Pediatric Hematology-Oncology Fellowship Training Program


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Pediatric Hematology-Oncology Fellowship Training Program

  1. 1. Pediatric Hematology-Oncology Fellowship Training Program
  2. 2. Pediatric Hematology-Oncology Fellowship Training Program St. Jude Children’s Research Hospital Le Bonheur Children’s Medical Center University of Tennessee, Memphis, College of Medicine Contents Our Mission .................................................................................................................. 2 The Hospital.................................................................................................................. 3 Memphis ....................................................................................................................... 4 Fellowship Program Goals and Objectives................................................................... 5 Physician-Scientist Training Program........................................................................... 5 Clinical Investigator Training Program......................................................................... 6 Application Process and Selection of Fellows.............................................................. 6 The Subspecialty Training Experience ......................................................................... 7 Educational Meetings.................................................................................................. 11 Evaluations.................................................................................................................. 14 Research Programs...................................................................................................... 15 Department of Hematology-Oncology Faculty .......................................................... 18 Program Director: Jeffrey E. Rubnitz, MD, PhD Associate Director: Russell E. Ware, MD, PhD Associate Director: Stephen X. Skapek, MD Chair, Department of Hematology-Oncology: Michael B. Kastan, MD, PhD Chair, Department of Pediatrics: Russell W. Chesney, MD
  3. 3. 22 Our Mission To find cures for children with catastrophic illnesses through research and treatment St. Jude Children’s Research Hospital is dedicated to providing the highest quality medical care to children with catastrophic illnesses—primarily pediatric cancer—and to finding cures for those diseases. The institution is committed to research that seeks to understand the molecular causes of disease, to improve diagnosis and treatment, and to minimize the immediate and long-term side effects of therapy. Clinical and basic science investigators work together in the same setting at which children benefit from their research. Clinicians work closely with laboratory-based researchers to translate scientific discoveries into improved therapies. We also recognize the devastating financial, emotional, and psychological effects of catastrophic disease on the family of a stricken child, and we are committed to providing support services to the families of our children, regardless of their ability to pay for treatment or services. Funds generated by the American Lebanese Syrian Associated Charities (ALSAC) provide the vital foundation that buttresses ongoing activities in patient care, research, and training within our hospital and, at the same time, enable active partnerships with affiliates, both in the United States and through our International Outreach Program. The success of future biomedical research depends on the availability of well-trained young investigators. St. Jude Children’s Research Hospital is dedicated to nurturing and supporting these clinicians and scientists. The education and training programs at St. Jude Children’s Research Hospital reflect the institution’s commitment to excellence.
  4. 4. 3 The Hospital St. Jude Children’s Research Hospital was founded by the late entertainer Danny Thomas, a man of boundless energy and optimism, who was driven by the conviction that “no child should die in the dawn of life.” He dreamed of a haven where sick children could find treatment, regardless of their race, religion, nationality, or ability to pay. He envisioned a place where the top scientists in the world could work together with superb clinicians to find cures for potentially fatal diseases of childhood. That dream became a reality when this non-denominational hospital, named for St. Jude Thaddeus—the patron saint of hopeless causes—opened its doors in 1962. Since then, the institution has become an international resource for the study and treatment of catastrophic childhood diseases. St. Jude Children’s Research Hospital is supported by the only National Cancer Institute (NCI) Cancer Center Support Grant directed solely toward pediatrics. It is the largest hospital in the United States dedicated to pediatric cancer and hematologic diseases, accepting approximately 350 new cancer patients each year. St. Jude Children’s Research Hospital also has the largest pediatric bone marrow transplant program in the world, currently performing nearly 200 transplants annually. St. Jude Children’s Research Hospital offers a rich intellectual environment for education and training. Fellows have the opportunity to work with world-renowned senior faculty members, including Peter C. Doherty, PhD, winner of the 1996 Nobel Prize for Physiology or Medicine and member of the National Academy of Sciences; Robert G. Webster, PhD, member of the National Academy of Sciences; Charles J. Sherr, MD, PhD, member of the National Academy of Sciences and recipient of the Landon-AACR Prize for Cancer Research and the General Motors Cancer Research Foundation Mott Prize; James N. Ihle, PhD, who, like Sherr, is a Howard Hughes Medical Institute investigator; St. Jude Director William E. Evans, PharmD, recently
