together to provide a comprehensive approach to cancer care based on a woman’s personal preferences. The clinic is also one of a few health care centers in the region offering cutting-edge 3-D mammography that can increase detection rates by 40 percent and reduce callback rates by 20 to 40 percent.

Opening this spring on the Nebraska Medical Center campus, is the Fred & Pamela Buffett Cancer Center. The Fred & Pamela Buffett Cancer Center will integrate high-tech clinical medicine with research to accelerate new therapies for patients. Scientists and clinicians will be working together in one building as a team to collaborate on the development of new cancer treatments.

“Our goal is to be a national leader in cancer research and clinical care and one of the leading cancer centers in the country,” says Ken Cowan, MD, PhD, director of the Fred & Pamela Buffett Cancer Center. “We’re not content with just being a part of these exciting developments in cancer care, we want to be pioneering and leading these new advances.”

Nebraska Medicine Earns Elite National Quality Award

Excellence Award from Vizient, Inc. for Quality Leadership Performance

Nebraska Medicine is honored to announce its recognition by Vizient, Inc., as a recipient of the 2016 Bernard A. Birnbaum, MD Quality Leadership Award. The award recognizes Nebraska Medicine’s performance among more than 100 academic medical centers participating in Vizient’s Quality and Accountability Study. Thirteen academic medical centers were recognized this year.  Nebraska Medicine is ranked tenth and is the only health system in the region to earn this recognition. The others are:

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  1. University of Utah Hospitals and Clinics
  2. NYU Langone Medical Center
  3. Mayo Clinic Hospital-Rochester
  4. Froedtert Health-Froedtert Hospital
  5. Rush University Medical Center
  6. WVU Medicine West Virginia University Hospitals
  7. Penn State Milton S. Hershey Medical Center
  8. Cedars-Sinai Health System
  9. Houston Methodist
  10. Nebraska Medicine
  11. The Ohio State University Wexner Health System
  12. University of Michigan Hospitals and Health Centers
  13. University of Vermont Medical Center
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“This is truly a special honor for everyone at Nebraska Medicine,” said Dan DeBehnke, MD, MBA, CEO of Nebraska Medicine. “Achieving a Five Star ranking took a tremendous amount of dedication and work from many, many people here.”

This year, more than 100 academic medical centers and 124 community hospitals were included in the study, which reviewed performance data from a variety of sources, including Vizient’s Clinical Data Base, the core measures data base, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

“Nebraska Medicine is dedicated to providing our patients with the highest quality, safest, most efficient and compassionate care available,” said Michael Ash, MD, Chief Transformation Officer, “To achieve a top ten Vizient Quality Leadership rank, among our nation’s elite academic medical centers, is a reflection of our colleagues and their devotion to extraordinary patient care.”

Study aims to improve pancreatic cancer therapies

Image with caption: Pankaj Singh, Ph.D.

Pankaj Singh, Ph.D.

Pankaj Singh, Ph.D., professor in the Eppley Institute for Research in Cancer and Allied Diseases, is the corresponding author of a paper published this month in the journal “Cancer Cell.”Dr. Singh’s paper, “MUC1 and HIF-1alpha Signaling Crosstalk Induces Anabolic Glucose Metabolism to Impart Gemcitabine Resistance to Pancreatic Cancer,” is visible on the journal’s website until Aug. 29.

This is the first study published in the journal that originated from UNMC. “Cancer Cell” is a top-tier journal in the field of cancer research with a 27-impact factor.

Pancreatic cancer strikes more than 53,000 people in the U.S. each year. The one-year survival rate of people with pancreatic cancer who do not have surgery is 29 percent and the five-year survival rate is 7 percent.

Poor survival in pancreatic cancer is due in part to modest response to the existing therapies. Current therapies include mimetics of nucleosides, which get modified and make DNA.

One such mimetic is gemcitabine, which has been used as a therapy, alone or in combination with other drugs, for decades. Studies from Dr. Singh’s lab establish a novel, widely-prevalent mechanism describing how cancer cells respond poorly to therapy by developing resistance.

Resistance to gemcitabine is mediated by a protein called Hypoxia-Inducible Factor1 (HIF1) alpha that changes how cancer cells take up nutrients and increase the levels of nucleosides in cancer cells. Such increased levels of nucleosides dilute the therapy levels in cancer cells and tumors respond poorly.

