In this section, you’ll find testimonials from recipients of BSH grants. These testimonials show how our grants have helped them achieve goals, create networks and further their research.
Scroll down and click on the headline to expand and read the full testimonial.
Have you received a BSH grant and want to share your experience in a text or video format? Please email [email protected].
Our 2023 Annual Scientific Meeting will be held at the ICC in Birmingham from 23-25 April.
We will be offering Abstract Scholarships, Travel Scholarships and Nursing Bursaries.
We have selected some reports from our ASM grant ambassadors who told us about their experience and learning at the 2022 Annual Scientific Meeting in Manchester and the 2019 Annual Scientific Meeting in Glasgow.
Dr Michael Norton, Senior Lecturer, University of Buckingham
This was my first BSH Annual Scientific Meeting (ASM) and my first medical conference as a doctor. Currently, I am teaching haematology, and I had hoped that attending this event would add to my knowledge and increase my confidence as a lecturer.
The ASM was well-organised.
The venue was appropriate and located in a fascinating city. The convention centre was clean, well-staffed, and with good facilities and signage. The IT seemed to go perfectly in all the sessions I attended.
My current post meant I needed to listen to presentations on educational and employment matters. There were no surprises in the information given in the session on Developing the professional role of haematology nursing. But the speakers and those who asked questions spoke with passion, and everything was very understandable.
More significant were the speakers in the Early Career Forum who explained the work of a PA and nurse specialist. I think those who attended this were enlightened. One speaker was absent.
It was good to meet a few of the key people in haematology.
Despite being upset that I could not tour the whole museum, I was able to speak with a few important members at the dinner and was given details of someone near me who may be able to help with my need for resources.
Ruth Evans was great, and Fiona Miall shared that her students were having similar problems to mine due to lockdown and online teaching.
In terms of science updates, for me, the most useful was the session on haemoglobinopathies.
Dr Potter was impressive with some interesting transplant news, and John James was someone I would like to meet again. I will elevate the status of sickle cell in my course curriculum.
I am very grateful that I received this funding, for it allowed me to attend this worthwhile event.
I got the most out of the resources I picked up at the small charity booths.
The photo shows me receiving a surprise prize at the Leukaemia Care stand.
I intend to attend the next event in Birmingham, and I am seriously considering working in haematology when I return to clinical practice.
Thank you to the BSH.
Agnerys López Sacerio, Haematologist, Arnaldo Milián University Hospital, Santa Clara, Cuba
This travel scholarship was a great opportunity to participate in the BSH Annual Scientific Meeting 2022.
This important meeting was a valuable experience to improve and update my knowledge as a haematologist and clinical researcher, especially in haematological malignancies and cancer-associated thrombosis.
It also allowed me to establish a scientific and academic exchange with colleagues from the UK and other parts of the world and present the results of our research.
All the above will allow us to improve the care of patients with haematological diseases we treat.
I am currently working on my PhD in venous thromboembolism (VTE) in haematological malignancies. This event helped me to learn about other research in this area. Because of my teaching role, my update will enhance the preparation of our hospital's residents-in-training.
Emily McMullen, Foundation Year 1 Doctor, Kingston Hospital
I would like to say a huge thank you for awarding me the abstract scholarship, as this allowed me to attend the ASM and present my audit. It will most certainly be one of the more impressive additions to my CV and portfolio. I am extremely grateful for the opportunity to present. If not for the abstract scholarship, I would not have been able to afford to attend the event.
I have been considering a career in haematology since finding it especially interesting in my undergraduate biomedical science degree, and it has continued throughout my medical training and clinical practice.
I appreciate that having presented at the ASM will no doubt put me in good stead if I do indeed decide to embark on a career in haematology.
I am also grateful for the experience of presenting an oral presentation. I found I rather enjoyed it, and it has built my confidence in public speaking.
I found the presentations I listened to very interesting and enjoyed the variety.
I learnt of rare disorders I had never heard of before, for example, Kabuki syndrome, and now appreciate how difficult it can be to research these conditions. There was very limited UK data on this syndrome, and data had to be extrapolated from elsewhere.
There was also the added problem that, often, Kabuki syndrome is not regarded as a separate entity from immune thrombocytopaenia generally. That must present a significant barrier to understanding Kabuki syndrome and, therefore, the information we, as clinicians, can provide to these patients and their families. I can only imagine how worrying it must be to be a parent to a child with a rare haematological disorder.
I also learnt how convoluted the clinical trials system can be in haematology, with exclusion criteria for studies often not published and a lack of continuity between researchers/government trials and the haematology trials body. I developed a new admiration for this body, as they direct patients towards clinical trials that could be appropriate, and this is something I cannot envisage ever having the time to stay up to date with whilst working as a doctor in the NHS.
Aside from this, I enjoyed reading the scientific posters on multiple myeloma. We often screen for this in some of our hospital inpatients as part of a routine workup for certain presentations/symptoms, but I rarely have time to appreciate the academic side of it.
Sion Williams, ST6 in infectious diseases and GIM, University Hospitals Birmingham
Thank you so much to the British Society for Haematology for awarding me this travel scholarship to attend the ASM.
I am a trainee in infectious diseases. My reason for attending the conference was mainly to make links with my colleagues in haematology and to see how we might strengthen our working relationship looking after haematology patients with infection.
As a trainee in infectious diseases, I have found delegates from the field of haematology to be incredibly welcoming and receptive.
I am presenting a poster on the use of AmBisome prophylaxis in high risk haematology patients. During the poster walk, I had numerous interesting and fruitful discussions with other delegates about the real challenges of keeping these vulnerable patients safe, whilst at the same time acting judiciously with our use of anti-microbials. I feel we bridged important ground between the aim of reducing the development of drug resistance, and safeguarding our patients from the potentially toxic side effects of powerful drugs.
One piece of original research I found particularly interesting was an original science project presented as a poster by James Boncan from Queen's University Belfast. The research looked at using a novel molecule purified from snake venom as a potential candidate for the treatment of acute lymphoblastic leukaemia (ALL), Purified phospholipase A2 from Pseudechis australis snake venom - A novel anticancer agent for the treatment of precursor-B acute lymphoblastic leukaemia. It was an exciting "proof of concept" piece of work showcasing how we might look to discover potential drugs in the future.
I come away from the conference feeling more than ever that haematology and the infection specialities are interlinked and that patient care will be best served by developing deeper working relationships.
In a scientific and professional environment where we are ever more specialised, there is a natural tendency for specialists to limit their sphere of concern to their own field. However, what patients need are the various diverse specialists caring for them to work more closely together, and to take an interest in each other's work and also each other's perspectives, to be more collegiate and understanding and less adversarial.
Attending this conference has greatly helped me work towards that ideal, and I'm sure more fruitful working with my colleagues in haematology will ensue, both with projects and with patient care.
Wei Yee Chan, Haematology Registrar (ST6), University College London Hospitals NHS Foundation Trust
I am thankful and honoured by the BSH's decision to award me an ASM abstract scholarship for my oral abstract on Antibody responses to SARS-CoV-2 vaccination in patients with acute leukaemia and high-risk MDS on active anti-cancer therapies, which I presented at the Top AML abstracts session on 4 April 2022.
The travel bursary covered my cost for attendance and travel to Manchester, and I had the opportunity to attend the ASM in person after two years of virtual conferences, an unfortunate result of the SARS-CoV-2 pandemic.
The merits of virtual conferences have been thoroughly explored during the pandemic. However, the benefits of ASM attendance in person really came to light this year. The engagement and social interactions (missed in virtual conference attendance) were far more exciting for me as a trainee. The ability to learn and listen to live speakers really brought innovation and practice recommendations to life with improved interaction from a live audience.
After taking an interest in antibody responses to SARS-CoV-2 vaccination in haematological malignancies, I was thrilled to hear Dr Sean Lim's presidential lecture talk discussing her findings from leading the UK PROSECO study on the immune responses to two and three SARS-CoV-2 vaccine doses in a large cohort of lymphoma patients.
She highlighted the poor responses generally in a cohort of lymphoma patients. She also highlighted the effects of systemic anti-cancer therapy and dysfunction in T-cell and humoral responses in these patients.
It is exciting to see such a large clinical study, with such important data to guide our practice moving forward in the pandemic, come to fruition in such a short period. I applaud and am in awe of what has been achieved in the publication of these results.
I would like to thank the BSH again for recognising my work and for the opportunity to present it at the ASM. I thoroughly enjoyed the ASM this year and have been brought up to date over the four days of attendance in various aspects of haematology.
But most importantly, I've been inspired by the ongoing work to improve our ability to deliver care to haematology patients in the United Kingdom. It is especially fascinating how some of this work can also influence care delivered internationally.
The ASM highlighted the UK's strong ability to recruit to academic clinical trials and deliver meaningful results, which truly influence how we practice.
1. Lim, S. H., Stuart, B., Joseph-Pietras, D. et al. Immune responses against SARS-CoV-2 variants after two and three doses of vaccine in B-cell malignancies: UK PROSECO study. Nat Cancer (2022). https://doi.org/10.1038/s43018-022-00364-3
Omolade Dada, Medical student, University of Nottingham
Attending the BSH Annual Scientific Meeting 2022 was a great pleasure!
The scholarship I received funded my travel, accommodation, food and general expenses for the three days.
I was inspired to see so many healthcare professionals sharing knowledge on their research with the primary aim of improving healthcare.
It was also fascinating to see the innovative products companies had created to improve the delivery of care. I was particularly interested in the biopharmaceutical company Global Blood Therapeutics, which raised awareness of sickle cell disease and their newly introduced drug that targets one of the primary causes of red blood cell sickling.
I also attended a scientific talk by Dr Carolyn Millar, Update on diagnosis and management of von Willebrand Disease: what are the current controversies?
I was encouraged by the fact that management strategies are constantly being revised as the body of knowledge within the scientific community improves.
It was also interesting to consider the impact of a diagnosis on the patient, such as the impact on their medical insurance, which Dr Millar briefly touched on.
Regarding my poster presentation, it was a huge encouragement to me to discuss my findings with those senior to me and answer their questions whilst discussing potential future research. One of my highlights was discussing my research with the members of Haemochromatosis UK.
Considering that my research was focused on this iron overload disease, meeting people diagnosed with haemochromatosis who also participate in research and work closely with those whose treatment was affected by Covid-19 really put my research into perspective and added great value. I perceived the potential impact of my research findings from this encounter.
The conference was a great opportunity to network. I made new friends and found potential partners to collaborate with on future research, and the ASM scholarship made it possible for me to attend. Thank you to the BSH!
Paul McLaughlin, Clinical Specialist Physiotherapist in Haemophilia and NIHR/HEE Clinical Doctoral Research Fellow, Royal Free London NHS Foundation Trust
I would like to express my thanks to the BSH for awarding me a travel scholarship to attend the 2022 Annual Scientific Meeting in Manchester.
I applied and received this scholarship as I was privileged to have been an awardee for the BSH/NIHR AHP Researcher of the Year. It gave me the opportunity to travel to Manchester for the Presidential session on Sunday, 3 April, to receive my award.
I wanted to attend in person as I felt it was a great platform and chance to make the role of allied health professionals in haematology more visible. I hope that doing so will encourage others to be more confident in sharing their research activities.
Katarina Flatman, IMT2 ACF, University of Leicester/University Hospitals Leicester NHS Trust
The ASM travel scholarship allowed me to attend the meeting in person, which I was very excited about, given the lack of such opportunities during the pandemic.
Attending in person has given me educational and networking opportunities that would not have been so well provided by online attendance.
