I dream of a future where it’s possible to prevent deadly cancers like AML.
My work leverages genomics, biostatistics, and epidemiology to build the foundation for early detection of pre-leukemic conditions and AML prevention.
Central to these efforts are themes of inclusion and equity. Just as all patients with AML should have access to current standards of care for management and treatment of the disease, all patients at risk for developing AML deserve the opportunity to participate in early detection and early intervention research!
Clonal Hematopoiesis Risk Score (CHRS):
Clonal hematopoiesis is the term used to refer to an asymptomatic precursor state for blood cancers such as acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) and myeloproliferative neoplasms (MPNs). Just as all skin moles (asympotmatic precursors of skin cancers) do not progress to skin cancer, all clonal hematopoiesis does not become blood cancers. Risk stratification is critical to communicating risk of progression with patients and for developing interventions that target the populations most likely to benefit. The CHRS is a simple and intuitive risk score that groups individuals with clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of uncertain significance (CCUS) into groups based on their 10-year risk of incident myeloid malignancy (MDS, AML or Philadelphia chromosome negative MPN). Over 50% of individuals defined as high risk by the CHRS will develop myeloid malignancy by year 10. This is compared to a 10-year MN risk of only 8% in individuals defined as intermediate risk and less than 1% in individuals defined as low risk. This is the first risk bonafide risk stratification tool for clonal hematopoeisis. Suggested usage includes providing patients with an absolute risk estimate of their risk of developing malignancy in steady state conditions (this model is not validated for individuals undergoing chemotherapy or radiation) and for selecting high risk patients for enrollment in clinical trials testing therapeutic interventions for CHIP and CCUS.
“Inflammaging” in Myeloid Malignancies:
A higher rate of inflammatory diseases of aging, also called diseases of inflammaging, are observed among individuals with myeloid malignancies. Using SEER-Medicare data, we analyzed the prevalence of diseases of inflammaging in the 5 years antecedent to hematologic malignancy. We observed that chronic inflammatory cardiovascular, pulmonary, bone and joint, and metabolic diseases were increased in prevalence in individuals carrying diagnosis of MDS or CMML compared to individuals without these diagnoses.
Race and Science:
Diversity in the hematology workforce is beneficial to our patients, trainees and overall community. Data indicates that diverse workforce enhances innovation and improves patient experience. Effective communication about equity, antiracism and diversity are essential to creating inclusive environments.