Preserving future fatherhood This service helps boys and men with cancer maintain their ability to father children.

Kazim Chohan, PhD (seated), leads Upstate’s Male Fertility Preservation Program, which came about through the efforts of Chohan and colleagues including pediatric oncologist Jody Sima, MD (standing); (and, not pictured) urologist JC Trussell, MD; oncologist Rahul Seth, DO; and pathology chair Robert Corona Jr., DO. (PHOTO BY ROBERT MESCAVAGE)


Some cancers, and some cancer treatments, can cause male reproductive damage. But a variety of techniques available through Upstate’s Male Fertility Preservation Program can help men with a cancer diagnosis or temporary or permanent infertility issue.

“Survival is the first thing on their mind. Not fertility,” says Kazim Chohan, PhD, director of Upstate’s andrology department, where the program is housed. “That’s precisely why this should be offered.” He says physicians should tell their patients about fertility preservation as soon as a cancer diagnosis is made. Some health insurers will pay for the service.

Males of almost any age who hope to one day father a child may be candidates for fertility preservation. This includes boys who have not yet reached puberty, whose parents must make the decision for him. Weekend appointments are available for patients undergoing emergency chemotherapy or radiation therapy.

Chohan comes from a family that has made careers studying reproduction in both humans and animals. His father was an expert in artificial insemination of livestock in Pakistan, and one of Chohan’s sons is studying reproductive matters. Chohan himself has worked on aspects of reproduction in humans and in mammals ranging from mice to water buffalo.

Frozen sperm cells should remain viable for several decades, he says, noting there is no scientific consensus on the time limit, but a sample frozen in 1971 was used in 2011 and resulted in a healthy baby. Freezing techniques have progressed to the point where he does not see a limit on the length of time a sample could be kept frozen.

Success rates for frozen sperm samples are comparable to those of fresh samples, he says, and there are no known risks of birth defects from using frozen sperm.

The samples are stored in sealed vials that prevent cross-contamination and can be shipped to fertility centers elsewhere, even overseas, in special canisters that stay cold for up to two weeks.

Using testicular tissue samples from young boys is a relatively new procedure that has so far only been used to produce animal offspring. Chohan believes the science is advancing rapidly enough that it will be a normal practice for humans within a decade. The testicular tissue, like the sperm samples, is frozen and stored in the andrology lab.

For fertility preservation questions, contact the andrology department at 315-464-6550.

Techniques available

Here’s what andrologist Kazim Chohan, PhD, and his staff offer at Upstate:

  • Sperm banking: Collecting and freezing semen in liquid nitrogen (cryopreservation) for future use is the standard and least expensive procedure to preserve male fertility. A basic semen analysis will evaluate the sperm to determine future options for assisted reproduction. Generally, three to five samples are needed for the best chance of achieving pregnancy.
  • Testicular sperm extraction: Men with no sperm in their semen due to blockage or other conditions can have sperm extracted directly from their testicles with a brief surgical procedure. The sample is then frozen.
  • Testicular tissue freezing: Still an experimental process, this involves surgically removing and freezing tissue from the testicles of boys not yet old enough to produce sperm. The hope is that this tissue could be used in the future, once the boys have matured, to either restore fertility or produce sperm.

Female options

Fertility preservation for women, including egg and embryo freezing, is also offered by Upstate in partnership with Boston IVF. Call 315-703-3050 for more information.

This article appears in the winter 2017 issue of Cancer Care magazine. Hear a radio interview/podcast with Chohan and Sima about how male fertility preservation works.

Posted in adolescents, cancer, health care, HealthLink on Air, men's health, sexuality, technology, Upstate Golisano Children's Hospital/pediatrics | Tagged , , , , ,

Removing a hidden cancer: Surgeon avoided nerves when he removed prostate; patient – and wife – are thankful

Patrick Young wears a necklace in memory of his mother, who died at age 59 from lung cancer. She taught him to hunt. The necklace is made from antlers of the first deer Young shot, plus wooden and brass beads and a Buffalo nickel pendant carved by a master gunsmith. (PHOTO BY ROBERT MESCAVAGE)


Prostate cancer usually grows slowly.

Unfortunately, Patrick Young’s cancer was aggressive, and furtive. It hid itself around the top side of his prostate, in the back, where a biopsy needle would be unlikely to reach.