It has enabled me to meet other IMT doctors who are planning to specialise in haematology, and it has been exciting to discuss our plans and to think that we might be meeting at similar events in years to come!
I have also been able to meet with registrars and consultants from around the country and hear about their exciting careers and ongoing enthusiasm for their speciality.
It has helped me understand the breadth of haematology as a speciality. Particularly by attending sessions about non-malignant haematology, to which I have had less exposure.
In terms of the conference content, I was fascinated to hear about the work of haematologists in characterising vaccine-induced thrombosis and thrombocytopenia (VITT) in such a timely manner during the pandemic. It was amazing to think of how quickly the international community were aware of this new phenomenon and the rapidity of response. It is a reminder of the importance of communication between centres in identifying these rare cases and formulating a rapid response to such a potentially devastating condition.
As a junior doctor, I particularly enjoyed the patient stories session; it was a format I hadn't previously experienced at a conference. It was brilliant that individuals with such different experiences were willing to be open about their experiences as patients. It gave me an opportunity to think about the impact of living with not just haematological diagnoses but also other long-term conditions and how all of us can strive to provide the best possible patient-centred care.
I am grateful to the BSH for giving me the opportunity to attend this conference, and I feel it has been very helpful in my understanding of haematology as a career.
Nicola Cecchi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan
The BSH abstract scholarship allowed me to get closer to the British medical reality. Different countries can have different views about managing patients.
This scholarship took me into a stimulating environment where I could show my work and how my team and I take care of the patients and, at the same time, compare our results with someone else's results.
Claudette Hewitt, SHO Doctor, Ealing Hospital, London North West Thames Healthcare Trust
The scholarship I received from the BSH enabled me to attend their Annual Scientific Meeting (ASM) in Manchester from 3-5 April 2022.
I am a junior doctor about to start internal medicine training (IMT) and am interested in a career in haematology. Attending the ASM provided the opportunity to get an insight into the world of haematology.
What struck me most is how new research and clinical trials constantly inform clinical practice. The conference made me appreciate how dynamic haematology is as a speciality, with many opportunities to expand our knowledge and refine our treatment options.
I particularly enjoyed the lectures on chimeric antigen receptor (CAR) T-cell therapy in lymphoma. I have been interested in CAR T-cells since I wrote an essay about their potential future therapeutic uses while at university.
Now, the National Institute for Health and Care Excellence (NICE) has licensed CAR T-cells for acute lymphoblastic leukaemia (ALL), diffuse large B-cell lymphoma (DLBCL), and mantle cell lymphoma (MCL) under certain conditions. CAR T-cell centres are being set up across the country.
However, the lectures demonstrated that even though we have progressed past clinical trials into clinical practice, our understanding of CAR T-cell therapy continues to be developed. The CAR T-cell centres have collected a wealth of data, which has been used to evolve the knowledge of the efficacy and toxicities of the therapy.
In particular, the risk of CAR T-cell toxicity can be estimated based on patient-specific factors such as their performance status, the lactate dehydrogenase (LDH) level on day 0 of infusion and whether their disease has progressed through bridging therapy. Therefore, toxicity prevention and management can be individualised based on the specific risk factors of the patient at hand.
After two years of Zoom meetings, I really enjoyed attending the conference in person. One of the best parts was meeting haematology registrars and other IMT doctors who are in the process of applying to haematology training. Hearing about their experiences and getting their advice was very valuable.
I came away from the conference inspired and motivated to pursue my interest in haematology!
4. Sanderson et al. ASH 2021 (abstract 531; oral)
Martin Gonzo, Biomedical Scientist and Senior Lecturer in Biomedical Science, University of Greenwich
I am very grateful to the British Society for Haematology for supporting me with a travel scholarship to attend their Annual Scientific Meeting in Manchester, UK, this year.
The 62nd ASM was my first time attending a BSH-organised event, and I must say, it will be one of many.
The ASM was a three-day meeting which was well organised and packed with opportunities to learn, network, and share professional practices in haematology.
The programme afforded me the opportunity to listen to experts in haematology.
The session on Developing the professional role of haematology nursing was very useful for me. This session took place on the 3rd of April and allowed me to appreciate the value of well-informed career guidance. It is an important aspect of my job as an academic and a personal tutor to undergraduate students.
Together with the early career forum on the 4th of April, they were important sessions that will impact how I support my tutees in decision-making beyond graduation.
Biomedical science graduates often wonder what else they can do with their first degree. The presentation by a clinical scientist and a haematology nurse gave me ideas on other career options to suggest for my students.
Another session I particularly enjoyed was the sponsored symposium titled Sickle cell disease: Shifting to a long-term view on patient care. This session, together with others on erythrocyte disorders, has improved and updated my knowledge of disease management from the patient's perspective.
Patients with sickle cell disease (SCD) are usually transfusion-dependent. As such, transfusion practices directly affect this patient group. A poster on Home transfusions: Balancing safety with individualised care was also a befitting presentation as it presented findings from 20 cases of home transfusions.
I had the opportunity to go through the posters displayed during the three days I was at the conference. Having spent several years studying for a Doctor of Health and researching in the area of erythrocyte disorders, it was refreshing to be reminded of the many advances still taking place in this and other areas of haematology.
The poster by Narayan et al. on Under or delayed transfusion: Risk factors leading to patient deaths certainly helped me to come up with a concept paper on transfusion practice in under-resourced settings. It has given me new ideas to research in blood transfusion practice in general.
Finally, this event could not have been a success without the networking events that punctuated the conference. The annual meeting has given me the opportunity to meet with experts in different fields of haematology.
The discussions will certainly inform my teaching, and I will be incorporating some of the case studies into my learning material. It helps me maintain currency as I teach and facilitate the learning of undergraduate biomedical science students.
1. Jennifer Davies. Home transfusions: Balancing safety with individualised care. Poster presented at the British Society for Haematology 62nd ASM; 03-05 April 2022; Manchester.
Lara Howells, ST4 Haematology Registrar, University College London Hospital NHS Foundation Trust
I would like to extend my thanks to the BSH committee for awarding me a scholarship to attend the Annual Scientific Meeting in Manchester from 3-5 April 2022.
As an ST4 haematology registrar, the conference – a hybrid event – provided the perfect opportunity to immerse myself in the world of haematology, meeting other trainees and colleagues from across the UK and abroad.
The conference kicked off in an unexpected but undoubtedly powerful way, with a stunning performance from grime artist A Star, who rapped about his first-hand experience of living with sickle cell disease. He spoke of how his challenges have spurred him to work with youth groups in East London, spreading education and awareness of sickle cell disease. I know that this is not the last we will see of A-star, as he continues to use his position of influence to drive change and ongoing engagement with both his local and the haematological community.
The popular BSH ’Pitfalls’ day preceded the conference on Saturday, 2 April. Here, we were delivered a schedule of quality lectures from experts across the UK.
Dr Joe Shariff delivered an engaging talk on lifelong care for patients with sickle cell disease, during which he illustrated a particularly gripping case presentation of protracted hyperhaemolysis. Another memorable session was delivered by Dr Cheryl Fitzgerald, highlighting the challenges in fertility preservation in young women with haematological disease.
Satisfyingly, I found that my newly ascertained knowledge from these sessions was translated directly back to the wards upon return to work when faced with similar complex cases.
A personal highlight was being provided with the opportunity to give an oral presentation on Covid-19 antibody responses in patients with myeloma who undergo autologous stem cell transplant, inviting questions from an engaged audience.
The topic of immune responses to Covid-19 vaccination in patients with haematological disease featured heavily throughout the ASM programme, highlighting our shared interest in doing all we can to mitigate our patients from Covid-19. Both in terms of the effects of the disease itself and the associated delays in treatment that occur as a result.
This was succeeded by a presentation from Dr Rakesh Popat, who summarised the results from two early phase trials in myeloma, resulting in a palpable level of anticipation and excitement amongst myeloma doctors in the room.
During the BSH Presidential Session and Medal Lecture, we were treated to a talk from Professor Marie Scully, MBE, on vaccine-induced thrombocytopenia and thrombosis (VITT). Here, the rapid identification of a new syndrome and formulation of a management strategy was particularly impressive and undoubtedly saved many lives.
In the face of such challenging and fast-paced circumstances, it was the level of collaboration between centres, sharing experience, knowledge and expertise around the UK and Europe, which I found to be enormously inspiring.
Being awarded this scholarship allowed me to fully embrace the conference experience.
I would like to thank Professor Adele Fielding and the BSH committee for providing this invaluable opportunity to attend at an early stage of training. I look forward to seeing many familiar faces at conferences over the years to come.
Lastly, this brief highlight reel would be incomplete without marking my colleagues on the dancing skills exhibited in the Manchester Museum of Science and Industry in true Craig Revel Horwood style – 10/10.
1. Pavord S., Scully M., Hunt B.J. et al. Clinical features of vaccine-induced immune thrombocytopenia and thrombosis. N Engl J Med. 2021 Oct 28:385(18):1680-1689
2. Craven B., Lester W.A., Boyce S. et al. Natural history of PF4 antibodies in vaccine-induced immune thrombocytopenia and thrombosis. Blood. 2022 Mar 9: blood.2021014684.
Stephen Hibbs, Haematology Registrar, Barts Health NHS Trust
I'm grateful to the BSH for the scholarship to pay for my funding for train fares and hotel accommodation for the ASM.
For the ASM, I contributed in the following ways:
- Co-organised and co-chaired the Blood stories session.
- Co-organised and co-chaired two virtual sessions: Blood stories part 2 and Haematology at the extremes.
- I played the piano for the Faculty dinner.
- I was a co-presenter of an ePoster.
In addition to the sessions I helped to lead, some of the highlights for me were:
a) The Meet the Expert (MtE) sessions. I attended four (haemostasis, global haematology, haemophagocytic lymphohistiocytosis (HLH) and marginal zone lymphoma). These were excellent and engaging discussions. A new project has emerged from the global haematology MtE session, in which I hope to be involved.
b) Discussions with some of the industry and charity stalls. For example, a discussion of a new bone marrow training project with BD and around finding foreign language patient information with Myeloma UK.
c) I found the opening performance of Hidden Pain by Alidor Gaspar (A Star) very moving and a fitting way to move forward with the tone of the meeting.
Louise Wallis, Haematology Specialist Nurse, Royal Bournemouth Hospital
Thank you for awarding me this scholarship and allowing me to attend the Annual Scientific Meeting to share my piece of work with the attendees as a speaker.
I found the meeting itself stimulating, and I felt it was important to attend in person, following the isolation of the Covid-19 pandemic.
Highlights for me fell into three categories.
Updates in MPNs and CML
I gained insight into the specifics of young myeloproliferative neoplasms (MPN) patients and difficult scenarios in MPNs from lectures. The posters enabled me to easily see a large quantity of information in a relaxed environment. Relevant to my practice were posters about pegylated interferon (UCL) and nurse-led telephone clinics (Manchester).
Interesting and thought-provoking lectures
A highlight of the entire meeting was listening to the entries for the Crucible prize. These were all interesting, were presented enthusiastically by the authors, and engaged the audience. The subjects were ones I had not previously really thought about and made me think more deeply about the future of haematology. Attending this type of session broadened my view of issues in haematology, which can be narrowed to my local area.
Resources for my patients
I will return to my workplace with an armoury of resources to directly benefit patients. These include different ways of recording quality of life to ensure this information is used in shared decision-making. I was made aware of two support programmes available to patients via apps and an advice line offered by Blood Cancer UK, specifically relating to clinical trials.
