Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Douglas Graham, Chief of the Aflac Cancer and Blood Disorders Center

Transcript

Dr. Douglas Graham, Chief of the Aflac Cancer and Blood Disorders Center · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  Welcome to the Becker's Healthcare Podcast. I'm Chris
• 0:02
  Sosa, your host, and I'm thrilled to be
• 0:04
  joined today by doctor Douglas Graham. He's chief
• 0:06
  of the Aflac Cancer and Blood Disorders Center
• 0:09
  at Children's Healthcare of Atlanta. Doug, thank you
• 0:12
  for joining us today.
• 0:13
  Thanks. It's great to be part of the
• 0:14
  podcast today.
• 0:16
  Wonderful. Doug, we're have you on the program
• 0:19
  today to discuss pediatric cancer, sickle cell disease
• 0:22
  treatment research,
• 0:23
  where it's going, and, you know, what's exciting
• 0:25
  you about it. So off the top, though,
• 0:27
  could you please just introduce yourself and tell
• 0:30
  us a bit about your background?
• 0:32
  Yeah. Absolutely.
• 0:33
  So, Chris, I, originally from North Carolina. That's
• 0:36
  where my training was,
• 0:38
  undergraduate at Wake Forest, and then I went
• 0:40
  to medical school in Chapel Hill where I
• 0:42
  I completed my MD and PhD there.
• 0:45
  And then I moved to Colorado. So I
• 0:47
  was in Denver for nineteen years as part
• 0:49
  of the faculty there at Children's Hospital of
• 0:52
  Colorado.
• 0:53
  I am a physician scientist. So I have
• 0:56
  a research lab,
• 0:58
  looking for new treatments for pediatric leukemia in
• 1:01
  particular.
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  But also I'm a pediatric leukemia doctor.
• 1:06
  So after being in in Colorado for nineteen
• 1:08
  years, I transitioned a little bit of my
• 1:11
  role to,
• 1:12
  in addition to being a a leukemia physician
• 1:14
  to have a more administrative role as the
• 1:16
  chief of the Aflac Cancer and Blood Disorder
• 1:18
  Center,
• 1:19
  in Atlanta, and I have been here now
• 1:21
  ten years.
• 1:22
  Doug, I wanna follow-up with that. Just what
• 1:25
  drew you to being a leukemia doctor in
• 1:27
  particular?
• 1:29
  Well, that, is a fantastic question, and I
• 1:32
  often get asked. And is it is it
• 1:34
  something that is a difficult career to to
• 1:36
  work with children in cancer?
• 1:39
  You know, I'll tell you that
• 1:41
  part of my interest in cancer came from
• 1:44
  my research interest. And so as I was
• 1:46
  doing my PhD research, it was in the
• 1:48
  field of cancer research and and understanding
• 1:51
  what causes,
• 1:52
  normal cells to turn into cancer cells and
• 1:55
  how do we develop new treatment for for
• 1:57
  cancer.
• 1:58
  But really the the passion
• 2:00
  came as I was in the clinic and
• 2:02
  and dealing with families that were going through
• 2:04
  the crisis of of having to hear the
• 2:07
  words that, you you know, your child has
• 2:08
  cancer.
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  And oftentimes,
• 2:11
  even though we couldn't explain
• 2:13
  why a child has cancer, we could say,
• 2:16
  we know the next step forward to be
• 2:17
  able to try to make your your child
• 2:19
  healthy again.
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  So over the last several decades, there's been
• 2:23
  remarkable progress in particular with leukemia.
• 2:27
  So I was born in the nineteen sixties.
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  And at the time, if if you were
• 2:30
  a child diagnosed with, with leukemia in the
• 2:32
  nineteen sixties,
• 2:34
  there was almost no hope for a cure.
• 2:36
  As a matter of fact, there was even
• 2:37
  debate, around that time whether or not we
• 2:40
  would even treat children who have leukemia with
• 2:43
  chemotherapy.
