Clinical Care

Hematology and Cellular Therapy

Cancer clinical trials are carefully designed research studies that assess the benefit of new treatments, new combinations, or new ways of caring for people with cancer. They are the only way new drugs, procedures, and approaches become standards of care. Every treatment that is “routine” today - chemo regimens, radiation techniques, immunotherapies - exists because of clinical trials. Many of the newest, most promising therapies - especially immunotherapies and targeted precision medicine drugs - are available only in clinical trials at first. This means that patients with treatment-resistant or reoccurring cancers can gain access to life-saving options available only through a clinical trial. We have clinical trials for all common blood cancers, and most of the rare blood cancers.

A correct diagnosis is always the first step and drives the right treatment: The diagnosis of blood disorders is notoriously challenging. With the support of expert surgeons, radiologists, and in partnership with expert hemato-pathologists and molecular pathologists, our disease-focused specialists can guide patients towards a conclusive diagnosis even in elusive cases. We use advanced tissue- and blood-based diagnostic methods, including flow cytometry, immunohistochemistry, FISH cytogenetics, PCR analysis, genetic testing, and next generation sequencing (NGS).

Expert clinical pharmacists are not just “medication dispensers.” They are highly trained drug specialists who work directly with our teams to optimize therapy, prevent harm, and improve outcomes. Hospitals with strong clinical pharmacy services consistently deliver safer, more coordinated, and more effective care. Our patients often take many medications. The presence of expert clinical pharmacists on the treatment team dramatically reduces the risk of harm, preventing medication errors, adverse drug reactions, and dangerous interactions.

HSCT is a medical procedure used to treat various blood disorders and cancers by replacing damaged or diseased bone marrow with healthy hematopoietic stem cells. HSC can be obtained from bone marrow, peripheral blood, or umbilical cord blood. The primary goal of HSCT is to reestablish normal blood cell production in patients whose bone marrow or immune system is compromised due to diseases such as leukemia, lymphoma, multiple myeloma, and certain genetic disorders. Autologous HSCT uses the patient's own stem cells, usually after high-dose chemotherapy. Allogeneic HSCT uses stem cells from a donor, typically a matched sibling, a compatible unrelated donor, or a half-matched (haploidentical) relative. 

Immunotherapy works by modifying and enhancing the immune system so it can better detect, target, and destroy cancer cells. Cancer cells hide from our immune cells, sending “off signals” that deactivate immune responses, and alter nearby tissues to suppress immune responses. Immunotherapy directly interferes with these escape mechanisms and is increasingly replacing chemotherapy for the treatment of cancer. At Markey, we offer treatment with state-of-the-art immunotherapy, including immune checkpoint inhibitors, monoclonal antibodies (mono- and bi-specific); CAR-T cells, and tumor‑infiltrating lymphocytes (TILs). Immunotherapy is also increasingly being used for non-malignant blood disorders, autoimmune diseases, and neurological diseases. We are experts in the safe delivery and monitoring of immunotherapy. We also support other specialties at UK in delivering these new treatments to patients with non-malignant conditions. 

MRD is the term used to describe the tiny number of cancer cells that persist in the body after treatment, even when the patient is clinically in remission. These residual cells are often undetectable by PET/CT scans or routine blood tests. MRD is most frequently detected through a “liquid biopsy”, which analyzes blood for the presence of circulating tumor DNA (ctDNA) or other cancer-specific markers. The presence of MRD is significant because it is associated with a higher risk of cancer recurrence. Therefore, detecting MRD can help guide treatment decisions and monitor the effectiveness and the duration of therapy. We are experts in the measurement and assessment of MRD, and we routinely use it to guide treatment decisions in patients with leukemia, myeloma, and lymphoma. 

Patients at UK/Markey have access to caregivers who help them cope with all their nutritional, physical, emotional, and psychological needs related to their cancers and their treatment. Advanced practice nurses and social workers assist with education, general information, and practical issues of travel and accommodation assistance. Nutrition specialists provide guidance on the best diet for patients with blood cancers. A Hope Lodge has been available on the UK campus since 1984, which provides housing support to adult patients and caregivers, in addition to children. 

Blood cancers are mostly treated with systemic therapies (chemo, immunotherapy, cellular therapy) but radiation is often used to treat localized tumors, particularly in lymphoma and myeloma. Our Hematology patients benefit from having access to Markey’s state-of-the-art radiation oncology services and the expertise of radiation oncology specialists who treat their specific cancer. Among the cutting edge type of radiation our patients can get: Intensity-modulated radiation therapy (IMRT), a type of radiation that protects the normal, healthy tissue and the critical tissues around the tumor; Stereotactic radiosurgery, a type of radiation that can treat brain tumors with surgical precision; and total body irradiation therapy, a type of radiation used in combination with chemotherapy to prepare patients for allogeneic HSCT. 

Apheresis involves the separation of blood components for treatment purposes. Apheresis is a medical procedure that removes whole blood from a patient or donor and separates it into its components, such as plasma, white blood cells, platelets, and red blood cells. Apheresis is crucial in treating many blood disorders, such as Waldenstrom Macroglobulinemia (WM), Sickle Cell Disease (SCD), Thrombotic Thrombocytopenic Purpura (TTP) and is used in both urgent and routine patient care. Apheresis is also an essential step in the production of CART cells for cancer therapy. 

Advanced blood transfusion services are essential for the care of patients with blood disorders and hematologic cancers. Careful screening and cross-matching of blood types is essential to minimize the risk of adverse reactions and ensure the safety and efficacy of each transfusion. Transfusions for patients with blood cancers require a specific treatment (irradiation) of the product, to ensure that serious complications, such as transfusion-associated GVHD, is prevented. Only a few centers in Kentucky offer irradiated blood products. 

ECP is a medical procedure that uses light to modify white blood cells, primarily lymphocytes, to treat various conditions, including certain cancers and autoimmune diseases. ECP involves the collection of a patient's blood, treatment of specific blood components with a photosensitizing agent (usually 8-methoxypsoralen), and exposure to ultraviolet A (UVA) light. After that, the modified cells are reinfused back into the patient. This process alters blood lymphocytes, enhancing the immune response against cancer cells or modulating the immune system to reduce harmful reactions in autoimmune diseases and transplant rejection. ECP is primarily used for the treatment of graft-versus-Host Disease (GVHD) after allogeneic SCT; cutaneous T-cell lymphoma (CTCL); and to prevent rejection in solid organ transplants. ECP is also being investigated for its potential in treating various autoimmune conditions, including scleroderma, lupus, and Crohn's disease (see partnerships below) 

Patients with lymphoma, myeloma, and leukemia require specialized imaging tests for staging and to objectively assess the results of treatment. Our Hematology patients have access to the best imaging available, such as PET/CT and SPECT/CT, so we can accurately define their stage, and measure how well they are responding during treatment (so-called interim PET/CT) and at the end of treatment (EOT PET/CT).  

Total skin electron beam radiation is a treatment for cutaneous T-cell lymphoma (CTCL), in particular mycosis fungoides. This technique delivers radiation to the entire skin surface in the form of low energy electrons, which stop at the skin surface without affecting the underlying tissues and organs. Markey is only cancer center in Kentucky to offer this therapy, with more than 25 years of experience.