Attending the conference enabled me to leave my normal place of work and participate in the high-quality, varied programme without everyday interruptions and distractions.
It was a great opportunity to learn about new evidence and different ways of building services as well as practical resources that can be signposted to patients and directly enhance their care.
Karen Desay, Biomedical Scientist, NHS Blood and Transplant
I was very grateful to receive an abstract scholarship from the BSH to attend the 2019 ASM in Glasgow. It gave me a platform to present my research in front of and be questioned by world-renowned experts in the field. I came away with new ideas, a sharpened focus, and a renewed vigour to continue research on genotyping haemoglobinopathy patients to reduce rates of alloimmunisation.
As a biomedical scientist, I don't have any patient contact. This conference expanded my horizons beyond the lab and gave me a greater appreciation of the clinical aspects of disease and the applications of our work. It has informed all of my subsequent writing and teaching on my topics of interest.
I particularly enjoyed the informal nature of the Meet the Expert sessions. They provided stimulating discussion and a fantastic opportunity to ask questions you might not usually ask in a large auditorium.
The conference also highlighted the cutting edge of clinical science. Dr Alexis A. Thompson, Head of Hematology at Lurie Children's Hospital of Chicago and Professor of Pediatrics at the Northwestern University Feinberg School of Medicine, presented the latest results from clinical trials on gene therapy in haemoglobinopathy patients. It represents a really exciting advancement which could transform treatment of these patients.
I also enjoyed the Novartis Sponsored Symposia entitled Artificial intelligence to reimagine haematology treatment.
It's always best to keep abreast of upcoming changes – the future could look very different!
I'd really recommend the BSH ASM to all scientists and clinicians alike, and I look forward to seeing what is in store next year.
Tricia Tay, Medical Student, University of Manchester
When I saw Dr A.V. Hoffbrand well up in tears on receiving his lifetime achievement award, I too welled up in tears to receive this invaluable opportunity of being awarded this scholarship to attend the BSH's 59th Annual Scientific Meeting.
I am grateful for the opportunity to present on behalf of my team on the treatment of natural killer/T-cell lymphoma in Singapore. As a medical student, it was a sheer delight to attend and present a poster at my first haematology conference.
With this scholarship, I have received invaluable feedback on our study and areas of improvement for our future projects. Observing how other presenters shared their presentations and subsequently presenting at this conference has improved my presentation skills.
It has improved my confidence in presenting, and stepping out of my comfort zone to seek constructive feedback on the poster and study design. It has also been pivotal in shaping the future of our study as we begin writing the article for publication.
In addition, this meeting has enhanced my understanding of the wider field of haematology and lymphoma. The session on Making sense of haematology for senior medical students and other professionals was a great session to build a strong foundation in the basics of haematology before the conference started.
We covered a range of topics that foundation doctors should be competent in: from reading full blood counts to dealing with haematological emergencies.
Interprofessional working was at the heart of the small group teaching as we applied our experience and knowledge to answer the questions with highly supportive tutors.
Many participants felt they were not sufficiently prepared for haematology in most of their curricula. We brainstormed how to tackle the stigma and improve the knowledge of our peers because haematology is vital in every speciality.
I am interested in education and research in haematology. The session, How to future-proof yourself in haematology, improved my understanding of how trainees can participate in research and education.
At the end of the day, patients value the clinician in front of them more than the research ongoing in the laboratory or in front of the computer, and it is the clinician's role to bridge the gap from bench to bedside.
This conference has also provided the opportunity to meet supportive mentors keen to teach and inspire the next generation of haematologists.
Attending the ASM felt like I was standing on a cliff – we are at the edge of change in haematology and healthcare in the United Kingdom and the world. I would highly recommend anyone to attend this conference.
I would also like to thank Dr Richard Byers, Haem-pathologist at the Manchester Royal Infirmary, for the initial inspiration in haematology and Dr Tiffany Tang, Haem-Oncologist at the National Cancer Centre Singapore, for the opportunity to conduct this study and present on behalf of the team in Singapore.
Dr Amelia Fisher, ST4 Haematology Registrar; NIHR Academic Clinical Fellow in Genomics, Leeds Teaching Hospitals NHS Trust, University of Leeds
The British Society of Haematology Abstract Scholarship enabled me to attend the BSH Annual Scientific Meeting 2019 to present the poster, Reducing inappropriate blood testing in haematology inpatients: A multicentre quality improvement project.
During a very enjoyable day in which I was also a speaker for the Crucible Prize session, I attended the National Institute of Health Research (NIHR): Better blood research session.
As an NIHR academic clinical fellow trainee, it was brilliant to hear how all grades of haematologists are being engaged by NIHR to bring haematology research and audit not just to teaching hospitals but to any hospital with willing participants.
This idea has been embraced by HaemSTAR, as highlighted in the Trainees propelling blood research talk by David Tucker. I have been fortunate to be a member of HaemSTAR, and David gave an excellent summary of how we are encouraging trainee participation in audit and research across the country.
One speaker I found particularly inspirational was Dr Charlotte Bradbury. She spoke about being a Young consultant initiating blood research, a position I hope to find myself in in future.
From my experience as a Haematology Registrar in Leeds and a member of HaemSTAR, I was aware of the FLIGHT trial that Dr Bradbury has led. To hear about the challenges of setting up this trial, from finding the right research question to ask, ethics, funding (especially when developing research involving a generic drug), and collaboration, was fascinating. Her experiences also demonstrated how hard work pays off – this was a good example of resilience in science!
Before this session, I had not given much thought to the fact patients could consent to two optional blood tests for translational research during the trial. As someone with a keen interest in genomics, I can see why Dr Bradbury chose to include this as part of the trial because there is a limited amount of genomic data available for ITP patients. The development of translational research to find the underlying mechanisms for disease could prove invaluable for developing more effective therapeutics.
At the evening poster moderation session, it was a pleasure to present my poster to moderators and be involved in discussion with them with regards to some of the challenges involved in quality improvement.
Challenges can include continuity of care, adapting a protocol for use at centres with different patient requirements and techniques to encourage the sustainability of changes.
I was pleased to receive feedback that the project was interesting, and the moderators agreed that it is important to rationalise the blood testing we do in haematology. This feedback has encouraged me to go ahead and write up the study results for submission for publication.
1. Pell J., Greenwood R., Ingram J., Wale K., Thomas I., Kandiyali R., Mumford A., Dick A., Bagot C., 7 Nichola Cooper, Hill Q., Bradbury C.A., Trial protocol: a multicentre randomised trial of first-line treatment pathways for newly diagnosed immune thrombocytopenia: standard steroid treatment versus combined steroid and mycophenolate. The FLIGHT trial, BMJ Open: first published as 10.1136/bmjopen-2018-024427 on 18 October 2018.
Dr Shasha Khairullah, Haematology Trainee, University of Malaya
This year was my first BSH Annual Scientific Meeting, and hopefully, it will not be my last. I gained a lot in terms of the most recent advances in clinical and laboratory haematology.
This year's focus was more on benign haematology, which I appreciated, as I find this section of haematology more difficult to comprehend in comparison to malignant haematology.
The Pitfalls Day was a comprehensive overview of what is required of a trainee, and I benefited a lot from it.
I have a special interest in thalassaemia and, therefore, was pleased to hear lectures from Dr Alexis Thompson and Professor John Porter on the success of gene therapy in sickle cell disease and β-thalassaemia. It is definitely a big step towards finding a cure for these debilitating chronic conditions.
I thought the best session was the MacFarlane-Biggs lecture by Professor Mark Crowther from McMaster University on antiphospholipid antibody syndrome (APLS) and the reversal of anticoagulants. He was brilliant at pointing out that a definitive diagnosis of APLS remains elusive and confirmed my prior learning on the management of this potentially devastating condition. It is, in fact, remarkable that so little progress has been made in APLS management, despite the advances in other haematological conditions.
The chimeric antigen receptor (CAR) T-cell lectures were inspiring, bringing hope for refractory conditions, although, of course, the costs preclude us from adopting this therapy widely in Malaysia at present.
The speakers, on the whole, were very knowledgeable and were fantastic at delivering their topics. There was adequate breadth and depth of the topics covered.
I would like to thank the BSH for the opportunity to present two posters on thalassaemia at the meeting. One on biomarkers of ineffective erythropoiesis in non-transfusion dependent b-thalassaemia; and one unique case report of moyamoya in a-thalassaemia.
I was very privileged to meet several well-known researchers in this field during the poster session.
I enjoyed my stint at the Glasgow BSH in April 2019 and my brief exposure to Scottish culture and hospitality. I would like to thank the committee for making this trip possible.
1. Thompson A.A., Walters M.C., Kwiatkowski J., Rasko J.E.J., Ribeil J.A., Hongeng S. et al. Gene therapy in patients with transfusion-dependent beta-thalassemia. N Engl J Med. 2018;378(16):1479-93.
Dr James Adam Austin, Postdoctoral Research Associate, University of Liverpool
Firstly, it was rewarding that my research was recognised to merit a travel scholarship that enabled me to partake in the BSH conference and join the showcase of excellent research occurring within and outside the UK.
It was my second consecutive year of attending the BSH conference and another great opportunity to promote and absorb current trends in haematological research.
As a post-doctoral researcher at the University of Liverpool, my expertise is in myeloid leukaemia and the malignant properties of the oncoprotein CIP2A. CIP2A is overexpressed in many cancers and is almost always associated with poor clinical outcomes.
Through attending the BSH meet, I was able to seek out works of interest to help develop my research ideas. The abstracts chosen by the BSH catered for a wide variety of research genres, and the quality of the presentations enabled a concise dissection of the key messages. It provided an efficient overview of haematology themes and enhanced the context of my research within the field.
Throughout the conference, I was in close proximity with experts in the field, which provided a great opportunity for in-depth discussion and a feel of current opinion within haematology.
It also provided assurance of the future direction of my research. This year I was impressed by the top-scoring abstract talks in the first 'Acute leukaemia' session, which touched on the hot topic of cancer metabolism. Reprogramming of energy metabolism in cancer is emerging as a means of survival in many leukaemias, including myeloid and lymphoblastic leukaemias[2–5]).
The presentation entitled Targeting metabolic vulnerabilities and aberrant signal transduction pathways in paediatric T-cell acute lymphoblastic leukaemia (T-ALL), presented by Laura Anselmi, was of particular interest, linking commonly mutated genes in T-ALL to metabolic alterations. Many of these changes rewired cellular metabolism towards glycolysis and involved many well-established cell signalling pathways, including AKT and mTORC1 signalling. These metabolic changes were relied upon by these cells and therefore present new vulnerabilities to treating residual disease. The data presented was easy to follow and had clear implications for the future treatment of these diseases.
Attending the BSH conference, I gained a wealth of additional information and contacts from which to strengthen future research. As such, I will aim to regularly attend the meeting in the future.
1. Lucas, C. M., Harris, R. J., Giannoudis, A., Copland, M., Slupsky, J. R. and Clark, R. E. (2011) Cancerous inhibitor of PP2A (CIP2A) at diagnosis of chronic myeloid leukemia is a critical determinant of disease progression. Blood 117, 6660–6668.
2. Chen, W.-L., Wang, J.-H., Zhao, A.-H., Xu, X., Wang, Y.-H., Chen, T.-L., Li, J.-M., Mi, J.-Q., Zhu, Y.-M., Liu, Y.-F. et al. (2014) A distinct glucose metabolism signature of acute myeloid leukemia with prognostic value. Blood 124, 1645–1654.
