Response: Interview Questions For Prof. Slavin

Dear Emily,

Here are some answers to your questions:

1. I have been practicing medicine since 1967. As soon as I finished my studies and internship I joined compulsory service in the navy and was the doctor of the frogman unit.
2. I practice mostly cell therapy and immunotherapy that is to say, using cells (hematopoietic stem cells, lymphocytes, mesenchymal stromal stem cells etc) in order to treat patients in need with nature's own tools. Mostly I am recognized as an expert in the field of stem cell transplantation for curing hematological malignancies, genetic diseases, diseases caused by deficiency of bone marrow products etc. More recently the use of stem cell transplantation has been extended to a treatment of certain types of other cancers as well as life threatening autoimmune diseases.
3. Indeed, cell therapy is exciting mostly because using such innovative modalities we can cure patients considered incurable by any other method. I started to study the role of stem cells first in experimental animals at Stanford University in 1975-1978 and then practiced stem cell transplantation at the Fred Hutchison cancer center in Seattle, Washington. I then developed new procedures for bone marrow transplantation based on better immunosuppression for prevention of rejection of donor bone marrow cells and subsequently came up with new ideas on how to use donor lymphocytes to kill cancer cells that are resistant to chemotherapy and radiation, a procedure known as donor lymphocytes infusion (DLI). The first case of DLI treatment was in December 1986 with a 2.5 year old boy who was considered incurable after a failed treatment with allogeneic stem cell transplantation and he was cured (still alive and well today, >20 years out) thus proving for the first time that lymphocytes can be more effective than any aggressive anti-cancer modality known.
4. I began research when I was in high school and then during the last years of med school and even today, as a qualified doctor, I am always involved in basic and clinically applied research trying to apply innovative modalities at the patient bedside.
5. DLI is a procedure started by me. Initially everyone was skeptical and couldn't believe that such a simple maneuver could cure patients that were otherwise resistant. Despite initial skepticism subsequently many people reproduced my work, and claimed they invented it... Many of them receive more recognition and awards than me but that is fine. The role of lymphocytes in eliminating undesirable host cells was the main concept that led to non-myeloablative stem cell transplantation. Although the concept was that in order to cure cancer the patient must receive maximally tolerated doses of chemotherapy and radiation in an attempt to physically kill all cancer cells and use the transplant as a rescue procedure, my concept in view of the above was that the role of transplant is mostly to achieve host-versus-graft tolerance and once tolerance is established donor lymphocytes can be permanently accepted and then they have an ample amount of time to do their job: elimination of undesirable malignant cells of the host.
6. The most common diseases that we can treat successfully with immunotherapy by allogeneic lymphocytes are all the hematological malignancies. Some of them respond better than others (for example: chronic myeloid leukemia).
7. I specialize in all forms of stem cell therapy including autologous stem cell transplantation, allogeneic stem cell transplantation from a matched donor, matched unrelated donor, cord blood stem cells and half-matched family donors. We are using transplants also of an enriched sub-population of stem cells known as mesenchymal stromal stem cells (MSC) because such cells are very [XXX cut off XXX].
8. CTCI is a new center, 2 years old. We treat several patients every day and our focus is personalized treatment and as such we devote each patient a lot of time because every patient is different and every cancer is different and therefore treatment cannot be the same and all the new principles must be well explained to the patient and their treating physician.
9. We never use embryonic stem cells for cell therapy. It is too early to do so because of many unsolved problems and anyone who does so at present time should be considered a charlatan.
10. My most memorable case is the boy who was first treated with DLI. He was cured and following his treatment a new concept was introduced in medicine and now thousands of patients all over the world owe their lives to this little child. We have other memorable cases as well, such as one Filipino girl treated at the age of 12 who is now a doctor 16 years later and she was the first one to prove that activated lymphocytes can cure cancer even without stem cell transplantation provided that patient is treated at the state of minimal disease. Another remarkable case we had that may change history of medicine in that particular field was the first case of successful gene therapy of severe combined immune deficiency. This is a disease that is sometimes called bubble baby disease because patients are born without an immune system and are susceptible to infections and cancer. We could show using a new approach that gene therapy could be used to cure such patients following our successful first case additional cases were done in Italy and all of them showed remarkable response to treatment using the same method used to treat the first child. We have additional modalities but I think it is enough for now.
11. Cancer immunotherapy is using the immune system to fight cancer.
12. Innovative treatment takes time to be expanded to other centers. Most doctors are initially very skeptical and it takes many years to receive meaningful and conclusive results. Unless such results are obtained colleagues are always skeptical and therefore, unfortunately, many patients in need cannot benefit from innovative treatment simply because their treating physicians are not aware of innovations in medicine.

I hope this information was useful, best luck to you on your project.