1 00:00:00,080 --> 00:00:02,399 Welcome to the Becker's Healthcare Podcast. I'm Chris 2 00:00:02,399 --> 00:00:04,480 Sosa, your host, and I'm thrilled to be 3 00:00:04,480 --> 00:00:06,960 joined today by doctor Douglas Graham. He's chief 4 00:00:06,960 --> 00:00:09,439 of the Aflac Cancer and Blood Disorders Center 5 00:00:09,439 --> 00:00:12,080 at Children's Healthcare of Atlanta. Doug, thank you 6 00:00:12,080 --> 00:00:13,219 for joining us today. 7 00:00:13,519 --> 00:00:14,719 Thanks. It's great to be part of the 8 00:00:14,719 --> 00:00:15,699 podcast today. 9 00:00:16,214 --> 00:00:19,095 Wonderful. Doug, we're have you on the program 10 00:00:19,095 --> 00:00:22,295 today to discuss pediatric cancer, sickle cell disease 11 00:00:22,295 --> 00:00:23,274 treatment research, 12 00:00:23,734 --> 00:00:25,975 where it's going, and, you know, what's exciting 13 00:00:25,975 --> 00:00:27,894 you about it. So off the top, though, 14 00:00:27,894 --> 00:00:30,135 could you please just introduce yourself and tell 15 00:00:30,135 --> 00:00:31,515 us a bit about your background? 16 00:00:32,190 --> 00:00:32,929 Yeah. Absolutely. 17 00:00:33,710 --> 00:00:36,429 So, Chris, I, originally from North Carolina. That's 18 00:00:36,429 --> 00:00:37,549 where my training was, 19 00:00:38,030 --> 00:00:40,030 undergraduate at Wake Forest, and then I went 20 00:00:40,030 --> 00:00:42,429 to medical school in Chapel Hill where I 21 00:00:42,429 --> 00:00:45,170 I completed my MD and PhD there. 22 00:00:45,534 --> 00:00:47,215 And then I moved to Colorado. So I 23 00:00:47,215 --> 00:00:49,774 was in Denver for nineteen years as part 24 00:00:49,774 --> 00:00:52,174 of the faculty there at Children's Hospital of 25 00:00:52,174 --> 00:00:52,674 Colorado. 26 00:00:53,614 --> 00:00:56,895 I am a physician scientist. So I have 27 00:00:56,895 --> 00:00:58,094 a research lab, 28 00:00:58,414 --> 00:01:01,899 looking for new treatments for pediatric leukemia in 29 00:01:01,899 --> 00:01:02,399 particular. 30 00:01:02,940 --> 00:01:05,359 But also I'm a pediatric leukemia doctor. 31 00:01:06,060 --> 00:01:08,700 So after being in in Colorado for nineteen 32 00:01:08,700 --> 00:01:11,180 years, I transitioned a little bit of my 33 00:01:11,180 --> 00:01:12,000 role to, 34 00:01:12,459 --> 00:01:14,620 in addition to being a a leukemia physician 35 00:01:14,620 --> 00:01:16,454 to have a more administrative role as the 36 00:01:16,454 --> 00:01:18,295 chief of the Aflac Cancer and Blood Disorder 37 00:01:18,295 --> 00:01:18,795 Center, 38 00:01:19,334 --> 00:01:21,094 in Atlanta, and I have been here now 39 00:01:21,094 --> 00:01:21,755 ten years. 40 00:01:22,375 --> 00:01:24,635 Doug, I wanna follow-up with that. Just what 41 00:01:25,094 --> 00:01:27,974 drew you to being a leukemia doctor in 42 00:01:27,974 --> 00:01:28,474 particular? 43 00:01:29,780 --> 00:01:32,659 Well, that, is a fantastic question, and I 44 00:01:32,659 --> 00:01:34,740 often get asked. And is it is it 45 00:01:34,740 --> 00:01:36,980 something that is a difficult career to to 46 00:01:36,980 --> 00:01:38,439 work with children in cancer? 47 00:01:39,380 --> 00:01:40,920 You know, I'll tell you that 48 00:01:41,234 --> 00:01:44,194 part of my interest in cancer came from 49 00:01:44,194 --> 00:01:46,435 my research interest. And so as I was 50 00:01:46,435 --> 00:01:48,515 doing my PhD research, it was in the 51 00:01:48,515 --> 00:01:50,694 field of cancer research and and understanding 52 00:01:51,314 --> 00:01:52,055 what causes, 53 00:01:52,674 --> 00:01:55,140 normal cells to turn into cancer cells and 54 00:01:55,140 --> 00:01:57,459 how do we develop new treatment for for 55 00:01:57,459 --> 00:01:57,959 cancer. 56 00:01:58,579 --> 00:01:59,879 But really the the passion 57 00:02:00,420 --> 00:02:02,340 came as I was in the clinic and 58 00:02:02,340 --> 00:02:04,659 and dealing with families that were going through 59 00:02:04,659 --> 00:02:07,140 the crisis of of having to hear the 60 00:02:07,140 --> 00:02:08,979 words that, you you know, your child has 61 00:02:08,979 --> 00:02:09,479 cancer. 62 00:02:10,305 --> 00:02:10,965 And oftentimes, 63 00:02:11,264 --> 00:02:12,564 even though we couldn't explain 64 00:02:13,025 --> 00:02:15,764 why a child has cancer, we could say, 65 00:02:16,144 --> 00:02:17,905 we know the next step forward to be 66 00:02:17,905 --> 00:02:19,504 able to try to make your your child 67 00:02:19,504 --> 00:02:20,405 healthy again. 68 00:02:20,864 --> 00:02:23,710 So over the last several decades, there's been 69 00:02:23,710 --> 00:02:26,370 remarkable progress in particular with leukemia. 