  5. 5. 44 elected to the Institute of Medicine; former St. Jude Director Arthur W. Nienhuis, MD, member of the Institute of Medicine and the National Cancer Advisory Board; Hematology-Oncology Chair Michael B. Kastan, MD, PhD, Board of Directors, American Association of Cancer Research; Developmental Neurobiology Chair Tom Curran, PhD, Former President of the American Association of Cancer Research; Ching-Hon Pui, MD, American Cancer Society Clinical Research Professor; and Pathology Chair James R. Downing, MD, member of the American Society of Clinical Investigation. At St. Jude, fellows are encouraged to attend regularly scheduled seminars, workshops, journal clubs, and lectures given by faculty members and by internationally known invited speakers. This rich academic environment is complemented by state-of-the-art facilities, equipment, and research support services. Memphis Situated on a bluff overlooking the Mississippi River, Memphis, Tennessee, is the metropolitan hub of a five-state region known as the Mid-South. Home to nearly a million residents, the greater Memphis area offers something for everyone. Memphians enjoy a relatively low cost of living, a temperate climate, four distinct seasons and good old-fashioned Southern hospitality. Memphis is also home to one of the largest medical centers in the United States. The city is called the home of the blues, birthplace of Rock’n’Roll, and is truly a music lover’s Mecca. From the legendary Sun Studio where Elvis Presley, Ike Turner, Carl Perkins, Rufus Thomas, Jerry Lee Lewis, and Johnny Cash recorded, to the Stax Museum of American Soul Music where Otis Redding, Booker T. and the MGs, and Isaac Hayes made music history, to the pulsating night life of blues clubs on historic Beale street, the Memphis beat never sleeps. Local symphony orchestra, ballet, live theatre performances, several museums, more than 150 diverse festivals, and special events are available to those seeking cultural
  6. 6. 5 activities. Nature lovers enjoy hiking, biking, hunting, fishing and boating at a variety of lakes, parks and nature preserves in and around the Memphis area. The city hosts major sporting events, including the FedEx St. Jude Classic, the AutoZone Liberty Bowl, the Kroger St. Jude Tennis Tournament, and the St. Jude Memphis Marathon. Memphis is also the home of the Pacific Coast AAA Memphis Redbirds and the NBA Memphis Grizzlies. Fellowship Program Goals and Objectives St. Jude Children’s Research Hospital provides a comprehensiveprogramfortrainingsubspecialty fellows in Pediatric Hematology-Oncology. The programiscertifiedbytheAccreditationCouncil for Graduate Medical Education (ACGME) and leads to subspecialty certification. The training program is an integrated part of the University of Tennessee, Memphis, Pediatric Residency Program (Program 3274731034). The goal of the program is to train the future leaders in academic pediatric hematology- oncology in the United States. Upon successful completion of our training program, fellows will have a comprehensive understanding of the pathophysiology of pediatric hematologic and oncologic disorders, will be competent in the clinical diagnosis and management of these disorders, will understand clinical trials methodology, and will have competence in a selected research interest. Our program seeks to nurture and develop laboratory researchers and clinical investigators. Physician-Scientist Training Program We have devoted special resources to a training program for physicians seeking careers in laboratory-based academic pediatric hematology-oncology. As an internationally recognized research center, St. Jude Children’s Research Hospital is in
