ASH president: ‘There is still so much to do’
Stephanie Lee, MD, MPH, to prioritize mentoring, diversity and public appreciation for hematology
In 1984, a teenage boy was lying in his hospital bed, his body ravaged by acute graft-versus host disease.
His grief-stricken sister — also his bone marrow donor — curled beside him on the bed as she struggled to accept that the stem cell transplant would not cure her brother of leukemia.
Stephanie Lee, MD, MPH — then a young pre-med volunteer at Fred Hutchinson Cancer Research Center — watched helplessly.
Unknown to her at that time, the experience would inspire her to pursue a career in allogeneic hematopoietic stem cell transplantation and identify strategies to better manage GVHD.
Thirty-six years later, it continues to guide her approach to scientific research and bedside care.
“Despite all of the amazing advances we have made, hematologic diseases still cause considerable illness and early deaths,” Lee, member and associate director of the clinical research division and David and Patricia Giuliani/Oliver Press endowed chair in cancer research at Fred Hutch, told Healio. “When we see the suffering and loss from these diseases, it provides ongoing motivation and reminds me there is still so much to do.”
Now, that philosophy will guide Lee as ASH president. Her 1-year term will run through December.
“Whether you’re an allogeneic transplanter, someone in transfusion medicine, a person who conducts platelet research or an expert in coagulopathy, we’re all joined by this profound desire to make an impact and make things better,” said Lee, who cares for patients at Seattle Cancer Care Alliance and University of Washington. “Some contribute at the bench, some through translational work, and some in the clinic or in other ways. ... My goal is to represent all of hematology and help us all strive for excellence.”
Healio spoke with Lee about the priorities she established for her presidency, the challenges facing the field, and how ASH membership can help make her term a success.
Question: What does it mean to you to serve as ASH president?
Answer: I am very honored to be in this position. I have been a member of ASH for 25 years and have served as a volunteer for about 20 years. It is a tremendous organization, and the opportunity to serve in a leadership role like this is unbelievable.
Q: How have you prepared for this opportunity?
A: Aside from serving ASH in many roles over the years, including as vice president and president-elect, my day-to-day activities have helped me prepare because I think I’m typical of ASH members. I still practice medicine. I take care of patients 2 months a year in the inpatient and outpatient settings. I also have a research career, so I understand what it’s like to write grants, enroll patients on studies and collaborate with others to try to advance the science. ASH really resonates with me, and much of what the organization does impacts me daily in my career.
Q: What is the greatest challenge facing hematology, and how can ASH help overcome that challenge?
A: I think the greatest challenge stems from rapid progress. The field is moving so quickly, it has become hard to keep up. There have been so many advances in hematology — both at the basic level and in therapeutics — that it has outstretched normal structures, including funding for research and clinical care. Access to therapeutics has become an issue because of cost. Technology also has advanced quickly — both in the lab and at the bedside — so we need to make sure we understand where and how to use it. I would call these ‘good’ challenges overall.
Q: What about more traditional challenges?
A: Research funding remains a big challenge. We are very appreciative of the more consistent increases in the NIH budget, but they came after quite a long drought. It is important that ASH advocates for necessary funding to ensure we continue to see the advances we have seen in recent years.
Researchers and practicing physicians also are feeling pulled in too many directions, so we must focus on recruitment and retention to help our members keep up with the field and with their lives. There will be a particular focus on nonmalignant hematology, which has been under threat. ASH recognizes there are not enough experts in these areas, and more are needed if people are going to get the best care. We are considering a variety of remedies, including giving trainees experiences that help them recognize this is a viable career pathway, fostering training opportunities once they get into their research or clinical fields, and making sure we promote the idea that expertise in these areas is recognized and rewarded.
Q: You hope to increase public appreciation for and understanding of hematology research and subspecialty care. Why is that important?
A: Basic research on blood and bone marrow, the lymph nodes and the vascular system has led to many of the headline-grabbing, science fiction-type therapies that we have. It is important for the public to connect the dots and understand that investment in research leads to major advances, and to appreciate hematology as a field. Hematology has given rise — at least conceptually — to a lot of the advances we are celebrating, such as blood and marrow transplantation, cellular immunotherapy, pharmacologic immunotherapy, and gene therapy and editing for genetic diseases.
Q: You also prioritized diversity and mentoring to help foster the next generation of hematologists. How do you intend to do that?
A: Diversity and inclusion has been a priority for ASH, but like everyone, we can always do better. We think about diversity in our speakers and our committees, and we go beyond gender or racial diversity. We also think in terms of expertise — nonmalignant vs. malignant — and geographic diversity. Diversity is part of the conversation of everything that is done and decided.
We will hold a mentoring summit later this year, and recommendations about how ASH can do even more to support mentoring will be available soon. In our recruitment and retention survey of trainees, it is clear that having a positive experience with a mentor is so critical to where one finds their place in medicine. If you want to foster a vibrant society and community, mentoring has to be part of it.
The effort must go beyond one-on-one mentoring, too. It’s also about the hematology community embracing the new generation. ASH contributes to that effort with its ASH-a-Palooza — a half-day event at the annual meeting that offers a relaxed educational experience for trainees — and by supporting many career development grants and opportunities, and encouraging people to get involved with the society. One of my big breaks was being a speaker in an educational session at ASH very early in my career. That was tremendously helpful. People got to know me, and I was invited to give other talks. As ASH plans speakers for our meetings, it’s important to think about whether there is a younger person or someone who isn’t as well-known who can be given a role. Anything we can do to foster the next generation will be extremely beneficial for carrying the field forward.
Q: What are your expectations for the field in the next 5 or 10 years?
A: Immunotherapy, cellular therapy and targeted therapies have been at the forefront of advances in the past few years. Those therapies work really well for some people, but many others with the same diseases do not derive benefit, and we don’t fully understand why. I think we’ll start to see second-generation or third-generation therapies intended to address those gaps and build upon the progress we have made.
There is a great deal of interest in different types of immunotherapy like bispecific antibodies, which harness the patient’s immune system and amp it up without having to introduce new cells or doing any genetic engineering. The progress with oral targeted therapies also has been amazing, to the point we often don’t even think about giving IV cytotoxic chemotherapy in the first- or second-line settings anymore.
Gene therapy and gene editing trials are ongoing and appear promising; look for even more activity in this area.
I believe we will see many more advances, and the way we practice in the next 5 or 10 years may be completely different from what we are doing now.
Q: How can ASH members make your term a success?
A: ASH relies on volunteer efforts. Ten percent of our membership was actively involved in the past year, either by serving on a committee or as an abstract reviewer, speaking at a meeting or publishing research in one of our journals. ASH has been fortunate in that we always have more people willing to volunteer than roles available to do so. This year, I am committed to expanding opportunities to get involved.
I mentioned the importance of engagement and making sure legislators and the public know what we are doing. Our members should contribute to that conversation and make sure people know about their work, how it fits into the broader field and how it links to their funding so we can make those connections very clear. I also want members to share their great ideas. That’s not to say we can do everything, but we certainly want to hear suggestions for what ASH can do that would be helpful to those in the field. – by Mark Leiser
For more information:
Stephanie Lee, MD, MPH, can be reached at Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, P.O. Box 19024, Seattle, WA 98109-1024; email: firstname.lastname@example.org.
Disclosures: Lee reports no relevant financial disclosures.