70 00:02:27,069 --> 00:02:28,830 So I was born in the nineteen sixties. 71 00:02:28,830 --> 00:02:30,670 And at the time, if if you were 72 00:02:30,670 --> 00:02:32,990 a child diagnosed with, with leukemia in the 73 00:02:32,990 --> 00:02:33,890 nineteen sixties, 74 00:02:34,349 --> 00:02:36,110 there was almost no hope for a cure. 75 00:02:36,110 --> 00:02:37,974 As a matter of fact, there was even 76 00:02:37,974 --> 00:02:40,294 debate, around that time whether or not we 77 00:02:40,294 --> 00:02:43,335 would even treat children who have leukemia with 78 00:02:43,335 --> 00:02:43,835 chemotherapy. 79 00:02:44,534 --> 00:02:47,415 So we progressed from there to now in 80 00:02:47,415 --> 00:02:48,395 today's world, 81 00:02:48,935 --> 00:02:51,574 about eighty percent of children with all childhood 82 00:02:51,574 --> 00:02:53,879 cancer, we can cure as an overall cure 83 00:02:53,879 --> 00:02:54,379 rate. 84 00:02:54,840 --> 00:02:57,400 And specifically within leukemia, some of the cure 85 00:02:57,400 --> 00:02:59,639 rates are as high as ninety to ninety 86 00:02:59,639 --> 00:03:02,360 five percent of children with leukemia. So there's 87 00:03:02,360 --> 00:03:04,439 a lot of promise and hope and really 88 00:03:04,439 --> 00:03:06,360 just a a a lot of, 89 00:03:07,245 --> 00:03:09,805 reward, I would say, in in working with 90 00:03:09,805 --> 00:03:11,885 families and being entrusted with the care of 91 00:03:11,885 --> 00:03:12,625 their children. 92 00:03:13,165 --> 00:03:15,004 Well, Doug, thankfully, there are people like you 93 00:03:15,004 --> 00:03:17,004 who are doing this hard work, this research. 94 00:03:17,004 --> 00:03:19,659 Obviously, you're not the only one. But to 95 00:03:19,659 --> 00:03:20,239 go from 96 00:03:20,539 --> 00:03:22,299 the numbers that you just set up to 97 00:03:22,299 --> 00:03:25,039 ninety nine percent ninety to ninety five percent, 98 00:03:25,180 --> 00:03:27,099 that's great. I'm sure your numbers you hope 99 00:03:27,099 --> 00:03:29,180 those numbers will get higher every single day. 100 00:03:29,180 --> 00:03:30,459 And that's part of what we're here to 101 00:03:30,459 --> 00:03:31,120 talk about. 102 00:03:31,674 --> 00:03:33,674 So, Doug, the next question I have for 103 00:03:33,674 --> 00:03:34,794 you is simply, what are some of the 104 00:03:34,794 --> 00:03:37,034 milestones that you've reached at the Aflac Cancer 105 00:03:37,034 --> 00:03:39,194 and Blood Disorder Center, and what effect have 106 00:03:39,194 --> 00:03:41,514 they had on children's health, whether it's in 107 00:03:41,514 --> 00:03:43,215 the Atlanta area or beyond? 108 00:03:44,330 --> 00:03:46,969 One of the things that is remarkable about 109 00:03:46,969 --> 00:03:49,229 the Aflac Cancer and Blood Disorder Center, 110 00:03:49,610 --> 00:03:51,709 is our partnership with the Aflac company. 111 00:03:52,330 --> 00:03:53,930 I don't really know of anywhere else in 112 00:03:53,930 --> 00:03:55,930 the country where there's anything quite like what 113 00:03:55,930 --> 00:03:57,530 we have with the partnership we have with 114 00:03:57,530 --> 00:03:58,544 Aflac. But, 115 00:03:58,944 --> 00:04:00,544 this has been a thirty year partnership. We're 116 00:04:00,544 --> 00:04:01,044 having 117 00:04:01,344 --> 00:04:03,764 our thirtieth birthday celebration this year. 118 00:04:04,544 --> 00:04:07,444 We have been funded by the Aflac company, 119 00:04:08,145 --> 00:04:10,625 thirty years ago because of a a unique 120 00:04:10,625 --> 00:04:11,125 patient, 121 00:04:11,504 --> 00:04:12,245 that we, 122 00:04:12,699 --> 00:04:14,939 cared for with within our center. And this 123 00:04:14,939 --> 00:04:17,839 was a a young girl who developed leukemia, 124 00:04:18,379 --> 00:04:20,459 and we were able to give the therapy 125 00:04:20,459 --> 00:04:22,620 that was necessary for the leukemia at the 126 00:04:22,620 --> 00:04:24,319 time for the upfront therapy, 127 00:04:24,954 --> 00:04:26,634 But then the child relapsed. And when the 128 00:04:26,634 --> 00:04:29,134 child relapsed, she needed a bone marrow transplant. 129 00:04:29,995 --> 00:04:31,834 We did not have the expertise at that 130 00:04:31,834 --> 00:04:34,235 time to to provide a bone marrow transplant 131 00:04:34,235 --> 00:04:35,995 at Atlanta, so we had to send our 132 00:04:35,995 --> 00:04:37,055 patient to Seattle. 