When Manali Kamdar, MD, joined the University of Colorado School of Medicine’s Division of Hematology as clinical director of lymphoma services in January 2015, she was fresh off her third fellowship (a bone marrow transplant and lymphoma fellowship at Stanford) and ready for a new challenge.
"At that point in time there was no lymphoma specialist within the division — every hematologist was seeing lymphoma patients. So, they were looking to hire a lymphoma lead to build a program,” Kamdar says. “As someone just out of training, I didn't really have any experience with leadership, but I took a leap of faith, and the division took a leap of faith in me.”
In the last six years, Kamdar and her growing team have made great progress.
Building a lymphoma program
Around the same time, Craig Jordan, PhD, was brought on as chief of the Division of Hematology, and Clay Smith, MD, came on as medical director. All three are CU Cancer Center members, and Jordan is also program co-leader for the Cancer Center’s Molecular and Cellular Oncology Program.
“Together, I think their vision has been really marvelous,” says Kamdar. “I knew that they were extremely supportive of the lymphoma program from the get-go.”
Kamdar’s first two goals for the program were to grow the number of patients and faculty members.
“With about 85 different subtypes of lymphoma, one faculty member was never going to be enough,” she says.
A few months after Kamdar started the program, she helped recruit Brad Haverkos, MD, a specialist in T-cell lymphomas and CU Cancer Center member. With two full-time lymphoma specialists and a focus on marketing the program and increasing referrals, Kamdar said the patient volume “skyrocketed,” with patients coming not just from Colorado but also from New Mexico, Wyoming, Kansas, and Nebraska.
By 2020, the program had more patients than it could handle. So, in the midst of the COVID-19 pandemic, Kamdar and the hematology leadership recruited two more lymphoma faculty members: Jagar Jasem, MD, MPH, now leads the lymphoma services at the Highlands Ranch Specialty Care Center, and Steven Bair, MD, specializes in B-cell lymphomas with a focus on bioinformatics on the Anschutz campus.
“We want to cure every single patient that walks through the door. That may seem like a lofty goal right now, but we hope to achieve it in the next few years as we continue to work together as a team.” - Manali Kamdar, MD
Kamdar and the other lymphoma specialists have also opened numerous clinical trials with the support of the hematology clinical trials unit.
“Thankfully, all the clinical trials that Dr. Haverkos and I initially opened led to FDA approval of the drugs,” Kamdar says. “This meant that our patients could get the drugs much sooner, control their disease better and have a higher chance of staying in remission.”
“In addition to developing a clinical trials program that would help patients with relapsed lymphoma we also wanted to build a tissue bank, as well as a usable database which would further assist us in unravelling the molecular underpinnings of lymphoma and assess our patient outcomes in the long run,” Kamdar says. “Over the last few years, we have been able to meet these goals and hope to continue our work on the clinical as well as on the research end”
Creating a successful lymphoma program also required investment in other areas, such as educating the support staff and forming relationships with other departments and programs on campus. For example, Kamdar partnered with Lavanya Kondapalli, MD, director of the Cardio-Oncology program and CU Cancer Center member, to start a lymphoma-specific cardio-oncology program.
“We have an established lymphoma cardio-oncology program where every single lymphoma patient who gets a particular type of chemotherapy that may put them at risk for cardiotoxicity sees Dr. Kondapalli and her team for follow up,” Kamdar explains. We have analyzed our outcomes with this approach and have been able to show immense utility in being able to prevent cardiotoxicity in our at-risk patients.
The lymphoma faculty have also focused on partnering with other lymphoma programs around the country on research to help increase awareness of the CU program and build its credibility, including both retrospective and prospective lymphoma studies.
Looking toward the future
Kamdar and her team’s goals for the program moving forward center on continuing to launch chemotherapy-free immunotherapy-focused clinical trials with the aim of curing hard-to-treat lymphomas without increase efficacy without increasing toxicity.
“Over the past few years, we have made a lot of progress with respect to CAR T-cell clinical trials,” Kamdar says. “It is probably one of the most promising immunotherapeutics for patients with relapsed aggressive lymphomas. Currently, we have a robust clinical CAR T-cell program, wherein Dr. Bair will be focusing on bioinformatics, Dr. Jasem will be looking at outcomes and toxicity assessment, and Dr. Haverkos will focus on similar immunotherapy approaches for T-cell lymphoma patients.”
Kamdar says that the leadership has been very supportive of hoping to recruit a translational scientist to join the team. “I think it will be really helpful to have a translational scientist join our clinical team which would be the perfect way to deep dive into the biology of lymphomas. It would be a dream come true to translate some of the fascinating discoveries made in the lab to clinical trials for patients, which would truly bring ‘bench to the bedside!’”
Kamdar reiterates that the overarching goal of the lymphoma program and her team is to provide top-notch care to our patients. To that end, she also hopes to open a survivorship clinic for lymphoma patients who have been in remission or are cured. This would finally then come a full circle.
“We want to cure every single patient that walks through the door,” she says. “That may seem like a lofty goal right now, but we hope to achieve it in the next few years as we continue to work together as a team.”