• 2:44
  So we progressed from there to now in
• 2:47
  today's world,
• 2:48
  about eighty percent of children with all childhood
• 2:51
  cancer, we can cure as an overall cure
• 2:53
  rate.
• 2:54
  And specifically within leukemia, some of the cure
• 2:57
  rates are as high as ninety to ninety
• 2:59
  five percent of children with leukemia. So there's
• 3:02
  a lot of promise and hope and really
• 3:04
  just a a a lot of,
• 3:07
  reward, I would say, in in working with
• 3:09
  families and being entrusted with the care of
• 3:11
  their children.
• 3:13
  Well, Doug, thankfully, there are people like you
• 3:15
  who are doing this hard work, this research.
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  Obviously, you're not the only one. But to
• 3:19
  go from
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  the numbers that you just set up to
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  ninety nine percent ninety to ninety five percent,
• 3:25
  that's great. I'm sure your numbers you hope
• 3:27
  those numbers will get higher every single day.
• 3:29
  And that's part of what we're here to
• 3:30
  talk about.
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  So, Doug, the next question I have for
• 3:33
  you is simply, what are some of the
• 3:34
  milestones that you've reached at the Aflac Cancer
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  and Blood Disorder Center, and what effect have
• 3:39
  they had on children's health, whether it's in
• 3:41
  the Atlanta area or beyond?
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  One of the things that is remarkable about
• 3:46
  the Aflac Cancer and Blood Disorder Center,
• 3:49
  is our partnership with the Aflac company.
• 3:52
  I don't really know of anywhere else in
• 3:53
  the country where there's anything quite like what
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  we have with the partnership we have with
• 3:57
  Aflac. But,
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  this has been a thirty year partnership. We're
• 4:00
  having
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  our thirtieth birthday celebration this year.
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  We have been funded by the Aflac company,
• 4:08
  thirty years ago because of a a unique
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  patient,
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  that we,
• 4:12
  cared for with within our center. And this
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  was a a young girl who developed leukemia,
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  and we were able to give the therapy
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  that was necessary for the leukemia at the
• 4:22
  time for the upfront therapy,
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  But then the child relapsed. And when the
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  child relapsed, she needed a bone marrow transplant.
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  We did not have the expertise at that
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  time to to provide a bone marrow transplant
• 4:34
  at Atlanta, so we had to send our
• 4:35
  patient to Seattle.
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  So outside of the state of Georgia to
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  receive the care and then come back to
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  us.
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  So we approached the Aflac company about, would
• 4:44
  you join us in a vision so that
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  someday
• 4:47
  every child that's diagnosed with cancer in the
• 4:49
  state of Georgia, we could care for in
• 4:51
  Georgia. We wouldn't have to send any kids
• 4:53
  outside of Georgia for any reason. As a
• 4:55
  matter of fact, we would like to be
• 4:56
  a referral center, a place that could be
• 4:58
  a safety net for other kids that are
• 4:59
  in the Southeast to to receive care that
• 5:01
  they would need.
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  So that started the journey thirty years ago,
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  and now,
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  the Aflac company,
• 5:07
  over this time span has given us a
• 5:09
  $190,000,000,
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  of investment to be able to make us
• 5:13
  one of the top centers in the country.
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  And and and the remarkable thing about it
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  is that in part, it comes from the
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  company, but it also,
• 5:21
  is an engagement with all of the Aflac
• 5:23
  field force workers all across the country.
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  So every month, more than 15,000
• 5:28
  of the field force workers contribute date contribute
• 5:31
  monthly from their paycheck to the Aflac Cancer
• 5:33
  and Blood Disorders Center.
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  This has allowed tremendous growth,
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  growth in expertise,
• 5:39
  of our faculty, for example. So twenty five,
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  thirty years ago, we had 18 faculty that
• 5:45
  were specialists in hematology, oncology, and bone marrow
• 5:47
  transplant.
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  And today, we have over a 130.
