The battle on blood cancers

Kim White was diagnosed with the blood cancer myelodyplastic syndrom four years ago.

Chris Cogle, M.D., and his pals are playing a game of hide and seek, trying to outwit their crafty competitors who know all the good places to hide.

Team A: the Hematologic Malignancies and Bone Marrow Transplantation Program in the UF College of Medicine’s Department of Medicine.

Team B: cancer cells in the blood, bone marrow and lymph nodes.

The multidisciplinary UF team is using molecular level studies and clinical trials to shine a searchlight on the bone marrow’s microenvironment — blood vessels, bone and fatty tissue — to see how it harbors sneaky cancer cells. To tackle an alphabet soup of disorders — AML, ALL, CLL, MDS, MPNs — the group is inventing new therapies and coming up with new ways to use old ones to help patients.

Patients such as Kim White, a Harley-riding, leather-jacket-wearing U.S. Air Force veteran who was diagnosed with myelodysplastic syndrome, or MDS, about four years ago. His chemotherapy seemed to have gone well, until doctors found that the tumor cells weren’t gone — they had only been hiding. Monthly blood transfusions were the only thing that helped. Eventually his hematologist referred him to Cogle, a member of the UF Shands Cancer Center, for an experimental treatment.

“I was kind of excited. I had been told that what I have is incurable,” White said. “But it is treatable.

The drug, called azacitidine, was first tested in the 1960s, but was too toxic. Decades later, researchers found that diluting it 10 to 20 times made it active against MDS and tolerable to patients. The drug nudges immature cancer cells out of hiding by forcing them to maturity and spotlighting them so the body’s defense system can say “Found you!” Not only that, the drug mimics DNA and prevents cells that take it up from replicating. Cogle’s team is testing a pill form of the drug that patients can take on their own at home or while traveling.

A few of the weapons

UF’s hide and seek with blood cancers has taken a number of forms:
• Attacking leukemia cells that camoufl age themselves as blood vessels by attaching certain proteins to their surfaces
• Using a virus to kill blood cancer cells without harming healthy blood stem cells
• Developing a drug called OXi4503, now in clinical trial, that poisons cancer cells and destroys the blood vessels that feed them
• Transplanting stem cells in new ways to roust out hidden blood cancer cells

“Our main goals are to cure patients of their blood cancers and provide excellent support for them and their loved ones,” Cogle said. “Our strengths include creativity, an understanding of these cancers, close collaborations and the ability to translate our findings from the laboratory bench to the clinic.”

Because of the UF group’s impact through specialized research and patient care, the MDS Foundation designated the program a Center of Excellence, one of just 55 in the United States.

“It’s a very frustrating disease to treat so you really want to go to someone who really understands it and will do no harm,” said Audrey Hassan, the organization’s patient liaison.

Dr. Chris Cogle and Kim White

The UF team, led by John Wingard, M.D., deputy director of the UF Shands Cancer Center, has been part of landmark clinical trials testing treatments that dramatically changed the course of leukemia care. One such is imatinib, sold as Gleevec. Another is a form of vitamin A called all-trans retinoic acid. The team is a national leader in blood and marrow transplants and was among the first to perform umbilical cord blood transplants in adults and to purge cancer cells from transplanted stem cells in patients who have a kind of cancer known as neuroblastoma. The group was the first  in Florida to do a blood stem cell transplant using donors whose genetic material only “half matched” that of recipients. Ultimately the group wants to develop personalized therapies for patients.

Their work is supported by several grants from the National Institutes of Health and other agencies, various foundations and grateful patients.

White, 66, is now healthy enough to ride long distances on his motorcycle and spend hours on end teaching youngsters how to build bikes. Patients often send Cogle photographs from cross-country biking trips and cruises, graduations of grandchildren and visits with faraway relatives. “They expand my horizons,” Cogle said. — Czerne M. Reid

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Winter 2012

Paul Okunieff, M.D

From the director’s desk

“Sometimes you have to balk at convention to cure cancer.”

The battle on blood cancers

Chris Cogle, M.D., and his pals are playing a game of hide and seek, trying to outwit their crafty competitors who know all the good places to hide.

UF’s Bone Marrow Transplant Unit succeeding through research and team care

At 68, Patricia Beiter still ran three miles a day, biked and swam and had just earned her teaching degree. But a routine blood test revealed a problem. Beiter was diagnosed with acute lymphoblastic leukemia.

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