Archive for the ‘Medical Professionals’ Category

New Minimally Invasive Procedure Provides Significant Results for Obese Patients

New Minimally Invasive Procedure Provides Significant Results for Obese Patients

A new noninvasive bariatric procedure that can be performed endoscopically has been approved by the Federal Drug Administration (FDA) and is available to patients at the Bariatrics Center at Nebraska Medicine.

The Orbera® intragastric balloon is providing obese patients with another option to achieve significant weight loss when traditional methods of diet and exercise have not worked.

“This is a very safe procedure that can be performed as an outpatient and requires minimal recovery time,” says Tiffany Tanner, MD, bariatric surgeon at Nebraska Medicine.

The procedure is one of several weight loss options available at the Bariatrics Center, which offers both surgical and non-surgical medical weight loss options for treating obesity. The program is designed and directed by physicians who are specialty trained in medical weight management and bariatric surgery and are supported by a multidisciplinary team of specialists.

“Obesity is a difficult condition to treat,” says Dr. Tanner. “The Bariatrics Center is the ideal place to send patients because it offers patients a variety of surgical and non-surgical options. Not all patients are ready to undergo surgery and our program allows us to meet patients where they are at and offer them options to help them loose weight.”

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Tiffany Tanner, MD

For many obese patients, however, surgery provides the most effective long-term solution for weight loss when other methods have failed. In a randomized clinical trial that involved 255 adults with a BMI between 30 and 40, people who had the intragastric balloon procedure along with behavioral therapy lost 27 percent of their excess weight. The group that had only behavioral therapy lost 10 percent of their excess weight at 9 months.

The Orbera® intragastric balloon procedure is a soft, deflated silicone balloon that is introduced into the patient’s stomach via an endoscope that is passed down a patient’s esophagus into the stomach. Once the intragastric balloon is endoscopically inserted, the empty balloon is filled with sterile saline. The balloon takes up space in the patient’s stomach, limiting food intake and reducing feelings of hunger. The intragastric balloon is removed after six months in another short endoscopic procedure. During that next six-month period, the patient continues to participate in a behavior modification program and follows a medically supervised diet.

Another difference with this procedure is that it has an indication for a lower BMI than that of traditional bariatric surgery. The National Institute of Health’s current guidelines for bariatric surgery require patients to have a BMI of 40 and over or a BMI of 35 and over with significant co-morbid conditions. This procedure can be performed on patients with a lower BMI of between 30 and 40. “This allows us to offer patients another option as we can intervene sooner and practice preventive medicine,” notes Dr. Tanner.

Patients are carefully selected after a thorough evaluation process that includes screening by the bariatric surgeon as well as a psychologist, exercise psychologist and nutritionist.

The intragastric balloon procedure is ideal for patients who are moderately overweight and want to begin with a less invasive weight loss procedure, notes Dr. Tanner.

As with other bariatric procedures and surgeries that lead to significant weight loss, the intragastric balloon may help improve or eradicate conditions often related to being overweight, says Dr. Tanner.

“Obesity has many implications for a patient’s health and can significantly increase a person’s risk for a number of serious diseases like cancer, heart disease, arthritis and diabetes, and therefore, increase mortality,” says Dr. Tanner. “It effects daily life, co-morbidities and mortality.”

A study published in the January issue of JAMA looked at patients who had undergone bariatric surgery (primarily roux en y gastric bypass) and compared them to matched controls and then looked at their survival. The study showed that at 10 years, mortality for obese individuals who had weight loss surgery was 13.8 percent versus 23.9 percent for the control group. “This study underscores how hard obesity is on the body,” says Dr. Tanner.

The Bariatrics Center at Nebraska Medicine is a nationally accredited program through the American Society for Metabolic and Bariatric Surgery (ASMBS) and American College of surgeons (of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)). The designation recognizes surgical programs with a certain physical, and human resources and standards of clinic practice. Clinical research shows that the most experienced and best-run bariatric surgery programs have much lower rates of complication.

 

About the Author

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Tiffany Tanner, MD is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better care for obesity.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Melanoma on the Rise

Early Detection and Staging of Melanoma is Key to Successful Outcomes

Skin cancer is the most common of all cancers. While melanoma accounts for only one percent of skin cancer cases, it is responsible for the majority of skin cancer related deaths.

