Leading the ASTCT During a Time of Transition

The field of blood and marrow transplantation has experienced significant change in recent years, with increasing emphasis on non-transplant cellular therapies. This shift prompted the American Society for Blood and Marrow Transplantation to change its name to the American Society for Transplantation and Cellular Therapy (ASTCT) in 2019.

As president of the newly minted ASTCT, Navneet Majhail, MD, MS, Director of Cleveland Clinic Cancer Center’s Blood and Marrow Transplant Program, helped guide the organization of more than 2,200 healthcare professionals and scientists from more than 45 countries through this time of transition. His one-year term ended in February 2020.

In this Q&A with Consult QD, Dr. Majhail reflects on his presidency, the challenges facing the blood and marrow transplantation and cellular therapy specialty, and what the future may hold.

Q: What did you hope to accomplish as president of ASTCT?

Dr. Majhail: Over the last few years, we’ve had a burst of innovative cell therapies that go beyond our traditional space of blood and marrow transplantation. And so, as the field evolves, so must the national society, to better support our specialty and members. This evolution was reflected in the goals of ASTCT during my presidency, which included increasing our focus on cellular therapy. In addition, our efforts were focused on increasing the international profile of the society to support our colleagues in well-developed countries as well as those in emerging economies where transplantation is growing. To help drive this forward, the society introduced new membership types that range from individual and institutional to international, reflecting all roles within the BMT and cell therapy field. I am very passionate about promoting new blood in our field. We did a lot of work to enhance the society’s news and information offerings with the introduction of Nucleus, an online magazine. We also worked on education and career development for our trainees and younger faculty. During my tenure, we started a training course that focuses on emerging leaders.

Q: What did you learn during your time as president?

Dr. Majhail: I developed a greater appreciation for the incredible time and effort many of my colleagues contribute to the society. There are so many individuals who work with the society and are dedicated to the success of not only our organization, but also the field as a whole. My time as president also reinforced how much of what we do is a team effort, and this includes not only physicians, but also our colleagues in nursing, advanced practice providers, social workers, pharmacists, administrators and so forth. Collaboration is crucial as we move the field and our society forward. The passion and motivation I witnessed in many of my colleagues was truly remarkable.

Q: What advice would you share with someone transitioning into their first leadership role?

Dr. Majhail: One of the key takeaways from my own experience is to remember that the people you work with are critical to success. I was very lucky to have an incredible group of colleagues at the society as well as here at Cleveland Clinic. It is also important as a leader to be kind, compassionate, and serve with empathy. And lastly, don’t forget to care for yourself as well as your family and loved ones. If that area suffers, so will everything else.

Q: What challenges does the specialty face?

Dr. Majhail: Some of the key challenges we currently face involve patient access and the healthcare disparities that exist in our country. We’ve been aware of these issues in our field for a long time and we’ve been actively trying to address them, but with newer, expensive cell therapies such as CAR T-cell therapy coming down the pipeline, these health disparities and access issues will be accentuated. This is partly due to the high costs of these treatments and the insurance coverage issues that many of our institutions continue to have. Access will remain a challenge, both in bone marrow transplantation and especially in cell therapy, as they move into standard of care.

Continued research, from basic science to clinical trials, also is a critical need for the field. We need to keep getting better at what we do and continue to make transplants and cellular therapies safer and more effective. The society’s role is all the more important in the face of funding cuts we are seeing in this area. Last but not least, we need to continue to promote a pipeline of committed and talented younger colleagues into the field. This has become a greater challenge over time for a variety of reasons, and the role of mentorship and coaching for trainees has become even more important.

Q: How is the ASTCT addressing these challenges?

Dr. Majhail: There are several issues we continue to focus on. One is education, for our colleagues in the field as well as those working in other specialties. For example, referring physicians are key to ensure that patients are referred at the right time. The second big piece is advocacy. The society has a strong advocacy arm that works at the federal and state levels to address these coverage issues. A lot of work is being done with payers to educate them and to serve as a resource as they brainstorm ways to provide adequate coverage for newer treatments. Another big piece is research. For us to provide access to patients, we have to make sure treatments are getting safer as well as simpler, and that they can be offered in a more resource-efficient way as we move forward. The society promotes research in this area. Finally, the society has several programs and funding mechanisms to support our trainees and junior faculty in their professional development and research.

Q: What is ahead for the society as well as the field as a whole?

Dr. Majhail: Our specialty will continue to evolve as more cellular therapies are developed, and it will also grow beyond the blood cancer space. Therefore, it is vital that we adapt to these changes. One of the things we offer, as a field, is that we know how to administer cellular therapies. We’ve done that for 50 years in the context of blood and marrow transplantation. So how do we approach our colleagues, who traditionally may not have worked with us, and emphasize that we can provide a service to their patients? The other big piece we have to think about as a field is the ongoing training of the next cadre of clinicians and researchers to ensure we can provide necessary care to our patients in the future. And of course, advocacy will continue to be a major emphasis. These are innovative therapies, but they do not fit our traditional payment models, at least in the United States. We want to make sure that we are trying to stay ahead of this and are working with the payers — both public and private — to ensure patients have access to these groundbreaking therapies.