3. Kuntz, E. M., Baquero, P., Michie, A. M., Dunn, K., Tardito, S., Holyoake, T. L., Helgason, G. V. and Gottlieb, E. (2017) Targeting mitochondrial oxidative phosphorylation eradicates therapy-resistant chronic myeloid leukemia stem cells. Nat. Med. 23, 1234–1240.
4. Galicia-Vázquez, G. and Aloyz, R. (2019) Metabolic rewiring beyond Warburg in chronic lymphocytic leukemia: How much do we actually know? Crit. Rev. Oncol. Hematol. 134, 65–70.
5. Knoechel, B. and Aster, J. C. (2015) Metabolic mechanisms of drug resistance in leukemia. Cell Metab. 22, 759–760.
Early-Stage Research Start-up Grants
Early-Stage Research Start-Up Grants are available from 30 June and 31 December annually.
The reports below may have had information redacted to ensure the confidentiality of sensitive research information or grant applications. The complete reports will be available once the sensitive content has been published.
Dr Christina Pina, Lecturer in Biomedical Sciences, Brunel University London
The funding received was critical for my installation as a new Lecturer in Biomedical Sciences at Brunel University London, College of Health, Medicine and Life Sciences.
It bridged my previous fellowship work at the University of Cambridge into my first established academic position. It also allowed me to recruit a talented MPhil (Res) student, Ralph Samarista, to undertake laboratory work whilst I got settled into the combined teaching, research and administrative commitments of my new post.
This student's recruitment was particularly critical during the Covid-19 pandemic, which placed a strong onus on teaching responsibilities with adaptation to remote and, later, hybrid teaching and extensive undergraduate student support.
Furthermore, charity-based funding opportunities that have historically supported work in the haematology and leukaemia fields were significantly reduced and, in many cases, suspended during the last two years, and the BSH funding was critical to sustain my research activity.
At an institutional level, my early establishment as an externally-funded researcher in the leukaemia field supported my nomination as the Cancer Cluster Lead in the newly-established Centre for Genome Engineering and Maintenance. It prompted a college-level financial commitment to upgrade the existing Novocyte flow cytometer analyser from 5 to 15 channels to enable my research.
More recently, my sustained research activity proved critical to a successful college matched-funded application to the Wolfson Foundation for the acquisition of a cell sorter.
Scientifically, the funding allowed me to analyse individual and combined contributions of epigenetic methylations and the unfolded protein response (UPR) in acute myeloid leukaemia (AML) and to explore the therapeutic potential of combined DNA demethylating agents and UPR modulators.
I had previously identified these two pathways as the main candidate mediators of AML dependency on the MAT2A enzyme, which catalyses the synthesis of S-adenosyl-methionine, the main methyl donor in the cell.
I have now shown that combined targeting of DNA methylation and activation of the pro-apoptotic arm of the UPR can cooperate in eliminating AML cells from different genetic backgrounds, both cultured AML cell lines and patient samples.
I will now aim to extend these results in vivo to confirm their translational therapeutic potential.
Dr Henry Wood, Clinical Fellow, King's College London
The grant was critical to enabling me to develop a novel mass cytometry panel to study human monocyte/macrophage populations in acute myeloid leukaemia (AML).
The funds paid for the purchase of antibodies and reagents used in the panel, custom metal conjugation of antibodies, and acquisition of data from stained samples on the Helios mass cytometer at the NIHR Biomedical Research Centre Flow Core at Guy's Hospital.
The mass cytometry panel was developed successfully through multiple optimisation steps using a range of frozen, fresh, cultured and stimulated samples from different haematopoietic tissues to assess the efficacy of the antibodies and titrate them appropriately.
Once optimised, the panel was used to assess paired blood and bone marrow samples from 5 normal donors and 20 AML patient samples (10 recorded as FAB M0-2 and 10 FAB M4-5) alongside umbilical cord blood controls.
The resulting data demonstrate biologically relevant monocyte/macrophage and immature haematopoietic cell populations with a high degree of consistency within normal samples, although preserving the expected differences between peripheral blood, bone marrow and umbilical cord blood.
The data revealed significant variation in the monocytic populations present in different AML samples, which were not always consistent with the previously assigned FAB classification.
The samples can be broadly categorised into primitive, monocytic, mixed (primitive and monocytic) or intermediate 'monoblastic' phenotypes. These categories provide a basis on which to explore the behaviour of AML samples when challenged with chimeric antigen receptor (CAR) T-cells and may be predictive of the severity of the inflammatory response.
Dr Richard Burt, Senior Clinical Research Fellow, University College London
The BSH grant has been enormously helpful in my career development as a clinician-scientist.
Following the completion of my PhD on the acute lymphoblastic leukaemia (ALL) microenvironment in Professor Fielding's lab, I was very keen to continue research in this area. However, before obtaining the BSH grant, I was not in a position to apply for an intermediate fellowship as I required evidence of output from my PhD, preliminary data for the intermediate fellowship and evidence of obtaining grants independently.
The BSH Early Stage Research Grant enabled me to complete the benchwork required for a high-impact publication in Blood from my PhD, produce the preliminary data required for the intermediate fellowship application and show evidence of obtaining a competitive independent grant.
Without the BSH grant, it would have been much more challenging to have the time and budget for consumables to complete the required work to get to the next stage of my career as an early clinician-scientist.
The overarching hypothesis of the work was that surviving cells post-chemotherapy in B-cell acute lymphoblastic leukaemia (B-ALL) reside in a protective niche, which alters their metabolic state and favours chemotherapy resistance.
The objectives of the work are to:
- Determine whether B-ALL cells are rescued from chemotherapy-induced oxidative stress via transfer of mitochondria in in vivo models.
- Establish patient-derived xenograft (PDX) models of B-ALL for use in intravital imaging.
- Compare niche formation in a B-ALL PDX model using intravital imaging across different genetic sub-types both before and after chemotherapy.
Using a B-ALL xenograft murine model, I confirmed my in vitro findings that B-ALL cells are rescued from oxidative stress induced by chemotherapy by residing in a protective bone marrow niche.
I was able to show that part of the protective mechanism within the niche is the transfer of mitochondria from bone marrow stromal cells to B-ALL cells, as demonstrated by the presence of murine mitochondrial DNA in human B-ALL cells.
The transfer of mitochondria to B-ALL cells enables them to resist oxidative stress induced by DNA damaging chemotherapy agents (e.g. Daunorubicin, Cytarabine). Importantly, this protective mechanism can be inhibited by microtubule damaging agents (e.g. Vincristine, Nocodazole) as the transfer occurs between cells via microtubule containing tunnelling nanotubes. This provides a strong scientific rationale for giving microtubule damaging agents with or prior to DNA damaging agents in B-ALL treatment.
The work was published in Blood, and there are plans to test the approach in a randomised fashion in the proposed UKALL15 trial.
Dr Rhys Morgan, Research Fellow, University of Bristol, School of Cellular and Molecular Medicine
Wnt/b-catenin signalling is an evolutionary conserved signalling pathway critical for normal development and heavily implicated in human cancer. The central mediator, b-catenin, is frequently overexpressed in acute myeloid leukaemia (AML), where its expression is linked with inferior patient survival. Furthermore, well-characterised experimental models of AML development have demonstrated b-catenin to play a pivotal role in leukaemogenesis, rendering the protein an ideal therapeutic target.
The stability, subcellular localisation and transcriptional activity of the central mediator b-catenin is dictated heavily by proteins interactions. To date, much of its molecular characterisation has been performed in epithelial cells. However, b-catenin's haematopoietic interactome is likely to vary from its epithelial interaction network given its less prominent cell adhesion role (adherens junctions) in blood cells and the relative scarcity of activating Wnt mutations (APC, Axin and b-catenin), which are frequent in solid tumours but rare in haematological malignancy.
Pertinent to the molecular targeting of b-catenin to disrupt its pathological role in AML is the prior characterisation of its interacting partners in leukaemia cells.
My BSH early-stage research start-up grant has allowed me to assess the feasibility of performing b-catenin interactome studies in leukaemia cells for the first time. Specifically, we have trialled the process of co-immunoprecipitating (co-IP) b-catenin protein from both leukaemia cell lines and primary AML patient blast samples, followed by mass spectrometry analysis.
Obtaining research funds from major grant funding bodies would have been a considerable challenge, given the perceived level of risk associated with our experimental approach. As a junior research scientist, I would have also struggled in more competitive funding schemes, given my relative inexperience in comparison with more senior co-applicants in the field.
However, our now optimised experimental strategy has proved successful. And the BSH grant has provided me with the novel and interesting data I require to build a more substantial and long-term research bid.
Dr Holger Auner, Clinical Senior Lecturer and Honorary Consultant in Haematology, Imperial College London
This BSH award contributed to the successful application for a Cancer Research UK (CRUK) Small Molecule Drug Discovery Award that will be activated in 2019 and will focus on validating a potential new therapeutic target to overcome proteasome inhibitor resistance.
My research group works on aspects of intracellular protein homeostasis (proteostasis) in cancer cells and non-transformed cells, with a particular interest in multiple myeloma. The ultimate goal of our work is to find ways to disrupt proteostasis in malignant cells while largely sparing non-cancerous cells.
This aim builds on the proposition that cancer cells and, in particular, myeloma cells are highly dependent on the mechanisms that coordinate protein degradation and synthesis. This notion is supported by the clinical success of inhibitors of the proteasome, the main effector of intracellular protein degradation.
The BSH grant allowed us to complete a set of experiments that formed a key part of a project that has now been completed, with a manuscript under review (May 2018).
The grant also enabled us to conduct a set of preliminary experiments that supported a successful grant application with an industry partner and another grant application submitted to a UK organisation.
While the experiments funded by the BSH grant formed part of a larger work programme, the results of these experiments became important components of both the submitted manuscript and the grant applications, providing critical support for our conclusions and hypotheses.
Deadline for general travel scholarships: 31 January and 31 July.
ASH and EHA Travel Scholarship deadlines vary by year.
I was grateful to receive the BSH Travel Scholarship to travel to the Gordon Research Conference on Megakaryocytes and Platelets in Galveston, Texas, USA.
I am an MB/PhD student currently studying for a PhD in the lab of Dr Cedric Ghevaert at the Department of Haematology, University of Cambridge, and the lab works on generating platelets in vitro for transfusions without the need for blood donors.
My project, in particular, focuses on developing engineered platelets as a targeted drug delivery system by loading the granules of platelets with drugs so that they can activate and secrete these drugs where they need to go, without systemic side effects.
Thanks to the help of the BSH, I was able to present my work at this international meeting, where I was able to meet the authors of all the major papers in the field of platelet biology!
I had the opportunity to discuss and receive valuable feedback on my work from many different perspectives, which would have been impossible otherwise.
I also had the chance to see my research in the context of the other fascinating advances taking place in the field.
The conference was very well organised, with several sessions with different themes. Each session started with short introductory slides presented by session chairs, followed by several presentations.
I was also able to talk to my contemporaries working globally on the similar issues we face and the big names in the field. I felt I was able to learn from both and made lots of new friends!
One of the reasons for attending the conference was to find out more about the tools that other labs use to ask similar kinds of questions that we are. One of the more fascinating talks was about some of these tools from the Hahn lab at the University of North Carolina at Chapel Hill.
They had developed biosensors to detect signalling GTPases spatiotemporally and to study how the dynamics of signalling take place in much more depth than can be shown by any western blot. They have developed computational techniques to analyse these videos and even engineered optogenetically activatable GTPases, using them to demonstrate how to activate Rac61 precisely and reversibly using blue lasers.
Rac61 is thought to control cell motility, and they were able to show how localised Rac activity was enough to mobilise cells to follow around the laser pointer, much like a cat.