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Nicole De Rosa, MD

The incidence of melanoma has been steadily increasing for at least 30 years. A 2012 study found that between 1970 and 2009, the rate of melanoma among women and men increased by eight-fold and four-fold, respectively.

“The incidence of melanoma has been steadily increasing on average by 1.4 percent each year over the past 10 years,” says Nicole de Rosa, MD, surgical oncologist at Nebraska Medicine, who specializes in melanoma, complex gastrointestinal cancers and sarcoma. “Common risk factors include UV light exposure from sunlight or tanning beds, older age, male gender, white race and family history. “If caught at an early stage and treated with proper surgical resection, it is highly curable.”

“Most skin cancers can be diagnosed early with a simple skin examination. Your doctor should check your skin carefully as part of a routine cancer-related check-up. Additionally, it’s important to check your own skin, preferably once a month, if you have many moles or any of the risk factors for melanoma”, says Dr. de Rosa. High-risk groups – those with a family history of skin cancer or a personal history of any skin cancer may benefit from a regular skin examination by a board-certified dermatologist.

Many moles are completely benign. Signs we use to determine if a mole may be suspicious for harboring cancer are known as the ABCDEs of a melanoma: Asymmetric shape, Border irregularity, Color variation or uneven distribution, Diameter (6 mm or anything larger than a pencil eraser), and most importantly Evolution, meaning a mole with recent changes in size, color, or irritation.

Melanoma can occur on any skin of the body, even those that have not been exposed to the sun, says Dr. de Rosa. Additionally, melanomas can more rarely form on other parts of the body including the eyes, mouth, genitals, and anal area.

“If a suspicious mole is detected, a full-thickness skin biopsy should be performed to get the most accurate staging information to direct future treatment,” says Dr. de Rosa. “Melanomas are treated based on the depth of extension into the skin, not on the width of the lesion.”

In general, melanomas up to 1 mm in depth are considered early stage and can be treated with wide local excision alone, as long as there are no signs that the lesion is high-risk. Melanomas deeper than 1 mm and without evidence of distant spread, should be treated with wide local excision and sentinel lymph node biopsy. “Patients who undergo sentinel lymph node biopsy have between a 5 to 40 percent chance of having cancer detected in the lymph node, based on the primary lesion characteristics,” says Dr. de Rosa.

“Early-stage melanomas can often be treated successfully with surgery alone, but more advanced cancers require additional treatments,” says Dr. de Rosa. Nebraska Medicine has a multi-disciplinary group of physicians who are dedicated to treating patients with melanoma and other complex skin cancers. This team includes surgical oncologists, medical oncologists, radiation oncologists, pathologists, as well as plastic and reconstructive surgeons who are highly specialized in optimizing oncologic and aesthetic outcomes.

 

About the Author

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Nicole De Rosa, MD is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better cancer care.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

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.”

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Ken Cowan, MD, PhD, director of the Fred & Pamela Buffett Cancer Center is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better cancer care.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Cardiac Anesthesiologists Expand Surgery Options for Cardiac Patients

Cardiac patients who need other types of surgical procedures are often denied surgery due to the risks and complexity of their cases. But that is no longer the case at Nebraska Medicine.

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Sasha Shillcutt, MD

Cardiac anesthesiologists have specialized training in monitoring the function of the heart during surgery using advanced cardiac monitoring tools called transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE). This tool allows them to measure the function of the heart and gives them direct visualization of the chambers of the heart, its valves and the major connecting vessels and veins that supply blood to the heart. While many large medical centers have a cardiac anesthesiology program that provides monitoring of patients during cardiac surgery, few in the country have echo-trained anesthesiologists who also monitor cardiac patients during non-cardiac related procedures.

“The use of echo in non-cardiac cases is a new phenomenon that is state-of-the-art,” says Sasha Shillcutt, MD, cardiac anesthesiologist at Nebraska Medicine and Director of Perioperative Echocardiography, at the University of Nebraska Medical Center (UNMC). “This is a very unique service that no one else offers in the state and fulfills a critical need for the safety of these patients. Without our expertise in TEE, most non-cardiac surgeons would otherwise not perform surgery on these types of patients simply because it is too risky.”

