The Royal Marsden’s Haemato-oncology Unit is one of the largest in Europe, treating blood cancers through advanced diagnostics, innovative scanning techniques and groundbreaking new treatments
“Our on-site specialists speed up the process of accessing the best stem cell matches for our patients”
It is an exciting time for haemato-oncology at The Royal Marsden. We have one of the largest research portfolios in the country, with up to 50 clinical trials running at one time for patients with multiple myeloma, leukaemia and lymphoma. In the past five years, the way we treat patients has been transformed by the introduction of novel drugs. And we perform more stem cell transplants than any other centre in the UK.
“The breakthroughs in therapy – with novel antibodies and targeted drugs such as ibrutonib – have improved outcomes and quality of life for our patients,” says Dr Mike Potter, Consultant Haematologist and Head of the Haemato-oncology Unit, “and, in some cases, are already included in standard treatment across the UK.
“Sophisticated diagnostics have been instrumental in helping us match patients to effective new treatments. We are fortunate to have the NIHR Centre for Molecular Pathology (CMP) in Sutton, where we operate a regional specialised diagnostic service for up to 40 other hospital trusts, serving a population of four million.”
The CMP houses a comprehensive specialist laboratory for the diagnosis of haematological malignancies. The laboratory is one of the leading units of its kind in the UK, testing more than 8,000 liquid samples a year from patients at The Royal Marsden, southwest London and Surrey, together with rare haematological cancer specimens from the rest of the UK and around the world.
This service allows the team to examine samples from the whole range of more than 70 blood cancer types, some of which are extremely rare. This has provided the basis for a research programme into these disorders.
Having the latest technology and expertise in a single location allows for a fully integrated approach to specimen analysis. This enables rapid and accurate diagnosis, as well as the identification of prognostic markers and potential targets for therapy. Clinicians can then select the most appropriate therapy for each patient based on this critical information. Many patients will be treated in clinical trials and their samples stored for translational research.
“Many leukaemias look similar down the microscope, but genetic tests have shown there are, in fact, many different subtypes caused by different mutations,” says Consultant Haematologist Dr David Taussig. “These mutations are critical in driving the leukaemias and we are increasingly able to target specific mutations with drugs.
“Treatment has become dependent on a thorough analysis of the leukaemia cells using a variety of techniques. We’re working to expand the testing so patients can benefit from new treatments that we believe will improve outcomes.”
7 in 10
patients with myeloma are treated with chemotherapy
VITAL DRUG DEVELOPMENTS
Pioneering drug treatments trialled at the hospital have revolutionised the way we treat patients with myeloma. Patients with this complex cancer can have periods when they experience symptoms and require treatment, followed by phases of remission or plateau when they don’t.
“Although we have a range of therapies – including stem cell transplants – that are effective in myeloma, these aren’t currently curative,” says Dr Kevin Boyd, Consultant Haematologist.
“Myeloma tends to relapse after a period of time, and although we can usually induce a good remission for a second and third time, eventually the drugs often become ineffective. We need new and improved treatments at all stages, to initially prolong the periods of remission and then help when standard treatments stop working.”
The Royal Marsden has a comprehensive portfolio of research trials for patients at all stages of their disease, including at initial presentation and at disease progression. We were the main UK recruiter to the POLLUX study, which successfully trialled the new immunotherapy drug daratumumab.
“The early results show the largest improvement of outcome of any trial in myeloma to date,” says Dr Boyd. “We are shortly opening trials of other immunotherapy drugs similar to those that have transformed the treatment of cancers such as melanoma.”
Consultant Haematologists Dr Kevin Boyd, Dr Martin Kaiser and Dr David Taussig
of people diagnosed with non-Hodgkin lymphoma in England and Wales survive for five years or more
HIGH-TECH GENETIC SEQUENCING
As well as improved drugs, next-generation sequencing (NGS) is also pivotal to the future of myeloma treatment. This innovative DNA sequencing process enables us to obtain genomic profiles of our patients, so we can identify more genetic differences that can help us to personalise treatment.
“Identifying patients’ mutations at the diagnosis stage means we can predict outcomes before starting treatment,” says Dr Martin Kaiser, Consultant Haematologist and Senior Clinical Research Fellow at The Institute of Cancer Research.
“This lets us identify the patients most likely to respond.” Through NGS, we have identified frequent mutations in the NRAS, KRAS and BRAF genes that are known in other tumours. This has opened up new treatment opportunities: drugs used in other tumour types have been made available to myeloma patients with those mutations taking part in experimental drug trials.
“The trials we’re running will spearhead new ways to diagnose myeloma and allow us to offer access to improved therapies,” says Dr Kaiser. “In the future, we will be treating a specific tumour type, personalising the patient’s treatment according to their genetic mutation.”
The trials we’re running will spearhead new ways to diagnose myeloma
people are diagnosed with leukaemia in the UK every day
ENSURING STEM CELL SUCCESS
Stem cell transplantation (SCT) remains one of the most successful ways to cure blood cancers. The treatment regime for these diseases can be intensive – involving high doses of chemotherapy and sometimes whole-body radiotherapy – and kills stem cells in the bone marrow, so these must be replaced through transplantation.
The Royal Marsden has one of the largest SCT centres in Europe, with more than 200 transplants performed at the Sutton site last year. These included patients matched with donors from the donor registers or their siblings, those whose own stem cells were used, and those who received stem cells from umbilical cord donors. In autumn 2016, we will start transplants for up to 20 private patients a year in Chelsea in the refurbished Wiltshaw Ward.
Our experienced team ensures patients receive the closest possible donor match. “The success of an SCT relies on the speed of finding a good-quality matched donor,” says Dr Potter. “We are one of the only trusts to have an Anthony Nolan clinical nurse specialist and a consultant haematologist working on site to help speed up the process.”
As leaders in the field, The Royal Marsden has developed whole-body diffusion-weighted MRI to help enhance treatment for myeloma patients. It is much more sensitive to detecting myeloma than traditional imaging techniques, and has the advantage of not exposing the patient to ionising radiation.
It is now the first imaging test recommended for patients, and we are one of the few centres in the country with the expertise to offer it to our patients.
“The technique allows us to see disease that was undetected before,” says Dr Christina Messiou, Consultant Radiologist. “We are running the iTIMM study to find out if it can be used to detect tiny amounts of residual disease that might persist after an SCT. This could guide the use of additional treatments in the future.”
A Patient’s Perspective: Rosanna Connolly, 23
I was first diagnosed with acute myeloid leukaemia in October 2009 when I was 16, and got the news that I had relapsed in June 2013.
I had my transplant at The Royal Marsden in Sutton in the Oak Centre for Children and Young People. It wasn’t straightforward as there was no match for me – I am of a mixed background and my two brothers were not matches.
When the doctors mentioned a double umbilical cord transplant, I was very confused about how that could work. When I found out the umbilical cords had been frozen for years, I was in awe at how medicine could be so advanced and forward-thinking.
The chemotherapy and radiotherapy treatments were intense and draining. The first transplant I had failed so I had to have another. I was in isolation for three months.
My body was weak and tired but I slowly began to recover. Three years on, I am back to ‘normal’, aside from getting quite tired sometimes – but who doesn’t?