133 00:04:37,420 --> 00:04:39,100 So outside of the state of Georgia to 134 00:04:39,100 --> 00:04:40,620 receive the care and then come back to 135 00:04:40,620 --> 00:04:41,120 us. 136 00:04:41,580 --> 00:04:44,540 So we approached the Aflac company about, would 137 00:04:44,540 --> 00:04:46,460 you join us in a vision so that 138 00:04:46,460 --> 00:04:46,960 someday 139 00:04:47,740 --> 00:04:49,980 every child that's diagnosed with cancer in the 140 00:04:49,980 --> 00:04:51,420 state of Georgia, we could care for in 141 00:04:51,420 --> 00:04:53,164 Georgia. We wouldn't have to send any kids 142 00:04:53,164 --> 00:04:55,084 outside of Georgia for any reason. As a 143 00:04:55,084 --> 00:04:56,444 matter of fact, we would like to be 144 00:04:56,444 --> 00:04:58,285 a referral center, a place that could be 145 00:04:58,285 --> 00:04:59,884 a safety net for other kids that are 146 00:04:59,884 --> 00:05:01,485 in the Southeast to to receive care that 147 00:05:01,485 --> 00:05:02,305 they would need. 148 00:05:02,685 --> 00:05:04,604 So that started the journey thirty years ago, 149 00:05:04,604 --> 00:05:05,264 and now, 150 00:05:05,644 --> 00:05:06,784 the Aflac company, 151 00:05:07,509 --> 00:05:09,110 over this time span has given us a 152 00:05:09,110 --> 00:05:10,969 $190,000,000, 153 00:05:11,669 --> 00:05:13,430 of investment to be able to make us 154 00:05:13,430 --> 00:05:15,129 one of the top centers in the country. 155 00:05:15,589 --> 00:05:17,430 And and and the remarkable thing about it 156 00:05:17,430 --> 00:05:19,514 is that in part, it comes from the 157 00:05:19,514 --> 00:05:20,735 company, but it also, 158 00:05:21,115 --> 00:05:23,115 is an engagement with all of the Aflac 159 00:05:23,115 --> 00:05:25,294 field force workers all across the country. 160 00:05:25,675 --> 00:05:28,394 So every month, more than 15,000 161 00:05:28,394 --> 00:05:31,354 of the field force workers contribute date contribute 162 00:05:31,354 --> 00:05:33,754 monthly from their paycheck to the Aflac Cancer 163 00:05:33,754 --> 00:05:34,975 and Blood Disorders Center. 164 00:05:35,730 --> 00:05:37,589 This has allowed tremendous growth, 165 00:05:37,970 --> 00:05:39,350 growth in expertise, 166 00:05:39,970 --> 00:05:42,930 of our faculty, for example. So twenty five, 167 00:05:42,930 --> 00:05:45,250 thirty years ago, we had 18 faculty that 168 00:05:45,250 --> 00:05:47,730 were specialists in hematology, oncology, and bone marrow 169 00:05:47,730 --> 00:05:48,230 transplant. 170 00:05:48,610 --> 00:05:50,629 And today, we have over a 130. 171 00:05:51,055 --> 00:05:53,454 So this really gives us experts in any 172 00:05:53,454 --> 00:05:55,294 kind of disease that you would have in 173 00:05:55,294 --> 00:05:57,375 the field. And that we have really top 174 00:05:57,375 --> 00:05:59,794 national experts that are right in Atlanta. 175 00:06:00,334 --> 00:06:02,095 And we no longer have, 176 00:06:02,495 --> 00:06:04,949 any reason to be able to send children 177 00:06:04,949 --> 00:06:07,589 outside of Atlanta to to exceed to receive 178 00:06:07,589 --> 00:06:08,649 accelerated care. 179 00:06:09,110 --> 00:06:10,329 As a matter of fact, 180 00:06:10,790 --> 00:06:12,949 we now have become a regional referral center. 181 00:06:12,949 --> 00:06:14,810 And if you look back over the last 182 00:06:15,189 --> 00:06:17,750 five years, we have seen patients from 45 183 00:06:17,750 --> 00:06:19,589 different states that have sent patients to us 184 00:06:19,589 --> 00:06:20,444 for their care. 185 00:06:21,324 --> 00:06:24,125 And I say also that, we have had 186 00:06:24,125 --> 00:06:26,785 a unique opportunity because we are, 187 00:06:27,404 --> 00:06:28,064 the only, 188 00:06:28,685 --> 00:06:29,824 children's hospital 189 00:06:30,285 --> 00:06:32,925 in a in a large metropolitan city of 190 00:06:32,925 --> 00:06:34,464 six or 7,000,000 people. 191 00:06:34,899 --> 00:06:36,740 So this makes us one of the largest 192 00:06:36,740 --> 00:06:37,240 volume 193 00:06:37,939 --> 00:06:39,879 pediatric cancer centers in the country. 194 00:06:40,660 --> 00:06:43,300 We see more than five hundred new cancer 195 00:06:43,300 --> 00:06:45,060 diagnosis a year, making us one of the 196 00:06:45,060 --> 00:06:47,539 very largest in terms of number of cancer 197 00:06:47,539 --> 00:06:50,314 patients that we see. And we are we 198 00:06:50,314 --> 00:06:51,774 are the number one, 199 00:06:52,235 --> 00:06:54,334 clinical volume for pediatric hematology. 