  7. 7. 66 an ideal position to provide training in molecular medicine, particularly as it relates to cancer and blood disorders. Our ultimate goal is to enable qualified physicians to become independent investigators at major academic institutions. After completing a one-year clinical training period in hematology and oncology, successful applicants for the laboratory research track will receive support for three years of laboratory research training at St. Jude, the minimum time needed to prepare researchers for productive careers in academic medicine. St. Jude is in a unique position to offer special resources for laboratory training for the entire fellowship period and for extended periods of laboratory research time if required. Because the training period may exceed the three-year requirement for subspecialty board certification in pediatric hematology-oncology, St. Jude provides generous stipends to qualified applicants, depending on their prior training and experience. This program should therefore provide the financial security and protected time needed to develop superior research skills and a comprehensive conceptual background in the molecular aspects of hematology-oncology. Clinical Investigator Training Program In addition to the laboratory-based research track, we offer a clinical research track for fellows interested in careers as clinical investigators. Formal training in clinical research can be obtained through early involvement in several ongoing clinical trials within the institution. Fellows may participate in the development of new institutional protocols and may conduct retrospective hypothesis-driven studies. In addition, fellows interested in pursing advanced degrees in clinical research or epidemiology can do so through our partnership with the University of Tennessee Health Sciences Center Application Process and Selection of Fellows St. Jude participates in the National Residency Matching Program and accepts six fellows each year for training in Pediatric Hematology-Oncology. Prospective fellows are encouraged to apply early in their second year of pediatric residency.The Fellowship
  8. 8. 7 Director, with the aid of the departmental Fellowship Committee, selects the applicants who will be offered interviews. St. Jude Children’s Research Hospital pays the costs of the interview, including lodging and travel. The following criteria must be met for acceptance into the training program: 1. Successful completion of an ACGME-accredited pediatric residency program. 2. A commitment to pursue a career in academic pediatric hematology-oncology. 3. Excellence in the clinical care of children. 4. Proven research ability or the strong potential for success in clinical or laboratory research. Acceptance is granted on the basis of the applicant’s potential to become a successful academic subspecialist. The Subspecialty Training Experience Overview of training ACGME-accredited subspecialty training in pediatric hematology-oncology requires a minimum of three years. The first year of training provides comprehensive clinical training in hematology, oncology, and stem cell transplantation, with initial exposure to ongoing clinical investigations and research methods. All inpatient rotations involve teams that include an attending faculty member, one first-year fellow, one or two pediatrics or medicine-pediatrics residents, medical students, one or more nurse practitioners or physician assistants, a social worker, a pharmacist, and a nutritionist. All admitted patients are treated by these care teams. The fellow learns to function as a member of this multidisciplinary team and to call on the skills and experience of team members. Two or more subsequent years are devoted to active, direct involvement in clinical or laboratory-based research.
  9. 9. 88 Clinical Rotations Inpatient Leukemia-Lymphoma Service (2 months at St. Jude): In 2004, 139 new patients with leukemia or lymphoma were seen at St. Jude. The fellow on service is responsible for the supervision of all inpatients on the Leukemia-Lymphoma service and becomes proficient at diagnosing leukemia and lymphoma, enrolling patients on treatment protocols, ordering chemotherapy, and providing supportive care. The fellow learns how to manage complications of therapy, including infectious complications in the immunocompromised host and complications of chemotherapy. He also develops expertise at performing bone marrow aspirates and administering intrathecal chemotherapy. Inpatient Solid Tumor/Neuro-Oncology Service (2 months at St. Jude): In 2004, 131 patients with solid tumors other than brain tumors were seen at St. Jude. The fellow on service is responsible for the supervision of all inpatients on the Solid Tumor service and becomes proficient at diagnosing malignant solid tumors, including neuroblastoma, Wilms tumor, Ewing sarcoma, osteosarcoma, rhabdomyosarcoma and other soft tissue sarcomas, hepatic tumors, retinoblastoma, germ cell tumors, colon cancer, melanoma, and other tumors, enrolling patients on treatment protocols, ordering chemotherapy, and providing supportive care. A major thrust of the clinical research is the development of new agents. Fellows are thus exposed to the details of Phase I protocols, methodologies and ethical considerations. Inpatient Stem Cell Transplant Service (2 months at St. Jude): Approximately 180 stem cell transplantation procedures are performed each year (90 autologous and 90 allogeneic). Patients are admitted to a specialized 14-bed BMT unit. During this rotation, the fellow cares for children and adolescents who are undergoing transplantation and gains experience with hematopoietic and solid malignancies, bone marrow failure syndromes,immunodeficiencydisorders,inheritedmetabolic disorders, and complications of stem cell transplantation, including graft failure, infectious complications, and graft- versus-host disease.