The recent study in “Cancer Cell” demonstrates that combining gemcitabine with other therapeutic treatments, specifically digoxin or Leflunomide, will decrease resistance to therapy in pancreatic cancer patients. Additionally, imaging for sugar uptake by tumors also demonstrates that pancreatic tumors with high sugar uptake respond poorly to chemotherapies and perhaps would benefit from the novel combination therapies tested in the manuscript in pre-clinical models.

In addition, the manuscript was selected as the issue highlight and received a special commentary from Chi Van Dang, M.D., Ph.D., an eminent scientist in the field of cancer biology.

“The published studies were truly inter- and intra-institutional collaborative studies and would not have been feasible without contributions from each of the basic and clinical investigators who are coauthors on the paper,” Dr. Singh said. “I really appreciate the supportive research environment at the Fred & Pamela Buffett Cancer Center, especially the Specialized Program of Research Excellence (SPORE) leadership by Dr. Tony Hollingsworth and overall support by Dr. Ken Cowan.”

The research also highlights the role of MUC1 mucin protein in causing therapy resistance in pancreatic tumors. An array of technological platforms, such as mass spectrometry-based steady-state metabolomics and kinetic flux metabolomics of stable isotopes, patient-derived xenografts, and CRISPR techniques, which are routine in the lab, were utilized in these studies.

This research was supported by a grant through the American Association for Cancer Research (AACR) and the Pancreatic Cancer Action Network (PanCAN) as well as multiple National Cancer Institute grants.

Glaucoma breakthrough featured in journal Stem Cells

by Lisa Spellman, UNMC public relations

Image with caption: Postdoctoral scholar Pooja Teotia, Ph.D., and Iqbal Ahmad, Ph.D., a professor in the department of ophthalmology and visual sciences.

Postdoctoral scholar Pooja Teotia, Ph.D., and Iqbal Ahmad, Ph.D., a professor in the department of ophthalmology and visual sciences.

A UNMC researcher has discovered that a common form of glaucoma that strikes adults may have early origin.The discovery, which is detailed in the August 9 issue of the journal Stem Cells, could result in earlier diagnosis and treatment of the disease that is the second leading cause of irreversible blindness and affects more than 3 million people in the United States and 60 million people worldwide.

Thanking the team

“The success of the project is greatly owed to the dedication and hard work of Pooja Teotia, Ph.D., a postdoctoral scholar in my lab and we are excited as she moves on to the next challenge to correct the RGC defect in the dish.” Dr. Ahmad said. “We also are thankful to Rand Alligham, M.D., of the Duke Eye Center at the Duke University School of Medicine in Durham, N.C., for providing blood samples; and Mathew Van Hook, Ph.D., an assistant professor in the department of ophthalmology and visual sciences at UNMC, for helping with functional analysis of the cells.”

Iqbal Ahmad, Ph.D., a professor in the department of ophthalmology and visual sciences at UNMC, led the team of investigators. He has spent more than a decade studying the stem cell approach to understand and treat glaucoma, which is called a silent robber of vision because it strikes without warning or any noticeable symptoms.

“There are several forms of glaucoma but all have two things in common – the progressive degeneration of retinal ganglion cells (RGCs) and the irreversible loss of vision,” Dr. Ahmad said.

The primary function of RGCs is to tell the brain through a series of synapses and connections what the eye sees, he said. Without RGCs, there is no perception of vision.

Since glaucoma is generally a late onset disease and RGCs are formed during gestation, Dr. Ahmad’s team had to find a way to study the degeneration process, which they hypothesized was because of a developmental abnormality.

Using blood from patients carrying a specific gene variation and also suffering from primary open angle glaucoma (POAG), one of the more common forms of the disease, Dr. Ahmad and his team created a pluripotent stem cell-based model of POAG to understand why and how RGCs degenerate.

Dr. Ahmad’s team was able to show that RGCs from POAG patients were different from those generated from healthy donors.

“They were developmentally abnormal in form, function and gene expression,” he said, adding that knowing the molecular basis of the defect and its biomarkers will allow early diagnosis and treatment.