The Perioperative Echocardiography Consult Service includes a team of 10 cardiac anesthesiologists who are trained in advanced TEE and TTE and eight other anesthesiologists who are trained in basic echocardiography and use their skills in trauma patients, liver transplants, vascular surgery and critical care medicine. Under Dr. Shillcutt, the department also leads a national perioperative echocardiography training program that prepares physicians across the country in basic and advanced perioperative echocardiography. It is one of a few training programs in the country.

Adult Congenital Heart Disease Conference

Friday, July 29 | 7:30 a.m. – 3 p.m.

Physicians, nurse practitioners, physician assistants, and nurses are invited to attend “Accepting the Challenge: Multidisciplinary Care of the ACHD Patient”.

For more information and to register go to unmc.edu/cce/achd

“Surgery is a very stressful event on the body,” explains Dr. Shillcutt. “When you take someone into surgery who already has had heart-related complications, the stress on the heart and potential risks are much more significant. All of our training is focused on getting the patient through surgery and out of the hospital without having a major cardiac event.”

The risk of having a cardiac event after surgery for patients with prior heart disease increases to 10 to 25 percent, notes Shillcutt. “We have been using echocardiography during open-heart surgery for years,” she says. “Using it in patients with heart disease undergoing major non-cardiac surgery only makes sense to improve outcomes. We have diagnosed blood clots, heart failure and holes in the heart during non-cardiac surgery. These are patients that might not have made it through surgery had we not had the technology and experience to detect these problems.”

The care in the operating room is backed by a team of critical care physicians, the state’s only certified heart failure team, cardiologists and other specialists who are trained to provide follow-up intensive care after surgery. “It’s an excellent example of a multi-specialty group of doctors working together to provide the best care for each patient,” says Dr. Shillcutt.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Sasha Shillcutt, MD is an inspiring and remarkable example of the caliber of specialists and researchers working tirelessly to help provide better Cardiac patient care.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Training Exercise for Highly Infectious Patient Transport

U.S. State Department Training Exercise Involved 5 Aircraft and 11 Mock Patients

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In the April 12 drill, one mock patient is seen arriving in a Gulfstream jet operated by Phoenix Air for the U.S. State Department.

The Nebraska Biocontainment Unit was one of five treatment centers that received patients during a practice drill organized by the U.S. State Department. During “Operation Tranquil Shift,” a total of 11 American citizens suspected of having or having been exposed to a simulated highly infectious disease were transported from Africa to the United States for treatment.

Three mock-patients arrived from Africa at Eppley Airfield the morning of April 12. Two patients arrived separately in one of two Gulfstream jets operated by Phoenix Air for the U.S. State Department. A third patient didn’t make the trip from Africa, but was also transported to the Biocontainment Unit.

A total of four aircraft (the two Gulfstreams which came to Omaha and two 747s) departed Atlanta, Georgia, and traveled to Freetown, Sierra Leone. Once patients were retrieved, all aircraft landed at the Washington-Dulles Airport to clear customs before continuing on to the five receiving facilities across the country, including Bellevue Hospital Center in Manhattan, New York, Johns Hopkins University Hospital in Baltimore, Maryland, the University of Minnesota Medical Center in Minneapolis, Minnesota, Denver Health Medical Center in Denver, Colorado, and Nebraska Medicine – Nebraska Medical Center. Once patients were transferred to ground ambulance teams, the aircraft departed for the next receiving facility or returned to Georgia for decontamination.  The scope of this exercise is unprecedented and a testament to the lessons learned and changes made in the aftermath of the Ebola outbreak.

The mock patient was transport to the Biocontainment Unit at the Nebraska Medical Center.

The mock patient was transported to the Biocontainment Unit at the Nebraska Medical Center.

“This was the next logical step in planning and preparing to transport a large number of patients with a highly infectious disease,” says Shelly Schwedhelm, executive director of Emergency Preparedness and Infection Prevention. “In November of 2016, we successfully transported three patients to the Nebraska Biocontainment Unit on one 747. We’re applying what we learned during the November drill to make even further improvements during this larger national exercise.”

The University of Nebraska National Strategic Research Institute (NSRI) works closely with the U.S. State Department to facilitate these transport exercises. “NSRI has assisted the State Department to develop the scenarios and develop a process for improving the transport and patient care process during transit.” says Eric Van Gieson, chief technology officer for NSRI.