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  So this really gives us experts in any
• 5:53
  kind of disease that you would have in
• 5:55
  the field. And that we have really top
• 5:57
  national experts that are right in Atlanta.
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  And we no longer have,
• 6:02
  any reason to be able to send children
• 6:04
  outside of Atlanta to to exceed to receive
• 6:07
  accelerated care.
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  As a matter of fact,
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  we now have become a regional referral center.
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  And if you look back over the last
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  five years, we have seen patients from 45
• 6:17
  different states that have sent patients to us
• 6:19
  for their care.
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  And I say also that, we have had
• 6:24
  a unique opportunity because we are,
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  the only,
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  children's hospital
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  in a in a large metropolitan city of
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  six or 7,000,000 people.
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  So this makes us one of the largest
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  volume
• 6:37
  pediatric cancer centers in the country.
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  We see more than five hundred new cancer
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  diagnosis a year, making us one of the
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  very largest in terms of number of cancer
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  patients that we see. And we are we
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  are the number one,
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  clinical volume for pediatric hematology.
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  So patients with blood diseases like sickle cell
• 6:57
  disease or thalassemia,
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  for example, or or hemophilia,
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  in part,
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  driven by the fact that we have more
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  than twenty one hundred unique sickle cell patients
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  that we care for.
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  And then our our other component of our
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  program is our bone marrow transplant program, which
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  is also one of the largest five centers
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  in the country in in terms of volume.
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  So I think those could together, the the
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  partnership that we've had have allowed us to
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  recruit
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  exceptional faculty,
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  to expand the the programs that we need
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  to to care for the large volume of
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  patients that we have.
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  But also the last component of it is
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  is the innovation.
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  The innovative programs that we've been able to
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  capitalize on. And we can talk more about
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  that, but we have some programs that,
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  are present in Atlanta,
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  that may only be present in one or
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  two or three places in the country outside
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  of Atlanta.
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  So we're we're very fortunate to,
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  receive the support that we have to to
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  provide the exceptional care that we wanna provide
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  to our children.
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  That's quite an impressive,
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  rate of growth, Doug, and I'm sure you
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  hope that that continues.
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  I also wanna talk to you about
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  the future, specifically
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  some of the most promising pediatric cancer treatments
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  that, you guys at the Aflac Cancer and
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  Blood Story Center are working on,
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  that may be affecting other health systems as
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  well?
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  Well, if you think about
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  where we have come in in terms of
• 8:25
  cure for cancer, if we have an eighty
• 8:28
  percent cure,
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  for all,
• 8:31
  pediatric cancer as a whole,
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  that's that's fantastic. Fantastic progress. And we've done
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  that,
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  as really a a a group across the
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  country in collaborating in with clinical trials,
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  to be able to advance the treatments, that
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  still leaves twenty percent of patients that we're
• 8:47
  not curing. Right? And so every year, if
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  we think about that,
• 8:50
  in Atlanta, if we have five hundred new
• 8:52
  cancer diagnosis, we might have four hundred of
• 8:54
  those that go on to be survivors, but
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  but there's still a hundred patients for which
• 8:59
  we need much better treatment.
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  And I would say better treatment in two
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  ways. We need more effective therapies,
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  therapies that will that will close the gap
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  on this twenty percent.
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  But it the second thing that we need
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  to do is to have less toxic treatments.
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  More more,
• 9:16
  treatments that are gonna have fewer side effects.
• 9:19
  And so,
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  even though there our cure rates are high,
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  studies have shown that
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  if you look at cancer pediatric cancer survivors,
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  that virtually every pediatric cancer survivor by the
• 9:33
  age of 50 is gonna have some chronic
• 9:35
  health condition.
• 9:37
  So there will be problems, issues related to
• 9:40
  heart function or lung function or thyroid function.
• 9:43
  There may be learning challenges in school.
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  There could be fertility
• 9:48
  preservation issues.
