Heme Scholars

Clinical Hematology Research Career Development Program

The Clinical Hematology Research Career Development Program at Washington University (Hematology CDP) is a new initiative of the NIH Roadmap that will prepare trainees (Heme Scholars) to address complex clinical and translational research problems in non-malignant hematology. Scholars are expected to become independent researchers and assume leadership roles in non-malignant clinical hematology.

The Hematology CDP combines disease-specific and general clinical research teaching with a mentored clinical research project, over two or three years, for Scholars selected from an outstanding and diverse candidate pool. Scholars will be clinical or research Fellows, clinical or research Instructors, or recently appointed Assistant Professors.

For more information, please visit the Heme Scholars web site at http://hemescholars.im.wustl.edu/.

Fellowships in Hematology-Oncology

Philosophy and Design

The Hematology-Oncology Fellowship Training Program at Washington University School of Medicine is designed to attract outstanding young physicians and train them for academic careers in the fields of hematology and oncology.

[Click here for a list of current fellows and recent graduates.]

The University offers a flexible program that provides trainees with comprehensive exposure to the various disciplines of hematology and oncology and accommodates their specific interests. A balance is sought between providing a sound clinical understanding of hematologic and malignant diseases and providing the environment for creative research into significant problems.

The Hematology-Oncology Fellowship Training Program is a single program that offers intensive clinical and research training in the Hematology and Oncology Divisions of the Department of Medicine. The training faculty for the Divisions includes approximately 50 full-time academic investigators.

The clinical training program provides the clinical expertise required as background for laboratory and clinical investigation in hematology and oncology. Approximately one-half of the trainees in the clinical training program in hematology and oncology enter the laboratory research training program.

Training focuses on providing basic and clinical research training in the fundamental aspects of hematology and oncology. Many faculty members have had formal research training in biochemistry, cell biology, genetics or molecular biology, and this is reflected in the heavy emphasis placed on basic investigation. However, even the most basic research projects deal with problems that eventually may have clinical applications.

Hematology Division

The Hematology Division was founded in 1938 by Carl V. Moore, M.D., and the three main goals established at its inception - research, teaching and clinical care - remain in place today. [Read a tribute to Carl Moore written by Oliver Lowry.]

The faculty of the Hematology Division epitomize excellence in basic and clinical science. The focus of the Division is on non-malignant disorders including diseases of red blood cells, platelets, and the coagulation and fibrinolytic pathways.

Inpatient consultative services provide the core of clinical hematology. Currently, there are 40 to 50 consultations per month at Barnes-Jewish Hospital, spanning a range of diseases and providing trainees with experience in the diagnosis and management of hematologic disorders. Included among these patients are those with hematologic complications from non-hematologic diseases and therapies.

The outpatient clinic, currently staffed by one full-time hematologist, sees approximately 50 patients per week. The focus of the outpatient setting is on patients with primary hematologic diseases who require continuing or intermittent medical care, including patients with sickle cell disease, hemophilia and acquired chronic illnesses such as polycythemia vera and ITP.

Hematology/Oncology/BMT Grand Rounds are held on Friday mornings. Pediatric hematologists and oncologists are active participants in the Friday morning conference. A less formal conference, held weekly with residents and faculty in the Division of Laboratory Medicine, reviews the diagnosis and management of patients with hematologic disease.

Although primary hematologic disorders account for only a small number of patients with medical illnesses, they represent a much larger component of medical complications which lead hematologists to actively interact with many other disciplines. The Division of Hematology is sufficiently flexible to take advantage of all of these components and provide a broad clinical and laboratory experience.

Oncology Division

Concerned with the medical treatment of cancer patients, the Oncology Division emphasizes six clinical areas: chemotherapy of cancer, palliative care, multidisciplinary care with surgical and radiation oncologists, stem cell transplantation, participation in national cooperative groups, and translational research involving basic scientists in the Sections of Molecular Oncology and Stem Cell Biology.