Fortunately, Patrick Young’s wife, a research scientist, found an expert urologic oncologist just 90 minutes from their home in rural Chenango County. Young became a patient of Gennady Bratslavsky, MD, who chairs the department of urology at Upstate and who specializes in cancers of the kidney, bladder and prostate.

“My wife and I both love how passionate he is about what he does,” says Young, who grows organic vegetables and raises free range hens in Guilford. He was 54 when he developed trouble keeping an erection.

Young and his wife, Rebecca Armstrong Young, PhD. (PHOTO BY ROBERT MESCAVAGE)

His primary care provider began monitoring his level of prostate specific antigen, or PSA, an enzyme found in high concentrations in the blood of men who have prostate cancer. PSA levels can also be affected by inflammation or enlargement of the prostate. Young also underwent a biopsy before his wife, Rebecca Armstrong Young, PhD, sought an experienced urologist to take over his care.

Bratslavsky began closely monitoring Young’s PSA level.

When the level rose, Bratslavsky scheduled a magnetic resonance imaging scan and biopsy done with a powerful 3-tesla MRI system that uses technology similar to global positioning navigation to locate hard-to-find cancers of the prostate.

This painting was made by Young’s wife about five months after his surgery. She took a photo of him when he came inside after working outdoors all morning. “I remember seeing him and thinking how grateful I was that he was well enough to be active again,” she explains. “To me, he was looking more alive than he had been in almost two years. I wanted to capture that moment.”

Upstate became the first provider in Central New York to offer the Philips UroNav Fusion Biopsy System in October 2013. Since then, about 300 precision-guided fusion biopsies have been done with as many as 25 percent revealing aggressive cancers that otherwise would have been missed. Many of the men found to have less-aggressive cancers were spared unnecessary treatment because the fusion biopsy provided reassurance that they were not harboring more aggressive cancers.

Young’s images and biopsy were done on Christmas Eve 2015. They revealed cancer had corkscrewed out from the prostate and attached itself to his bladder. Surgery was Young’s only option, since he has ulcerative colitis. In order to give his body time to heal from the biopsy, surgery was scheduled for Feb. 29.

“I was scared, and I’m not normally a scared type of person,” Young admits. “Lung cancer killed my mother, and my baby brother had testicular cancer 12 years ago. Thankfully, he has gotten through it.”

Bratslavsky’s plan was to remove Young’s prostate, delicately avoiding the nerves around the gland. That’s not always possible, Young knew, but he was hopeful.

The surgery was a success.

At a follow up appointment, Young kissed Bratslavsky on the cheek. “I love what you’ve done for Becky and me.”


Upstate urologist Gennady Bratslavsky, MD, meets with Young. (PHOTO BY ROBERT MESCAVAGE)

This article appears in the winter 2017 issue of Cancer Care magazine.











Posted in cancer, health care, men's health, patient story, sexuality, surgery, technology, urology | Tagged , | 1 Comment

Cancer patient as a child, now a cancer nurse


Nurse manager Nellie Diez. (PHOTO BY KATHLEEN PAICE FROIO)


Nellie Diez remembers being startled by her mother, whose first name she shares, as a 12-year-old in treatment for cancer.

For four weeks, mother and daughter had been at a children’s hospital two hours from their home in Puerto Rico. Diez was diagnosed on admission with non-Hodgkin lymphoma on Nov. 23, 1988. Now it was Christmas Eve, and Nellie Santiago was told to enjoy what would likely be her daughter’s last year of life.

Santiago gave terse instructions to Diez: “Get dressed. We’re leaving.”

They were off to find more aggressive care, a move Diez today says saved her life.

Diez’s parents were divorced. Her father lived in New York City. He helped get her an appointment at Memorial Sloan Kettering Cancer Center, and she and her mother traveled to New York. Diez was a patient there for five months. She underwent 10 radiation treatments, plus chemotherapy.

“I had a lot of chemo. A lot,” she recalls. Her heart and lungs were affected by the cancer and its treatment.

She returned to Puerto Rico when she was discharged, coming back to the cancer center every two months for follow-up appointments. Her final treatment was in April 1991.

