Fourth Year Fellowship in Pediatric Leukemia

The Pediatric Hematology-Oncology Program is ACGME accredited and has been in existence for 50 years. The Pediatric Leukemia Fellowship Training Program is Texas Medical Board accredited for one year of advanced training in comprehensive clinical and research training for candidates interested in a career in academic pediatric hematology-oncology with a primary focus on leukemia research, evaluation and management.

Currently, pediatric leukemia is the most common malignancy of childhood. Therapies are increasingly complex and specific for selected disease subtypes and should only be directed by individuals with expertise. As a result, outcomes are continually improving. Those who survive require long-term follow up as cancer survivors. Patients who have progressive or relapsed disease are often treated with bone marrow transplantation (BMT) and/or phase I and II drug trials. Such multifaceted treatment of children with leukemia requires a multidisciplinary team of medical specialists. The need for unique subspecialists who can orchestrate such a highly specialized multidisciplinary team has produced the concept of a pediatric leukemia specialist.

Goals and Objective

The overall objective is to develop clinical expertise, leadership skills and research expertise in the field of leukemia and related diseases.

The specific clinical training goals of the leukemia fellowship are:

  • To provide advanced training in the evaluation, diagnosis, and management of children and adolescents with leukemia and related diseases
  • To augment administrative and clinical expertise in the multidisciplinary field of pediatric leukemic diseases
  • To improve the trainees’ knowledge of leukemia biology in such a way that they will have a comprehensive understanding of this topic
  • To train individuals in the current Phase I, II and III therapies of pediatric leukemia such that they will have expertise in the clinical management of patients with this disease
  • To further enhance the teaching and leadership skills of trainees in this area

Curriculum

The trainee will participate in outpatient clinics 2-3 days per week under the direction of C. Philip Steuber, M.D., Clinical Director of the Leukemia Team at Texas Children’s Cancer and Hematology Centers, with the following roles:

  • Participate in the diagnosis of and management planning for newly diagnosed patients in both inpatient and outpatient settings
  • Observe and participate in the diagnostic conferences and presentation of recommendations for therapy to patients and families
  • Be responsible for primary patients including follow up, scans, relapse management, chemotherapy orders
  • Obtain consent from patients and families to enroll on clinical trials and research protocols.

Through the following core rotations, each lasting for one to two months, the trainee will acquire multidisciplinary knowledge and skills necessary for the management of children and adolescents with leukemia. Depending on the rotation, the trainee will spend 2-3 days weekly in these learning venues in addition to the time spent in the leukemia clinic service as noted above. The trainee will participate in the following:

Clinic

  • See leukemia patients in hematology/oncology clinic, long-term survivors clinic, bone marrow transplant clinic, and phase 1/2 clinic.

Protocol development

  • Understand how to develop protocols for the treatment of leukemic diseases.
  • Under the supervision of a leukemia attending, participate in the protocol rotation for leukemia team, to present clinical trials and research protocols to newly diagnosed patients.

Hematopathology

  • Using morphology and various stains, become more proficient in distinguishing between the different types of leukemia.

Flow Cytometry

  • Using immunophenotyping, be able to distinguish between the different types of leukemia.

Cytogenetics

  • Using conventional cytogenetics, FISH, and molecular studies, be proficient in detecting and interpreting chromosomal abnormalities associated with leukemia.
  • Based on cytogenetic information, be able to risk-stratify and tailor treatment.

Bone Marrow Transplant

  • Develop a strong fund of knowledge regarding the indications for BMT in the treatment of pediatric leukemia. 
  • Understand the preparative regimens for and prognosis of BMT in pediatric leukemia patients.

Phase I and II / Pharmacology

  • Develop a strong fund of knowledge regarding the pharmacology of standard and investigational agents used in the treatment of pediatric leukemia.
  • Participate in phase I and II clinic, examining patients and enrolling them onto currently available studies.

Long Term Survivor

  • Develop a strong knowledge base about the long-term complications that leukemia survivors may encounter.
  • Participate in long-term survivor clinic to examine, evaluate and educate patients.
  • Become knowledgeable regarding the use of the Passport for Care.