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  So
• 9:51
  the the goal that we have as we
• 9:54
  look forward to the future are more targeted
• 9:56
  therapies
• 9:57
  that are effective
• 9:59
  and are are less toxic.
• 10:01
  And so we we are we are doing
• 10:03
  that in a couple different ways. The the
• 10:05
  first way that we are trying to address
• 10:08
  having more targeted therapies, therapies that are really
• 10:11
  only hitting the cancer cells more specifically and
• 10:14
  and less of the normal cells,
• 10:16
  is we do that through programs such as
• 10:18
  precision medicine programs.
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  So
• 10:21
  in our cancer center and and in other
• 10:23
  centers across the country,
• 10:25
  we now have the ability to understand on
• 10:27
  a genetic level what might be driving individual
• 10:31
  cancer. So it's not, for example, that all
• 10:33
  the leukemias
• 10:34
  are the same, that of the patients we
• 10:36
  see. But there might be unique drivers for
• 10:39
  each leukemia patient. And that might help us
• 10:41
  figure out better treatment plans as a a
• 10:44
  better prognosis and a better treatment plan that's
• 10:46
  directly tailored for that patient.
• 10:49
  So there are more than 20,000
• 10:52
  genes in a in a normal cell or
• 10:54
  leukemia cell. And what would have taken,
• 10:57
  you know, forever to be able to figure
• 10:59
  out and dissect all the different genes in
• 11:01
  a cancer cell,
• 11:02
  we now can, in just a matter of
• 11:04
  days, sequence all the genes in a cancer
• 11:06
  cell. And we can figure out how those
• 11:08
  genes are different from the normal cell.
• 11:11
  This allows us to figure out if we
• 11:13
  if we if we decipher a specific genetic
• 11:16
  lesion, is there a drug that can be
• 11:18
  targeted for that? Is there a specific drug
• 11:20
  that can help that patient?
• 11:22
  So in that way,
• 11:24
  the future is bright and that the understanding
• 11:26
  that we have and advances we have in
• 11:28
  molecular medicine are helping us tailor certain types
• 11:31
  of, therapies for patients. And also help us
• 11:34
  understand in some patients,
• 11:36
  are there are there ways that they may
• 11:38
  metabolize chemotherapy differently? So we might even adjust
• 11:41
  some of the way that we give chemotherapy
• 11:44
  agents based on some genetic information we we
• 11:47
  obtained for the patient.
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  The second thing is that,
• 11:51
  which is an exciting advancement besides the,
• 11:55
  precision medicine
• 11:56
  and and the use of of targeted therapies
• 12:00
  is is really the, I would say the
• 12:02
  coming of age of of using immunology. Using
• 12:04
  your own immune system to help fight cancer.
• 12:07
  So we have begun,
• 12:10
  in in the field of pediatric oncology, and
• 12:13
  I would say adult oncology as well,
• 12:15
  to to learn tricks to be able to
• 12:18
  ramp up, and rev up your immune system
• 12:20
  to help you fight cancer, to turn on
• 12:22
  the immune system specifically
• 12:24
  as as as a as an aid to
• 12:26
  to cancer fighting.
• 12:28
  Well, there are medicines that we can give
• 12:30
  that can turn on the immune system and
• 12:32
  and that can help. But and another way
• 12:34
  is that we can take immune cells from
• 12:36
  a patient.
• 12:37
  So
• 12:39
  outside of the body
• 12:40
  and train those immune cells to detect
• 12:44
  cancer cells, such as leukemia cells, and then
• 12:47
  give them back to the to that patient.
• 12:49
  And so you're using cells as drugs as
• 12:51
  well. And an example of this is is
• 12:54
  this type of therapy that I'm discussing is
• 12:56
  called CAR T cell therapy.
