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