Blood cancer: better care after innovative cell therapy

In recent years, innovative cell therapies have significantly improved the chances of recovery for patients with blood or lymphatic cancers. The University Hospital Carl Gustav Carus Dresden is one of three hemato-oncological centres in Saxony where patients can be treated with a stem cell transplant or CAR-T cell therapy. After these complex therapies, there is a high risk of life-threatening complications for those affected. This is where the SPIZ project (cross-sectoral care for patients with haematological diseases following innovative cell therapy) comes in. „Patients who are included in this study receive intensive follow-up care, regardless of their place of residence“, says Prof Michael Albrecht, Medical Director at the University Hospital. „The aim is to detect serious complications in good time, but to avoid long trips to hospital.“

As part of the new SPIZ aftercare programme, a total of 302 patients from the three hächsian hämato;oncology centres at the university hospitals in Dresden and Leipzig and at Chemnitz Hospital will be included in the study after receiving one of the novel cell therapies. The catchment area is up to 200 kilometres, which makes regular outpatient visits for follow-up care difficult. „In studies, the results of innovative cell therapies are better than in routine care, which is probably due not least to effective aftercare. Our aim is to translate this potential of the therapies into the reality of care, especially in rural areas," explains Prof. Martin Bornhäuser, Director of the Medical Clinic I at Dresden University Hospital and member of the Executive Board of the National Centre for Tumour Diseases Dresden (NCT/UCC).

SPIZ aims to provide patients with close and digitally supported care, including by means of an app and video consultation, in order to recognise complications after cell therapy in good time and improve the quality of life of the patients involved. At the same time, they are to be spared many long journeys to the centres for regular follow-up care by having oncological nurses make home visits alternating with the outpatient appointments at the centre. This year, around 80 to 100 blood cancer patients are being cared for at Dresden University Hospital via the SPIZ programme. Further patients will be treated at the other participating centres, Leipzig University Hospital and Chemnitz Hospital. In order to test its effectiveness, SPIZ is designed as a randomised controlled trial in which the innovative care pathway is compared with current standard care. Together with the consortium partner AOK PLUS, a health economic analysis will also be carried out in order to enable the transfer to standard care following a positive evaluation.

The app is used to document symptoms


The SPIZ programme provides for video consultations as part of intensified aftercare in addition to outpatient appointments in order to enable symptoms to be resolved quickly and reduce long journeys. In addition, an „onco-nurse“ visits patients at home at regular intervals, can assess their condition on site, take blood samples, advise relatives and assess the need for support in the home environment. Patients continuously document symptoms and other important parameters in a special app. The data is read out five days a week by oncological nurses and presented to the medical staff in the event of any irregularities. Regular online case conferences enable close cooperation between all those involved in patient care, for example from the fields of social work, psycho-oncology, general practitioners and oncology centres. If patients have any questions or problems, they can contact specially trained case managers at any time, who also coordinate all appointments and the collaboration between the various stakeholders.

„We expect that the improved aftercare will result in fewer emergency hospital admissions, which are associated with considerable costs. On the other hand, video consultations can reduce long and therefore expensive journeys, which are usually made by taxi, as those affected are usually unable to use public transport or their own car due to medication and immune deficiencies," explains Dr Jan Moritz Middeke from the Medical Clinic I at Dresden University Hospital and research group leader at the Else-Kröner-Fresenius Centre for Digital Health (EKFZ).

AOK Plus is actively supporting the project and providing billing data. All effects of the project on the state of health and quality of life of the participating patients as well as the costs incurred are continuously recorded and evaluated by the Centre for Evidence-based Healthcare (ZEGV). If the evaluation is positive, the form of care proposed in the project will be permanently integrated into the standard care provided by health insurance companies. The consortium project is being funded with 4.1 million euros from the innovation fund of the Federal Joint Committee (G-BA).

The funding underlines the expertise at the Dresden site in the field of oncological research and care of patients with innovative cancer therapies,

says Medical Director Prof. Michael Albrecht.

First patient at Dresden University Hospital to be treated via SPIZ

Elke Hartwig is one of the first patients to be included in the programme at Dresden University Hospital. In 2019, the 60-year-old was diagnosed with multiple myeloma, a malignant bone disease that is a type of blood cancer. At the time, Elke Hartwig had severe rib and back pain treated by her doctor, and an MRI scan finally revealed the tumour on her skeleton. She was then referred to the university hospital. That was a great stroke of luck for me," says Elke Hartwig today. Initially, she was treated with a stem cell transplant, but the cancer came back. In the meantime, other innovative cell therapies have shown good results. „An incredible amount has happened in this area in the last year or two“, says Dr Katharina Egger-Heidrich, a specialist in internal medicine. Unlike acute leukaemia, multiple myeloma is not curable. However, we have achieved good remissions with the new cell therapies, which means that the symptoms of the disease can be delayed.

Since the beginning of January, Elke Hartwig has been treated with CAR-T cell therapy, which is working very well. This is a cancer immunotherapy in which T-cells are collected from the blood and genetically modified so that they fight cancer cells in the body itself. „At least that gives me hope that I can still enjoy some time with my grandchildren“, says the patient, who lives in Arnsdorf in the Dresden area. The fact that she now reports daily feedback on her state of health to the university hospital via the SPIZ project gives Elke Hartwig peace of mind. „It feels good to be in contact with the medical staff via the app.“ There she indicates, for example, how high her blood pressure and body temperature are and whether she has a fever or other complaints.

If any abnormalities occur, a doctor will get in touch and discuss the next steps,

says Dr Katharina Egger-Heidrich.

In addition to Dresden University Hospital, Saxocell, NIO/BNHO (associations of oncologists in private practice), the National Centre for Tumour Diseases Dresden (NCT/UCC) and the Centre for Evidence-based Healthcare (ZEGV) at Dresden University Hospital are also involved in the project. The Saxocell future cluster is focussing in particular on current developments in the field of gene modification, especially of immune cells. These modified or edited cells can, for example, destroy tumour and other disease-causing cells if they are equipped with specific tumour-recognising receptors. In SaxoCell's vision, such chimeric antigen receptors, or simply CARs, are the key to producing "living drugs". CARs can redirect the immune system to almost any target. After genetic modification, either of the patient's own cells or of cells that can be used for all patients (so-called allogeneic approaches), it may theoretically be possible to cure many serious diseases for the first time in a truly causal way.