  10. 10. 9 Hematology: 2 1/2 months at Le Bonheur Children’s Medical Center and St. Jude Children’s Research Hospital. Care for all children and adolescents with nonmalignant hematologic disorders is provided at both Le Bonheur and St. Jude. Patients with hemoglobinopathies and bleeding disorders are admitted to the inpatient hematology service at Le Bonheur, while patients with bone marrow failure syndromes are admitted to St. Jude. The fellow also participates in an active Hematology Consultation service at Le Bonheur and occasionally in the Newborn Nursery. During the Hematology rotation, the fellow attends the weekly outpatient hematology clinics (half day on Mondays at St. Jude and a full day on Thursdays at Le Bonheur) and the comprehensive hemophilia and thrombosis clinics (half day on Wednesdays), and a general hematology clinic (half day on Tuesdays). Through these clinical experiences, the fellow participates in the diagnosis and treatment of the entire range of common and rare hematologic disorders in children, including bone marrow failure syndromes, hemoglobinopathies, red cell membrane and metabolism disorders, hemolytic and nutritional anemias, white cell disorders, platelet and coagulation disorders, and immunodeficiencies. The fellow presents one hematology case of interest with didactic discussion each month at the St. Jude Leukemia-Lymphoma-Hematology conference and one or two cases at the combined pediatric and adult hematology conference held with the University of Tennessee every other week. After Completion of Therapy Clinic (two weeks at St. Jude): During this rotation, the fellow gains experience with the long-term effects of treatment. Fellows participate in ongoing studies of late effects of therapy on the skeleton; in evaluations of neurotoxic and cardiotoxic effects of therapy; and in investigations of risk factors for second malignancies. Neuro-oncology (one month at St. Jude): In 2004, 137 patients with newly diagnosed brain tumors were seen at St. Jude. This rotation provides education in the diagnosis and management of CNS tumors. Fellows also attend the weekly multidisciplinary
  11. 11. 1010 brain tumor clinical conference where new patients and consults are presented and discussed. Hematopathology (one month at St. Jude): During this rotation, the fellow develops expertise in reading peripheral blood and bone marrow smears, and becomes familiar with modern ancillary diagnostic techniques such as cytogenetics, flow cytometry, and molecular diagnostics. In addition, the rotation offers exposure to essential aspects of specimen handling in Surgical Pathology and in Microbiology (the latter including conventional and molecular methodology). Electives (six weeks): Available electives include blood banking, radiation oncology, coagulation disorders, general hematology,sicklecelldisease,infectiousdiseases,pediatric oncologic surgery, and intensive care. Continuity clinic (weekly at St. Jude): During the first year, fellows are assigned 25-30 new patients for whom they become the primary caregivers. For one-half day per week throughout the fellowship experience, fellows attend a continuity clinic at which they provide direct patient care to these patients under the supervision of the primary attending or clinic attending. Scope of the inpatient experience: The fellows have direct supervisory responsibility for care provided by residents, nurse practitioners, and physician assistants on all inpatient rotations. They review patient assessments and management plans and are responsible for assuring that protocol requirements are completed. They assume primary care responsibility for a minority of patients on the Leukemia, Solid Tumor, and Hematology services. They assume primary care responsibility for as many as half of the patients on the Bone Marrow Transplant service. The inpatient attending physician directly supervises the fellow on each rotation.
  12. 12. 11 Educational Meetings The training program offers fellows a comprehensive series of didactic sessions and teaching rounds, including the following: Hodgkin’s staging conference: This working conference provides a weekly update of all patients with Hodgkin’s disease who have undergone initial staging or re-staging. The Hematology-Oncology, Surgery, Diagnostic Imaging, and Radiation Oncology departments participate. Fellows are encouraged to attend when their patients are discussed. Hematology-Oncology Fellows Rounds: This weekly meeting is organized by the fellows and attended by fellows and faculty. Each fellow is expected to present a topic or journal article about two times per year. Hematology conference: This is a combined conference for pediatric and adult hematologists at the University of Tennessee. At each meeting, one pediatric and one adult hematology case is presented. The St. Jude fellow on the Hematology service is expected to give the case presentation and discussion. Leukemia/Lymphoma/Hematology conference: This is a formal conference held each week at St. Jude. Fellows are expected to present the case each week and may also be asked to present the discussion. This conference is attended by faculty from the Hematology-Oncology, Pathology, Diagnostic Imaging, and Infectious Diseases Departments. Attendance is required for first-year fellows and encouraged for all others. Pediatric Grand Rounds:This weekly conference on diverse topics in General Pediatrics is organized by the Department of Pediatrics and is held at Le Bonheur Children’s Medical Center. Attendance is optional.
