MGH Joins Multinational Effort to Provide Earthquake Relief in Iran

In response to an urgent request from President Bush, a team of 24 MGH clinicians flew to Bam, Iran on December 27 to provide emergency medical assistance to the victims of a devastating earthquake that claimed the lives of 41,000 people and injured 17,000 more. Working alongside medical colleagues from France, Norway, Spain, Ukraine and 15 other countries, the MGH clinicians were among the first Americans to enter Iran in an official government capacity since the Islamic Revolution of 1979.

The MGH group - which consisted of 14 nurses, six physicians, two respiratory therapists, one physician assistant and one pharmacist - traveled to Iran under the auspices of the International Medical Surgical Response Team (IMSuRT), which was founded by Susan Briggs, a celebrated MGH surgeon and pioneering disaster relief expert, after the 1998 terrorist attacks on US Embassies in Kenya and Tanzania.

Able to mobilize in about four hours and capable of rapidly assembling a portable hospital anywhere in the world, IMSuRT is the only civilian medical team of its kind in the U.S. Two thirds of the IMSuRT team is comprised of MGH clinicians; the remaining third come from other New England hospitals, including Children's Hospital and the Boston Shriners Hospital.

Over a period of 10 days, the IMSuRT team treated 727 patients. They delivered six babies and performed seven operations. Most of the patients had been buried under rubble for hours and required treatment for broken bones, spinal injuries, respiratory infections, head trauma and psychological problems.

The Iran mission marked IMSuRT's third deployment; many of the MGH personnel who went to Bam had previously been called to the World Trade Center after the Sept. 11, 2001 terrorist attacks and to Guam in the aftermath of a typhoon in 2002.

Photos courtesy of the Federal Emergency Management Agency

Letter from the Executive Director

Many of you will have seen stories in the international media about MGH's extraordinary response to the devastating earthquake in Bam, Iran. Inspiring and newsworthy, the MGH clinicians involved in the Bam mission exemplify the very highest ideals in global medicine. But beneath the headlines, there are hundreds of similar, untold stories in which caregivers from the Partners' hospitals travel around the globe, many on their own time and expense, to offer critical services to those in greatest need.

On any given day, our staff may be found repairing cleft palates in Russia, performing GYN surgery in Nigeria, battling TB in Haiti, or training midwives in Honduras. Without exception, the volunteers who return from these missions report a kind of "reverse philanthropy" - they feel that they receive so much more than they give to their patients. Plastic Surgeon Jacob Joffe, a veteran of 14 humanitarian missions, typified this experience when he commented that international work "helps remind us all why we went into medicine in the first place."

Dr. Joffe's philosophy is shared by a growing number of young physicians, nurses and other professionals who expect to participate in international medicine, but all too often find that choosing to do so comes at the expense of their careers. Currently there is even less incentive for mid-career professionals to devote significant time to global health. If the medical establishment values these activities, and at Partners the evidence is clear that we do, we need to do a better job of providing incentives and support within our own walls.

This month Harvard Medical School is introducing a new course entitled "Physician in Community: A Service Learning Course in Community Medicine and International Health." Beginning in July, Brigham and Women's Hospital will offer a unique four-year residency in "global health equity." These new developments, as well as the recent establishment of the Durant Fellowship in Refugee Medicine at MGH, reflect the emerging integration of global health into training programs within the Partners community.

Physician Profile: Ik-Kyung Jang

"I was drawn to cardiology because the heart is the most dynamic and important organ in the body," explains Dr. Ik-Kyung Jang, "And in an academic medical environment, you are continuously developing new treatments and better diagnostic tools. For me, that is the joy of being a physician."

Indeed, Dr. Jang has made "continuous development" - both personal and professional - one of the central themes in his life. After earning his M.D. in 1980 at Kyung-Hee University in Seoul, Dr. Jang set his sights upon Harvard University in the U.S. Unfortunately, at the time there was no exchange program between Kyung-Hee and Harvard. As a result, Dr. Jang became the first Kyung-Hee graduate ever to be granted a fellowship to Leuven University in Belgium.

"Prior to arriving at Leuven," he recalls, "I had been told the language of study was English. On my first day there, a professor asked me if I wanted to focus on cardiology research or clinical practice. When I chose clinical practice, the professor said, 'Okay, but first you have to learn Dutch.'"

Ten months of night school did the trick.

While at Leuven, Dr. Jang studied under the renowned Belgian scientist Desire Collen, who developed TPA, which is one of the world's most widely prescribed medications for heart attack. Within a span of 7 years, Dr. Jang completed his medical residency, a fellowship in Cardiology and a doctorate in Physiology... all in Dutch.

Today Dr. Jang is one of the most active interventional cardiologists at Massachusetts General Hospital. He is also internationally recognized for his pioneering work with Optical Coherence Tomography (OCT), a new imaging technology that preempts heart attacks by identifying vulnerable arterial plaque. Vulnerable plaque causes 85% of all heart attacks, and experts estimate that OCT could soon prevent approximately 1 million heart attacks each year.

Photo by Paul Batista

Next Generation Blood and Bone Marrow Transplantation

by Joseph H. Antin, MD Chief, Medical Oncology Stem Cell Transplantation Program, Brigham and Women’s Hospital and Dana-Farber Cancer Institute Associate Professor of Medicine, Harvard Medical School

Hematopoietic stem cell transplantation (HSCT) is an excellent treatment for leukemia, lymphoma, and blood disorders. Advances in research and clinical practice, along with the increasing availability of national and international marrow and cord blood donor registries have made this therapy possible and beneficial for more patients with a broader range of diseases.