200 00:06:54,795 --> 00:06:57,194 So patients with blood diseases like sickle cell 201 00:06:57,194 --> 00:06:58,574 disease or thalassemia, 202 00:06:58,955 --> 00:07:00,495 for example, or or hemophilia, 203 00:07:01,595 --> 00:07:02,334 in part, 204 00:07:02,879 --> 00:07:04,639 driven by the fact that we have more 205 00:07:04,639 --> 00:07:07,040 than twenty one hundred unique sickle cell patients 206 00:07:07,040 --> 00:07:08,020 that we care for. 207 00:07:08,639 --> 00:07:10,639 And then our our other component of our 208 00:07:10,639 --> 00:07:12,879 program is our bone marrow transplant program, which 209 00:07:12,879 --> 00:07:15,040 is also one of the largest five centers 210 00:07:15,040 --> 00:07:16,740 in the country in in terms of volume. 211 00:07:17,654 --> 00:07:20,535 So I think those could together, the the 212 00:07:20,535 --> 00:07:23,095 partnership that we've had have allowed us to 213 00:07:23,095 --> 00:07:23,595 recruit 214 00:07:23,975 --> 00:07:25,115 exceptional faculty, 215 00:07:25,894 --> 00:07:28,454 to expand the the programs that we need 216 00:07:28,454 --> 00:07:30,214 to to care for the large volume of 217 00:07:30,214 --> 00:07:31,435 patients that we have. 218 00:07:31,959 --> 00:07:34,199 But also the last component of it is 219 00:07:34,199 --> 00:07:35,180 is the innovation. 220 00:07:35,560 --> 00:07:37,399 The innovative programs that we've been able to 221 00:07:37,399 --> 00:07:39,079 capitalize on. And we can talk more about 222 00:07:39,079 --> 00:07:41,419 that, but we have some programs that, 223 00:07:42,040 --> 00:07:43,740 are present in Atlanta, 224 00:07:44,384 --> 00:07:46,064 that may only be present in one or 225 00:07:46,064 --> 00:07:47,745 two or three places in the country outside 226 00:07:47,745 --> 00:07:48,485 of Atlanta. 227 00:07:48,785 --> 00:07:51,024 So we're we're very fortunate to, 228 00:07:51,584 --> 00:07:53,664 receive the support that we have to to 229 00:07:53,664 --> 00:07:56,064 provide the exceptional care that we wanna provide 230 00:07:56,064 --> 00:07:56,884 to our children. 231 00:07:58,169 --> 00:07:59,789 That's quite an impressive, 232 00:08:00,410 --> 00:08:02,329 rate of growth, Doug, and I'm sure you 233 00:08:02,329 --> 00:08:03,789 hope that that continues. 234 00:08:05,370 --> 00:08:07,069 I also wanna talk to you about 235 00:08:07,849 --> 00:08:09,389 the future, specifically 236 00:08:09,849 --> 00:08:12,669 some of the most promising pediatric cancer treatments 237 00:08:13,185 --> 00:08:15,824 that, you guys at the Aflac Cancer and 238 00:08:15,824 --> 00:08:17,605 Blood Story Center are working on, 239 00:08:18,144 --> 00:08:20,625 that may be affecting other health systems as 240 00:08:20,625 --> 00:08:21,125 well? 241 00:08:21,985 --> 00:08:23,524 Well, if you think about 242 00:08:23,824 --> 00:08:25,904 where we have come in in terms of 243 00:08:25,904 --> 00:08:28,410 cure for cancer, if we have an eighty 244 00:08:28,410 --> 00:08:29,389 percent cure, 245 00:08:29,930 --> 00:08:30,729 for all, 246 00:08:31,129 --> 00:08:32,909 pediatric cancer as a whole, 247 00:08:33,610 --> 00:08:36,490 that's that's fantastic. Fantastic progress. And we've done 248 00:08:36,490 --> 00:08:36,990 that, 249 00:08:37,529 --> 00:08:40,009 as really a a a group across the 250 00:08:40,009 --> 00:08:42,830 country in collaborating in with clinical trials, 251 00:08:43,184 --> 00:08:45,345 to be able to advance the treatments, that 252 00:08:45,345 --> 00:08:47,264 still leaves twenty percent of patients that we're 253 00:08:47,264 --> 00:08:49,184 not curing. Right? And so every year, if 254 00:08:49,184 --> 00:08:50,325 we think about that, 255 00:08:50,705 --> 00:08:52,625 in Atlanta, if we have five hundred new 256 00:08:52,625 --> 00:08:54,865 cancer diagnosis, we might have four hundred of 257 00:08:54,865 --> 00:08:57,149 those that go on to be survivors, but 258 00:08:57,230 --> 00:08:59,470 but there's still a hundred patients for which 259 00:08:59,470 --> 00:09:00,930 we need much better treatment. 260 00:09:01,389 --> 00:09:03,070 And I would say better treatment in two 261 00:09:03,070 --> 00:09:05,250 ways. We need more effective therapies, 262 00:09:05,710 --> 00:09:07,950 therapies that will that will close the gap 263 00:09:07,950 --> 00:09:09,090 on this twenty percent. 264 00:09:10,154 --> 00:09:12,235 But it the second thing that we need 265 00:09:12,235 --> 00:09:14,654 to do is to have less toxic treatments. 266 00:09:15,115 --> 00:09:16,254 More more, 267 00:09:16,955 --> 00:09:19,375 treatments that are gonna have fewer side effects. 268 00:09:19,914 --> 00:09:20,575 And so, 269 00:09:21,115 --> 00:09:23,214 even though there our cure rates are high, 270 00:09:24,235 --> 00:09:25,649 studies have shown that 271 00:09:26,129 --> 00:09:28,950 if you look at cancer pediatric cancer survivors, 272 00:09:29,649 --> 00:09:33,090 that virtually every pediatric cancer survivor by the 273 00:09:33,090 --> 00:09:35,410 age of 50 is gonna have some chronic 274 00:09:35,410 --> 00:09:36,230 health condition. 