• 12:58
  So,
• 12:59
  CAR T cell therapy has changed
• 13:02
  the the the path for for many patients
• 13:05
  that have failed other therapies. And so, in
• 13:08
  in the past, you know, before,
• 13:10
  a decade ago, before the advent of CAR
• 13:12
  t t cell therapy, there may have been
• 13:14
  patients that we have said, well, we we've
• 13:16
  really run out of options of what we
• 13:18
  can do for you. But now, through these
• 13:20
  cellular therapies such as CAR t cell therapy,
• 13:22
  we can now say, we have another option.
• 13:24
  And then a very effective option to now
• 13:26
  cure patients using immune cells,
• 13:29
  and and cells in this case that we
• 13:31
  derive from from that particular patient to help
• 13:34
  fight the cancer and achieve cures from which
• 13:37
  a way we could not have done in
• 13:38
  the past.
• 13:39
  So so those are what I would say
• 13:41
  is promising
• 13:43
  to be able to close the gap on
• 13:44
  this twenty percent. How do how do we
• 13:46
  reach a goal sometime that we have a
• 13:48
  therapeutic option for every patient that we see
• 13:50
  that has childhood cancer?
• 13:52
  Jag,
• 13:54
  I'm very impressed.
• 13:56
  Let me just say this. The picture painting
• 13:58
  of how these therapies work
• 14:01
  is just incredibly easy for me to follow,
• 14:03
  and I'm not anywhere close to an MD
• 14:05
  or PhD. So I appreciate you putting in
• 14:07
  this in such a way,
• 14:10
  that makes me super excited about where all
• 14:12
  these therapies are going. And and no doubt
• 14:14
  your your patients and communities feel the same.
• 14:18
  Looking even further into the future,
• 14:21
  so what are the Aflacancer and Blood Disorder
• 14:24
  Centers? What are your next steps in advancing
• 14:26
  your mission, and what are you gonna need
• 14:27
  to accomplish your goals?
• 14:29
  Well, you know, I'll tell you as as
• 14:31
  we discuss,
• 14:33
  these therapies, I I mentioned cell therapy.
• 14:36
  Our mission will continue
• 14:38
  to advance upon,
• 14:41
  expanding options for cell therapy. So we have
• 14:43
  great options for cell therapy for leukemia patients
• 14:46
  and the CAR T cell therapy.
• 14:48
  Our team and other teams across the country
• 14:50
  are looking for how do we use that
• 14:51
  technology
• 14:52
  and expand it to other types of cancers
• 14:54
  that are solid tumors, for example. So, right
• 14:57
  now, we're trying to develop the same kind
• 14:59
  of cellular therapy for for brain cancer,
• 15:02
  and for tumors such as neuroblastoma
• 15:04
  that we're testing.
• 15:06
  So
• 15:06
  we are so excited to be in the
• 15:09
  new hospital, the new Arthur,
• 15:11
  in blank,
• 15:13
  hospital right,
• 15:15
  in Atlanta that we have moved into.
• 15:18
  It has,
• 15:20
  446
• 15:21
  beds. 98 of the beds are for the
• 15:23
  Aflac Cancer and Blood Disorder Center. State of
• 15:25
  the art facility allows us to to deliver
• 15:28
  exceptional care that we want to provide in
• 15:30
  in state of the art facilities.
• 15:32
  But the other thing that that the Arthur
• 15:34
  Blank,
• 15:35
  hospital has
• 15:36
  are GMP laboratories. So these are good manufacturing
• 15:40
  practices laboratories
• 15:42
  that allow us now for the first time
• 15:44
  ever to manufacture
• 15:45
  these cell therapies that I'm talking about. So,
• 15:48
  prior to moving into this hospital,
• 15:51
  any cell therapy trial that we would wanna
• 15:53
  conduct would have had to been in collaboration
• 15:55
  with a pharmaceutical company or with another center.
• 15:58
  But now that we have the manufacturing capability
• 16:00
  right in the hospital, we actually can think
• 16:02
  of new ideas for cell therapy and for
• 16:05
  gene therapy for our patients and manufacture these
• 16:07
  products right in the hospital to give even
• 16:09
  quicker delivery and to to come up with
• 16:11
  new ideas and next generation ideas.