“We are excited, as it is an important first step toward early diagnosis and treatment of this debilitating disease,” Dr. Ahmad said.

Shane Havens, M.D., a glaucoma specialist at UNMC’s Truhlsen Eye Institute, said, “Dr. Ahmad’s work could help us better understand the pathophysiology of degenerative conditions and in turn, reveal new treatment targets and cell replacement therapies.”

Treatment of Acute Stroke with IV tPA

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Marco Gonzalez-Castellon, MD

Every year, more than 800,000 people have a stroke. Stroke is the number one cause of non-traumatic long term disability in the United States. Ischemic stroke is a treatable condition. Since 1996, there has been a specific treatment for acute ischemic stroke.

Recombinant tissue plasminogen activator (rt-PA) was approved by the Food and Drug Administration (FDA) for treatment of acute ischemic stroke. Recombinant tissue plasminogen activator is a potent blood thinner that reestablishes blood flow by dissolving blood clots blocking cerebral blood vessels. Reestablishing blood flow reduces stoke size improving the chances for recovery. The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA study showed that treated patients were at least 30 percent more likely to have minimal or no disability after three months. Since rt-PA is a potent blood thinner, there is risk of cerebral hemorrhage, however this complication was only seen in 6 percent of patients.

Treatment with IV rt-PA is time dependent and is more effective if its given within the first hours. Eligible patients must be treated within 4 ½ hours form symptoms onset to minimize complications. Best results are achieved in patients treated early; therefore it is vital to recognize the symptoms of stroke and call EMS.

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The devastating effects of a stroke can be reduced if treatment is started right away.

Signs of a Stroke
The devastating effects of a stroke can be reduced if treatment is started right away. F.A.S.T is an easy way to remember the sudden signs of a stroke. If you suspect someone is having a stroke, call 911 for help right away.

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?

Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?

Time to call 911 – If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

2017 Update on Evolving Therapies for Multiple Myeloma and AL Amyloidosis

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Muhamed Baljevic, MD

A number of targeted immune therapies and small molecules are emerging as potential candidates with tremendous potential for the treatment of multiple myeloma and AL amyloidosis. With different strategies designed to either harness the power of our own immune system in the fight against cancer, or to target molecules found in myeloma or amyloidosis that play a role in cellular transport proteins or cell death, stronger and deeper responses are being achieved.

In a previous blog post, we have heard about several new drugs that are showing very promising activity in multiple myeloma. Now, more studies are confirming and updating their valuable role in the treatment of the same patients:

Selinexor which is a novel, first-in-class small molecule drug that inhibits exportin 1 is involved in nuclear transport. This oral drug is taken 1-2 times per week, and has strong antimyeloma effects. Previous combination with low-dose dexamethasone showed activity in heavily pretreated refractory multiple myeloma. Importantly, response rates were similar in the overall population and in patients with high-risk cytogenetic abnormalities, with adverse events, which were manageable with dose interruptions, dose reductions and supportive care. Expanding on this experience, recent combinations that added other myeloma drugs such as pomalidomide, bortezomib  or lenalidomide to this combination showed significant responses in all treatment combinations, and  in heavily pretreated patients with high risk features such as del17p and/or prior refractoriness to other standard rugs such as bortezomib. Importantly, these newer combinations were well tolerated.

Venetoclax is a drug that affects cell death pathways associated with CBL2 molecule. The overall response rate in patients with high BCL2 expression was 88 percent, with longer time to progression achieved in those expressing the protein strongly. This is particularly useful as we may be able to use BCL2 as a selective marker of higher response in patients. Response rates were even higher in patients who are not refractory to bortezomib and those who received only 1-3 prior types of therapy.

Pembrolizumab which is an immune checkpoint inhibitor showed significant effect in combination with pomalidomide with previously heavily treated myeloma patients. More recent studies have combined this drug with other myeloma drugs such as Lenalidomide, and showed overall response rate of 50 percent, with 15 percent achieving ≥ 90 percent reduction in myeloma disease burden.