275 00:09:37,170 --> 00:09:40,070 So there will be problems, issues related to 276 00:09:40,254 --> 00:09:42,914 heart function or lung function or thyroid function. 277 00:09:43,694 --> 00:09:45,954 There may be learning challenges in school. 278 00:09:46,495 --> 00:09:48,034 There could be fertility 279 00:09:48,414 --> 00:09:49,714 preservation issues. 280 00:09:50,654 --> 00:09:51,154 So 281 00:09:51,855 --> 00:09:54,095 the the goal that we have as we 282 00:09:54,095 --> 00:09:56,639 look forward to the future are more targeted 283 00:09:56,700 --> 00:09:57,200 therapies 284 00:09:57,740 --> 00:09:58,639 that are effective 285 00:09:59,100 --> 00:10:00,799 and are are less toxic. 286 00:10:01,419 --> 00:10:03,419 And so we we are we are doing 287 00:10:03,419 --> 00:10:05,419 that in a couple different ways. The the 288 00:10:05,419 --> 00:10:08,159 first way that we are trying to address 289 00:10:08,485 --> 00:10:11,365 having more targeted therapies, therapies that are really 290 00:10:11,365 --> 00:10:14,245 only hitting the cancer cells more specifically and 291 00:10:14,245 --> 00:10:15,865 and less of the normal cells, 292 00:10:16,165 --> 00:10:18,485 is we do that through programs such as 293 00:10:18,485 --> 00:10:19,945 precision medicine programs. 294 00:10:20,644 --> 00:10:21,144 So 295 00:10:21,470 --> 00:10:23,710 in our cancer center and and in other 296 00:10:23,710 --> 00:10:25,090 centers across the country, 297 00:10:25,549 --> 00:10:27,870 we now have the ability to understand on 298 00:10:27,870 --> 00:10:31,250 a genetic level what might be driving individual 299 00:10:31,309 --> 00:10:33,790 cancer. So it's not, for example, that all 300 00:10:33,790 --> 00:10:34,450 the leukemias 301 00:10:34,830 --> 00:10:36,750 are the same, that of the patients we 302 00:10:36,750 --> 00:10:39,205 see. But there might be unique drivers for 303 00:10:39,205 --> 00:10:41,684 each leukemia patient. And that might help us 304 00:10:41,684 --> 00:10:44,084 figure out better treatment plans as a a 305 00:10:44,084 --> 00:10:46,904 better prognosis and a better treatment plan that's 306 00:10:46,964 --> 00:10:48,985 directly tailored for that patient. 307 00:10:49,940 --> 00:10:51,879 So there are more than 20,000 308 00:10:52,100 --> 00:10:54,100 genes in a in a normal cell or 309 00:10:54,100 --> 00:10:56,600 leukemia cell. And what would have taken, 310 00:10:57,220 --> 00:10:59,059 you know, forever to be able to figure 311 00:10:59,059 --> 00:11:01,220 out and dissect all the different genes in 312 00:11:01,220 --> 00:11:02,120 a cancer cell, 313 00:11:02,454 --> 00:11:04,214 we now can, in just a matter of 314 00:11:04,214 --> 00:11:06,294 days, sequence all the genes in a cancer 315 00:11:06,294 --> 00:11:08,375 cell. And we can figure out how those 316 00:11:08,375 --> 00:11:10,475 genes are different from the normal cell. 317 00:11:11,174 --> 00:11:13,095 This allows us to figure out if we 318 00:11:13,095 --> 00:11:15,754 if we if we decipher a specific genetic 319 00:11:16,279 --> 00:11:18,279 lesion, is there a drug that can be 320 00:11:18,279 --> 00:11:20,279 targeted for that? Is there a specific drug 321 00:11:20,279 --> 00:11:21,500 that can help that patient? 322 00:11:22,120 --> 00:11:23,660 So in that way, 323 00:11:24,519 --> 00:11:26,860 the future is bright and that the understanding 324 00:11:26,920 --> 00:11:28,600 that we have and advances we have in 325 00:11:28,600 --> 00:11:31,855 molecular medicine are helping us tailor certain types 326 00:11:31,855 --> 00:11:34,894 of, therapies for patients. And also help us 327 00:11:34,894 --> 00:11:36,195 understand in some patients, 328 00:11:36,654 --> 00:11:38,815 are there are there ways that they may 329 00:11:38,815 --> 00:11:41,855 metabolize chemotherapy differently? So we might even adjust 330 00:11:41,855 --> 00:11:43,875 some of the way that we give chemotherapy 331 00:11:44,415 --> 00:11:47,669 agents based on some genetic information we we 332 00:11:47,669 --> 00:11:48,730 obtained for the patient. 333 00:11:49,590 --> 00:11:51,289 The second thing is that, 334 00:11:51,669 --> 00:11:54,730 which is an exciting advancement besides the, 335 00:11:55,350 --> 00:11:56,409 precision medicine 336 00:11:56,950 --> 00:11:59,450 and and the use of of targeted therapies 337 00:12:00,105 --> 00:12:02,264 is is really the, I would say the 338 00:12:02,264 --> 00:12:04,904 coming of age of of using immunology. Using 339 00:12:04,904 --> 00:12:07,004 your own immune system to help fight cancer. 