The Oncology Division has dedicated wards for oncology, stem cell transplantation, and leukemia patients. and sees inpatients in consultation throughout Barnes-Jewish Hospital. The Division and its related Sections see approximately 250 new consultations per month. The outpatient clinics, which are visited by more than 30,000 patients per year, recently moved into the new multi-disciplinary Alvin J. Siteman Cancer Center. The Division staffs four Siteman Cancer Center satellite clinics, which care for patients with cancer in the greater St. Louis metropolitan area.

The Section of Medical Oncology performs initial patient evaluations and follow-up visits, provides second opinions and administers chemotherapy and blood products. Because cancer patients frequently require the care of physicians from several specialties, multidisciplinary conferences and treatment plans often involve the joint participation of medical oncologists with surgical and radiation oncologists.

Clinical research activities include active participation in treatment protocols of several national and regional multidisciplinary cooperative oncology groups, institutional multidisciplinary therapeutic protocols and studies with investigational agents sponsored by pharmaceutical companies. Multidisciplinary clinics for breast, head and neck, gastrointestinal, and lung cancer are currently in place.

Two medical residents and a hematology-oncology fellow staff the dedicated inpatient medical oncology ward. Rounds featuring didactic teaching are conducted six days a week. Multi-disciplinary rounds on the ward provide experience in interacting with nurses, social workers, psychologists, psychiatrists, dietitians, and home health and supportive care personnel. Residents on other medical services often interact with the medical oncology attending physicians and fellows on the inpatient consultation service.

The Section of Molecular Oncology concentrates on a research laboratory approach to cancer. A basic cancer research program is included, along with a clinical science program that interacts directly with the Section of Medical Oncology.

The basic science themes include cancer genetics and mouse developmental biology. The mechanisms of oncogenesis of the genes responsible for human cancers are emphasized. Models using transgenic mice and gene ablated knockout mice confirm the oncogenic role of each gene. Ultimately, these murine models of neoplasia will provide an experimental system to test novel therapeutic approaches.

The clinical science laboratory program builds on the strengths of basic science resources and attempts to translate them directly into clinically relevant projects. Human cancers are being used to define new oncogenes at sites of chromosomal abnormalities. Molecular diagnostics categorize cancers by their oncogene abnormalities to define prognosis, response to therapies and selection of patients for appropriate therapies. Innovative therapeutic approaches to cancer concentrate on the pharmacology of cell death, immunotherapy and gene therapy.

Interaction between the Sections of Medical and Molecular Oncology provides fellows with a comprehensive experience that will establish a foundation for management of cancer patients.

The Section of Bone Marrow Transplantation & Leukemia and the Section of Stem Cell Biology were established to focus on the clinical aspects of bone marrow transplantation as well as the biology and physiology of hematopoietic stem cells. These sections provide potentially curative therapy for patients suffering from fatal diseases such as leukemia, lymphoma, myeloma, and aplastic anemia. The members of these sections are committed to increasing understanding of the molecular events that regulate the production of normal blood cells which, when altered, may contribute to marrow dysfunctional states such as myelodysplasia and acute leukemia.

These two sections have assembled an outstanding group of clinical and basic science faculty who share interest in both the clinical and molecular aspects of engraftment, graft vs. host disease, cytokines and their receptors, and expansion and genetic manipulation of both T cells and stem cells. These sections support active clinical programs in peripheral blood stem cell transplantation, low-intensity preparative regimens, prevention and treatment of GVHD, CD34 stem cell selection, T cell depletion for haploidentical transplants, ex vivo expansion, and gene therapy.

In addition, the Section of Bone Marrow Transplantation & Leukemia works closely with St. Louis Children's Hospital on transplant protocols in children and is building a transplant program for both children and adults through the National Donor Registry and through multiple umbilical cord blood registries throughout the world. The transplant program also participates in Cancer and Leukemia Group B and the North American Bone Marrow Transplant Group.

In addition, the Section of Bone Marrow Transplantation & Leukemia and the St. Louis Children's Hospital are members of the International Bone Marrow Transplant Registry (IBMTR) and the Autologous Blood and Marrow Transplant Registry - North America (ABMTR), and are participating centers in the National Marrow Donor Program (NMDP). Approximately 40 to 50 unrelated bone marrow transplants, facilitated by the NMDP are carried out yearly at Washington University for both children and adults. The Stem Cell Transplant Program's survival rates for unrelated donor transplants are comparable or superior to those of other leading centers in the world. St. Louis Children's Hospital and the Section of Stem Cell Transplantation & Leukemia are working closely to build a cord blood transplant program.