From this, I learnt a lot about the frontiers of what was possible with protein engineering and new techniques for studying these signalling cascades in a way I had not considered before and certainly plan to use going forward.
Overall, I would like to thank the BSH for this opportunity to be able to travel, present my work, discover more about the work of others and the challenges we are facing together, and foster potential collaborations in the future that will hopefully benefit us all.
1. Wu, Y. I. et al. A genetically encoded photoactivatable Rac controls the motility of living cells. Nature 461, 104 (2009).
Souradip Mookerjee's Twitter: @souramoo
I am very grateful to the British Society for Haematology for supporting me with a travel scholarship to attend the Fondazione Italiana Linfomi (Italian Lymphoma Foundation) Cantera in Lecce, Italy.
Cantera, literally meaning 'quarry' in Spanish, is a term used to refer to Spanish sporting academies. Taking its inspiration from this training model, the FIL Cantera is an annual three-day course that aims to bring together a small number of trainees from across Europe and beyond to receive instruction from a leading expert in the field of lymphoma.
The brainchild of Professor Massimo Federico of the University of Modena and Reggio Emilia, Modena, Italy, the course has been co-sponsored by the European Haematology Association Lymphoma Group since 2018.
In previous years, course experts have included Bruce Cheson (2013), Richard Fisher (2014), Randy Gascoyne (2015), Andrew Zelenetz (2016), Steven Rosen and John Chan (2017) and Stephen Ansell (2018).
Professor Anas Younes of Memorial Sloan Kettering Cancer Center, New York, led this year's course. A highly respected international expert, Professor Younes works in the development of novel targeted therapies and the identification of biomarkers for lymphoma. He has been the principal investigator in numerous clinical trials, including some of the pivotal studies of Nivolumab and Brentuximab vedotin in Hodgkin's lymphoma.
Designed with an emphasis on interactivity, each session involved a presentation by Professor Younes, with generous amounts of time allocated to discussion, giving ample opportunity to ask questions and share and reflect on each other's experiences and opinions.
This year's theme was Precision medicine in lymphoma. Sessions were delivered on the current standards of care in lymphoma, drug development, clinical trial design, circulating tumour DNA, immune therapy, combination strategies, trial endpoints and target populations.
On the final day, the trainees pitched a clinical trial proposal that they had developed in groups to a panel of experts comprising Professors Younes and Federico, joined by Professors Antonino Carbone and Martin Dreyling. The most popular proposals received promises of support from the panel to help develop them in future.
The course venue was Lecce, a beautiful town in Salento, Italy. With evenings spent dining together in some very nice restaurants, the course was also a great opportunity to network with like-minded individuals and to lay the foundations for future collaborative relationships.
It was a tremendously valuable educational experience that I would highly recommend to anyone wishing to develop an interest in lymphoma.
I have thoroughly enjoyed my experience attending the 60th American Society of Hematology Annual Meeting & Exposition in San Diego for numerous reasons.
I greatly benefited from the extensive and well-planned programme and was struck by how much effort is placed into educational sessions geared towards haematology trainees.
I have definitely improved and updated my knowledge of the pathophysiology, diagnostic and management process of various haematological diseases.
One session I found particularly interesting was entitled Low iron promotes megakaryocytic commitment of megakaryocytic-erythroid progenitors in human and mice, which showed the pathophysiological process behind why iron deficiency anaemia is often accompanied by thrombocytosis. A question asked many times during my medical student teaching sessions that I am unable to answer.
Secondly, I had the opportunity to present a poster entitled Long-term safety and efficacy of autologous or allogeneic donor stem cell transplantation in patients with Behçet's syndrome. Another abstract I co-authored entitled Randomized trials of autologous hematopoietic stem cell transplantation for diffuse cutaneous systemic sclerosis: Systematic review and meta-analysis with trial sequential analysis of overall mortality was presented as an oral poster.
Being given this opportunity has definitely further developed my interest in research and has motivated me to continue to be involved in research at a local and national level whenever the opportunity arises.
Thirdly, this annual meeting has given me the opportunity to interact with haematologists from all around the globe. We were able to exchange experiences, and I was able to see how haematological conditions are being managed differently in other developed or developing countries. This experience has opened my eyes and given me a broader perspective of the overall issues surrounding haematology.
In conclusion, these three reasons have not only given me motivation in my career as a haematologist to further expand my knowledge and deliver the best care to my patients, but they have also contributed to my development as a well-rounded haematologist.
1. Low iron promotes megakaryocytic commitment of megakaryocytic-erythroid progenitors in human and mice. Juliana Xavier-Ferrucio, Xiuqi Li, Vanessa Scanlon, Ping-Xia Zhang, Nadia Ayala-Lopez, Toma Tebaldi, Stephanie Halene, Karin E. Finberg and Diane S. Krause. Blood 2018 132:2; doi: https://doi.org/10.1182/blood-2018-99-115214
This year's American Society of Haematology (ASH) conference was held in sunny San Diego, California. Celebrating its 60th anniversary, it lived up to my expectations.
As a clinician, albeit one who has recently started a PhD in megakaryocyte biology, the conference provided an opportunity to get updates about the latest trials and evidence.
One of the big talking points of the conference was the presentation of data from genome-wide association studies (GWAS) on the heritability of de novo AML, which indicated that up to 20% of patients might have an inherited genetic disposition for developing the condition.
Other notable highlights were the results from trials looking at the utility of direct oral anticoagulants (DOACs) in malignancy-related VTE.
Sickle cell disease also featured highly with some fascinating educational sessions reporting on the progress in gene-editing of the beta haemoglobin gene, which may present a potential 'cure' for the condition without the need for a bone marrow transplant.
The conference included several superb educational scientific talks within the area of haematopoiesis, the focus of my PhD. These included Stress and haematopoiesis, Thrombopoiesis and the lung, and How to make a red cell. The talks summarised key discoveries in the field and gave some insights into where the field seems to be going in the future.
The conference was also an opportunity to present my own work and discuss my findings and approaches with other scientists and clinicians. My poster, entitled Bayesian analysis of TPO in immune thrombocytopenia, is part of a larger body of work that aims to understand how the immune system affects the normal functioning and regulation of megakaryocytes in both autoimmunity and inflammation more generally.
Using novel mathematical approaches and computer simulations, I generated a model of TPO production in immune thrombocytopenia. The work attracted a great deal of interest and inspired lively discussion both about the research itself and about possible future directions the work could take.
I am very grateful to the BSH for sponsoring my attendance at the conference.
It has been a wonderful experience and a great opportunity for me, especially at this early stage in my scientific training.
The 10th International Workshop on Waldenström's Macroglobulinemia (IWWM) conference was held in New York City, USA, in a historic area near Wall Street and the 9/11 Memorial Museum.
The conference was an extremely well-organised three-day event with presentations covering a range of topics relating to WM. There were sessions on the genomic landscape of WM, diagnosis and management of the disease, clinical trial updates and resistance mechanisms.
Without the support of the British Society for Haematology and the travel scholarship, I would not have been able to attend this exciting event and present our group's research.
Our abstract, entitled Sequential analysis of TP53 variation using targeted next generation sequencing (NGS) in patients with Waldenström macroglobulinaemia, was selected as a poster presentation and shown at the poster viewing reception on Friday 12 October.
Our research showed that TP53 variation could develop over the course of the disease in WM patients. It implies that TP53 testing should be performed both at presentation and prior to any therapy initiation during the time course of the disease in order to accurately appraise therapy choices.
One of the most interesting topics for me was a talk by Irene Ghobrial from the Dana-Farber Cancer Institute on whether cell-free DNA (cfDNA) could be used to assess mutation status in WM. Her group found almost 99% concordance between somatic mutations found in liquid and tumour biopsies. The application of this technique is extremely sensitive, with batch sampling proving cost-effective.
The idea was most appealing to me for use in the sequential sampling of the patient over time, enabling minimally invasive procedures and avoiding the use of repeat bone marrow aspiration. Despite the bulk of disease occurring in the bone marrow, this group have shown that cfDNA from peripheral blood can better reflect the tumour heterogeneity.
One of the keynote speakers, Dan Landau, also discussed this method of testing as a useful way to study the evolutional landscape of Ibrutinib resistance, with his expertise based on studies in chronic lymphocytic leukaemia (Landau et al 2017).
That was another key theme of the conference, with Ibrutinib resistance becoming more common with increased use of BTK inhibition in this patient cohort. The outcome of these discussions led to the opinion that combination therapy rather than single-agent therapy is the key to overcoming clonal evolution of resistant clones.
I would like to thank the BSH committee for their generous travel scholarship award of £1,000, which enabled me to travel to New York, USA, for this conference.
The experience has been invaluable, and I hope it will impact my research work both now and in the future.
1. Landau, D. A., Sun, C., Rosebrock, D., Herman, S. E. M., Fein, J., Sivina, M., Underbayev, C., Liu, D., Hoellenriegel, J., Ravichandran, S., Farooqui, M. Z. H., Zhang, W., Cibulskis, C., Zviran, A., Neuberg, D. S., Livitz, D., Bozic, I., Leshchiner, I., Getz, G., Burger, J. A., Wiestner, A. & Wu, C. J. (2017) The evolutionary landscape of chronic lymphocytic leukemia treated with ibrutinib targeted therapy. Nat Commun, 8, 2185.
I would like to take this opportunity to thank the BSH for supporting me in attending the Sixth International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma (NHL) in Rotterdam, the Netherlands. This four-day symposium focused on translational research and clinical trials in paediatric and young adult NHL.
During the symposium, I had the opportunity to present our work entitled Investigation of FOXO1 mutations in paediatric endemic and sporadic Burkitt lymphoma, which was selected as an oral presentation in the poster discussion session. This study described the high frequency of FOXO1 mutations in Burkitt lymphoma (BL) and the oncogenic role of FOXO1 in BL that makes it a potential therapeutic target.
I also had the chance to engage with senior researchers from around the world who gave suggestions and criticism that helped us put this work together into a manuscript after the symposium and submit it for publication.
This conference broadened my knowledge of recent progress in paediatric and young adult NHL, such as current molecular and bioinformatics research, ongoing clinical trials, global clinical experience (especially in developing countries), stem cell transplantation, patient stratification and recent improvement in treatments.
One particularly interesting research field was chimeric antigen receptor (CAR) T-cells. Gardner et al demonstrated the efficacy of anti-CD19+ CAR T-cells in paediatric relapsed or refractory NHL with well-tolerated toxicities in a phase II trial. Ryotaro Nakamura improved in vivo expansion of CAR T-cells by developing CMV-CD19 bi-specific T-cells with CMV vaccine stimulation, which has progressed to phase II clinical trial (British Journal of Haematology, 182, (Suppl. 1), 5–109). These studies offered hope to paediatric NHL patients who failed front-line therapies and stem cell transplantation.
Overall, this was a focused and informative conference that kept me updated on recent NHL research and clinical trials, provided the opportunity to network with researchers from other countries and led to the establishment of potential collaborations.
Once again, I am very grateful to the BSH for granting me funding to attend this symposium.
Without this, I would not have had the chance to present my data to experts in NHL or get valuable feedback.
Thanks to the generous support of the BSH, I was able to travel to Atlanta to attend the 59th Annual Meeting and Exhibition of the American Society of Haematology (ASH).
I presented my group's work entitled Histone acetyl-transferase Kat2a regulates transcriptional heterogeneity and impacts self-renewal of acute myeloid leukemia cells in a disease-specific manner at the conference and enjoyed multiple opportunities for discussion.