Her experience is a story she’s wiling to share with patients of Upstate University Hospital, where Diez, 40, is a nurse manager of the 27-bed adult oncology unit. Some patients appreciate hearing from someone who has gone through what they face.

Diez began charting a future in nursing as a patient at Memorial Sloan Kettering. One of her physicians pointed her to Syracuse University, which at the time had a college of nursing. Diez wound up attending SU and doing her student nursing internship at the same cancer center where she had been a patient.

Today she works at Upstate, an academic medical center just blocks from where she attended college.

When she graduated with her bachelor’s degree, she intended to work in pediatric oncology – but there were no job openings. “So I convinced myself that we are all kids at heart” and applied for a position in adult oncology. That was 16 years ago.

She married in 2008. A few years later, she and her husband, José Diez, learned that because of her heart trouble, a pregnancy would be considered high risk – if she was even able to conceive. She got pregnant. And she felt her life come full circle when she learned her due date was Nov. 23, the same date of her cancer diagnosis 23 years before. Her son, Leonidas, was born by a scheduled cesarean section Nov. 23. He’s 4½ now. Her daughter, Livia, is 18 months old. José Diez is a stay-at-home dad.

With the benefit of 30 years’ hindsight, and motherhood, Diez is able to appreciate that her mother was looking out for her when they made their abrupt departure from the hospital in Puerto Rico. It was the action of someone looking out for a loved one with cancer.

Diez gets it.

She’s on the other side of the bedside now, with a unique ability to relate to the fear and uncertainty that accompany cancer. As a nurse and cancer survivor caring for someone with cancer, Diez sees her role as sacred. “I have the honor of taking care of people in very vulnerable conditions.”

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma is cancer that starts in cells called lymphocytes, part of the body’s immune system. This type of cancer accounts for about 5 percent of all childhood cancers, and about 500 children age 14 and younger are diagnosed with non-Hodgkin lymphoma in the United States each year. Its cause is unknown.

An array of imaging scans, blood tests and biopsy analyses may be used in diagnosing non-Hodgkin lymphoma. Chemotherapy is the main treatment for children with this cancer. Surgery, radiation and stem cell transplants may also play a role in treatment. — American Cancer Society

This article appears in the winter 2017 issue of Cancer Care magazine.

Posted in cancer, health careers, nursing | Tagged | 1 Comment

World traveler … and grateful lung cancer patient

Upstate oncologist Ajeet Gajra, MD, and his patient Patricia Kranbuhl.


Nearly three years ago, Patricia Kranbuhl was diagnosed with stage IV lung cancer. After participating in a clinical trial at the Upstate Cancer Center, she is symptom free and is now back to doing the things she loves, including traveling the world.

In April 2014, Kranbuhl was excited to be taking her granddaughters on their first trip to New York City to see a Broadway show. “At that time, I had a nagging breathing issue, which I thought was probably asthma,” she said.

Her asthma concern turned out to be a diagnosis of stage IV lung cancer. Kranbuhl was immediately referred to Upstate’s Ajeet Gajra, MD. Gajra explained to Kranbuhl that there was a malignant tumor on her lung, but as the cancer was also in her lymph nodes and blood, surgery was not an option. However, he noted that Upstate was conducting a clinical trial for which she would be a perfect candidate.

For the treatment, Kranbuhl had a port inserted into her chest wall.  “Dr. Gajra asked if I wanted to start an IV infusion treatment that day, and I said yes. I wanted to stop the tumor from growing as soon as possible and do whatever I could to eliminate it,” Kranbuhl said. “It took two days to do the first treatment, one afternoon followed by treatment the next morning.”

She credits the staff at the Upstate Cancer Center with helping her with the healing process. “They stayed with me, as they do with all their patients, every step of the way. They were compassionate beyond words. I could not be more grateful for the care that I continue to receive to this day,” she said.

When Kranbuhl received a letter from the Upstate Foundation as part of its annual Doctors’ Day celebration, she wrote a tribute and made a donation in honor of Dr. Gajra and the research that she says extended her life.

While she continues maintenance treatment once a month, Kranbuhl’s love for travel is back on track. “I worked all my life. When I retired, I decided I would take a big trip every year to see the world.”