The Stem Cell Transplant Unit (SCTU) is a 30-bed facility located on the 5th floor of Barnes-Jewish North. In addition, transplants and leukemia overflow patients are cared for by the faculty and staff on the medical oncology floor located on the 4th floor of Barnes-Jewish North. The SCTU functions as the primary treatment arm for patients with acute leukemia and serves about 80 percent of the Medical Center's patients with lymphoma. The SCTU averages 6,000 patient visits per year, 700 to 800 of which are new referrals. Approximately 300 autologous and allogeneic stem cell transplants are performed annually at Washington University, establishing this program as one of the five largest transplant centers in the world. The SCTU inpatient service is staffed by one faculty member, two fellows, and two medical residents.

Training Schedule and Rotations

Six new fellows enter the Hematology-Oncology Fellowship Training Program each year. The training program can be completed in three to five years, depending on the goals and requirements of each candidate.

Fellows elect to follow either a clinical science track or a laboratory track. Trainees who intend to take board examinations in both hematology and oncology will complete 18 months of clinical training, while fellows planning to be certified in only one subspecialty can complete their full-time patient care requirements in 12 months. Thereafter, all fellows must maintain a one-half day per week outpatient clinic for the next 12 or 18 months.

The major emphasis during the first year of training is to provide a solid clinical foundation in hematology and oncology, with exposure to and responsibility for the care of a large number of patients. In addition to this initial clinical exposure, the trainee is given the opportunity to become thoroughly acquainted with staff members and problems under investigation in their clinical and laboratory studies. Assisted by a committee of faculty members chosen by the trainee, each first-year fellow prepares a clinical protocol for submission to the appropriate institutional review board; many of these protocols are funded and implemented during the second year of training.

During the first year, fellows spend three months on the hematology-hemostasis service, five months on the oncology services at the Barnes-Jewish and Veterans Hospitals, three months on the stem cell transplantation service, and one month on an elective rotation. Possible electives include pediatric hematology-oncology, general hematology, pathology, blood banking, and radiation oncology.

While rotating on the various services, trainees are responsible for the hematological and oncological consultations of inpatients as well as their outpatient follow-up under the preceptorship of rotating full-time staff members. Approximately 800 new patients are seen on the consultation services at Barnes-Jewish Hospital each year. Besides consultations, trainees are in large part responsible for conducting weekly, hour-long rounds for house staff, trainees, interested physicians and senior staff members.

[Click here for the stated goals and responsibilities of each clinical rotation.]

After the 12 or 18 months of full-time clinical care, trainees who desire further clinical experience may pursue clinical elective rotations that usually are integrated with clinical investigative projects under the guidance of a senior staff member. Fellows who choose to pursue laboratory training have a wide variety of research opportunities. All trainees are encouraged to attend rounds, research seminars, and clinical conferences within the Divisions of Hematology and Oncology and the Department of Medicine.

Washington University Medical Center

The Washington University Medical Center employs 16,000 people and includes Barnes-Jewish Hospital, St. Louis Children's Hospital, Washington University School of Medicine, Barnard Free Skin and Cancer Hospital and Central Institute for the Deaf. Integral units within the Medical Center include the Mallinckrodt Institute of Radiology, The Institute for Biomedical Computing and the Irene Walter Johnson Institute of Rehabilitation. A network of pedestrian bridges connects all buildings of the Medical Center, symbolizing and facilitating the free interaction among all of its components.

The School of Medicine has a rich history of success in research, education and patient care that dates back to the early part of the century. Its teachers were pioneers in bedside teaching and were leaders in the early transformation of empiric medical knowledge to scientific medicine. Today, the School of Medicine remains a leading institution of clinical care, education and research. The school ranks fourth among U.S. medical schools in the amount of funding received from the National Institutes of Health (NIH), with support distributed among hundreds of grants and contracts.