Critically, I initiated two collaborations only possible due to my attendance at the meeting.
The ASH meeting is an intense yet highly-rewarding experience that articulates clinical with basic science perspectives and audiences. The unpublished or recently-published nature of the work presented provides investigators with very clear and live notions of the directions the field is taking.
It assists young principal investigators such as myself in making strategic decisions at project bifurcations. Moreover, the quantity and diversity of the sessions on display inevitably sheds new light on the interpretation of one's own data.
This year, from a basic research perspective into myeloid malignancies, there were very clear focuses on the role of metabolism, particularly mitochondrial metabolism, in influencing leukaemia progression.
A more recent but equally timely area of research was the articulation between epigenetic regulation and alternative splicing, a novel theme for which there is a strong body of emergent evidence, whilst precise mechanistic connections are still being defined. The idea that epigenetic dysregulation inherent to myeloid malignancies may perturb not only the quantity but also the quality of gene expression is remarkably interesting to me.
I focus my research on the contribution of transcriptional heterogeneity to fate transitions in acute myeloid leukaemia (AML) and employ manipulation of individual epigenetic regulators to promote differentiation or death of AML cells with therapeutic intent.
I had previously viewed epigenetic regulators as sensors and translators of metabolic cell status into initiation, processivity and/or suppression of gene expression. The association with alternative splicing suggests that metabolic status and availability of intermediate metabolites can additionally modify the protein diversity of the cell with the generation of variability in and complex rewiring of regulatory networks. I had encountered tentative associations between metabolic status, splicing and protein synthesis in my data, which now take shape in light of substantive unpublished data presented at the conference.
My travel to ASH, much like everybody else's, was complicated by the extremely cold weather conditions in the southern states, and I eventually arrived in Atlanta a day later than expected, and by taxi rather than plane.
Despite the bumpy start, ASH proved to be the enriching experience I had anticipated. It generated numerous ideas that already bear fruit in my group's research.
I thank the British Society for Haematology and my own Fellowship funding body, the Kay Kendall Leukaemia Fund, for making this trip possible.
The BSH travel scholarship enabled me to travel to ASH in Atlanta this year.
My abstract, entitled High-throughput sequencing in patients with inherited bleeding and platelet disorders: novel gene discovery and robust diagnosis, was selected as one of the top six abstracts (out of more than 6,000) for presentation in the ASH plenary scientific session.
It was a wonderful opportunity for me personally and professionally. The work I presented is the culmination of several years of collaborative work from an international team of clinicians, geneticists, and laboratory and computational scientists and has been the focus of my PhD research.
Showcasing my work on this platform at ASH enabled me to bring our research to a wider audience. To show how high-throughput sequencing using whole genome sequencing and a targeted gene panel is transforming diagnosis for patients with rare coagulation, thrombotic and platelet disorders.
Since my talk, I have been approached by clinicians from around the world with interest in our study, and I have been able to bring haematologists and scientists working on specific diseases together.
I have also had interest in sequencing more patients on our gene panel, and it is great to have been able to spread the word and get more people using this resource.
Giving a presentation like this was a great privilege. I learned a lot about preparing for and talking to a large, diverse audience.
It was my first trip to ASH, and I also appreciated the diverse quality of presentations across the field of haematology. It was refreshing to be reminded of the many advances in other areas of haematology, having spent the last few years doing a PhD in rare bleeding and platelet disorders. And how interesting it is being a haematologist!
I also attended some education sessions, which were really useful for my clinical practice.
Finally, giving a presentation at ASH was an ideal way to meet haematologists and scientists interested in my area of research from across the world. And to meet up and maintain links with colleagues across haematology.
I am enthused to carry on and make the most of this opportunity. It was an invaluable experience and many thanks to the BSH for their support in making it possible.
I'm very grateful to the BSH for the travel scholarship to support my attendance at the International Workshop on Chronic Lymphocytic Leukaemia (CLL) in May 2017.
The workshop is a four-day meeting with a blend of clinical/translation studies and basic biology with the aim of advancing the understanding and treatment of CLL (and associated malignancies).
The workshop opened with sessions focused on the factors leading to the development of CLL, including a description of familial CLL. Tait Shanafelt described how 10% of patients have first degree relatives with CLL. Monoclonal B-cell lymphocytosis (MBL) may also contribute to the development of CLL. And genome-wide studies have identified nine loci associated with an increased risk for CLL. Richard Houlston explained how single nucleotide polymorphisms (SNPs) conferring risk for CLL map to areas of open chromatin where they may be involved in regulation of gene expression.
At the meeting, I also had the opportunity to present a poster entitled Activation of p53 by the MDM2 antagonist RG7388 in CLL cells ex vivo triggers cell death via a pro-apoptotic gene signature. The poster describes part of our recent work from the Cancer Research UK Drug Discovery Newcastle team working in alliance with Astex Pharmaceuticals.
We are investigating how MDM2 antagonists may be used in CLL, particularly as this represents a non-genotoxic therapy with minimal effect on normal cells.
The poster was well received and gave me the opportunity to engage with others in the field and consider possible combination therapies using MDM2 antagonists.
Finally, these relatively small workshops facilitate interaction. I was able to meet with two collaborators to discuss recent data and progress future directions with novel small molecule inhibitors that are of mutual interest.
Many thanks to the BSH for this award, which was much appreciated.
Student Elective Scholarships
I used the BSH grant to fund my elective, and I went on elective in India. I went to a part of India called Kerala, which is where my parents are from. I've been to Kerala a few times but never experienced the healthcare system, and I was particularly interested in how cancers were treated - in particular, blood cancers - in that part of the world.
I was looking for funding for my elective, and I happened to do an internet search for funding, and I found it on... I think it was a website called money for medical students, and I found BSH, and the requirements were very, very few.
So I just applied for it, and they wanted a report or some evidence of academic standing and what extra-curricular activities I participate in. And they accepted my request.
The BSH grant has opened a lot of doors for me. It has allowed me to go and see things in my chosen country that I probably wouldn't have had the opportunity to see, such as lab experience.
I am able to pay more money into seeing things such as FISH and SKY procedures that are done in the laboratories, which are probably not accessible to see in the UK unless you get special permission. So that's really helped me a lot.
The highlight of my elective was going to an outpatient clinic on my first day and being given a stack of notes, and being asked to clock in patients in a totally different language. That was a great experience.
The BSH grant has changed my experience of haematology. Being able to see various presentations on haematology, things I had never seen in the UK. And it allowed me to see things that I'll probably never see again in my lifetime. And I'm very grateful to the British Society for Haematology for that.
Due to the generous contribution of the British Society for Haematology, I was able to compare the work of haematologists in the highly-specialised department of Oxford Healthcare Trust with the relatively resource-poor and politically-complicated setting of the Augusta Victoria and Makassed hospitals, Jerusalem, two hospitals serving the Palestinian community of the West Bank.
In Oxford, I worked with Dr Ramasamy's team on a project looking at bone health in myeloma. It gave me insight into how the multidisciplinary team work together to produce research and inform evidence-based medicine.
They spent time to enable me to understand the different processes involved in data collection, clinical practice and writing. I saw how haematology treatments are developing (particularly for multiple myeloma) so that disease is increasingly controlled, and long term management of symptoms is required.
The Augusta Victoria, I suspect, provided a truly unique experience as it is a specialist oncology and haematology centre serving a community fraught with political complications. Whilst it has many resources not available in truly developing countries, monetary restrictions limit the care available.
The patients travel from all over Palestine. However, movement is restricted by the borders and checkpoints separating their land from Israel.
The week before I arrived, no patients had been allowed to travel from Gaza due to the recent bombings. When they reached the hospital, their situation had progressed, and often, the given diagnosis was incorrect.
Patients in need of bone marrow transplants required transfer to the local Israeli hospital, Hadassah. However, this is also barred by the government, so two patients who had been worked up and prepared for bone marrow transplant had to have their expectations managed and treatment altered to fit the limitations of the medications available in the Augusta Victoria.
The doctors and nurses do an excellent job managing the situation presented to them daily, dealing with relative shortages in staffing, facilities and medication.
Further, what made it so unique was the excellent tuition of Doctor Morabito, an Italian haematologist heading the department for a year. He is helping develop the haematology service and will hopefully get a bone marrow transplant service in place by the end of 2019.
He tutored me in diagnostic techniques, the interpretation of blood films, spectroscopy, and much, much more! So whilst I learnt huge amounts about their life and medical practice from the friendly staff welcoming me wherever I went, I also saw haematology in practice.
Makassed is a general medical hospital and more representative of the facilities available to the Palestinian population. Whereas the Augusta Victoria manages to provide a clean, quiet and generally effective hospital service, Makassed is busy, often dirty, and frantic. The staff did not hold back in telling me about problems they face.
Again, the staff were friendly, and spending a day in endocrine, rheumatology and neurology clinics allowed me to see a massive range of disease presentations.
It was an informative and rewarding elective which allowed me to explore a beautiful country, learn about the political situation and explore many aspects of medicine.
I feel committed to helping medical services in Palestine in the future and have enrolled in Arabic lessons.
I would like to thank the British Society for Haematology for this scholarship that enabled this elective to take place. And for their support through some unexpected circumstances.
My elective consisted of a five-week clinical placement in haematology and paediatrics at Mater Dei Hospital, Malta. Alongside this, I undertook a project under the supervision of Professor Christian Scerri investigating the management of β‐thalassaemia and its complications in terms of transfusion-related endocrinopathy.
Clinically, I was able to integrate into the teams and explore both specialities from inpatient and outpatient perspectives, learning a vast amount in the five weeks.
Malta has a similar healthcare system to the NHS. But important differences exist: late presentations are common, and guidelines seem less ubiquitous, with clinical judgement often carrying more influence (interestingly, often to patient benefit).
The sociocultural context and Catholicism of the country also contributed to significant differences in attitudes towards health for patients and doctors alike.
Malta is a small Mediterranean island, an important factor in its genetic disease profile.
With my project supervisor, I was able to attend thalassaemia and genetics clinics, gaining an insight into conditions that are vanishingly rare in the UK.
The project was an opportunity to further explore β‐thalassaemia as one such condition. In particular, the challenge of keeping these patients safe from the natural course of the disease and the complications of treatment.
Maltese β‐thalassaemia is considered thalassaemia intermedia, with four causative mutations characterised by Prof Scerri (1998). Thirty years ago, it was recognised these patients do better on a hypertransfusion regimen akin to that used in thalassaemia major, aiming Hb at 10g/dL (+/- 0.5g/dl); thus, they are managed now as cases of transfusion-dependent thalassaemia (TDT).
This is consistent with the growing body of evidence that complications arise due to chronic anaemia in non-TDT (NTDT). And that quality of life may be more impaired in NTDT than in TDT (Musallam et al, 2011).
Hypertransfusion, however, is associated with iron-related endocrinopathy. Globally, iron chelators are used to minimise this (oral desferasirox in Malta), aiming at serum ferritin <1000 g/L; nevertheless, DeSanctis (2014) found an internationally high prevalence of such complications. The five major problems he identified - hypogonadism, short stature, glycaemic abnormalities, hypoparathyroidism and hypothyroidism - were taken as a basis by which to assess endocrinopathy in the Maltese population.
Here there are effectively two cohorts of 'thalassaemia intermedia'; the older cohort (A), regularly transfused only later in life (n=14), and another group (B), regularly transfused from early childhood (n=15). Further subgroupings might show other differences; this is a preliminary analysis.
