Pediatric Hematology-Oncology Fellowship Pediatric Stem Cell Transplantation and Cellular Therapy Fellowship

The Stem Cell Transplant Fellowship at Baylor College of Medicine and Texas Children's Hospital is a one-year advanced training program designed for physicians seeking specialized expertise in stem cell transplantation and cellular therapy.

Cell therapy and stem cell transplantation have evolved into highly specialized areas within pediatric hematology-oncology, encompassing stem cell biology, transplantation immunology, tumor immunology, hematology and transplant-related infectious diseases. The breadth and complexity of this field require focused training beyond standard pediatric hematology-oncology fellowship education.

Recognizing the specialized expertise required for transplant physicians, the Foundation of Accreditation of Cellular Therapy (FACT) defines adequate clinical training as a minimum of one year of experience managing transplant patients in both inpatient and outpatient settings.

The fellowship training requirements of the American Board of Pediatric Hematology and Oncology do not include sufficient experience with stem cell transplant to provide competency, per the current FACT standards. This fellowship provides the advanced clinical, research and scholarly training necessary to meet these expectations and prepare future leaders in cell therapy and stem cell transplantation.

Goals and Objectives

• Provide advanced clinical, research and scholarly training in stem cell transplantation and cellular therapy.
• Prepare fellows for careers as academic and clinical leaders in pediatric stem cell transplantation.
• Provide training that meets applicable FACT accreditation standards.

Program Eligibility

Candidates must have completed three years of an accredited U.S. Pediatric Hematology-Oncology Fellowship or equivalent.

Foreign medical graduates and visa holders: At this time, we are only able to accept J-1 training visas, but not those with H1B visas.

The process for selection involves the following:

• Candidates provide their curriculum vitae and a statement of career goals and areas of interest
• Submissions will be reviewed by the Fellowship Committee and candidates will be ranked using the NIH system
• Applicants will be contacted for information about acceptance
• Suitable candidates will visit for interviews with the committee members and other faculty members, and will be given tours of the relevant sites
• If a candidate desires to present a seminar that may be arranged.

Program Duration

One year

Program Dates

July - June

Curriculum

The curriculum leverages the strengths of the Cell Therapy and Bone Marrow Transplant Program at Texas Children's Hospital, Texas Children's Cancer and Hematology Center and Baylor College of Medicine to provide a comprehensive clinical and research training experience. Training includes clinical, laboratory, didactic and scholarly activities.. Training will include clinical, laboratory, didactic, and scholarly activities.

The schedule for the 12-month training program is:

• 4 months inpatient service in the Cell Therapy and Bone Marrow Transplant Program at Texas Children's Hospital
• 4 months outpatient stem cell transplant clinic and protected research time
• 1 month laboratory:
  • Stem cell procurement and processing
  • Immune function testing
  • Regulatory affairs, Good Manufacturing Practice (GMP) and Good Clinical Practice (GCP)
• 1 month Radiation Oncology at the University of Texas M.D. Anderson Cancer Center
• 1 month HLA typing in TMH HLA laboratory
• 2 weeks to attend scientific meetings
• 3 weeks' vacation

Clinical and Research Training

Fellows gain experience in both the inpatient and outpatient settings of the Cell Therapy and Bone Marrow Transplant Program, providing comprehensive clinical care for transplant and cellular therapy patients. Fellows also participate in the evaluation of newly referred patients and present cases at multidisciplinary conferences. Fellows are trained in pertinent procedures, including bone marrow aspiration and biopsy, bone marrow harvesting protocols, peripheral stem cell collection, infusion of transplant products, and radiation oncology (at The University of Texas M.D. Anderson Cancer Center).

A specific requirement of the fellowship is the successful completion of a mentored clinical or scholarly research project. Research planning begins during the application and onboarding process so that scholarly work can commence at the start of the fellowship and continue throughout the training year. This project must be different from that which the fellow completed during their pediatric hematology-oncology subspecialty training program. A mentor from among the faculty will guide the research and monitor progress. The product of this scholarly activity should be either: a scientific manuscript submitted for publication, an abstract submitted to a relevant scientific society meeting, or a clinical protocol with an informed consent document submitted for regulatory review.

Laboratory training introduces fellows to the Histocompatibility and Transplantation Immunology Laboratory at Houston Methodist Hospital, and the Stem Cell Processing Laboratories of the Center for Cell and Gene Therapy at Baylor College of Medicine.

Supervisory and Patient Care Responsibilities

Under the direct supervision of an attending physician, fellows learn to diagnose and manage the spectrum of stem cell transplant-related issues seen in infants, children, and adolescents on the inpatient and outpatient services.

• All fellows independently perform initial evaluation and management planning for patients of all levels of acuity, including ordering of laboratory and imaging studies as indicated 
• Fellows have a direct one-to-one relationship with their attending faculty and work closely to formulate differential diagnoses and management plans for each patient 
• Fellows will request the expertise of the appropriate consultants and then discuss the diagnostic and treatment plan with these consultants 
• Fellows will meet formally with the attending to establish competencies, set goals for the rotation, and review their performance 
• Progress is communicated in writing to the coordinator of the training program who can then pass on this information to the subsequent attendings
• On-call fellows triage calls after hours for the service and consult their attendings when needed for appropriate disposition 
• On the inpatient stem cell transplant and cellular therapy service, fellows, along with the attending, lead the multidisciplinary team which includes categorical fellows, nurses, pharmacists, and social workers involved in the care of their patients in daily rounds to patient care plans 
• Fellows, with supervision from the attending, will also perform procedures, including those relating to diagnostic and therapeutic lumbar punctures and bone marrow aspiration, biopsy and harvesting 
• Procedures will be performed with appropriate supervision and may be performed in the operating room under general anesthesia or in the patient floor or outpatient clinic under sedation. 
• A competency verification record of successfully performed procedures which have been observed by the licensed practitioners is maintained by the fellow and turned into the program coordinator when completed\
• Fellows will work with a junior fellow and assume a teaching role for that individual in addition to providing direct patient care (both will be under the immediate supervision of an attending as well as with all inpatient rotations) 
• The fellow will prepare and give presentations related to specific patient problems or topics on rounds or at a variety of multidisciplinary conferences, which commonly form the basis for subsequent treatment recommendations

Clinical Procedural Requirements

FACT cognitive and procedural skills to be mastered for accreditation of competency in cell therapy and stem cell transplantation includes the knowledge of indications, clinical recognition and management; evaluation of potential stem cell sources (autologous, sibling, haplo-idental, unrelated, bone-marrow, PBSC, cord); selection of regimens for preparative cytoreduction, immunosuppression and anti-neoplastic therapy, prophylaxis, recognition and treatment of complications; appropriate use of immune suppressants to control graft versus host disease and graft rejection; stem cell procurement, processing and evaluation; regulatory compliance standards, and documentation methods.

Didactic

• Human Subject Research: Undergo the educational training and become familiar with the conduct of clinical research with the goal of increasing the understanding of the Institutional Review Board in the protection of human research subjects and in the performance of clinical research. 
• Texas Children's Hospital Clinical Research Course to strengthen fellows' understanding of clinical research methodology.
• Stem Cell Transplant Conference: weekly clinical rounds with multidisciplinary presence discussing management and rationale for current patients and future plans for incoming patients. 
• Grand Rounds; Tumor Boards; Fellow Training Seminars; Team Meetings. 

Apply

Fellows interested in this fellowship training program must complete and submit an application along with three letters of reference, a curriculum vitae and a statement of interest.