She enjoys meeting people, experiencing their cultures and learning their histories. Since her diagnosis, Kranbuhl has cruised the Mediterranean on a small boat and visited Cuba and India. Her favorite destination, however, remains her 2014 trip to Africa. “Waking up in the Serengeti was beyond spectacular,” she said.

Both Gajra and Kranbuhl say they are pleased with her progress. Her tumor is undetectable and all tests are stable. Kranbuhl adds: “I listen to Dr. Gajra because I trust him with my life, and I have a lot more traveling yet to do.”

To donate to Friends of Upstate Cancer Center, click here or contact the Upstate Foundation at 315-464-4416.

This article appears in the winter 2017 issue of Cancer Care magazine.

Posted in cancer, drugs/medications/pharmacy, health care, lung/pulmonary

With lung cancer at bay, she’s cruising Florida coast on her Harley


Toni Lindgren on the motorcycle she and her husband bought for her after her chemotherapy treatments for lung cancer. This winter, she is riding it along the eastern coast of Florida. (PHOTO BY SUSAN KAHN)


As a retired police officer, Toni Lindgren knows how to deal with problems. So, when a physician at Fort Drum said, “I think it’s cancer,” Lindgren said, “I’m going to Upstate. I want the doctors who do cancer all day, every day.”

Last March, Lindgren, 58, of Carthage saw her primary care physician because she was concerned that her stuffy nose and occasionally bloody cough might be symptoms of an infection that her elderly mother could catch.

“Just to be on the safe side, let’s do a chest X-ray” said Lindgren’s primary care doctor. She and her husband receive care though Fort Drum because of his military service.

That evening, the doctor called her at home. He made sure she wasn’t alone. Her husband, Dale, was with her. “There’s a large mass on the lower lobe of your right lung,” the doctor told them. “Don’t wait until Monday. Get a CT scan at Carthage Hospital now.”

The CT scan confirmed a tumor in her lung, and Lindgren’s doctor gave her a referral to the Upstate Cancer Center.

At Upstate, Birendra Sah, MD, inserted a scope through her mouth so he could view her lungs, trachea and surrounding area with the scope’s camera. That procedure, called a bronchoscopy, showed lung squamous cell carcinoma in a lymph node. It was followed by a PET scan, which illuminated the cancerous tumor and a number of concerning spots near her trachea.

“I lit up like a Christmas tree,” described Lindgren, shaking her head.

Since the PET scan made it appear that cancer had spread from the lung to the lymph nodes, the initial plan was to treat Lindgren with chemotherapy and radiation.

Lindgren’s reaction was, “This thing’s growing every day. I want surgery to get it out!”

The multidisciplinary thoracic oncology team at Upstate met to discuss Lindgren’s case and, with her involvement, decided that a second biopsy, called a mediastinoscopy, was warranted to further examine the middle of her chest, between the lungs.

The results were encouraging. Surgeons Jason Wallen, MD, and Robert Dunton, MD, biopsied multiple lymph nodes, and none  were cancerous. Most of the areas illuminated by the PET scan were “false positives,” meaning noncancerous. Now, surgery was an option.

On May 3, Lindgren had minimally invasive surgery to remove the lower lobe of her right lung. She was released from the hospital four days later, on her husband’s 60th birthday.

The final pathology report showed that only two lymph nodes were cancerous.

Oncologist Stephen Graziano, MD, recommended 12 weeks of chemotherapy. Between June and August, Lindgren and her husband rose at 5 a.m. to drive from Carthage to Syracuse for her treatments.

Lindgren tolerated the chemotherapy well. She had just a couple of bouts of nausea and never lost her hair. However, a few weeks into treatment, Lindgren faced another blow: While she was being treated at Upstate, her mother died in another hospital in another city.

“I couldn’t visit Mom because my resistance was low because of the chemo,” explained Lindgren. “But we were able to video chat. Mom told me she’d decided to stop her treatment for a lung condition. Now, she and my dad, who died six years ago, are angels in heaven making sure I’m OK.”

One tough day at the hospital, Lindgren’s husband mentioned that they ought to look at a white Harley-Davidson motorcycle that was for sale in Utica. For Lindgren, it was love at first sight. She had long dreamed of riding a Harley on Highway A1A, a scenic route along the east coast of Florida, with her husband.