The average number of transfusions received per year was 0.94 for the older cohort (A) versus 7 for the younger cohort (B). Cohort B had a statistically significantly higher mean ferritin over time (1752g/L versus 1113g/L; p < 0.0376), and there was a higher incidence of endocrinopathy: mean BMI over time was significantly lower (mean BMI 18.4 versus 23.4; p < 0.0012). 4/11 patients (36%) were considered to have hypogonadism from biochemical results relative to 0/9 patients (0%) transfused from later life (cohort A).
Diabetes mellitus (glycaemic abnormalities) was more common in the later-transfused cohort (A) (3/14 versus 0/14). But there was no control population for comparison nor control for factors such as the background incidence of diabetes and patient age (mean 50.8 in cohort A versus 26.3 years in cohort B). Thyroid and parathyroid function were within the normal range for all patients.
Fig. 1: Table summarising endocrinopathy per cohort (*Statistically significant difference between the two cohorts on unpaired t-test).
Mean number of transfusions per year
Growth (BMI < 18.5)*
BMI used as a standardised measure for growth due to variable ages and parental height unavailability.
No general population control group; difficult to account for age.
It was a pleasure and privilege to work with Professor Scerri and his team and contribute to the care of these patients. I would like to express my sincere gratitude for their welcome and continued support.
I would also like to thank the Royal Society of Medicine, the University of Cambridge Clinical School, Gonville and Caius College Cambridge, and Christ's College Cambridge, who supported this elective.
Firstly, I would like to thank the British Society for Haematology for generously funding my elective.
I spent my elective period at UCL Cancer Institute under the supervision of Dr Marc Mansour and Dr Simon Richardson. The Mansour laboratory has extensively studied the mechanisms of leukaemogenesis. And novel therapies in T-cell acute lymphoblastic leukaemia and acute myeloid leukaemia.
I was involved in a project investigating PRDM16 as a putative oncogenic driver of normal karyotype acute myeloid leukaemia (NK-AML). Cytogenetic analyses are currently used to stratify AML patients into different prognostic groups. However, in 40-50% of AML cases, no chromosomal abnormality is visible by conventional karyotyping.
Molecular analyses have recently identified several recurrent, distinct mutations in NK-AML patients. These include activating mutations such as internal tandem duplications of the receptor tyrosine kinase FLT3 gene (FLT3-ITD), point mutations of the RAS protooncogenes, mutations altering genes encoding transcription factors (AML1, CEBPA), and mutations interfering with tumour suppressor pathways such as NPM1.
Identification of these mutations can provide insight into the mechanisms that promote and maintain NK-AML. And not only aids risk stratification in this cytogenetically heterogenous group but also guides therapeutic decisions.
PRDM16 is a zinc finger transcription factor and also encodes for histone methyltransferases that maintain heterochromatin integrity. It plays a critical role in the regulation of hematopoietic stem cells and is, therefore, a prime candidate for leukaemogenesis.
High PRDM16 expression is a significant predictive marker for poor prognosis in paediatric and adult AML patients and correlates with other known mutations in adult AML. Furthermore, it is preferentially overexpressed in NK-AML.
I completed an ongoing screening of NK-AML patient samples for PRDM16 expression as part of the project. It involved preparing RNA from the biobank, making cDNA libraries, and performing quantitative PCRs, which allowed for the identification of monoallelic cases and differentiation between short and long isoform expression. This work allowed us to investigate the correlation between PRDM16 expression and clinical outcomes, particularly disease relapse.
In addition, to elucidate the mechanism of PRDM16, I helped to characterise 2 AML cell lines – 1 PRDM16+ NPM1 WT and 1 NPM1+ – by performing Western blot analysis for PRDM16 on nuclear, cytoplasmic, and whole-cell extracts. I also performed shRNA knock-down experiments in both cell lines and assessed PRDM16 expression and cell viability. Finally, I was able to commence making an NPM1 knock-in cell line using CRISPR-Cas9 genome editing techniques.
This elective gave me the opportunity to spend time with both clinicians and scientists, allowing me to gain insight into the current challenges and questions asked in malignant haematology and the molecular biology strategies available to answer them.
Furthermore, I was able to build on skills from my PhD in an entirely new field. Overall, my elective most certainly did meet and exceed expectations.
I would like to express my sincere gratitude to Dr Marc Mansour and Dr Simon Richardson for their supervision and support and to the rest of the Mansour lab for allowing my elective period to be thoroughly enjoyable and memorable.
Firstly, I would like to thank the British Society for Haematology for the scholarship they have awarded me. It allowed me to visit the country of Sri Lanka and meet patients suffering from serious diseases and their families. This experience will certainly change the way I practise medicine in the future.
Had it not been for this bursary, I would not have had the opportunity to study in Sri Lanka, and therefore I could not be more grateful. I studied in the southern state of Sri Lanka, in Galle, splitting my time between Karapitiya teaching hospital and various community clinics and medical facilities, allowing me to fully experience a completely different healthcare system.
I chose to do this report on haematological malignancies in Sri Lanka. After some initial research, I found that after accidental death, haematological malignancy is the second most common cause of death in the entire country, making it an important public health concern for Sri Lanka.
Furthermore, although Sri Lanka has some public funding for healthcare, there are limited resources, which makes charity assistance a necessity, particularly with regard to patient support. However, in the southern province of the island, there is very little charity support for paediatric patients suffering from leukaemia. The northern province has its own charity, so I was intrigued to speak to patients and their families and find out their personal experiences.
I first spent two weeks with paediatric hospital inpatients, going on the oncological specialist ward rounds that visited the unit and then speaking to the families of the patients on the ward.
It struck me how much of a role the parents play in the wards here. It is essential for there to be a family member with every patient, and they are much more intricately involved in the patient care than we see in Great Britain. The parents would be with the child all day during their stay on the wards. Ensuring their needs were met and acting as the responsible adult for each child.
A lot of the treatment for leukaemia is carried out as a hospital inpatient in Sri Lanka. Therefore, the child will spend a great deal of time in hospital. As mentioned, the parents are vital in the child's care and, therefore, it is a great difficulty for the whole family to be caring for the child whilst in hospital.
I learned that there is a large paediatric haematological malignancy unit in the country's capital of Colombo. That means that for patients who live outside of one of the large cities, families may need to travel to one such facility and spend a long time there caring for the child, with relatively little charitable support compared with what we experience in Great Britain.
Furthermore, the time spent on the wards really helped develop my scientific understanding of haematological malignancies, and their chemotherapeutic treatments, in the paediatric population, which is something I have never had much experience with before. It was invaluable for my learning. I now understand what these patients truly go through on a day-to-day basis which is so important to see first-hand to fully appreciate the immensity of it.
I spent the following two weeks on community medicine posts, which focused on serious paediatric conditions, prioritising haematological malignancies. Here, my focus was much more on the family experience of the disease and the treatment and care they received. The thing that struck me most about this period of study was the difficulty experienced by parents if they are worried that their child may be showing signs of illness.
There are no publicly-funded GPs. Instead, children receive basic health checks whilst at school. Doctors visit larger schools at grades 1, 4, 7 and 11, giving the children vaccinations and an overview health check.
However, even in these situations, it would be difficult to pick up signs of a haematological malignancy unless the child verbally discussed any complaints themselves.
Other than the school checks, the only ways a parent can get their child seen would be to pay for a private general practitioner - which many patients do not have access to. Or to queue up at the hospital from the early hours and hope to see a general paediatrician who can examine the child thoroughly.
However, it can take hours to be seen by a doctor in this way. Arriving at the hospital at 9 am, the corridors would already be filled with patients and families hoping to be seen by a doctor. Other than the access to care, most families reported feeling incredibly lucky to be treated at such an amazing facility and had nothing but praise for the care they had received.
This elective has truly changed my future in medicine.
It has taught me not only a great deal about the scientific and medical intricacies of treating haematological malignancies in paediatrics. But it has also truly opened my eyes to a healthcare system that has such a core role for the patient's family. And I feel very lucky to have witnessed this first hand.
Thank you to the BSH for giving me this opportunity and helping to shape my future career.
Firstly, I would like to say a tremendous thank you to the British Society for Haematology for awarding me a Student Elective Scholarship, without which my elective would not have been possible.
For my elective, I travelled to Seoul National University Hospital (SNUH) in South Korea to undertake a placement in paediatric haematology, a speciality in which I have been interested throughout my time at medical school.
As one of South Korea's leading tertiary hospitals with a 300-bed children's hospital, SNUH was an attractive location for me to gain a breadth of experience in both specialist and core haematology.
During my placement, I was supervised by Professor Kang Hyoung Jin, who has a specialist interest in the development of novel treatments for refractory leukaemia. I integrated into his team and attended handover, ward rounds and clinics, weekly radiology meetings, pathology meetings and journal clubs.
I was also given the opportunity to attend clinics for benign haematology. I was able to learn about the clinical trials they were undertaking and the process that this entails, both administratively and clinically.
During my elective, I completed two literature review projects that I presented at departmental meetings. The first review was centred on the key genetic mutations in acute myeloid leukaemia, their effect on prognosis and potential for targeted therapies. The second review concentrated on key haematological tumour antigens and related immunotherapies. It was a very useful opportunity for me to read about certain areas of malignant haematology in depth, allowing me to gain a good overview of promising future directions in these fields.
With South Korea being so culturally and socially different from the UK, I had to adapt to difficult communication and differing patient expectations.
The approach to offering investigations and discussing disease with patients was also very different from my previous experiences, with a focus on explaining pathology in detail. It was interesting to see how this changed patient experience of healthcare.
I was able to appreciate the remarkable work ethic and time management skills of the clinical team, from attending to over fifty patients in a single ward round to seeing patients in clinic with a turnover of five minutes.
I experienced challenging and educational medicine while learning how to holistically manage complex and very unwell paediatric patients.
Paediatric oncology with interest in haematology at the Royal Hospital for Children in Glasgow was a four-week venture into the Schiehallion ward.
Under the supervision of Dr Ronghe, I was able to diversify my learning between the three specialities that share the ward: oncology, haematology and transplant medicine.
Partaking in ward rounds and clinics of these three specialities and visits to the lab and apheresis unit at Gartnaval Hospital, I was able to see a vast amount in four weeks.
In addition, I completed two projects: the first was an audit of paediatric neuroblastoma patients. To complement this, a spreadsheet program to provide dates for a treatment plan for paediatric patients with neuroblastoma.
The core outcomes of my elective were to learn how paediatric medicine differs from adult medicine and contribute to the field by completing an audit. During completion of these educational outcomes, I would learn through exposure to different scenarios how a paediatric doctor fulfils his duty of care to his patients. Observing the interplay of various health professionals would, in turn, add to my growing understanding of what it means to be a health professional.
My supervisor, paediatric consultant Dr Ronghe, listened to my goals and ensured I could access the right people and facilities to achieve them.
He introduced me to consultant haematologist, Dr Kenneth Douglas, who explained the challenges of treating paediatric neuroblastoma. It became my audit subject.
Treatment is guided by the SIOPEN trial, which dictates whether the patient receives the N7 or COJEC chemotherapy. Peripheral blood stem cell (PBSC) transplant is a critical component in the treatment of neuroblastoma patients, as this ensures adequate populations of progenitor blood stem cells remain in the patient's bone marrow.
These cells are collected after chemotherapy once the bone marrow has had a chance to recover. However, the limited success of PBSC collections is thought to be contributed to by the design of the trial. My audit, therefore, centred on gathering data on which mobilising chemotherapy achieved the most successful PBSC collections.
In addition to my audit project, another doctor provided me with a brief on a second project. He stated a need for a program that effectively planned each stage of the treatment protocol for the SIOPEN trial. What resulted was a program that required one date for starting chemotherapy.
