Update from the Section of Hematology – Division of Hematology, Oncology and Blood & Marrow Transplantation

The following is a guest post from Steven Lentz, MD, PhD, Chief of the Section of Hematology. It is part of an ongoing 2019 series of division updates.

The Division of Hematology, Oncology and Blood & Marrow Transplantation has grown dramatically over the last 15 years as the care of patients with cancer and blood disorders has become more complex and more treatment options have become available.

During the past year, the Division reorganized administratively into two Sections: Hematology, directed by me, and Oncology, directed by Dr. Mohammed Milhem. In this post, I provide some highlights of recent achievements by the Section of Hematology, which includes general hematology, malignant hematology (leukemia, lymphoma, myeloma, and related disorders), blood & marrow transplantation (BMT), and cellular immunotherapies.

Our postdoctoral fellowship training program in hematology, which I direct, received notification that it will be funded by the National Institutes of Health (NIH) for another 5 years. This program has been successful in attracting young scientists and physician-scientists into academic careers in hematology for more than 40 years.

Over the last three years we have pioneered Hematology e-Consults, an electronic consultation service for patients with general hematological conditions. This service provides timely consultative hematological advice to referring providers and directs patients requiring more extensive evaluation to appropriate venues. We completed more than 120 e-Consults in the past year. We are looking forward to expanding the Hematology e-Consult service to additional referring providers in the next year. The Hematology e-Consult service is staffed by Usha Perepu, MBBS; Donald Macfarlane, MD, PhD; Grerk Sutamtewagul, MD; and me.

Dr. Perepu
Dr. Macfarlane
Dr. Sutamtewagul

Anil Chauhan, PhD, was one of the first scientists nationwide to receive a prestigious R35 grant from the National Heart, Lung and Blood Institute of the NIH. The goal of Dr. Chauhan’s research program is to better understand how metabolic reprogramming regulates platelets and leukocytes and contributes to blood clots and vascular inflammation. If successful, this research could lead to a therapeutic strategy toward better management of patients at high risk for heart disease and stroke. In addition, Dr. Chauhan will serve as co-principal investigator of an NIH U01 grant to fund the University of Iowa Stroke Preclinical Assessment Center, one of only six such centers nationally. Dr. Chauhan is also an outstanding mentor for young investigators. Through his mentorship, Research Assistant Professor Nirav Dhanesha, PhD, secured funding from the American Society of Hematology.

Dr. Chauhan
Dr. Dhanesha

The Comprehensive Sickle Cell Program team at University of Iowa Hospitals & Clinics includes hematologists, a nurse practitioner, a neuropsychologist, a genetic counselor, a social worker, a research coordinator, a community navigator, a dental hygienist, and a data manager. Our mission is to provide high-quality care to patients with sickle cell disease throughout the state of Iowa. The adult sickle cell team is led by Usha Perepu, MBBS. We now care for more than 100 adult patients with sickle cell disease, and we are creating a dedicated comprehensive adult sickle cell clinic. We hosted our first annual sickle cell symposium for patients in 2016. This was a great success and has now become an annual event. The 4th annual Iowa Sickle Cell Symposium will be held at Bloomsbury Farm on September 8, 2019.

The Iowa Hemophilia and Thrombosis Center (HTC) provides services to more than 400 adult and pediatric patients from Iowa and western Illinois who have been diagnosed with a bleeding disorder. We offer state-of-the-art comprehensive clinical care, education to patients and their families, and accessibility to clinical research projects that are oriented to improve the lives of people with these types of disorders. The Iowa HTC is the only federally-funded comprehensive HTC in the State of Iowa. Adult HTC patients are seen by Usha Perepu, MBBS; Grerk Sutamtewagul, MD; Donald Macfarlane, MD, PhD; and me. Iowa HTC nurse specialist Karla Watkinson, RN, will receive the 2019 Nurse of the Year Award from the National Hemophilia Foundation for her dedication and kindness to the bleeding disorder community for nearly 30 years. Congratulations, Karla!