With surgery and chemotherapy completed, Lindgren and her husband were ready to snowbird. Lindgren’s CT scan in September and chest X-ray in November were clear, paving the way for their extended trip. Shortly after her birthday on Nov. 14, the couple left Carthage for St. Augustine, Fla. She will see doctors there, and then she has an appointment with Graziano in April at Upstate.

The couple is grateful.

“When I got the news of lung cancer last spring,” admits Lindgren, “I didn’t think I’d live to see my birthday.”

Now, she’s in remission. She’s enjoying warm weather and long motorcycle rides with her husband.

This article appears in the winter 2017 issue of Cancer Care magazine.

Posted in cancer, drugs/medications/pharmacy, health care, lung/pulmonary, medical imaging/radiology, surgery | Tagged ,

Upstate is the place to go for pancreatic cancer treatment

Outside of New York City, Upstate is the only institution in the state that the National Pancreas Foundation has designated as an NPF Center for the Care and Treatment of Pancreatic Disease. The illustration above shows the pancreas’s location in the body.

Upstate University Hospital is uniquely qualified to provide top-quality care for patients with pancreatic cancer and other diseases that affect the pancreas. The hospital earned a designation from the National Pancreas Foundation after an extensive auditing process.

Upstate is one of four institutions in New York and the only one outside of New York City that the foundation allows to call itself an NPF Center for Care and Treatment of Pancreatic Disease.

It’s an important recognition that highlights Upstate’s multidisciplinary team approach of treating each patient individually to formulate comprehensive and compassionate care plans for the best possible outcomes. The audit made sure Upstate provides expertise in certain specialties, access to clinical trials, a variety of patient-focused programs, and more.

Dilip Kittur, MD, is proud of the designation. He’s the division chief of liver, pancreas and gallbladder surgery at Upstate. He points out the variety of state-of-the-art treatments for even advanced pancreatic cancer, including robotic pancreatic surgery, stereotactic radiation and advanced chemotherapy.

This article appears in the winter 2017 issue of Cancer Care magazine.



Posted in cancer, health care, pancreas/liver/gallbladder/bile ducts, surgery

Syracuse University student died at a Carrier Dome basketball game – and lived to tell about it


Syracuse University student Alex McMillan posed one month later with the Upstate emergency physician who helped save his life during an SU basketball game Feb. 4. Photo by Michael J. Okoniewski/Syracuse Athletics.

February 4 was “pretty much a typical morning” for Alex McMillan, 20, an economics major at Syracuse University. An alto sax player, McMillan would be at the noon basketball game against Virginia as part of the Sour Sitrus Society.

He remembers eating a pulled pork sandwich and drinking bottle of water at the Carrier Dome.

Next he knew, he awoke in a hospital bed. IV lines were poking from each arm. Electrodes were taped to his chest. Medical machines surrounded him. He was in the cardiac intensive care unit at Upstate University Hospital.

The Orange were celebrating a 66-62 come-from-behind victory.

But it was McMillan who made the more dramatic comeback at the Dome that day.

Not even four minutes after tipoff, without warning, McMillan’s heart just stopped. His body slumped onto a band mate. He and the person on McMillan’s other side laid him on a riser. They called for help.

Emergency physicians from Upstate University Hospital staff the first aid station at the  Dome. Depending on the size of the crowd, a dozen or more paramedics and emergency medical technicians are on duty for SU basketball games and other mass gathering events at the Dome.

A pair of EMTs were about 20 feet from where McMillan collapsed. “They started CPR right away,” explains Christopher Tanski, MD, the emergency doctor on duty that day. Their compressions kept blood circulating through McMillan’s body, keeping his vital organs nourished.

Meanwhile, Tanski made his way down the stairs from the first aid station. He directed other EMTs to bring the stretcher down an elevator.

 One look at McMillan, and the emergency doctor knew the situation was serious. Young people rarely suffer sudden cardiac arrest. A handful of things can cause a heart in a healthy, young person to suddenly stop beating – but Tanski was too busy to ponder them.

 “Once the heart is stopped, it doesn’t really matter why,” he explained. “You just need to get it started again.”

 Briefly Tanski considered moving McMillan to a more private location, but he knew he could not afford the seconds that could take. Instead, he and the EMTs cared for McMillan behind the Syracuse baseline. The game continued, punctuated by roars from the 27,553 in attendance.

