Areas of Interest
Chronic lymphocytic leukemia/Small lymphocytic lymphoma; Leukemia precursor states including clonal hematopoiesis (sometimes referred to as “CHIP” – clonal hematopoesisis of indeterminate potential) and CCUS – clonal cytopenia of undetermined significance); Monoclonal B-cell lymphocytosis; Myelodysplastic syndromes; Hairy cell leukemia; Large granular lymphocytic (LGL) leukemia; Prolymphocytic leukemia
I have two major areas of research interest. First, I have an interest in clonal hematopoiesis (CH), which denotes the presence of somatic mutations in hematopoietic cells in absence of hematologic malignancy. CH is an increasingly recognized and appreciated entity with a risk for development of subsequent hematologic cancer but also with increased risk for cardiovascular complications via increased inflammatory signaling. My focus involves the impact of CH on patients with non-hematologic cancers. My work has focused on characterizing this risk through both broad and specific cancer cohorts. Through prior work, I have demonstrated that CH leads to an increased risk of therapy-related hematologic cancers and shorter survival when the mutations are at high variant allele frequencies and in presumptive drivers. I have also shown an association between CH and prior radiation and prior chemotherapeutic agents. My next focus has been on how CH can confound interpretation of next-generation sequencing (NGS) assays of unfractionated tumor biopsies, which are used frequently in the workup and management of oncologic patients. I have started a “precursor clinic” at UNC in September 2020, where I focus on seeing patients with CH and “CCUS” (clonal cytopenias of undetermined significance). This clinic involves counseling regarding the risk of these mutations to patients’ health, ongoing monitoring for clonal evolution, and mitigation of risk for cardiovascular complications.
My next focus is in the clinical care of patients with chronic lymphocytic leukemia, which has led me to participate in multicenter studies examining the “real-world” implications of novel therapeutic agents on the lives of patients. This work has helped answer important questions regarding the role of novel agents, including the importance of sequencing available agents and combination versus monotherapies. I have additionally worked with a number of individuals in the Pharmacy department to better understand the role of adherence to oral chemotherapeutic agents for patients with chronic lymphocytic leukemia. Lastly, I have served as an investigator on a number of clinical trials, including both cooperative group studies run by ECOG and Alliance and early-phase trials of novel agents.
Education and Training
- Undergraduate Saint Louis University
- Medical School University of Cincinnati
- MS University of Cincinnati
- Residency Duke University Medical Center
- Fellowship Memorial Sloan Kettering Cancer Center