340 00:12:07,784 --> 00:12:09,804 So we have begun, 341 00:12:10,745 --> 00:12:13,065 in in the field of pediatric oncology, and 342 00:12:13,065 --> 00:12:15,245 I would say adult oncology as well, 343 00:12:15,720 --> 00:12:18,039 to to learn tricks to be able to 344 00:12:18,039 --> 00:12:20,679 ramp up, and rev up your immune system 345 00:12:20,679 --> 00:12:22,679 to help you fight cancer, to turn on 346 00:12:22,679 --> 00:12:24,059 the immune system specifically 347 00:12:24,519 --> 00:12:26,759 as as as a as an aid to 348 00:12:26,759 --> 00:12:27,899 to cancer fighting. 349 00:12:28,415 --> 00:12:30,254 Well, there are medicines that we can give 350 00:12:30,254 --> 00:12:32,014 that can turn on the immune system and 351 00:12:32,014 --> 00:12:34,415 and that can help. But and another way 352 00:12:34,415 --> 00:12:36,894 is that we can take immune cells from 353 00:12:36,894 --> 00:12:37,475 a patient. 354 00:12:37,934 --> 00:12:38,434 So 355 00:12:39,054 --> 00:12:40,274 outside of the body 356 00:12:40,735 --> 00:12:43,955 and train those immune cells to detect 357 00:12:44,470 --> 00:12:47,110 cancer cells, such as leukemia cells, and then 358 00:12:47,110 --> 00:12:49,210 give them back to the to that patient. 359 00:12:49,509 --> 00:12:51,590 And so you're using cells as drugs as 360 00:12:51,590 --> 00:12:54,230 well. And an example of this is is 361 00:12:54,230 --> 00:12:56,149 this type of therapy that I'm discussing is 362 00:12:56,149 --> 00:12:57,610 called CAR T cell therapy. 363 00:12:58,325 --> 00:12:58,825 So, 364 00:12:59,445 --> 00:13:01,705 CAR T cell therapy has changed 365 00:13:02,884 --> 00:13:05,684 the the the path for for many patients 366 00:13:05,684 --> 00:13:08,644 that have failed other therapies. And so, in 367 00:13:08,644 --> 00:13:10,345 in the past, you know, before, 368 00:13:10,740 --> 00:13:12,899 a decade ago, before the advent of CAR 369 00:13:12,899 --> 00:13:14,820 t t cell therapy, there may have been 370 00:13:14,820 --> 00:13:16,659 patients that we have said, well, we we've 371 00:13:16,659 --> 00:13:18,340 really run out of options of what we 372 00:13:18,340 --> 00:13:20,340 can do for you. But now, through these 373 00:13:20,340 --> 00:13:22,419 cellular therapies such as CAR t cell therapy, 374 00:13:22,419 --> 00:13:24,574 we can now say, we have another option. 375 00:13:24,574 --> 00:13:26,574 And then a very effective option to now 376 00:13:26,574 --> 00:13:28,914 cure patients using immune cells, 377 00:13:29,534 --> 00:13:31,855 and and cells in this case that we 378 00:13:31,855 --> 00:13:34,574 derive from from that particular patient to help 379 00:13:34,574 --> 00:13:37,054 fight the cancer and achieve cures from which 380 00:13:37,054 --> 00:13:38,334 a way we could not have done in 381 00:13:38,334 --> 00:13:38,995 the past. 382 00:13:39,480 --> 00:13:41,799 So so those are what I would say 383 00:13:41,799 --> 00:13:42,459 is promising 384 00:13:43,080 --> 00:13:44,360 to be able to close the gap on 385 00:13:44,360 --> 00:13:46,679 this twenty percent. How do how do we 386 00:13:46,679 --> 00:13:48,759 reach a goal sometime that we have a 387 00:13:48,759 --> 00:13:50,919 therapeutic option for every patient that we see 388 00:13:50,919 --> 00:13:52,139 that has childhood cancer? 389 00:13:52,815 --> 00:13:53,315 Jag, 390 00:13:54,175 --> 00:13:55,235 I'm very impressed. 391 00:13:56,495 --> 00:13:58,815 Let me just say this. The picture painting 392 00:13:58,815 --> 00:14:00,915 of how these therapies work 393 00:14:01,455 --> 00:14:03,855 is just incredibly easy for me to follow, 394 00:14:03,855 --> 00:14:05,855 and I'm not anywhere close to an MD 395 00:14:05,855 --> 00:14:07,855 or PhD. So I appreciate you putting in 396 00:14:07,855 --> 00:14:09,649 this in such a way, 397 00:14:10,110 --> 00:14:12,590 that makes me super excited about where all 398 00:14:12,590 --> 00:14:14,669 these therapies are going. And and no doubt 399 00:14:14,669 --> 00:14:17,809 your your patients and communities feel the same. 400 00:14:18,590 --> 00:14:20,690 Looking even further into the future, 401 00:14:21,134 --> 00:14:24,014 so what are the Aflacancer and Blood Disorder 402 00:14:24,014 --> 00:14:26,175 Centers? What are your next steps in advancing 403 00:14:26,175 --> 00:14:27,615 your mission, and what are you gonna need 404 00:14:27,615 --> 00:14:28,915 to accomplish your goals? 