The Stem Cell Transplantation Program at Brigham and Women's Hospital and Dana-Farber Cancer Institute, now in its thirtieth year, is one of the largest and busiest in the United States, and its scientists and physicians have among the longest HSCT experience in this country. Our patients benefit from all the resources of Partners HealthCare, not only in transplantation, but in hematologic oncology and related disciplines, as well.

We offer the highest level of care, including the full spectrum of transplant activities - autologous, matched family member, unrelated donor, cord blood, and peripheral stem cell transplantation. Our clinicians and scientists are in the forefront of translating important research findings to clinical practice, and we can offer our patients both conventional and innovative treatments and participation in national, local, and institutional trials of promising new treatments.

Our services include:

• Consultation, confirmation of diagnosis, and review of therapeutic options, including non-transplantation alternatives
• Arrangements for unrelated donor stem cell collection
• Conventional and innovative treatments, and
• Post-transplant care, including collaboration with local hematologist/oncologists.

Chemotherapy-related toxicity and graft versus host disease (GVHD) are significant complications of allogeneic transplantation. Thus, immunologic cancer control - maximizing the graft versus malignancy response and minimizing GVHD - is the focus of our research and clinical programs.

Allogeneic transplantation following non-myeloablative chemotherapy

Patients treated with this so-called "reduced intensity transplant" receive lower doses of chemo and/or radiation therapy that destroy some but not all of the cancer cells and bone marrow, followed by allogeneic stem cell transplantation. We intend by this approach to take advantage of the graft versus malignancy effect to further destroy cancer cells. We hope to achieve maximum engraftment and disease control with minimum toxicity.

Currently, we are offering the reduced intensity approach for two groups of patients, higher risk patients - older and/or sicker patients who would not be expected to tolerate conventional conditioning therapy and would be deferred for transplantation - and patients who have had previous autologous transplants and have relapsed. If it is successful in these groups, we believe it may be equally or perhaps even more effective in selected other patients.

Our challenge is to demonstrate which diseases are susceptible and which are resistant to this approach. We expect that reduced intensity may prove to be a good alternative for patients with slow-growing malignancies including chronic myeloid leukemia, low-grade lymphoma, myelodysplasia, and chronic lymphocytic leukemia - diseases that are incurable with routine therapy. However, it also is effective in patients with more aggressive disease, particularly when transplantation is undertaken in disease remission.

Multiple Myeloma

Currently, in addition to a number of institutionbased trials of non-myeloablative therapy, we are participating in a national multicenter clinical trial, sponsored by the Clinical Trials Network of the National Institutes of Health, for patients with multiple myeloma. This is a randomized trial comparing autologous transplant followed by reduced intensity transplant with autologous transplantation followed by conventional dexamethazone and thalidomide. Similar trials for patients with Hodgkin and non-Hodgkin lymphoma are currently in development, and we hope to begin enrolling patients within the year.

Allogeneic peripheral blood cell infusion with selective T cell depletion

This investigational therapy involves infusion of an engineered blood product from peripheral blood. We believe that if we remove CD8 cells, the CD4 cells can provide a potent graft versus tumor effect with less risk of GVHD. Preliminary data from an already completed trial with matched siblings have been quite encouraging, and we are now seeking to enroll patients who are getting unrelated donor transplants with conventional dose conditioning therapy.

GVHD prevention with sirolimus-based combination therapy

Graft versus host disease remains a risk of HSCT, and a number of our clinical trials are targeted to new methods of GVHD prevention and control. Augmenting standard therapy (tacrolimus and methotrexate) with sirolimus, we hope to reduce the use of methotrexate while enhancing GVHD control. In a study of patients receiving unrelated donor transplants, we have been able to achieve good GVHD control and eliminate the use of methotrexate altogether, resulting in less toxicity to the patient. Currently we are conducting a trial of this regimen without methotrexate for matched sibling transplants, and so far, the results have been outstanding. We are offering this therapy in a reduced intensity form, as well.

For further information on these and other clinical trials in stem cell transplantation, please visit our website at http://www.cancercare.harvard.edu/cli/find.asp. Questions related to patient referrals may be directed to Ann McKay, R.N., B.S.N. at 01 (617) 724-6420 or amckay1@partners.org.

The Stem Cell Transplantation Program is a service of Dana- Farber/Partners CancerCare, a collaboration in adult oncology among the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Massachusetts General Hospital. Stem cell transplantation is performed at the Dana-Farber/Brigham and Women's Cancer Center, as well as at the Massachusetts General Hospital Cancer Center.

BWH Performs First Quintuple Lung Transplants

Last month BWH performed America's first quintuple lung transplants. Led by a team of expert thoracic surgeons including Dr. David Sugarbaker and Dr. Raphael Bueno, more than 100 BWH surgeons, nurses and staff harvested five lungs from three separate donors and transplanted them into five patients within a 36-hour period.

Advances in Acute Trauma Management:
An International Conference for Physicians, Nurses, Paramedics and Emergency Medical Technicians Hamilton, Bermuda, April 22-23, 2004

Designed to provide the latest information on evaluations and therapies for neurologic, psychiatric, neurovascular, pediatric and orthopedic trauma, this unique conference will feature Harvard Medical School faculty from Brigham and Women's Hospital and the Massachusetts General Hospital. Continuing education credits will be awarded to all participants. For further information, please contact Leslie Shane, M.S., R.N. at 01 (617) 724-4987 or lshane@partners.org. To register online, visit www.cme.hms.harvard.edu.

The Global Health Update is published three times per year by the International Program of Partners HealthCare System, Inc. The International Program develops opportunities for Partners staff to contribute to the improvement of health care around the world.

This publication provides medical news. It is not intended to provide medical advice, which should always be obtained directly from a physician. To subscribe, request additional copies or make comments, please contact us via email at partersinternational@partners.org or by phone at 01 (617) 724-6420.

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©2004. Partners HealthCare System, Inc.