Martin S. Tallman , an internationally recognized expert in caring for patients with acute and chronic leukemias has been at the forefront of several key clinical trials that have led to new standards of care. He joined Memorial Sloan Kettering in 2010 as Chief of the Leukemia Service in the Department of Medicine, following a 21-year career at Northwestern University.
We asked Dr. Tallman how research has led to improvements in the treatment of leukemia and what challenges remain.
As Chief of the Leukemia Service, what are your top priorities?
I came to Memorial Sloan Kettering with a specific vision of what I thought it would take to develop the finest leukemia service in the world. Recruitment has been one of my top priorities, and we have added nine junior and senior faculty members since 2010. Adding more clinical trials is my second priority. There has never been such an explosion in our understanding of the pathogenesis of both acute and chronic leukemia, the number of novel agents with unique mechanisms of action, and other new strategies, including immunologic approaches.
A third priority is to foster interactions between laboratory scientists and clinical investigators. I think that if we can accomplish these goals, we will further distinguish this already very prestigious institution and make important contributions.
How do you hope to build on Memorial Sloan Kettering’s rich history of developing effective leukemia therapies?
Since 2010, we have opened many clinical trials , all with important correlative laboratory science studies. The number of exciting new targeted molecules and therapies now available is unprecedented. I want to see our laboratory efforts increase to learn more about how these therapies work and to see them applied in well-designed, meaningful clinical trials. I think that’s the responsibility of our institution — not just to deliver pristine patient care, which we do, but also to develop new treatments that change the standards of care and improve the lives of patients.
There has been an explosion of knowledge addressing the molecular genetics of acute and chronic leukemias. How is this area progressing, and how is it impacting patient care?
Our group has been at the forefront of identifying what have become so important now, which are the genetic abnormalities in a given leukemia cell and the relationship of those abnormalities to each other. These findings have begun to influence our treatment decisions. For example, physician-scientists Ross Levine and Omar Abdel-Wahab and their colleagues identified gene mutations in acute myeloid leukemia , or AML, and demonstrated the importance of their interactions in a large group of patients.
These advances are extremely important because certain gene relationships confer a very favorable prognosis — meaning we can decrease the intensity of a patient’s treatment and avoid unnecessary treatment — while others are associated with an unfavorable prognosis, indicating we should use new and hopefully more effective strategies. Other investigators at Memorial Sloan Kettering, including Michel Sadelain, Isabelle Rivière, Renier Brentjens, and Jae Park, are working to harness the ability of T cells to eradicate leukemia and have shown very encouraging results in patients with acute lymphoblastic leukemia.
What are the biggest challenges remaining in leukemia research?
The real challenge for the future is to develop a nimble infrastructure for the development and activation of clinical trials to evaluate new agents and other therapeutic strategies. It is a challenge to make important trials attractive and easier to conduct for patients and their treating physicians. While we still need more insight into what drives a leukemia cell and what turns a benign cell into a malignant one, a number of the major challenges aren’t so much scientific as logistical.
What philosophy guides your care of patients?
I’ve long said that I like to imagine every patient is a member of my own family and to treat them accordingly. You find yourself thinking, “If this were my spouse or my brother or my child, would I really recommend a given therapy?” The patient may not respond to a certain treatment, but no healthcare professional makes anything but the best decisions for his or her own family. This way of thinking connects a doctor to a patient.
What treatment advance drives home the improvement in treating leukemias today compared to just a decade or two ago?
Acute promyelocytic leukemia has emerged as the most highly curable subtype of AML. It’s very exciting — we can now cure about 85 to 90 percent of all patients. Historically, we have treated patients with this subtype of AML as we have all others, with induction chemotherapy and consolidation chemotherapy. Two decades ago, we began treating all patients with a vitamin A derivative called ATRA (all-trans-retinoic acid) plus chemotherapy.
In the last decade, we’ve also witnessed the development of a new formulation of the old drug arsenic trioxide. New studies show that treating patients with ATRA and arsenic trioxide, with minimal to no chemotherapy, has produced spectacular results. The cure rate is high, and we can also spare the patient from the side effects of chemotherapy.
What do you hope to accomplish next?
My broad goals are to recruit more patients to well-designed clinical trials and to continue to link clinical trials with important correlative studies in the laboratory to elucidate the mechanisms by which effective treatments work. I sincerely hope that soon almost every patient will be on a clinical trial, and that we will be treating very few patients off-study.
Ultimately, we want to change the standard of care and to contribute to the cure of more patients with leukemia. We have initiated efforts to move consolidation therapy in AML completely to the outpatient setting. Furthermore, given the new, more potent antibiotics available, growth factor support, and comprehensive home care, we are developing a protocol to move induction therapy after initial chemotherapy to the outpatient setting.
We’ve made tremendous progress in treating several subtypes of leukemia, but for most patients with acute myeloid leukemia and acute lymphoblastic leukemia, we still have much work left to do.