The trainee will actively participate in several recurrent educational conferences:

  • Tumor Board: Tuesday
  • Departmental Research Seminar: Thursday
  • Fellow’s Reflective Practice and Leadership Seminar: twice a month
  • Clinical and Research Mentor Meeting: weekly
  • Journal Review (selected topic regarding hematopoiesis, lymphocyte biology or molecular biology of leukemia): weekly with laboratory members
  • Leukemia Team Meeting: weekly
  • Laboratory Group Meeting: weekly

In addition, the trainee will plan to attend or apply to at least two of the following courses and workshops:

  • Clinical Scientist Training Program (Master of Science in Clinical Investigator): This program is offered by Baylor College of Medicine and consists of three core courses: Fundamentals of Clinical Investigation (4 week course in July), Clinical Investigation for the Career Scientist (year long course on Monday afternoons) and Seminars in Translational Research (year long course on Wednesday afternoons). The Fundamentals of Clinical Investigation course will likely have been completed during the 1st year of fellowship and the rest of the core courses will start in August during the 4th year of fellowship.  In addition to these core courses, the following electives will be included in this program: Molecular Methods, Biostatistics for the Translational Researcher, Introduction to Carcinogenesis, and Animal Models of Disease.
  • Molecular and Translational Oncology Workshop organized by the Cancer Education Consortium.
  • Transitional Research Training in Hematology Workshop organized by the American Society of Hematology.
Conference Frequency Role of the Fellow
Tumor Board & Problem Case Conference Weekly Organizes and Conducts conference
Moderates discussion
Participant in discussion
Leukemia Team Conference Weekly Observer
Participant in Q&A
Research Seminar Conference Weekly Observer
Participant in Q&A
Bone Marrow Transplant Meeting Weekly during BMT month Observer
Participant in Q&A
Phase I and II Meeting Weekly during Phase I and II month Observer
Participant in Q&A

Research

In order to succeed as a physician-scientist, the trainee must acquire the academic and scientific skills necessary to conduct research which may include basic laboratory research, translational research or clinical research. During this year, the fellow will be involved in the conduct of a  research project, which includes the generation of a hypothesis, study design, mastery of laboratory techniques (if applicable), data evaluation and ultimately a grant application.  The trainee will work under the supervision of a research mentor and with the input of members of a scholarship oversight committee (SOC). The membership of the SOC will be determined by the nature of the research endeavor and will consist of his research mentor and at least two other members chosen on the basis of their expertise in the area of research being pursued by the trainee.  Fellows continuing on from their three-year fellowship program at TCH/BCM will retain their SOCs from the previous years.  For those trainees coming from outside institutions, a SOC will be selected at the start of their 4th year fellowship. The trainees will present their work weekly to the members of their laboratory and/or their mentors, semi-annually (at the beginning and mid-year) to their SOCs in order to receive feedback and guidance on the progress of their research.

The data from this project will hopefully serve as a foundation to further expand the trainee’s understanding of leukemia research. When appropriate, the research experience is expected to result in the development of a grant application and potentially in an eventual publication.

Implementation of research:

  • Conduct a hypothesis-driven research project
  • Attend, participate and present at weekly laboratory meeting
  • Obtain specific training in different laboratory techniques through core laboratories at Baylor College of Medicine and Texas Children’s Cancer Center
  • Familiarize and participate in the grant application process in collaboration with other members of the mentor’s laboratory or Texas Children's Cancer Center

Eligibility Criteria

Candidates should be American Board of Pediatrics eligible for pediatric hematology-oncology or should have received equivalent training as judged by the program directors.

Apply

Fellows interested in this fellowship training program must complete and submit an application, 2 letters of reference, a curriculum vitae and a statement of interest. Download the Application

Fellows interested in this fellowship training should email a curriculum vitae and the 2 letters of recommendation to:

Program Director
David G. Poplack, M.D.
Texas Children’s Cancer and Hematology Centers
1102 Bates Street, Suite 1570
Houston, TX 77030
832-822-4556
TXCHEducation@TexasChildrens.org