“This exercise was a tremendous example of the power of collaboration,” says Christopher J. Kratochvil, MD, UNMC associate vice chancellor for clinical research, and vice president for research at Nebraska Medicine. “The coordinated efforts by numerous federal agencies and local partners allowed us all the opportunity to successfully test procedures in a very realistic setting. The lessons learned will significantly help prepare us for future international and domestic outbreaks.”

Two members of the NSRI team were observers onboard the aircraft coming to Omaha and spoke to the media at Eppley Airfield. The NSRI is one of 13 Department of Defense (DoD) authorized University Affiliated Research Centers in the nation. Established in 2012, NSRI is a long-term, strategic partner of its (DoD) sponsor, the U.S. Strategic Command (USSTRATCOM).

Along with the agencies previously mentioned, the U.S. Department of Health and Human Services, Douglas County 911, Douglas County Emergency Management, Omaha Fire Department, Omaha Airport Authority, Douglas County Health Department and the Nebraska Department of Health and Human Services all took part in the drill.

Watch the drill unfold in this video.

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Our medical faculty and staff are inspiring and remarkable examples of the caliber of specialists and researchers working tirelessly to help provide emergency preparedness.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Scientists Achieve Research Milestone with Parkinson’s Disease

The three key people on the phase I clinical trial were (left-right) Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD.

The three key people on the phase I clinical trial were (left-right) Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD.

In an early phase human clinical trial, researchers at UNMC tested a drug that transforms the immune system for diagnostic and therapeutic gain in Parkinson’s disease (PD).

The medicine was proven safe and generally well tolerated. Side effects were minimal, but included skin irritation, bone pain and an allergic reaction. Preliminary evidence of improvement in motor skills was observed and recorded in several of the treated patients, but validation will require larger patient enrollments.

PD ravages nearly 1 million Americans and generates direct and indirect costs of nearly $25 billion per year in the U.S. alone.

About the Study

To conduct the phase 1 clinical study, scientists partnered with 14 academic and community-based physicians and neuroscientists with extensive expertise in neurophysiology, bioimaging, clinical trials execution and movement disorders. The research was conducted in basic science laboratories at UNMC and Scripps Research Institute in La Jolla, California. The study subjects were seen at Nebraska Medicine.

Clinical support was overseen at UNMC by Pamela Santamaria, MD, a Nebraska Medicine neurologist and founder of Neurology Consultants of Nebraska; Danish Bhatti, MD, assistant professor in the Department of Neurological Sciences; and by David Standaert, MD, PhD, professor and chair of neurology and director of the Division of Movement Disorders at the University of Alabama at Birmingham.

Using a blinded clinical study approach for investigation, the patients, their caregivers and their physicians could not tell whether the drug or a placebo was being administered.

For more information on the study, call 402.559.6941.

The findings — which appeared March 24 in the journal npj Parkinson’s Disease — mark a milestone for PD research. At the heart of the discovery was the immune transformation of disease-inciting circulating white blood cells (called effector T-cells or Teff) to cells that protect and defend against brain injury (called regulatory T cells or Treg). The drug changed neurodestructive Teff into functional neuroprotective Tregs.

The research team was headed by two UNMC scientists, Howard Gendelman, MD, professor and chair of the Department of Pharmacology and Experimental Neuroscience, and R. Lee Mosley, PhD, pharmacology and experimental neuroscience professor and head of the Movement Disorders Research Laboratory. The discovery results from more than two decades of laboratory and animal investigation.

The idea was conceived in cell studies then validated in animals. During each step, immune transformation was realized with the drug granulocyte macrophage colony stimulating factor (also known as Sargramostim® Sanofi-Genzyme Pharmaceuticals).

Importantly, such drug-induced transformation has not only been successful for PD but also holds promise for a range of neurodegenerative disorders that include Alzheimer’s disease, stroke and amyotrophic lateral sclerosis.

The drug was found to produce significant and encouraging changes in the production of Treg cells in the blood of patients. These same changes did not take place in patients who received the placebo. Initial clinical observations proved encouraging and varied in intensity between patients, Dr. Gendelman says.

During the trial, physiological brain improvements were seen in specific motor areas of the brain for those patients receiving Sargramostim. This was recorded through the use of magnetoencephalography by a research team headed by Tony Wilson, PhD, associate professor and vice chair, basic/translational research for UNMC and director of the Magnetoencephalography Laboratory in the Department of Neurological Sciences.

