Introduction
I am pleased to appear before the Subcommittee today and testify on behalf of The Leukemia & Lymphoma Society (LLS).
During its 53-year history, the Society has been dedicated to finding a cure for the blood cancers -- leukemia, lymphoma, and myeloma. The Society has the distinction of being both the largest private organization dedicated to blood-related cancers and the nation’s second largest private cancer organization.
Our central contribution to the search for a cure is providing a significant amount of the funding for basic and translational research in the blood cancers. In 2003, we will provide almost $40 million in research grants. In addition to our role funding research, we provide a wide range of services to individuals with the blood cancers, their caregivers, families, and friends through our 60 chapters across the country. Finally, we advocate responsible public policies that will advance our mission of finding a cure for the blood cancers.
We are pleased to report that impressive progress is being made in the treatment of many blood cancers. Over the last two decades, there have been steady and impressive strides in the treatment of the most common form of childhood leukemia, and the survival rate for that form of leukemia has improved dramatically.
And two years ago, a new therapy was approved for chronic myelogenous leukemia, a form of leukemia for which there were previously limited treatment options, all with serious side-effects. Let me say that more clearly, if three years ago your doctor told you that you had CML, you would have been informed that there were limited treatment options and that you should get your affairs in order. Today, those same patients have access to this new therapy, called Gleevec, which is a so-called targeted therapy that corrects the molecular defect that causes the disease, and does so with few side effects.
The LLS funded the early research on Gleevec, as it has contributed to research on a number of new therapies. We are pleased that we played a role in the development of this life-saving therapy, but we realize that our mission is far from complete. Many forms of leukemia, lymphoma and myeloma present daunting treatment challenges. There is much work still to be done, and we believe the research partnership between the public and private sectors – as represented in many of the Pentagon research programs – is an integral part of that effort and should be strengthened.
The Grant Programs of The Leukemia & Lymphoma Society
The grant programs of the Society are in three broad categories: Career Development Grants, Translational Research Grants for early-stage support for clinical research, and Specialized Centers of Research. In our Career Development program, we fund Scholars, Special Fellows, and Fellows who are pursuing careers in basic or clinical research. In our Translational Research Program, we focus on supporting investigators whose objective is to translate basic research discoveries into new therapies.
The work of Dr. Brian Druker, an oncologist at Oregon Health Sciences University and the chief investigator on Gleevec, was supported by a translational research grant from the Society. Dr. Druker is certainly a star among those supported by the LLS, but our support in this field is broad and deep. Through the Career Development and Translational Research Programs, we are currently supporting more than 400 investigators in 33 states and ten foreign countries.
Our new Specialized Centers of Research grant program (SCOR) is intended to bring together research teams focused on the discovery of innovative approaches to benefit patients or those at risk of developing leukemia, lymphoma, or myeloma. The awards will go to those groups that can demonstrate that their close interaction will create research synergy and accelerate our search for new therapies, prevention, or cures.
Impact of Hematological Cancers
Despite enhancements in treating blood cancers, there are still significant research opportunities and challenges. Hematological, or blood-related, cancers pose a serious health risk to all Americans. These cancers are actually a large number of diseases of varied causes and molecular make-up, and with different treatments, that strike men and women of all ages. In 2003, more than 100,000 Americans will be diagnosed with a form of blood-related cancer and over 60,000 will die from these cancers. For some, treatment may lead to long-term remission and cure; for others these are chronic diseases that will require treatments on several occasions; and for others treatment options are extremely limited. For many, recurring disease will be a continual threat to a productive and secure life.
A few focused points to put this in perspective:
• Taken together, the hematological cancers are fifth among cancers in incidence and second in mortality.
• Almost 700,000 Americans are living with a hematological malignancy in 2003.
• More than 60,000 people will die from hematological cancers in 2003, compared to 40,000 from breast cancer, 30,200 from prostate cancer, and 56,000 from colorectal cancer.
• Blood-related cancers still represent serious treatment challenges. The improved survival for those diagnosed with all types of hematological cancers has been uneven. The five-year survival rates are:
Hodgkin’s disease 83% Non-Hodgkin’s lymphoma 53% Leukemias (total) 45% Multiple Myeloma 29% Acute Myelogenous Leukemia 14%
• Individuals who have been treated for leukemia, lymphoma, and myeloma may suffer serious adverse events of treatment, including second malignancies, organ dysfunction (cardiac, pulmonary, and endocrine), neuropsychological and psychosocial aspects, and quality of life.
Trends
• Since the early 1970s, incidence rates for non-Hodgkin’s lymphoma (NHL) have nearly doubled.
• For the period from 1973 to 1998, the death rate for non-Hodgkin’s lymphoma increased by 45%, and the death rate for multiple myeloma increased by more than 32%. These increases occurred during a time period when death rates for most other cancers are dropping.