• 16:14
  In addition to the cell therapy, I I
• 16:16
  mentioned gene therapy, and I I do wanna
• 16:17
  touch on that for just a second as
• 16:19
  well.
• 16:20
  Gene therapy has changed the the way that
• 16:23
  we even think about cures for some of
• 16:26
  our children.
• 16:27
  And and and and this used to, you
• 16:30
  know, just a few years ago, would have
• 16:32
  been, wouldn't it be nice, for example, if
• 16:34
  we had a way that we could cure
• 16:35
  children with sickle cell disease? Well, now today
• 16:38
  is the day. Today is the day that
• 16:39
  we can do that.
• 16:41
  There's gene therapy
• 16:42
  trials.
• 16:43
  There have been gene therapy trials that we
• 16:46
  participated in over the last few years
• 16:48
  that allowed
• 16:50
  as a community across the country for us
• 16:53
  to develop an effective gene therapy product for
• 16:56
  patients with sickle cell disease.
• 16:58
  So we now,
• 16:59
  are in the process of enrolling patients to
• 17:02
  receive this new gene therapy treatment,
• 17:05
  right here in Atlanta. As a matter of
• 17:07
  fact,
• 17:08
  we already have over 60 patients on the
• 17:10
  wait list to receive gene therapy for sickle
• 17:12
  cell disease.
• 17:14
  So we we're in a new era of,
• 17:16
  of of offering cures for patients for sickle
• 17:19
  cell disease that we never could have done,
• 17:21
  in in the past using gene therapy.
• 17:25
  I'll say that this compliments though
• 17:28
  another kind of therapy that we've been involved
• 17:30
  with for a number of years already within
• 17:32
  our center, and and that's the use of
• 17:34
  bone marrow transplant for for patients with sickle
• 17:37
  cell disease.
• 17:38
  So in our center, we have transplanted more
• 17:40
  than a 150
• 17:41
  patients with sickle cell disease already.
• 17:44
  Many of them have been able to have
• 17:46
  transformed lives and be able to have a
• 17:49
  a curative option.
• 17:51
  We hope that the gene therapy would be
• 17:53
  a next generation for that and will have
• 17:54
  some advantages
• 17:56
  of having not as many of the side
• 17:58
  effects potentially that a patient would have that
• 18:00
  undergoes a bone marrow transplant.
• 18:02
  But in addition, this idea of gene therapy
• 18:05
  is being extended to other types of diseases
• 18:07
  as well within our center.
• 18:09
  So we have already treated this year of
• 18:12
  of a patient,
• 18:14
  with gene therapy for beta thalassemia.
• 18:17
  And and for that disease, we have more
• 18:19
  than 26 patients that are already on a
• 18:22
  waiting list for this therapy as well.
• 18:24
  And then finally, we have we have contributed
• 18:27
  significantly to gene therapy for hemophilia.
• 18:30
  As a matter of fact, one of our
• 18:32
  faculty at the Aflac Cancer and Blood Disorder
• 18:34
  Center came up with the new gene therapy
• 18:37
  product for hemophilia
• 18:38
  that was just tested internationally in India,
• 18:41
  and has been so successful,
• 18:43
  in this therapy that it was just published
• 18:45
  just just in the last couple months in
• 18:47
  the New England Journal of Medicine
• 18:49
  reporting the early success of that trial.
• 18:52
  Doug, I can't imagine the amount of hope
• 18:54
  that comes out of,
• 18:56
  the center that you're working for and and
• 18:58
  every single day.
• 19:00
  Thank you so much for being on the
• 19:03
  podcast today.
• 19:04
  You know, hopefully, this will not be the
• 19:06
  last time that we share with our audience
• 19:08
  your insights on on everything.
• 19:11
  Your expertise is incredible. So thank you again,
• 19:14
  and until next time. Thank you so much,
• 19:16
  and I enjoy the conversation, Dane. Look forward
• 19:18
  to future conversations with you as well.