Blood metabolites known to increase the number of neuroprotective Treg cells were observed in parallel studies on the same blood samples used to record the immune biomarkers. These biochemical studies were performed at the Scripps Research Institute by Gary Siuzdak, PhD, professor and director, Scripps Center for Metabolomics and Mass Spectrometry.

Doses of L-DOPA and other dopamine-sparing drugs used to treat PD were continued to all study subjects throughout the study.

“To our knowledge, this study represents the first time immune transformation was performed on any patient with neurodegenerative disease,” Dr. Mosley states.

Dr. Gendelman says the next step will be a broader study that will include larger patient numbers. This is being planned in the next one to two years, after the manufacture of an oral medicine.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Howard Gendelman, MD, Pamela Santamaria, MD, and R. Lee Mosley, PhD are inspiring and remarkable examples of the caliber of specialists and researchers working tirelessly to help provide better Parkinson’s disease treatment.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Emerging Therapies for Multiple Myeloma: ASH 2016 Update

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The ASH meeting emphasizes the critical importance of continued research efforts.

Although 2016 was a very exciting year for multiple myeloma, with the approval of four new drugs, the reality is that the majority of patients will become resistant to all available drugs. Therefore, it is still vitally important that new treatment strategies and new drugs are developed. At the recent annual meeting of the American Society of Hematology (ASH), there were many exciting presentations discussing new treatments. Here I will review some of the key studies exploring new treatments for relapsed/refractory myeloma.

CAR T cell therapy: CAR T cell therapy involves the engineering of one’s own T cells to be able to recognize a target on the cancer cell of interest in order to stimulate the patient’s immune system to attack the cancer cells. Investigators from University of Pennsylvania presented the results of CAR T cell therapy against BCMA in myeloma patients. Examples of patients who had very refractory disease prior to receiving this therapy were presented, several of whom had remarkable responses to the CAR T cell therapy. Not all patients responded to therapy and, as observed with other CAR T cell trials, the toxicities associated with this treatment can be very significant. There continues to be a lot of optimism about this type of therapy, although much more research is needed to determine the optimum target and ensure the safety of the treatment.

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Sarah Holstein, MD, PhD

Checkpoint inhibitor therapy: Checkpoint inhibitors, which harness the power of one’s immune system to fight cancer, are being widely tested in almost all cancers. These therapies have already been approved for the treatment of several cancers including bladder cancer, Hodgkin lymphoma, kidney cancer, lung cancer, and melanoma. As single agents, checkpoint inhibitors have not shown much activity against myeloma. However, ongoing studies are exploring the combination of checkpoint inhibitors with standard myeloma drugs. One study presented at ASH focused on the combination of the checkpoint inhibitor pembrolizumab with pomalidomide and dexamethasone. Around seventy percent of patients were refractory to both lenalidomide and proteasome inhibitors (bortezomib or carfilzomib). The overall response rate presented during the meeting was 65%. To put this in context, the expected response rate for pomalidomide and dexamethasone would be around 35%. This regimen is not without toxicity though, as 12% of patients suffered from pneumonitis (inflammation of the lungs) and 10% of patients discontinued therapy due to side effects.

Selinexor and penta-refractory disease: Selinexor is an oral drug which inhibits nuclear transport, thus this is a novel mechanism of action with respect to myeloma drugs. As noted above, although the new drugs approved for use in 2016 have improved outcomes for patients, most patients will become refractory to all available drugs. Penta-refractory disease refers to myeloma that no longer responds to lenalidomide, pomalidomide, bortezomib, carfilzomib, or anti-CD38 antibody (e.g., daratumumab) therapy. At that point, treatment options are limited. It was therefore interesting to see a new drug being tested in this patient population. This study investigated the combination of selinexor and dexamethasone in penta-refractory patients. Approximately 20% of these patients responded to this therapy. This therapy was associated with a number of side effects including nausea/vomiting, fatigue, diarrhea, and lowered blood counts. Thus although the majority of patients did not respond, there is evidence of activity and there are several ongoing studies investigating the use of this new drug in combination with other myeloma drugs.