 

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Before (left) and after (right) PET scans of a patient with multiple myeloma treated with BCMA-targeted CAR T-cells. Photo credit: National Cancer Institute

CAR T-cells are highly exciting and rapidly emerging form of therapy for many cancer types, multiple myeloma included. CAR T-cells work by recognizing targets on cancer cells, and those that have been engineered to target B-cell maturation protein (BMCA) on myeloma cells are of particular importance, as this protein is expressed most uniformly on myeloma cells, and not normal cells. Previously encouraging results in myeloma have been upstaged by an even bigger news of response in 33 of 35 patients (94 percent) with relapsed or refractory multiple myeloma, who  experienced clinical remission after treatment with CAR T-cells targeting BCMA. Substantial but reversible toxicity was comparable to that observed in previous CAR T-cell studies. In a follow up of an earlier reported first-in-human multicenter study of bb2121 anti-BCMA CAR T cell therapy for relapsed/refractory multiple myeloma, 100 percent of patients showed response. It must be noted that the experience and expertise with CAR T-cell therapy in multiple myeloma is still limited, and further larger studies will be needed to confirm safety and utility of this immune therapy in multiple myeloma.

While an ongoing work has surely expanded our understanding and proficiency in using the therapies previously introduced, myeloma and amyloidosis community is working hard on bringing novel treatment modalities to the clinical arena, where many patients have already benefited from their efficacy. Few of the notable mentions include:

Subcutaneous Therapy with Daratumumab

Daratumumab is a monoclonal antibody that targets CD38 protein on myeloma cells. This drug has been a block-buster in myeloma treatment arsenal since it’s early days by showing very strong activity on its own in heavily pretreated myeloma patients. This efficacy has been enhanced in combination therapies with other myeloma drugs such as pomalidomide, bortezomib  or lenalidomide . A major challenge in its widespread use however has been intravenous mode of infusion requiring long-infusion visits due to possible allergic reactions. However, a new strategy to administer daratumumab as subcutaneous therapy may make daratumumab available to wider patient populations. The phase Ib study included 53 patients with relapsed/refractory multiple myeloma who received subcutaneous daratumumab. The overall response rate for one group of treated patents was 38 percent, including 13 percent with high degree responses where reduction in myeloma was ≥ 90 percent. One quarter of patients had infusion-related reaction, which occurred during the first 4 hours of infusion, without severe reactions noted. This is a significant improvement from 50 percent infusion-related reaction rate expected and observed previously with intravenous mode of delivery.

Radium-223 Dichloride

This is an alpha particle-radiation-emitting compound that has strong additive effects when combined with bortezomib. A phase 1b/2 trial is evaluating the safety and efficacy of radium-223 dichloride in combination with bortezomib and dexamethasone in early relapsed multiple myeloma.

NEOD001 Monoclonal Antibody

Amyloidosis is the general term used to describe extracellular deposition in body tissues of small fibril portions of a variety of proteins, as they circulate in human plasma. These deposits may result in a wide range of organ dysfunctions depending upon their type, location, and the amount of deposition. Traditional treatment for amyloidosis involves the use of chemotherapy directed at the plasma cells responsible for the production of amyloid protein. This unfortunately does nothing for already deposited amyloid by the time diagnosis is established. NEOD001 is a monoclonal antibody that specifically targets amyloid fibrils, assisting in their dissolution from the tissues where they deposited. First-in-human phase I/II study of NEOD001 evaluated this therapy in 27 patients with AL amyloidosis who competed chemotherapy, but had persistent organ dysfunction that remained. Time to response was very fast, within 2-4 months. In 14 patients with heart amyloid involvement, 57 percent responded and 43 percent had stable disease, while in 15 kidney-amyloid patients, 60 percent responded and 40 percent had stable disease. This therapy is likely to transform our ability to effectively manage amyloidosis, as it was also demonstrated hat the effectiveness of it was not related to the depth of response to prior chemotherapy, nor the time passed since last chemotherapy before the delivery of NEOD001.

Robotic Thyroid Surgery Doesn’t Leave a Visible Scar

We’re One of a Few Academic Medical Centers Offering Robotic Thyroidectomies

Katie O’Callaghan was working the checkout line at her parents’ grocery store in Hastings, Nebraska, when a customer noticed a lump on O’Callaghan’s neck. The 24 year old, who was four months pregnant with her first child, brought it up at her next OB/GYN appointment. A biopsy later revealed she had thyroid cancer.

Estelle Chang, MD.