• Non-Hodgkin’s lymphoma and multiple myeloma rank second and fifth, respectively, in terms of increased cancer mortality since 1973.
• Recent statistics indicate both increasing incidence and earlier age of onset for multiple myeloma.
• Multiple myeloma is one of the top ten leading causes of cancer death among African Americans.
• Despite the significant decline in the leukemia death rate for children in the United States, leukemia is still one of the two most common diseases that cause death in children in the United States.
• Lymphoma is the third most common childhood cancer.
Causes of Hematological Cancers
The causes of hematological cancers are varied, and our understanding of the etiology of leukemia, lymphoma, and myeloma is limited. Chemicals in pesticides and herbicides, as well as viruses such as HIV and EBV, play a role in some hematological cancers, but for most cases, no cause is identified. Researchers have recently published a study reporting that the viral footprint for simian virus 40 (SV40) was found in the tumors of 43 percent of NHL patients. These research findings may open avenues for investigation of the detection, prevention, and treatment of NHL. There is a pressing need for more investigation of the role of infectious agents or environmental toxins in the initiation or progression of these diseases.
Importance To The Department of Defense
The Leukemia & Lymphoma Society believes this type of medical research is particularly important to the Department of Defense for a number of reasons.
First, research on blood-related cancers has significant relevance to the armed forces, as the incidence of these cancers is substantially higher among individuals with chemical and nuclear exposure. Higher incidences of leukemia have long been substantiated in extreme nuclear incidents in both military and civilian populations, and recent studies have proven that individual exposure to chemical agents, such as Agent Orange in the Vietnam War, cause an increased risk of contracting lymphoid malignancies. In addition, bone marrow transplants were first explored as a means of treating radiation-exposed combatants and civilians following World War II.
The connection of blood cancers to military exposures was further illustrated in a recent report by the Institute of Medicine, finding that Agent Orange exposure is connected to cases of chronic lymphocitic leukemia (CLL). Immediately after the determination, the Veterans Administration announced that it will cover the medical expenses of veterans with CLL. The Vietnam-era defoliant is now credited with causing lymphomas, chronic myelogenous leukemia (CML) as well as CLL.
Consequently, in the current environment DOD medical research needs to also focus on the broader area of blood cancer research as it affects our military and domestic preparedness. Soldiers in the field, domestic first-response personnel, and the civilian population all face blood cancer risks from chemical or nuclear exposures, such as a "dirty bomb." Higher incidences of leukemia have long been substantiated in extreme nuclear incidents in both military and civilian populations. As our nation is contemplating the threat of biological, chemical or nuclear terrorism, we need better understanding of, and preparation for, the hematological malignancies that would inevitably result from such events.
Secondly, additional funding would expedite the cure for other cancers. Research in the blood cancers has traditionally pioneered treatments in other malignancies. This research frequently represents the leading edge in cancer treatments that are later applied to other forms of cancer. Chemotherapy and bone marrow transplants are two striking examples of treatments first developed in the blood cancers.
From a medical research perspective, it is a particularly promising time to build a DoD research effort focused on blood-related cancers. That relevance and opportunity were recognized over the last two years when Congress appropriated a total of $9.25 million to begin initial research into chronic myelogenous leukemia (CML) through the Congressionally Directed Medical Research Program (CDMRP). As members of the Subcommittee know, a noteworthy and admirable distinction of the CDMRP is its cooperative and collaborative process that incorporates the experience and expertise of a broad range of patients, researchers and physicians in the field. Since the CML program was launched, eleven proposals were recommended for funding. The review panel found the overall quality of the proposals was high and quality research from this CMLRP would benefit from additional funding. Additionally, innovative projects that have a high probability of finding new targets for the development of future therapies and new medicines to treat CML were recommended for funding.
Unfortunately, $9.25 million does not go very far in medical research. Recognizing that fact and the opportunity this research represents, bipartisan members of Congress have requested that the program be modestly increased to $25 million and be expanded to include all the blood cancers – the leukemias, lymphomas and myeloma. This would provide the research community with the flexibility to build on the pioneering tradition that has characterized this field.
DoD research on the other forms of blood-related cancer addresses the importance of preparing for civilian and military exposure to the weapons being developed by several hostile nations and to aid in the march to more effective treatment for all who suffer from these diseases. This request clearly has merit for inclusion in the FY 2004 legislation.
The Leukemia & Lymphoma Society strongly endorses and enthusiastically supports this effort and respectfully urges the Committee to include this funding in the FY 2004 Defense Appropriations bill.
We believe that building on the foundation Congress initiated over the last two years would both significantly strengthen the CDMRP and accelerate the development of cancer treatments. As history has demonstrated, expanding its focus into areas that demonstrate great promise; namely the blood-related cancers of leukemia, lymphoma and myeloma, would substantially aid the overall cancer research effort and yield great dividends.