Venetoclax: Venetoclax is an oral drug which works on a protein involved in regulating cell death (apoptosis). This drug is being tested in a variety of different hematological cancers, including myeloma. The results from a phase I study of the drug (either alone or in combination with dexamethasone), suggest that it may be particularly active in the subset of myeloma patients with t(11;14) (a translocation involving the #11 and #14 chromosomes in the myeloma cells). The overall response rate for the study was 21%, but was 40% in patients with t(11;14). In another study, venetoclax was tested in combination with bortezomib and dexamethasone. The overall response rate for the study was 68%. In this study, though, the response rates were similar regardless of whether patients had the t(11;14).

As always, the ASH meeting emphasizes the critical importance of continued research efforts. If new therapies are to be developed, then funding for the initial basic science research is required as is patient participation in the clinical trials. Without these, we won’t be able to offer new treatments to patients suffering from myeloma.

The information contained in this article is to be utilized for information purposes only. For specific questions regarding your medical condition or treatment plan please consult with your doctor directly. To schedule an appointment with a cancer specialist at Nebraska Medicine, call 800.922.0000.

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Dr. Sarah Holstein is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better multiple myeloma treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancercare and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Three Heart Transplants in 34 Hours

When transplant surgeon John Um, MD, walked into Nebraska Medicine – Nebraska Medical Center the morning of April 11, little did he know, it was the start of two very long days. By the evening of April 12, Dr. Um had performed three heart transplants in 34 hours – a personal best for himself and the transplant team at Nebraska Medicine.

“The surgeries were pretty long. About six to eight hours each,” describes Dr. Um.

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From left to right: Harvey Brandy, Lucas Kollars, Curt Spethman and Dr. John Um. It all started with 24-year-old Lucas Kollars of Arlington, Neb., who was found unresponsive at home by his mother. After receiving a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD), Kollars was on the heart transplant waiting list for 58 hours.

“Dr. Um said I had about two more days to live,” says Kollars.

Twelve hours after finishing Kollars’ heart transplant, Dr. Um started on the second one. The patient was 57-year-old Harvey Brandy of Omaha. Brandy’s heart problems began several years ago with a heart attack. After receiving a stent and pacemaker, Brandy’s name was placed on the transplant waiting list. It took three days to find a match.

“At the time, I was feeling really, really bad,” says Brandy. “My heart was only functioning at ten percent.”

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While Dr. Um finished Brandy’s procedure, 60-year-old Curt Spethman of Omaha was being prepped for surgery. Spethman’s heart issues were fairly recent, but progressing quickly. His name was only on the transplant waiting list for five days.

“I was amazed at how fast it happened,” says Spethman. “You’re scared, but then you go – ‘I’m getting a heart. A second chance.'”

At 10:40 a.m. on April 12, Dr. Um began Spethman’s transplant. Even though it was his third in two days, Dr. Um was prepared and ready to go. He couldn’t let Spethman miss out on his second chance at life.

“I have a couch in my office where I can put my feet up, get some sleep and grab a coffee,” explains Dr. Um. “We also have multiple teams that are able to come in. They’re refreshed as well. This allowed everyone to be working at the best possible level. It’s a testament to the med center to invest in those resources and have the personnel to do those things.”

On May 11, all three patients met each other for the first time. They also thanked Dr. Um for his incredible work.

“I feel great. I’m walking around – about a mile or more a day,” says Kollars. “I want to thank Dr. Um and Dr. Aleem Siddique. They saved my life about nine different times.” “If it weren’t for the team at Nebraska Medicine, I wouldn’t be here. . It’s amazing what they do,” adds Spethman. “I’m now walking down the sidewalk and planting flowers again. It’s incredible.”

“One day, I’m going to come back and buy them a box of donuts,” laughs Brandy. “To show my appreciation.”

To learn more about the three heart transplants in 34 hours, watch this video.

 

Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “ John Um, MD is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better heart treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

Twin Diagnosed With Rare Form Of Cancer, Brother’s Stem Cells Save Life

By: Channing Barker

 

http://www.nwahomepage.com/news/fox-24/twin-diagnosed-with-rare-form-of-cancer-brothers-stem-cells-save-life/659566107

 

FAYETTEVILLE, AR. — – Bruce and Blair Johanson have been together since the moment of conception. They now work side by side in Fayetteville. They look, talk and even walk alike. They were told at birth they were fraternal twins.