  13. 13. 1212 Solid tumor staging conference: At this weekly conference, management of specific solid tumor patients is discussed by the Hematology-Oncology, Surgery, Diagnostic Imaging, and Radiation Oncology faculty. Fellows are encouraged to attend when their patients are discussed. Solid Tumor, Leukemia, and BMT Division Rounds: In addition to daily ward rounds, each division holds weekly rounds at which the inpatient team presents the current inpatients to the entire division. The inpatient fellow is required to attend. St. Jude Grand Rounds: This is a weekly formal presentation of a clinical or basic science topic related to pediatric hematology-oncology. Attendance is required for all fellows. TumorBoard:Thisisaformalweeklyconference in which a solid tumor case is presented and discussed. Attendance is required for first-year fellows and encouraged for other fellows. Fellows are also expected to present several cases throughout the year. Danny Thomas Lecture Series: This series consists of weekly lectures presented to the entire St. Jude community by distinguished visiting scientists and clinical researchers. Cancer Biology Forum: This lecture series for postdoctoral fellows and graduate students focuses on the major areas of cancer biology studied at St. Jude. It is held every other week and is presented by faculty members of the institution. Oncology-Biostatistics Journal Club: Held monthly, this is a combined journal club attended by members of the Hematology-Oncology and Biostatistics Departments. At each meeting, a Hematology-Oncology fellow presents a journal article and a member of the Biostatistics Departments discusses the design and analysis of the study. Hematology Journal Club: At this monthly meeting, fellows present recent articles focusing on nonmalignant hematology.
  14. 14. 13 Psychosocial aspects of subspecialty care Inpatient rounds on all services include members of the multidisciplinary team. Therefore, patient care decisions that affect the allocation of resources or that have social, cultural, and economic impact are routinely discussed and planned in the context of appropriate psychosocial input. End-of-life decisions and allocation of limited resources are reviewed with the primary physician and the inpatient attending physician. St. Jude’s commitment to International Outreach assures the presence of a significant population of patients from other countries. This clinical exposure provides a very wide spectrum of social, cultural, and economic considerations, which is not available in many training programs. Service Duties The first year fellow is required to make daily inpatient rounds during each inpatient rotation and provide weekend coverage for rounds on an every other weekend schedule. Thus, every other weekend (two of each fourteen day block) is free of all clinical care responsibilities. During outpatient and elective rotations, the first year fellow provides coverage for weekend rounds on the alternate weekend not covered by the inpatient fellow. Weekend coverage is provided primarily by the first year fellows, although fellows in subsequent years are asked to provide weekend coverage for 4-8 weekends per year. Although we do not require fellows to do in-house call, fellows at all levels of training may choose to take optional in-hospital night call, up to 6 nights per month. The institution provides a generous stipend for fellows and junior faculty to provide this coverage. Therefore, usual demand for these night call slots is sufficiently high that no more that 4 nights per month are available to any fellow. This in-hospital night call (3 physicians assigned each night) provides complete coverage for all inpatient care, walk-ins, emergency admissions, and telephone coverage for the hospital. Consequently, once the inpatient fellow has signed out to the on-call team, his inpatient clinical care responsibilities are suspended until
  15. 15. 1414 the following morning, but he is required to be on call from home to provide backup to the in-house physicians. All phone consultation from Le Bonheur for Hematology patients is handled by the hematology inpatient fellow. Routine admissions to the Hematology service are admitted by the on call resident team at Le Bonheur. Emergent situations and critical changes in clinical status requiring presence of the Hematologist are triaged to the Hematology fellow on call at home. Since July 1, 2003, fellow work hours has been limited to 80 hours per week and no more than 30 continuous hours of patient care. Fellows continue to have 2 weekends free of all clinical duties every month. Evaluations Evaluation of fellows Written yearly progress reports and written evaluations for all clinical rotations are required. The inpatient attending physician is responsible for completing the written evaluation form at the end of each rotation on that inpatient service. Evaluations should be discussed with the fellow. Forms are reviewed by the Fellowship Committee and become a permanent part of the fellow’s file. The inpatient attending physician is also responsible for assurance that thefellowacquiresnecessaryskillsinperforming the procedures used by pediatric hematologists and oncologists. If fellows encounter problems in acquiring these skills, the inpatient attending physician notifies the Fellowship Directors. Additional supervised training will then be made available to the fellow. Supervision of the research training is the direct responsibility of the laboratory research mentor. Written yearly progress reports, including descriptions of abstracts and manuscripts, are required. The Fellowship Committee monitors progress during the research portion of the training program.
