Periodically, the Office of Philanthropy invites City of Hope® leaders, faculty and researchers for conversation to learn more about them and their groundbreaking work.
We spoke with Eileen Smith, M.D., the Francis & Kathleen McNamara Distinguished Chair and Professor, Department of Hematology & Hematopoietic Cell Transplantation. She has spent three decades at City of Hope as an integral member of its nationally renowned transplantation practice.
Q: What inspired you to pursue a career in oncology?
I was a fellow at USC in hematology, taking care of a patient named Tara. She was 21 years old, had a 6-year-old son and was a single mom. She had chronic myeloid leukemia in blast crisis. In 1986 there were no drugs specifically for chronic myeloid leukemia. Tara was kind of a flower child. She had a guitar with her all the time, and when other patients were having a rough day, she would sing them to sleep. Just one of those people that radiated love. I called City of Hope because I knew bone marrow transplant was potentially curative for this disease, but there was no registry yet for unrelated donor transplants. Tara passed away, but my encounter with City of Hope stayed with me. They took time to hear about my patient, discuss her treatment and offer advice, support and comfort to me and my patient. I thought: I’ve got to go to City of Hope and figure out what transplant is about, because there’s got to be a way to help people like Tara. I was just so taken by the passion and engagement of that team and how they all went the extra mile for every patient.
Q: What is your perspective on the changes at City of Hope and how the field of hematology has evolved?
The changes at City of Hope have been most dramatic in the last 10 years. There were no major treatment paradigm shifts in the first 10 years I was in the field. The science of immunology had to advance to where we understood how to do better donor/recipient matching before we could do unrelated donor transplants. We clinicians are fortunate to be at a place like City of Hope where scientists in the Beckman Research Institute were working on those problems. Now we do multiple unrelated donor transplants in the same day. We do 800 transplants a year. We’re all working together for the good of the patients. There’s this connection that people have here to a mission that is bigger than themselves. They really feel engaged in something that is making the world a better place.
Q: What has been one of City of Hope’s greatest successes in hematology or transplantation?
City of Hope is now known for transplantation and cellular therapy which makes sense because cellular therapy is really an extension of cell-based transplant therapy. A big obstacle to transplant success was graft-versus-host disease, when the cells of the donor recognize the recipient’s tissues as different and start attacking them. So, you have to develop medications that will suppress those donor immune cells, but you’ve got to find that fine line, because if you suppress immune cells too much, you risk increased infections. City of Hope was a pioneer in investigating clinical trials of different combinations of immune-suppressing drugs to find the best way of preventing graft-versus-host disease. Because of knowledge and experience gained from these trials, we are now the largest center in the country in the volume of unrelated donor transplants.
Q: How does City of Hope’s work in transplantation relate to its leadership in cellular therapies?
The work on understanding, preventing, and treating graft-versus-host disease led to our expertise in cellular therapy. We realized that the actual therapeutic benefit of the transplant is: We’re harnessing the power of the immune system of the donor to have an immune-mediated graft-versus-leukemia effect against the leukemia cells. The logical extension is: Is there another way to harness that effect without doing a transplant? You don’t need to repopulate the whole bone marrow to accomplish that. You need to get T cells that are programmed to recognize the cancer cells as different and eliminate them, and that’s the basis for CAR T cell therapy (chimeric antigen receptor therapy).
It makes perfect sense that a center like City of Hope, which had a group of scientists and clinicians totally focused on how to improve the transplant therapy, would make the next step into developing CAR T therapy. Today, we have the largest and most successful bone marrow and blood stem cell transplant program in the nation and one of the largest and most comprehensive immune cell therapy programs in the world. There is no other center that excels in both of those areas.
Q: What is the role of philanthropy in your work?
Thank you to every one of our philanthropy partners, because the work we do is work that has to be supported. If we spend all of our time writing grants to get funding, we’re not going to be making progress fast enough. Every day of grant writing that we save because we have philanthropic support gets us to life-saving innovations faster.
Every day of grant writing that we save because we have philanthropic support gets us to life-saving innovations faster.
-Eileen Smith, M.D.
Q: What do you see for your team in the next three to five years? What are you most excited about?
One goal is to make sure that the quality of care in transplant and cellular therapy at City of Hope’s sites in Phoenix, Atlanta and Chicago is as good as the care in Duarte.
The next focus will be the further development of immunotherapies with bispecific antibodies, an antibody that has two portions: One attaches to the tumor cell, the other attaches to a T cell and brings them together to achieve immune-mediated eradication of the cancer cells. Maybe 10 years from now we wont do CAR T therapy anymore because we have these bispecific antibody approaches that can accomplish the same purpose of activating T cells to eliminate cancer cells.
The final goal to increase delivery of these is to do these therapies in the outpatient setting. We want to help as many patients as we can. If we find ways to deliver these therapies safely in the outpatient setting, we will have more in-patient beds for therapies that can only be done in the outpatient setting.
Q: What’s your favorite thing about what you do at City of Hope?
The bone marrow transplant reunion every year and seeing patients that I cared for 20 and more years ago. Hearing how they’re doing and what’s new in their lives. And seeing them watch their kids and their grandkids grow.