405 00:14:29,855 --> 00:14:31,934 Well, you know, I'll tell you as as 406 00:14:31,934 --> 00:14:32,675 we discuss, 407 00:14:33,215 --> 00:14:35,715 these therapies, I I mentioned cell therapy. 408 00:14:36,710 --> 00:14:38,090 Our mission will continue 409 00:14:38,629 --> 00:14:40,090 to advance upon, 410 00:14:41,029 --> 00:14:43,670 expanding options for cell therapy. So we have 411 00:14:43,670 --> 00:14:46,389 great options for cell therapy for leukemia patients 412 00:14:46,389 --> 00:14:47,850 and the CAR T cell therapy. 413 00:14:48,355 --> 00:14:50,274 Our team and other teams across the country 414 00:14:50,274 --> 00:14:51,794 are looking for how do we use that 415 00:14:51,794 --> 00:14:52,294 technology 416 00:14:52,835 --> 00:14:54,754 and expand it to other types of cancers 417 00:14:54,754 --> 00:14:57,235 that are solid tumors, for example. So, right 418 00:14:57,235 --> 00:14:59,154 now, we're trying to develop the same kind 419 00:14:59,154 --> 00:15:01,860 of cellular therapy for for brain cancer, 420 00:15:02,419 --> 00:15:04,120 and for tumors such as neuroblastoma 421 00:15:04,579 --> 00:15:05,480 that we're testing. 422 00:15:06,019 --> 00:15:06,519 So 423 00:15:06,980 --> 00:15:09,379 we are so excited to be in the 424 00:15:09,379 --> 00:15:11,399 new hospital, the new Arthur, 425 00:15:11,860 --> 00:15:12,519 in blank, 426 00:15:13,299 --> 00:15:14,440 hospital right, 427 00:15:15,299 --> 00:15:17,399 in Atlanta that we have moved into. 428 00:15:18,235 --> 00:15:18,954 It has, 429 00:15:20,074 --> 00:15:21,115 446 430 00:15:21,115 --> 00:15:23,115 beds. 98 of the beds are for the 431 00:15:23,115 --> 00:15:25,595 Aflac Cancer and Blood Disorder Center. State of 432 00:15:25,595 --> 00:15:28,095 the art facility allows us to to deliver 433 00:15:28,314 --> 00:15:30,475 exceptional care that we want to provide in 434 00:15:30,475 --> 00:15:31,934 in state of the art facilities. 435 00:15:32,420 --> 00:15:34,340 But the other thing that that the Arthur 436 00:15:34,340 --> 00:15:34,820 Blank, 437 00:15:35,379 --> 00:15:36,440 hospital has 438 00:15:36,899 --> 00:15:39,960 are GMP laboratories. So these are good manufacturing 439 00:15:40,340 --> 00:15:41,480 practices laboratories 440 00:15:42,019 --> 00:15:44,100 that allow us now for the first time 441 00:15:44,100 --> 00:15:45,080 ever to manufacture 442 00:15:45,894 --> 00:15:48,714 these cell therapies that I'm talking about. So, 443 00:15:48,934 --> 00:15:50,714 prior to moving into this hospital, 444 00:15:51,174 --> 00:15:53,575 any cell therapy trial that we would wanna 445 00:15:53,575 --> 00:15:55,595 conduct would have had to been in collaboration 446 00:15:55,654 --> 00:15:58,235 with a pharmaceutical company or with another center. 447 00:15:58,519 --> 00:16:00,779 But now that we have the manufacturing capability 448 00:16:00,840 --> 00:16:02,919 right in the hospital, we actually can think 449 00:16:02,919 --> 00:16:05,000 of new ideas for cell therapy and for 450 00:16:05,000 --> 00:16:07,720 gene therapy for our patients and manufacture these 451 00:16:07,720 --> 00:16:09,720 products right in the hospital to give even 452 00:16:09,720 --> 00:16:11,639 quicker delivery and to to come up with 453 00:16:11,639 --> 00:16:13,580 new ideas and next generation ideas. 454 00:16:14,014 --> 00:16:16,014 In addition to the cell therapy, I I 455 00:16:16,014 --> 00:16:17,774 mentioned gene therapy, and I I do wanna 456 00:16:17,774 --> 00:16:19,455 touch on that for just a second as 457 00:16:19,455 --> 00:16:19,955 well. 458 00:16:20,575 --> 00:16:23,215 Gene therapy has changed the the way that 459 00:16:23,215 --> 00:16:26,254 we even think about cures for some of 460 00:16:26,254 --> 00:16:26,914 our children. 461 00:16:27,509 --> 00:16:30,470 And and and and this used to, you 462 00:16:30,470 --> 00:16:32,070 know, just a few years ago, would have 463 00:16:32,070 --> 00:16:34,470 been, wouldn't it be nice, for example, if 464 00:16:34,470 --> 00:16:35,670 we had a way that we could cure 465 00:16:35,670 --> 00:16:38,230 children with sickle cell disease? Well, now today 466 00:16:38,230 --> 00:16:39,910 is the day. Today is the day that 467 00:16:39,910 --> 00:16:40,889 we can do that. 468 00:16:41,235 --> 00:16:42,455 There's gene therapy 469 00:16:42,914 --> 00:16:43,414 trials. 470 00:16:43,955 --> 00:16:46,274 There have been gene therapy trials that we 471 00:16:46,274 --> 00:16:48,615 participated in over the last few years 472 00:16:48,995 --> 00:16:49,894 that allowed 473 00:16:50,595 --> 00:16:53,315 as a community across the country for us 474 00:16:53,315 --> 00:16:56,129 to develop an effective gene therapy product for 475 00:16:56,129 --> 00:16:57,509 patients with sickle cell disease. 