The code was such that an alteration in any of the dates - for example, a delayed chemotherapy treatment due to line sepsis - would result in the rescheduling of all other dates to the new timetable. In this way, a plan was available to both the healthcare team and the patient's parents.
I was proud of the final product, as when I took on the project, I was not confident in using Excel to this end. I used my initiative and, at the same time, gained an understanding of trial design that will benefit me in interpreting the complex details of some trials.
Delving into this audit, I developed my understanding of a new area of oncology. Neuroblastoma is an example of the malignancy of embryonic stem cells. I understand now why blastoma type cancers are prevalent in children and how they are treated differently. This linked to the necessity of PBSC transplants in the treatment protocol.
Learning about PBSC transplants provided a link between oncology and haematology, my special interest. Autologous transplants are different to allogeneic transplants as the aim is to encourage regrowth of the patient's native immune cells, in contrast to using the graft vs host effect to attack cancer cells.
Transplant and oncology specialities work together efficiently, and communication is aided by sharing the same ward. MDTs are held daily, and care is highly-coordinated. I noted, in particular, how tightly care was coordinated. And how this translated into benefit for the patient and their family. Parents were kept so well informed; in essence, the doctor-parent relationship was the basis for a greater trust placed on the doctor than I had seen before.
The weight of responsibility on the doctors was intense. Occasionally, the doctors' room was a place for consolation following conversations on dolorous topics with parents. The doctor must inform the patient's carers in such a way as to allow them to make decisions that may result in the death of their child. The parent places trust in the doctor's knowledge, their opinion, and in the speciality as a whole.
It was humbling to have even a minor role in the care of any patient. The privilege of treating any sick patient is an understanding I never want to lose hold of in my career. Taking responsibility for the care of a human in the most vulnerable period of their life is a humbling experience.
The weight of the responsibility can be shared among the team members. Everyone in a team has a different background and views, but in Schiehallion, I saw them brought together by their duty of care for their patients. The strength of a team comes from the safety they feel in their job. The confidence to make decisions does not come entirely from knowledge and experience but from the assurance received from being part of a dependable and cohesive team.
Ideally, I would have liked to have completed my paediatric block before my elective. It would have given me a greater appreciation of just how different a paediatric speciality is, compared to adult medicine.
I feel the most enjoyable aspect of an elective is the freedom to explore the areas you are passionate about without the restrictions placed on you to complete cases and coursework.
I am a student who works best with minimal guidance, and the audit work and Excel program I designed were examples of my best work. I had a task and a deadline. I planned as best as I could and got the job done.
The confidence I have gained from looking back at my work and seeing that I have made a difference - seeing what I can do when I grasp opportunities - will be something I wholeheartedly take forward in my fast-approaching professional life.
As part of my PhD, I focused on the role of a subset of natural killer (NK) cells - CD56bright NK cells - following IL-2 therapy. The elective period was principally spent learning new techniques and applying them in the context of a new scientific area of interest - the role of NK cell exhaustion in melanoma - in a collaborative laboratory environment.
It enabled me to explore further a field of interest (cancer immunotherapy) whilst also giving me more laboratory experience in a different system and a greater understanding of the translation of therapies from bench to bedside.
The Bhardwaj Research Laboratory has extensively studied the tumour microenvironment in melanoma to understand whether the cellular dysfunction seen in T cells is also present in natural killer (NK) cells.
In particular, these studies have focused on the immunoregulatory protein T cell immunoglobulin and mucin-domain containing molecule 3 (Tim3), a mediator of exhaustion in T cells, understanding its role in NK cells and whether exhaustion of this cell subset contributes to disease progression. These cells reduce their cytokine secretion in the context of melanoma, and this project was to further investigate the profile of such putatively exhausted cells.
I also had the opportunity to spend time with clinicians and others in the translational pathway to more fully understand how these treatments were moving from bench to bedside and to observe their effects on patients.
The sheer speed of development of new therapeutics and the very impressive remission rates using such drugs is remarkable. The effects on patients are extremely dramatic, both in terms of life-lengthening and quality of life.
In addition, I was able to spend time becoming familiar with new forms of personalised medicine, for example, the use of tissue biopsy. And humanised mouse models of tumour growth to characterise the genetics and test therapies or particular drugs in the context of their specific disease.
At present, the model is not fast enough to impact directly upon the individual patient's care, but in the future, the use of such techniques may revolutionise cancer care.
This elective gave me a fantastic opportunity to develop my PhD skills and knowledge in a new area.
Already having some skills developed in those years helped enormously, as I was able to immediately perform a number of experiments and pick up other techniques quickly. Working in a different environment from my PhD was also helpful to really understand how various laboratories engage with the science, and the different research regulatory and academic environment was interesting to experience.
Overall, my elective most certainly did meet and exceed expectations. I am delighted to have gained a poster from the research period. I was made extremely welcome in the laboratory, and overall, it must be said, that New York City is a great place for both academic and social collaboration.
I would like to express my sincere gratitude to the British Society for Haematology; the University of Cambridge Clinical School (Hawkins Award); Queens' College, Cambridge; the Royal College of Physicians; the British Medical and Dental Students' Trust and the Gilchrist Trust for funding this amazing opportunity. And to Elena Gonzalez-Gugel and Nina Bhardwaj for their supervision, support, and for making this possible.
Firstly, I would like to thank the British Society for Haematology for sponsoring this period of elective study.
I carried out my elective in the state of Kerala, tucked away in the southwestern corner of India. I chose Kerala as my elective location as it is the place of my parents' origin, and from previous visits to India, it is somewhere I can identify with culturally.
I was intrigued by the 'Kerala model' of development, which has seen the state achieve the best living conditions in India. With only 3% of India's population, this diminutive state excels in indicators of social development such as low levels of infant mortality and population growth; the highest levels of literacy in the country, particularly among females; and higher life expectancy relative to the whole Indian population.
These statistics are even more impressive considering such indicators are comparable to many developed countries despite Kerala's per capita income being much lower. I wanted to explore the basis for the state's impressive health standards and compare it to the UK's National Health Service.
Unfortunately, Kerala is reported to have the highest number of cancer patients in the country. I wanted to study whether cancer care was proficient in Kerala, so I decided to visit the Regional Cancer Centre (RCC) in the state capital, Thiruvananthapuram.
The RCC is an autonomous scientific institution sponsored jointly by the government of Kerala and the government of India, which prides itself on being an internationally recognised centre providing state-of-the-art care.
I also had a specific interest in haematological malignancies and was allocated to observation in the Medical Oncology department. I was expected to attend the morning ward round, where the majority of patients were diagnosed with acute myeloid leukaemia (AML), acute lymphoblastic leukaemia (ALL) or non-Hodgkin lymphoma. Just as in the UK, all three are present in the top twenty types of cancer.
The ward looked barren, the only cooling was from ceiling fans, and there were no curtains between patients' beds.
The ward round consisted of a senior resident and a nurse working in a pair, reviewing the female and male bays, during which time each of the three consultants would pop in at various periods to check on their patients.
The senior resident would check any outstanding blood results, palpate for any new lymphadenopathy, look inside the mouth for fungal infection, and auscultate the chest for signs of respiratory disease.
Once the rounds were completed, I was afforded the opportunity to observe patients receiving lumbar punctures and administration of intrathecal methotrexate as part of their chemotherapy regimen. The residents were amicable and keen to explain the intricacies of the various chemotherapy protocols.
I was briefed about routine investigations such as blood tests and what important parameters to look out for. I was able to observe how diagnostic methods were being employed in the laboratory. Bone marrow studies helped identify possible chromosomal translocations, and flow cytometry classified various cell populations that were used to identify types of leukaemia.
I was also shown newer techniques required in the identification of the Philadelphia chromosome, such as fluorescence in situ hybridisation (FISH) and spectral karyotyping (SKY).
During the afternoons, I was expected to attend outpatient clinics. These were undoubtedly the highlight of my trip. The outpatients' department consisted of two consulting rooms with a room dedicated to procedures adjacent to them.
The rooms were swelteringly hot, and there were no facilities for cooling. Each room was smaller than a standard NHS consulting room, and personnel were split, with consultants being in one room seeing follow-up patients and junior doctors in the other clerking in new patients. There would always be three doctors in each tiny room working simultaneously and up to 10 people in a room, including patients, nurses and relatives.
I was overwhelmed by the turnover of patients within the department; one could argue it is up to three times as efficient as an NHS outpatient clinic despite a complete disregard for patient confidentiality.
On my first day, I was handed a pile of new patient notes and asked to call in patients to be clerked while being supervised by one of the postgraduate doctors. I found it extremely challenging to clerk patients in my native language, Malayalam. Even though I was reasonably fluent in conversing with the local population, asking questions or explaining complicated medical concepts was a struggle. Fortunately, my supervisors often came to my rescue.
There are vast differences in practice between the UK and India regarding communication from caregivers. I was present when bad news was broken to a patient about a cancer diagnosis in what seemed like an insensitive manner, without the classical 'warning shot' we are taught at medical school. The patient felt understandably devastated and, being the breadwinner from a modest farming family, was fearful about the cost of treatment. Fortunately, at RCC, cancer treatment is subsidised by the Indian government, with more funding available for those on a lower income.
There has been much discussion over the role of Ayurveda in cancer treatment. It is an ancient Indian system of medicine involving therapies based on complex herbal compounds, prayer, meditation and nutritional supplements as a means of healing from cancer.
According to Cancer Research UK, there is no scientific evidence to prove Ayurveda can treat cancer. Experts at RCC I spoke to corroborated this conclusion and further went on to mention how some patients try alternative treatments first due to their perception of the financial burden a cancer diagnosis may create, which then fail, resulting in patients presenting late, at a stage when their disease cannot be cured.
Overall, I have enjoyed my trip to Kerala. The weather was fantastic, the people were a joy to work with, and the food was delicious and cheap!
I was exposed to a wide variety of clinical presentations, and I was able to gain a lot of valuable hands-on experience.
Being thrown into the deep end by being asked to communicate in a different language, and diagnose and work out appropriate treatment strategies, proved to be an important character-building experience. I will definitely be carrying forward these positive experiences into my clinical practice.
The deadline for the Visiting Fellow grant is 30 June.
Please allow sufficient time for your application to be reviewed, usually 6-8 weeks after the deadline.
Please note: Retrospective claims will not be considered.
Sickle cell disease and β-thalassemia are common monogenic disorders that cause significant morbidity and mortality globally. Currently, the only curative treatment is allogeneic hematopoietic stem cell transplantation. It is unavailable to many patients due to a lack of matched donors and carries risks, including graft-versus-host disease.
Genome editing therapies targeting the BCL11A erythroid enhancer or the HBG promoter are already demonstrating success in reinducing fetal haemoglobin. However, where a single locus is targeted, reliably achieving levels high enough to deliver an effective cure remains a challenge.
We investigated the application of a CRISPR/Cas9 multiplex genome editing approach, in which both the BCL11A erythroid enhancer and HBG promoter are disrupted within human hematopoietic stem cells.
We demonstrate superior fetal haemoglobin reinduction with this dual editing approach without compromising the engraftment or lineage differentiation potential of edited cells post-xenotransplantation.
However, multiplex editing consistently resulted in the generation of chromosomal rearrangement events that persisted in vivo following transplantation into immunodeficient mice. Therefore, the risk of oncogenic events resulting from such translocations currently prohibits its clinical translation. But it is anticipated that, in the future, alternative editing platforms will help alleviate this risk.