Under the leadership of Margarida Silverman, MD, the adult BMT and Cellular Immunotherapy program had a landmark year, highlighted by the opening of the new Stem Cell Transplant and Cellular Therapies Unit on 3JCP. The number of patients who received a bone marrow transplant at UIHC increased to 190 in 2018. In addition, we became one of very few centers in the United States, and the first in the state of Iowa, to be approved to offer a groundbreaking new type of cellular immunotherapy called CAR T-cell therapy. This exciting new program is led by Umar Farooq, MD, who is a leading investigator of CAR-T cells. CAR T-cell therapy is currently available for selected patients with non-Hodgkin’s lymphoma or acute lymphoblastic leukemia and is being developed for patients with other types of cancer. Since November 2018 we have treated 17 patients with CAR T-cell therapy at UIHC.

Dr. Silverman
Dr. Farooq

It’s been a busy year for Malignant Hematology! Clinical trial enrollment for patients with leukemia and related disorders is growing under the leadership of Carlos Vigil, MD, Director of Clinical Research in Leukemia. Members of the division have been working together with the outstanding Pathology services of UIHC to provide multi-disciplinary care and consultation for university- and community-referring physicians. Michael Tomasson, MD, has led the establishment of a Leukemia Tissue Banking Study to provide translational research infrastructure to parallel those in lymphoma and myeloma. In the coming year, plans are underway to expand the inpatient Leukemia Service to include non-transplant leukemia, lymphoma, and multiple myeloma patients in a new Malignant Hematology Teaching Service to improve patient care, resident and fellow education, and clinical research. The service is staffed by Carlos Vigil, MD; Michael Tomasson, MD; Oana Paun, MD; and Sabarish Ayyappan, MBBS.

Vigil Gonzales~Carlos
Dr. Vigil
Dr. Tomasson
Dr. Paun
Dr. Ayyappan

JethavaYogeshUnder the leadership of Yogesh Jethava, MBBS, our multiple myeloma service is growing steadily, with more than 115 new patients seen and more than 90 bone-marrow transplants performed in 2018. Myeloma patients are staffed by Dr. Jethava and Dr. Michael Tomasson.

fzhanFenghuang (Frank) Zhan, MD, PhD, recently received approval notification for two new external grants: an NIH R01 award entitled “Novel NEK2 Signaling in Myeloma Pathways” and a Department of Defense (DOD) award entitled “CD24 tumor-Initiating Cell as a Novel Therapeutic Target in Myeloma.” Dr. Zhan’s lab focuses on translational research in multiple myeloma, a human blood cancer. One important aspect of his research is to develop novel treatment approaches to overcome drug resistance in myeloma.

The lymphoma team remains robust and enjoys ongoing success in grant funding, publications, and clinical advances. An important backbone to our lymphoma research is funded by the P50 Iowa-Mayo Lymphoma SPORE grant from the National Cancer Institute, led by George Weiner, MD. Basic and translational research with a focus on development of novel approaches to immunotherapy are supplemented by funding from the Leukemia and Lymphoma Society and other grants. Prospective observational database research exploring genetic, epidemiologic, biomarker discovery, and clinical outcome questions are augmented by a U01 Lymphoma Epidemiology of Outcomes (LEO) grant and a newly awarded ORIEN NOVA award, both led by Brian Link, MD. Clinical management of lymphoid malignancies have evolved with many important new innovations in recent years. Drs. Weiner and Farooq have teamed up to offer new clinical trials exploring new paradigms in immunotherapy, while the observational registries have been key international tools in refining patient prognostics, thereby identifying people who are the most appropriate candidates for these novel therapies or clinical trials.

Dr. Weiner
Dr. Link

Readers of the above will have seen many names repeated more than once. This is because our outstanding faculty members wear many hats; as clinicians, educators, and researchers, sometimes all at the same time. Because we are so busy and because we keep our eye focused on the future as the spectrum of hematology continues to expand, we are continually looking to recruit both from within our competitive fellowship program and from outside the institution. We are fortunate, most recently, to have welcomed Sabarish Ayyappan, MBBS, as a clinical assistant professor. We are confident that his arrival and those who will soon join him as new faculty members will find the Section of Hematology a welcoming and stimulating environment.

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