  16. 16. 15 Evaluation of faculty members At the end of each inpatient rotation, fellows are required to provide written evaluations of the attending faculty members. These evaluations assess each attending physician’s knowledge of pediatrics, pediatric hematology-oncology, and the literature relevant to these areas; conduct of rounds; teaching ability; availability; encouragement of the fellow; and overall performance. Significant problems are discussed with the inpatient attending physician. Teaching ability is one criterion established by the institution for yearly evaluations of faculty members and for academic promotion. Evaluation of program Once each year, the fellows are required to provide written evaluations of the fellowship program. These evaluations are reviewed by the Fellowship Committee and discussed at the Hematology-Oncology faculty meetings as needed. Research Program St. Jude Children’s Research Hospital is the only National Cancer Institute-designated Cancer Center solely devoted to pediatrics (Cancer Center Support Grant, P30 CA21765, Michael B. Kastan, MD, PhD, Principal Investigator). Dr. Kastan, Chair of Hematology-Oncology, is also the Principal Investigator of the NCI training grant (T32 CA70089) for laboratory training of clinical oncologists. This grant provides support for up to three years of research training beyond the first year of clinical training. To qualify for support on this grant, fellows must be citizens or permanent residents of the United States. Research at St. Jude is also supported by National Institutes of Health funding to individualinvestigatorsandbyseveralmulti-projectgrants,includingthePediatricBrain Tumor Consortium, UO1 CA081457, (James Boyett, PhD, Program Director), the Solid Tumor Program Project, PO1 CA23099, (Studies of Childhood Solid Tumors, Peter J. Houghton, PhD, Program Director), the Childhood Cancer Gene Program Project, PO1
  17. 17. 1616 CA071907, (James R. Downing, MD, Program Director), the Gene Therapy for Sickle Cell Disease Program Project, PO1 HL053749, (Arthur W. Nienhuis, MD, Program Director), the Development of a Novel AIDS Vaccine Program Project, PO1 AI45142, (Julia L. Hurwitz, PhD, Program Director), and the Brain Tumor Program Project, PO1 CA096832, (Normal & Neoplastic Growth Regulation in the Brain, Thomas Curran, PhD, Program Director). St. Jude researchers are active participants in the Children’s Oncology Group (Institutional Principal Investigator, Wayne Furman, MD). In addition, St. Jude is one of 10 comprehensive sickle cell centers to receive a grant from the National Heart, Lung and Blood Institute, U54 HL070590, (The St. Jude Comprehensive Sickle Cell Center, Winfred Wang , MD, Principal Investigator). The Cancer Center has been supported by consecutive Cancer Center Support Grants from the National Cancer Institute since 1977. Members of the center are committed to laboratory-based research integrated with a broad program of clinical investigation, currently supported by approximately $50 million in extramural funding. The center is structured to emphasize interdisciplinary research programs with applicability to the understanding, prevention, and treatment of childhood cancer. The 7 programs around which the center is organized are targeted toward specific diseases (Hematological Malignancies and Neurobiology & Brain Tumor), conceptual themes (Signal Transduction, Molecular Oncology, and Infection & Host Defense), or novel therapeutic approaches (Developmental Therapeutics for Solid Malignancies and Transplantation & Gene Therapy). Each program supports cross-disciplinary, multi-departmental collaborations that foster innovative translational research. The success of such research is due in part to the use of crucial Cancer Center- supported Shared Resources, which include the Hartwell Center for Bioinformatics & Biotechnology. The Cancer Center also includes the International Outreach Program. Based on a humanitarian mission, the International Outreach Program aims to improve the survival rates of childrenwithcancerworldwidebyassistingpartnercountries in establishing effective treatment protocols, facilities, educational opportunities, and collaborative research projects. Many research opportunities for fellows are available within the International Outreach Program.