Estelle Chang, MD

“I couldn’t believe it,” says O’Callaghan. “Being pregnant with my first child was intimidating enough, let alone discovering I had cancer.”

Wanting a second opinion, O’Callaghan was referred to Estelle Chang, MD, an otolaryngology head and neck surgeon at Nebraska Medicine, who completed a six-month Advanced Robotic Head and Neck Endocrine Surgery Fellowship at Severance Hospital of the Yonsei University Health System in Seoul, South Korea. During her fellowship, Dr. Chang studied the latest, minimally invasive, thyroid and parathyroid surgery techniques.

“Traditionally, thyroidectomy has been performed using a 4 to 8 centimeter incision in the front of the neck, which can leave a visible scar,” explains Dr. Chang. “Robotic thyroidectomy is a minimally invasive surgical technique that is used to remove all or part of a thyroid gland without leaving a visible scar. This is the future and we should be at the forefront.”

At Nebraska Medicine, three robotic thyroidectomy approaches are offered for patients:

  • Underarm
  • Facelift (behind the earlobe)
    • If the patient wants a complete facelift at the end of the procedure, that’s a possibility
  • Through the mouth

    Katie O’Callaghan was shocked to learn at 24 years old, she had thyroid cancer.

    Katie O’Callaghan was shocked to learn at 24 years old, she had thyroid cancer.

“We can tailor to the patient, depending on the size of the tumor and the patient’s physical characteristics,” explains Dr. Chang. “This type of surgery is a great option for Caucasians who tan easily, African-Americans and Asians. They all tend to have a difficult time with scarring.”

Not wanting a scar on her neck, O’Callaghan opted for Dr. Chang to perform the facelift approach. For the safety of the baby, surgery was put on hold until after O’Callaghan gave birth to her son. On May 22, O’Callaghan became the first patient to undergo a robotic thyroidectomy at Nebraska Medicine. Dr. Chang made the incision behind O’Callaghan’s earlobe and surgery took approximately three hours. O’Callaghan was kept overnight for observation and released the next day.

“I knew I was in good hands at Nebraska Medicine,” says O’Callaghan. “Currently, I have no cancer in my body and I feel great. By looking at me, you’d never know I had thyroid surgery. I’m really happy with the outcome.”

Thyroid nodules are very common and occur in approximately 30 percent of all people in the United States. By the age of 60, more than half of women will have a thyroid nodule. The vast majority of the nodules are benign, with about 5 to 10 percent being cancerous. Symptoms of thyroid cancer can involve swollen lymph nodes in the neck, difficulty swallowing or breathing – but most patients don’t experience any symptoms.

“While thyroid cancer can be seen in people of any background, age or gender, most cases occur in women, people less than 55 years old, and those with Caucasian or Asian backgrounds,” says Nebraska Medicine surgical oncologist Abbey Fingeret, MD. “Fortunately, in most cases, it can be completely cured with surgery.”

Abbey Fingeret, MD

Abbey Fingeret, MD

Dr. Fingeret is currently the only endocrine surgery fellowship-trained surgeon in the state of Nebraska. She completed her fellowship at Harvard University and Massachusetts General Hospital, performing more than 500 thyroid operations. Dr. Fingeret also finished a three-month Advanced Robotic Endocrine Surgery Fellowship in South Korea. This summer, she looks to perform her first robotic thyroidectomy at Nebraska Medicine.

“I truly believe in the mission of Nebraska Medicine,” says Dr. Fingeret. “We are here to offer state-of-the-art care, where the patient always comes first. It’s my honor and privilege to be part of this exceptional team of ancillary staff, clinicians and researchers.”

“Nebraska Medicine treats all aspects of thyroid ailments and endocrine-related disorders,” adds Harris Frankel, MD, chief medical officer. “We have a large and experienced multidisciplinary team, which includes physicians from ENT, Endocrinology, General Surgery and Cancer Services. When you walk in the door, you can be seen by an endocrinologist and thyroid surgeon on the same day.”

We are one of a few academic medical centers in the country offering robotic thyroidectomies. Patients with multiple medical problems who shouldn’t be under anesthesia for extended periods of time are not ideal candidates. Robotic surgery can also be used to remove other benign masses of the neck, such as lipomas and thyroglossal duct cysts.

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