476 00:16:58,049 --> 00:16:59,190 So we now, 477 00:16:59,809 --> 00:17:02,929 are in the process of enrolling patients to 478 00:17:02,929 --> 00:17:05,430 receive this new gene therapy treatment, 479 00:17:05,970 --> 00:17:07,730 right here in Atlanta. As a matter of 480 00:17:07,730 --> 00:17:08,230 fact, 481 00:17:08,825 --> 00:17:10,904 we already have over 60 patients on the 482 00:17:10,904 --> 00:17:12,825 wait list to receive gene therapy for sickle 483 00:17:12,825 --> 00:17:13,565 cell disease. 484 00:17:14,025 --> 00:17:16,265 So we we're in a new era of, 485 00:17:16,984 --> 00:17:19,545 of of offering cures for patients for sickle 486 00:17:19,545 --> 00:17:21,484 cell disease that we never could have done, 487 00:17:21,945 --> 00:17:24,509 in in the past using gene therapy. 488 00:17:25,289 --> 00:17:27,309 I'll say that this compliments though 489 00:17:28,009 --> 00:17:30,250 another kind of therapy that we've been involved 490 00:17:30,250 --> 00:17:32,410 with for a number of years already within 491 00:17:32,410 --> 00:17:34,650 our center, and and that's the use of 492 00:17:34,650 --> 00:17:37,130 bone marrow transplant for for patients with sickle 493 00:17:37,130 --> 00:17:37,789 cell disease. 494 00:17:38,115 --> 00:17:40,434 So in our center, we have transplanted more 495 00:17:40,434 --> 00:17:41,555 than a 150 496 00:17:41,555 --> 00:17:43,494 patients with sickle cell disease already. 497 00:17:44,035 --> 00:17:46,775 Many of them have been able to have 498 00:17:46,835 --> 00:17:49,234 transformed lives and be able to have a 499 00:17:49,234 --> 00:17:50,295 a curative option. 500 00:17:51,089 --> 00:17:53,089 We hope that the gene therapy would be 501 00:17:53,089 --> 00:17:54,849 a next generation for that and will have 502 00:17:54,849 --> 00:17:55,589 some advantages 503 00:17:56,049 --> 00:17:58,049 of having not as many of the side 504 00:17:58,049 --> 00:18:00,210 effects potentially that a patient would have that 505 00:18:00,210 --> 00:18:01,750 undergoes a bone marrow transplant. 506 00:18:02,289 --> 00:18:04,950 But in addition, this idea of gene therapy 507 00:18:05,009 --> 00:18:07,434 is being extended to other types of diseases 508 00:18:07,494 --> 00:18:08,795 as well within our center. 509 00:18:09,335 --> 00:18:12,775 So we have already treated this year of 510 00:18:12,775 --> 00:18:13,674 of a patient, 511 00:18:14,375 --> 00:18:16,315 with gene therapy for beta thalassemia. 512 00:18:17,255 --> 00:18:19,654 And and for that disease, we have more 513 00:18:19,654 --> 00:18:22,289 than 26 patients that are already on a 514 00:18:22,289 --> 00:18:24,150 waiting list for this therapy as well. 515 00:18:24,929 --> 00:18:27,829 And then finally, we have we have contributed 516 00:18:27,970 --> 00:18:30,150 significantly to gene therapy for hemophilia. 517 00:18:30,769 --> 00:18:32,210 As a matter of fact, one of our 518 00:18:32,210 --> 00:18:34,690 faculty at the Aflac Cancer and Blood Disorder 519 00:18:34,690 --> 00:18:37,035 Center came up with the new gene therapy 520 00:18:37,035 --> 00:18:38,095 product for hemophilia 521 00:18:38,634 --> 00:18:41,134 that was just tested internationally in India, 522 00:18:41,674 --> 00:18:43,054 and has been so successful, 523 00:18:43,595 --> 00:18:45,434 in this therapy that it was just published 524 00:18:45,434 --> 00:18:47,355 just just in the last couple months in 525 00:18:47,355 --> 00:18:48,815 the New England Journal of Medicine 526 00:18:49,115 --> 00:18:51,214 reporting the early success of that trial. 527 00:18:52,580 --> 00:18:54,840 Doug, I can't imagine the amount of hope 528 00:18:54,900 --> 00:18:56,200 that comes out of, 529 00:18:56,740 --> 00:18:58,820 the center that you're working for and and 530 00:18:58,820 --> 00:18:59,799 every single day. 531 00:19:00,660 --> 00:19:03,220 Thank you so much for being on the 532 00:19:03,220 --> 00:19:04,279 podcast today. 533 00:19:04,734 --> 00:19:06,414 You know, hopefully, this will not be the 534 00:19:06,414 --> 00:19:08,894 last time that we share with our audience 535 00:19:08,894 --> 00:19:10,595 your insights on on everything. 536 00:19:11,454 --> 00:19:14,014 Your expertise is incredible. So thank you again, 537 00:19:14,014 --> 00:19:16,255 and until next time. Thank you so much, 538 00:19:16,255 --> 00:19:18,414 and I enjoy the conversation, Dane. Look forward 539 00:19:18,414 --> 00:19:20,355 to future conversations with you as well.