“Whenever we would talk about being identical, mother would say no you’re fraternal and we’d say no we’re identical,” said Blair.

Something they doubted, especially in the past year when Bruce was diagnosed with Mantle Cell Lymphoma, a rare form of cancer.

“Once we learned with him what he was going to go through, praying that everything would work well with him and whatever we could do to support him through the process,” said Blair.

That included chemotherapy treatments and a trip to a specialist in Nebraska.

“At the very end, we were talking about family and I said ‘I have a twin brother ‘ and she says ‘What!?’ and she said ‘Well, that changes things,” said Bruce.

Doctors told Bruce, if he had an identical twin, there was a way his brother could be his true life saver.

“We need to have him tested to see if you’re truly identical and we want to use his stem cells versus your own, Since he’s cancer free,” said Bruce.

Blair gave new meaning to the term “brotherly love” and donated his stem cells.

“In my mind there was no question as to who the donor would be,” said Blair.

“It’s pretty special and awesome to have that,” said Bruce. “I mean,  we’re close as it is already, now we’re closer because I have his super cells.”

After dozens of treatments, Bruce was given the cancer free diagnosis last week.

“I wish everybody had a twin brother so they could get their stem cells from their twin brother or twin sister,” said Bruce.

The two are grateful for the doctors and the treatment made available by science.

 


Nizar Mamdani, Executive Director and founder of the International Healthcare Services at Nebraska Medicine says, “Dr. Julie Vose is an inspiring and remarkable example of the caliber of specialist and researchers working tirelessly to help provide better oncology treatment and educational opportunities.  Through collaborative strategic partnerships with 122 institutions in 44 countries, we continue to provide innovative educational and treatment options, as well as specialized tele-pathology and second opinion consultation services for Neurology, Cancer care and Transplantation patients around the world.”

 

Contact | nmamdani@nebraskamed.com; www.unmc.edu/international; +1 (402) 559-3656

 

Longtime UNMC supporter Nancy Armitage dies

by Tom O’Connor, UNMC public relations

Image with caption: Nancy Armitage

Nancy Armitage

One of UNMC’s longtime supporters, Nancy (Roker) Armitage, died Monday at her home following more than a year-long battle with pancreatic cancer. Armitage, who is the wife of James Armitage, M.D., a legendary oncologist at UNMC and its clinical partner, Nebraska Medicine, was 70.

Service information

A memorial service for Nancy Armitage will be held at 1:30 p.m. on Friday, March 3, at Countryside Community Church, 8787 Pacific St.

Both the Armitages grew up in Kearney, Neb., where they first met in nursery school as young toddlers. They went to Kearney High School together as well as the University of Nebraska-Lincoln.

“Everyone needs a guardian angel. Nancy was Jim’s for a lifetime,” said Mike Sorrell, M.D., professor, UNMC Department of Internal Medicine-Division of Gastroenterology-Hepatology and longtime friend.

Nancy Armitage earned a nursing degree and worked at University of Nebraska Hospital, where she helped open the first intensive care unit for surgical patients on 6 West.

As Dr. Armitage’s career as a world-renowned lymphoma expert took off, Nancy Armitage took on the task of being a mother and grandmother to their four children and 11 grandchildren. She also became a key, behind-the-scenes figure in meeting with many of her husband’s patients and providing support to them.

One of the Armitages’ sons, Joel, earned his medical degree at UNMC and is on the UNMC faculty serving as assistant professor, internal medicine-general medicine.

Active in the community, Nancy Armitage played an important role in supporting her husband when he served as king of Aksarben in 1998.

Earlier this year, nearly $600,000 was raised to establish the Nancy Armitage Pancreas Cancer Clinical Research Professorship at UNMC. Much of the money raised came from family friends and former patients who had been treated by Dr. Armitage. Nancy’s mother died of pancreatic cancer at age of 67.

The goal is to raise $1 million, so an endowed chair can be established.

To make a gift to the University of Nebraska Foundation, click here. Pledge cards also are available in the Oncology/Hematology Offices on the 8th floor of the Lied Transplant Center, the Cowdery Patient Care Center on the 2nd floor of the Lied Transplant Center, or by contacting Tom Thompson at the University of Nebraska Foundation at (402) 502-4116.

Click here to read a Jan. 30 column on the Armitages in the Omaha World-Herald.

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