McMillan’s heart was in a dangerous quivering rhythm known as ventricular fibrillation. An electrical shock, delivered by an automated external defibrillator, prompted it to begin beating somewhat normally again. His pulse returned. He began moving around. One of the paramedics started an IV, and McMillan was moved to the stretcher and wheeled to the ambulance.

He was half asleep, half awake and really confused by the time the ambulance got him to the adult emergency department at Upstate, where its director, Jeremy Joslin, MD, happened to be working that afternoon.

Joslin quickly connected McMillan to a monitor to watch his heart’s electrical activity, and he kept close watch on his blood pressure, which required some supportive medication. Hearts in healthy young people typically don’t stop beating except in cases of trauma, or if the heart grows abnormally large, or in the case of an electrical malfunction. Joslin summoned cardiologists and set about determining what caused McMillan’s heart problem.

 A groggy McMillan kept asking the same question, not remembering the answer: Did SU win? Did they beat Virginia?

 Tanski stopped at the emergency department after the game to check McMillan’s condition. Both emergency doctors marvel at the young man’s good fortune.

 “If you put me in his shoes and I got to pick where I had this event, if it couldn’t be inside a hospital, I’d want it to be in the Dome,” Joslin said.

 “The Dome is known for having good survival rates,” said Tanski, adding that the outcome surely would have been different if McMillan had been driving, or alone in his dorm room, when his heart stopped.

McMillan is from Ashland, in suburban Boston. His parents were away on Feb. 4, visiting a college with his younger brother. Somehow, the social worker in the emergency department – whom Joslin says regularly works miracles – tracked them down quickly.

While he remained hospitalized, McMillan underwent a series of tests to determine what caused his heart to stop beating.  Structurally, his heart was normal. The problem appeared to be electrical. He recalled that he was still hooked to a heart monitor on Feb. 7 when SU traveled to South Carolina to play Clemson. As the clock ticked down to the 82-81 “buzzer beater” win, McMillan watched the lines of his heart rate spike.

In a cardiac catheterization procedure the next day, cardiac electrophysiologist Tamas Szombathy, MD, determined that McMillan needed an implantable cardiac defibrillator, a small battery-powered device designed to shock him back to life if his heart ever stops beating again.

 “I can definitely feel it in my chest,” McMillan says of the defibrillator. A month after its insertion, he says the bruising and swelling have subsided, but he still has the restriction against lifting his arm above his head to prevent the defibrillator system from being displaced.


Upstate emergency physician Christopher Tanski poses with Otto the Orange and SU student Alex McMillan, who was revived when his heart stopped during the basketball game on Feb. 4. Photo by Mike Okoniewski/Syracuse Athletics

What caused his heart to stop beating? “They think it’s a genetic thing,” McMillan said. He had blood drawn and met with a genetic counselor at Upstate. If other members of his family are found to have the same genetic mutation, and receive pre-emptive care, more than just McMillan’s life will have been saved that Feb. 4 day in the Dome.

 McMillan missed several days of classes while he was in the hospital, but by the end of the month he was caught up with his studies. He was not allowed to play his saxophone again yet, but he did feel up to attending another Dome game on Feb. 22.

 That was the Duke game. The Orange won with an epic 3-point basket sunk in the final second of the game. People started once again referring to the team as the “Cardiac Cuse.”

 McMillan felt his heart racing. He was thrilled to be part of the court-storming, after-game celebration.

 In more reflective moments, he’s grateful he was at the Dome game 18 days prior, where, after his heart stopped, he was brought back to life. ###

Posted in emergency medicine/trauma, genetics, health care, heart/cardiovascular, patient story | Tagged , , | 3 Comments

Multiple myeloma is his opponent – and so far, he’s winning


Jack Durr sees the oncology team at the Upstate Cancer Center’s office in Oneida for most appointments. Having chemotherapy treatments, blood tests and checkups close to his home in Vernon is important to Durr, 72, who loves his job and dreads missing a day of work.

Jack Durr, 72, of Vernon, receives much of his cancer treatment at the Upstate Cancer Center’s Oneida office. He underwent a stem cell transplant at the main Cancer Center site in Syracuse. (PHOTOS BY SUSAN KAHN)

For 35 years, Durr has worked in a lab at the SUNY Polytechnic Institute in nearby Utica. He is enthralled by the scientific discoveries and technological advances that he has witnessed at the college over the years. “When I started, we didn’t have computers,” he explains. “Now we’re doing nanotechnology.”