  18. 18. 17 The Cancer Center is currently expanding its Cancer Prevention & Control Program. Dr. Les Robison, Principal Investigator of the Childhood Cancer Survivors Study, has recently been recruited to St. Jude as the first Chair of the Department of Epidemiology andCancerControl.HewillalsoserveasCo-leaderoftheCancerPreventionandControl Program. Under Dr. Robison’s leadership, we anticipate that St. Jude will become the leader in childhood cancer prevention and cancer control and the premier program for the conduct of etiologic and outcomes-based research in childhood cancer. Key areas of research in the Molecular Oncology Program include oncogenes and tumor suppressors, cell cycle regulators, chimeric transcription factors, and molecules governing stress responses, apoptosis, and checkpoint control. The program encourages the application of emerging laboratory findings in a practical clinical setting while attempting to pinpoint clinical problems for which understanding and treatment may be advanced through laboratory-based discovery. The Transplantation & Gene Therapy Program is focused mainly on diseases that may be treated by manipulation of hematopoietic stem cells and their progeny. A primary interest is the development of haploidentical transplantation in which the parent serves as the stem cell donor for his or her child. Additional research is devoted to the development of gene therapy for hematopoietic disorders. The goals of this research are the effective transfer of genes into repopulating stem cells, the selective growth of genetically modified stem cells in vivo, and the lineage-specific expression of a transgene at appropriate levels. Fellows begin participation in the research activities of the institution through patient care activities, by enrolling patients on protocols, ensuring their eligibility for protocol enrollment, following protocol guidelines, and carefully documenting protocol events. Preparation for important institutional presentations often requires reviews of patient materials, and these reviews occasionally lead to publishable results. During the first year, the fellows learn about the research opportunities available at the institution and select research mentors. Research mentors may be selected from any ongoing clinical or laboratory-based research program at St. Jude. During their second and subsequent years of training,
  19. 19. 1818 fellows are given generous resources and about 90% protected research time to allow them to be productive and become fully prepared for careers as independent clinical, translational, or basic science investigators. Fellows interested in formal training in clinical investigation may enroll in the Master of Science in Epidemiology Program at the University of Tennessee. Fellows on the clinical investigator track have the opportunity to participate in the development of clinical protocols in hematology, oncology, or stem cell transplant. Fellows are also expected to participate in the analysis, interpretation, and publication of retrospective studies. St. Jude has a substantial infrastructure dedicated to clinical research, including data managers, research nurses, statisticians, and database developers. Fellows can take advantage of these resources to develop their own ideas for studies and ask original research questions. In summary, our fellowship program offers a wide variety of research options that span all areas of pediatric hematology-oncology and that will prepare fellows for careers as clinical or laboratory-based investigators. A more complete coverage of research activities may be found in the St. Jude Children’s Research Hospital Scientific Report and on our Web site ( Department of Hematology-Oncology Faculty After Completion of Therapy Division Melissa M. Hudson, MD Member Director, After Completion of Therapy Late effects of cancer therapy; health education and promotion in childhood cancer survivors Scott Howard, MD Assistant Member Director of Clinical Trials, International Outreach Program Improving treatment in countries with limited resources
  20. 20. 19 Experimental Hematology Division Brian P. Sorrentino, MD Member Director, Experimental Hematology Division Co-Director, Transplantation and Gene Therapy Program Hematopoietic stem cell biology, gene therapy John M. Cunningham, MD Associate Member Medical Director, Cell and Gene Therapy Laboratories Stem cell biology Edwin M. Horwitz, MD, PhD Associate Member Stem cell biology Carl W. Jackson, PhD Member Associate Director of Academic Programs Platelet development and function, thrombopoietin Arthur W. Nienhuis, MD Member Gene therapy Derek Persons, MD, PhD Assistant Member Gene therapy for beta thalassemia and sickle cell anemia Hematology Division Russell E. Ware, MD, PhD Member Director, Hematology Division Sickle cell disease; genetic modifiers of disease expression John M. Cunningham, MD Associate Member Medical Director, Cell and Gene Therapy Laboratories Developmental erythropoiesis; fetal globin induction Pedro A. De Alarcon, MD Member Deputy Chief Medical Officer Hemophilia, thrombophilia, thrombosis Jane Hankins, MD Assistant Member Sickle cell disease