Clinical Environment

Washington University School of Medicine provides a unique environment for the hematology-oncology fellow interested in either the clinical or the laboratory track. Barnes-Jewish Hospital is one of the largest non-profit voluntary hospitals in the country, operating more than 1,200 acute care beds with more than 30,000 hospital admissions annually. The hospital serves the community and a far-reaching Midwestern referral area. The John Cochran Veterans Affairs (VA) Medical Center houses more than 600 beds for acute care and serves as a regional referral center for other VA hospitals.

By providing services at these prominent hospitals, the hematology-oncology fellow gains experience with a wide variety of patient populations and diseases. Interactions with the Hematology-Oncology Division of St. Louis Children's Hospital are also frequent.

The Medical Library and Biomedical Communications Center, completed in 1989, is an architecturally unique building that houses an outstanding collection of journals and books as well as the media-computer center, Archives and Rare Books and a health information network.

Research Environment

A multitude of basic and clinical research opportunities is available at the Medical Center. Research facilities for preclinical and clinical departments, including the School of Medicine and the Clinical Sciences Research Building, are adjacent to Barnes-Jewish and Children's hospitals. This proximity eases the close interaction basic scientists have with clinical and preclinical departments as well as with clinical researchers.

Over the years, many important scientific contributions have been made by faculty in the hematology and oncology divisions. Faculty members have been elected to both the National Academy of Sciences and the Institute of Medicine. Three current faculty members have been awarded the Dameshek Prize bestowed by the American Society of Hematology for outstanding research in hematology. Faculty members have received a number of other awards for excellence in science.

Key discoveries made by Washington University faculty include:

• basic aspects of iron metabolism in health and disease
• original description of several hemoglobinopathies
• demonstration that ITP is due to anti-platelet antibodies
• initial use of 32P for treatment of polycythemia vera
• basic studies on the role of platelets in blood coagulation and regulation of the clotting cascade
• cloning of a number of blood clotting factors and accessory molecules
• initial purification of the vitamin B12 binding proteins, including intrinsic factor and TCII
• demonstration of the mechanism of action of aspirin and the initial studies of low dose aspirin as an antithrombotic agent
• identification of mutations in von Willebrand's disease
• discovery that the v-sis oncogene is PDGF (platelet derived growth factor), the first linkage of an oncogene to a physiologic growth factor
• basic studies of mechanism of signal transduction
• basic aspect of glycoprotein biosynthesis
• mechanism of lysosomal enzyme targeting
• enzyme defect in the genetic disorder Mucolipidosis II and III
• role of Bcl-2 in lymphoma
• role of cytokine-mobilized peripheral blood stem cells for allogeneic transplantation

Stipends and Benefits

Trainee stipends are equivalent to Barnes-Jewish house staff stipends for comparable years of experience. The possibility of research fellowship support for additional research training for unusually well qualified applicants can be arranged on an individual basis.

Additional benefits include:

• annual vacation - fifteen days
• holiday vacation as arranged for coverage
• allowance for one trip annually to a scientific meeting
• access to computerized information services
• photocopying allowance
• meals available at reduced rates
• laboratory coats
• paid medical liability insurance
• participation in group health plans; dental plans variable depending on origin of salary
• life, accidental death and dismemberment, and long-term disability insurance are available

Application Procedure

The fellowship program is filled for 2008.

All applications to the Hematology-Oncology Fellowship are to be submitted through ERAS, the Electronic Residency Application Service (http://www.aamc.org/audienceeras.htm). Your application should include a curriculum vitae, at least 3 letters of recommendation, and a personal statement. Applicants invited to interview are asked to provide a photograph. The deadline for submission of an application is December 30. Interviews for fellowships beginning July 1, 2009 are scheduled for the following dates: February 1, March 14, and April 4, 2008.

If you have questions about the application process or about the status of your application, please contact our fellowship coordinator, Margie Anderson, at (314) 747-8479 or manderso@im.wustl.edu.

Instructions for Visiting Applicants

Washington University Medical Center is easily accessible by automobile from Interstate 64 (US 40), a major east-west highway through the center of the metropolitan area. Take the "Kingshighway North" exit and park in any of the garages that surround the Medical Center. The MetroLink light rail system also links the Medical Center (Central West End station) to Lambert-St. Louis International Airport and to downtown St. Louis.