That love of scientific progress took on greater meaning when Durr was diagnosed with a cancer called multiple myeloma in 2009. Seven months after diagnosis, Durr had an autologous stem cell transplant (see below) at the Upstate Cancer Center’s main site in Syracuse. The transplant put the disease in remission and likely saved Durr’s life.

Stem cell transplants are available in Central New York only at Upstate, says Upstate oncologist Teresa Gentile, MD, PhD. She points out that “we’re at the cutting edge of clinical trials, and Upstate has access to more recently approved immunotherapy drugs.”

In 2010, Durr was hospitalized for 17 days for the transplant.  “Before the transplant, I had three trips to the hospital and was hooked up to a machine for three to four hours to harvest stem cells out of my blood. After they got my stem cells, the transplant starts with a big blast of chemo to get rid of any cancer. Then, they put my stem cells back into me, so I could make new, healthy blood,” he smiles. “When I was done, I was like a new, little baby. I had to get all my childhood vaccines again.”

When the transplanted stem cells were injected into Durr’s bloodstream, they moved into his bone marrow, where they proliferated and developed into healthy platelets and red and white blood cells.

Oncologist Teresa Gentile, MD, PhD, with Durr, her patient, at the Upstate Cancer Center office in Oneida. Upstate oncologists have been treating patients in Oneida for 25 years.

To further battle the multiple myeloma, Gentile recommended the immunotherapy drug Revlimid to strengthen Durr’s immune system and stop new cancer cells from developing.  Durr’s cancer stayed in remission for six years.

“But, cancer figured it out again,” says Durr, who served in Army intelligence during the Vietnam War and stays energized and upbeat by viewing cancer as an enemy he needs to outsmart.

Durr and Gentile put their heads together and discussed options for dealing with the cancer relapse. Rather than a second stem cell transplant, Durr chose new immunotherapy medication combined with chemotherapy. He is in remission again, thanks to 32 weeks of chemotherapy treatments at the Oneida office, plus Pomalyst, a new immunotherapy drug.

What if cancer figures it out again? “Maybe I’ll have that second transplant,” Durr says with a grin. “Or, Dr. Gentile will tell me about new drugs we can try.”

What is multiple myeloma?

Multiple myeloma is a cancer formed by malignant plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system. — American Cancer Society

What is a stem cell transplant?

In a stem cell transplant, the patient gets high-dose chemotherapy (sometimes with radiation) to kill cells in the bone marrow. Then the patient receives new, healthy, blood-forming stem cells. Before the transplant, drug treatment is used to reduce the number of cancerous cells in the patient’s body. With an autologous transplant, the patient’s own stem cells are removed from his or her bone marrow or blood, stored and reinfused into the patient’s blood after treatment to kill cancer cells. — American Cancer Society

What are stem cells?

Stem cells differ from other kinds of cells in the body. All stem cells have three general properties: They are capable of dividing and renewing themselves for long periods; they are unspecialized (they could potentially become many different types of cells); and they can give rise to specialized cell types. — National Institutes of Health

What is immunotherapy?

A type of biological therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. — National Cancer Institute

This article appears in the winter 2017 issue of Cancer Care magazine.

Posted in cancer, drugs/medications/pharmacy, health care, patient story, weight loss | Tagged

Scientists explore genetic roots of rare blood cancer

Golam Mohi, PhD

Scientists at Upstate have made progress in understanding the cause of a rare blood cancer called myelofibrosis, and they hope to learn how to block the disease’s progression.

Professor of pharmacology Golam Mohi, PhD, has been studying the life-threatening disorder, in which a defect in the bone marrow leads to overproduction or underproduction of various blood cells. Patients may suffer severe anemia, weakness and fatigue and get progressively worse. Some develop a more serious form of leukemia.

Mohi and graduate student Yue Yang and colleagues recently wrote about their laboratory research in the journal Blood. They focused on a gene mutation (called JAK2V617F) that is linked to myelofibrosis and two similar blood cancers. They found that loss of a particular gene (called EZH2) cooperates with the mutation in the development of myelofibrosis.