  21. 21. 2020 Joseph Mirro, Jr., MD Member Chief Medical Officer/Physician in Chief AML; stem cell transplantation Ulrike M. Reiss, MD Assistant Member Nonmalignant hematology Winfred C. Wang, MD Member Director, Pediatric Hematology Center of Memphis Sickle cell disease; bone marrow failure Leukemia/Lymphoma Division Ching-Hon Pui, MD Member Vice-Chair, Hematology-Oncology Director, Leukemia/Lymphoma Division Program Director, Hematological Malignancies Fahad Nassar Al-Rashid Chair of Leukemia Research American Cancer Society FM Kirby Clinical Research Professor Biology and treatment of childhood leukemia and lymphoma Dario Campana, MD, PhD Member Monitoring of minimal residual disease in leukemia and lymphoma; treatment of B- cell malignancies with receptor-modified immune cells; identification of factors that support leukemia cell growth Nobuko Hijiya, MD Assistant Member Treatment and biology of leukemia and lymphoma Scott Howard, MD Assistant Member Hodgkin lymphoma, supportive care Melissa M. Hudson, MD Member Hodgkin and non-Hodgkin lymphoma Sima Jeha, MD Associate Member Director, Leukemia/Lymphoma Developmental Therapeutics Developmental therapeutics
  22. 22. 21 Monika Metzger, MD Assistant Member Hodgkin lymphoma Bassem I. Razzouk, MD Associate Member Medical Director, Middle East and Telemedicine Programs, International Outreach Program Biology and treatment of AML; developmental therapeutics Raul C. Ribeiro, MD Member Director, International Outreach Program Biology and treatment of AML; international pediatric oncology Jeffrey E. Rubnitz, MD, PhD Associate Member Director, Pediatric Hematology-Oncology Fellowship Training Program Biology and treatment of AML John T. Sandlund, MD Member Biology and therapy of NHL and ALL Molecular Therapeutics Division Michael B. Kastan, MD, PhD Member Chair, Hematology-Oncology Director, Molecular Therapeutics Division Co-Director, Molecular Oncology Program Cellular stress responses; molecular signaling pathways Jeffrey Dome, MD Associate Member Biology and treatment of renal tumors; telomeres and telomerase Stephen X. Skapek, MD Associate Member Cell-cycle regulation and differentiation in skeletal muscle; sarcoma biology Neuro-Oncology Division Amar Gajjar, MD Member Director, Neuro-Oncology Division Brain tumors; late effects Alberto Broniscer, MD Assistant Member Neuro-oncology; biology and therapy of gliomas
  23. 23. 2222 Maryam Fouladi, MD Assistant Member Brain tumors; developmental therapeutics; late effects Richard J. Gilbertson, MD, PhD Associate Member ErbB receptor signaling in brain tumors Solid Tumor Division Victor M. Santana, MD Member Charles B. Pratt Chair in Solid Tumor Research Director, Solid Tumor Division Co-Leader, Solid Malignancies Program Biology and treatment of neuroblastoma; research ethics in children Najat C. Daw, MD Associate Member Osteosarcoma; developmental therapeutics Wayne L. Furman, MD Member Developmental therapeutics Lisa M. McGregor, MD, PhD Assistant Member Neuroblastoma; developmental therapeutics Fariba Navid, MD Assistant Member Biology and therapy of sarcomas Carlos Rodriguez-Galindo, MD Associate Member Biology and treatment of retinoblastoma, bone tumors, and histiocytoses Sheri L. Spunt, MD Associate Member Childhood soft-tissue sarcomas Stem Cell Transplantation Division Rupert Handgretinger, MD, PhD Member Director, Stem Cell Transplantation Co-Director, Transplantation and Gene Therapy Program Haplo-identical stem cell transplantation; immunotherapy
  24. 24. 23 Raymond C. Barfield, MD, PhD Assistant Member Stem cell transplantation; immune reconstitution; immune therapy; bioethics Gregory Hale, MD Associate Member Clinical Director, Stem Cell Transplantation Stem cell transplantation Edwin M. Horwitz, MD, PhD Associate Member Stem cell transplantation Kimberly Kasow, DO Assistant Member Stem cell transplantation for nonmalignant disorders Wing H. Leung, MD, PhD Associate Member Stem cell transplantation; late effects of cancer treatment; molecular epidemiology; natural killer cells Janice Riberdy, PhD Assistant Member T cell development and regulation Paul Woodard, MD Assistant Member Allogeneic stem cell transplantation for non-malignant diseases, with emphasis on sickle cell disease, severe aplastic anemia, and inborn errors of metabolism Usman Yusuf, MD Assistant Member Stem cell transplantation with emphasis on graft versus host disease International Outreach Program Raul C. Ribeiro, MD Director, International Outreach Program Bassem I. Razzouk, MD Medical Director, Middle East and Telemedicine Programs, International Outreach Program Judith A. Wilimas, MD Medical Director, Central America Gaston K. Rivera, MD Medical Director, Chile
  25. 25. 2424 For more information, contact: Jeffrey E. Rubnitz, MD, PhD Department of Hematology-Oncology St. Jude Children’s Research Hospital Mail Stop 260 332 N. Lauderdale St. Memphis, TN 38105-2794 t 901.495.2388 f 901.521.9005 Photography credits: Seth Dixon, Lajar Hajar, and Ann-Margaret Hedges Carlos Rodriguez-Galindo, MD Medical Director, Mexico Scott Howard, MD Director of Protocol Development and Clinical Trials
  26. 26. 07/05—Biomedical Communications