“It is imperative to better understand the cause of the disease, so that more targeted therapies can be developed to help manage the disease, and optimally, to prevent the disease from progressing,” Mohi says.

Work in his laboratory continues.

This article appears in the winter 2017 issue of Cancer Care magazine

Posted in cancer, genetics, research | Tagged

Revealing research: Kidney tumor analysis helps decipher proteins’ role in cancer development

The June issue of the global scientific journal Nature Communications features work by (pictured, from left) graduate student Diana Dunn; research assistant Mark Woodford; biochemist/molecular biologist Mehdi Mollapour, PhD; urologist Gennady Bratslavsky, MD; and assistant professor Dimitra Bourboulia, PhD. The research team also includes professor Stewart Loh, PhD; graduate student Adam Blanden and librarian Wendi Ackerman. (PHOTO BY ROBERT MESCAVAGE)

The June issue of the global scientific journal Nature Communications features work by (pictured, from left) graduate student Diana Dunn; research assistant Mark Woodford; biochemist/molecular biologist Mehdi Mollapour, PhD; urologist Gennady Bratslavsky, MD; and assistant professor Dimitra Bourboulia, PhD. The research team also includes professor Stewart Loh, PhD; graduate student Adam Blanden and librarian Wendi Ackerman. (PHOTO BY ROBERT MESCAVAGE)


Some of the tumors Gennady Bratslavsky, MD, removes from patients’ kidneys are no bigger than olives. Some are the size of watermelons. Since July 2014, many have ended up in the laboratory of Bratslavsky’s research partner, Mehdi Mollapour, PhD.

After the surgeon removes the tumors, they are packaged on sterile ice in a cooler. A technician carefully transports the tissue from the operating room at Upstate University Hospital to the laboratory in adjacent Weiskotten Hall. There, Mollapour and laboratory members Mark Woodford and Diana Dunn dissect the tumors, extracting proteins from them for analysis.

It’s a classic example of “bench-to-bedside” research that typically occurs at an academic medical center such as Upstate. Doctors at a patient’s bedside collaborate with scientists at a laboratory bench, sharing a focused mission to gain particular knowledge. In this case, what Bratslavsky, Mollapour and colleagues have learned about a specific type of kidney cancer applies to all kidney cancers — and likely many other cancers as well.

Their initial work was on cells from people with Birt-Hogg-Dube syndrome. That is a rare, inherited cancer syndrome caused by a mutation of the gene FLCN, which predisposes people to form kidney tumors, pulmonary cysts and benign skin tumors.

Bratslavsky chairs the urology department at Upstate. Mollapour, an assistant professor of urology, leads the renal cancer biology section of the urology department.

Their team deciphered the complex relationship between FLCN and some crucial proteins, one called Hsp90 and a pair called FNIP 1 and FNIP 2 that watched over and exerted influence on Hsp90. The proteins’ interactions affect processes that take place within cancer cells that are forming, at a time so early in development that their existence cannot be detected through available testing.

“One of the biggest things that has been shown with this research is that control of Hsp90 is extremely precise,” Mollapour says. While their work on the tumors continues, the research team’s 15-page paper — which appears in the June issue of Nature Communications, a global scientific journal —  details how Hsp90 is controlled.

That’s particularly encouraging because Hsp90 is found in all cancer cells, not just kidney cancer cells. Learning how to manipulate this protein could lead to improved cancer treatment.

Consider someone with cancer who takes a drug but sees no effect. The drug may not work simply because it cannot gain entry to the cancer cells.

Or, consider someone who cannot tolerate a cancer drug because of debilitating side effects. It may be because too much of the drug is getting into healthy cells.

In both cases, regulation of the Hsp90 protein might help the drugs work better.

Drugs already in clinical trial are being tested for their ability to inhibit Hsp90, Bratslavsky says. And, it turns out, greater levels of the drugs accumulate in cancer cells when levels of the FNIP proteins are high.

It’s promising research, which only began because an Upstate surgeon decided to team up with a laboratory scientist to investigate a rare syndrome.

Layout 1This article appears in the winter 2017 issue of Cancer Care magazine


Posted in cancer, genetics, kidney/renal/nephrology, research, urology | Tagged ,