Pulling Back the Curtain: Lukas Wartman, MD
biopsies, and the course master,
Scot Hickman, MD, was very
passionate about malignant
hematology. I rotated through
his clinic during my fourth
year, and that experience – the
combination of learning about
the science and taking care of
patients – solidified my choice to
pursue malignant hematology.
The complicated answer is
that a few months after that
rotation, I was diagnosed with
acute lymphocytic leukemia
(ALL). I can’t deny that that
experience shaped my career
path.
There’s a bad joke that I like to
tell to explain it: I’m a leukemia
doctor, a leukemia researcher,
and a leukemia patient, and my
name is Luke – I’m a simple
person with a one-track mind.
How did the diagnosis
and treatment affect your
career path?
During the initial nine months
of intense chemotherapy I was
pretty sick, so I took time off from
medical school.
As I transitioned to main-
tenance chemotherapy, I felt
better and began doing research
in the hematology lab of Stuart
Kornfeld, MD. I spent a year
doing research, completed my
maintenance treatment, and then
jumped back in, with just a month
of medical school left to finish.
I was able to start my residency
immediately after that.
My story takes a lot of twists
and turns from there. I relapsed
after my first year of fellowship,
had a stem cell transplant,
recovered, and was able to
start working in the lab with
Timothy Ley, MD, at Washington
University in St. Louis. Then, five
years after my initial diagnosis,
my disease relapsed again. Salvage
chemotherapy failed to put the
disease back into remission, so
then I had the lethal combination
of relapsed and refractory adult
ALL.
At that time, Tim and other
colleagues at Washington
University’s McDonnell Genome
Institute had started sequencing
patients with acute myeloid
leukemia. They had just opened
a protocol for ALL and offered
to comprehensively sequence my
leukemia genome.
My DNA sequencing results
did not reveal an actionable target,
but RNA sequencing showed
that the gene FLT3 was greatly
overexpressed in my leukemia
12
ASH Clinical News
cells. This aberration could be
targeted with the tyrosine kinase
inhibitor sunitinib; although
we had no knowledge of any
other adult ALL patient having
been treated with the drug.
I started sunitinib a couple
weeks later, along with mild
chemotherapy, and my disease
went into complete remission. I
underwent a matched unrelated
stem cell transplant in 2011 and,
thankfully, my ALL has remained
in remission since then. (Editor’s
note: In July 2012, The New York
Times told Dr. Wartman’s story
and the discovery of FLT3 in
“Genetic Gamble: In Treatment
for Leukemia, Glimpses of the
Future.”)
“I never
seriously
entertained
the idea [of
switching
to another
career or
specialty].
There was
nothing
else that I
was truly
passionate
about.”
Did you ever think about
switching to a different, less
demanding career?
Looking back, I’m sometimes
surprised that I didn’t consider
choosing another career path – or
at least another area of research
that would have given me some
distance from my own illness.
People I respect would suggest
that I switch to radiology or
dermatology or another specialty;
I know they had my best interests
at heart, but I never seriously
entertained the idea. There was
nothing else that I was truly
passionate about.
Do you share your diagnosis
and history with your
patients?
It depends. It’s not something I do
routinely, but if I’m with a patient
who is struggling with his or her
diagnosis or treatment and its side
effects and I think that sharing
my own story will help, then I’m
happy to talk about it.
How has your daily life been
affected by the diagnosis –
and the treatment?
After I recovered from the
second transplant, I developed
graft-versus-host disease (GVHD)
and other complications related
to the transplant itself. For a few
years after the procedure, my
oncologist and I weren’t optimistic
about finding a treatment that
would work and that I would be
able to tolerate, but now we are
seeing more active drugs come
into play for the treatment of
ALL. That includes chimeric
antigen receptor T-cell therapies
that have revolutionized the
treatment of ALL, as well as two
other drugs – blinatumomab
and inotuzumab ozogamicin –
that are now approved for the
treatment of relapsed disease.
Knowing that we had new options
that were active and that I could
potentially tolerate, we performed
a bone marrow biopsy to look for
minimal residual disease a couple
of years ago. Fortunately, the
panels didn’t show any.
I’m absolutely relieved that the
test was negative and, since then,
the disease isn’t something that I
need to follow up on every year. I
make sure that my blood counts
are stable; as long as I’m staying
at my baseline, I try not to worry
about it too much.
For the past few years, I’ve
been focused on building my
research laboratory. A typical day
involves working with graduate
students and postdocs in the lab
and doing my own research as
well. That’s been fulfilling; it’s
exciting to work with trainees,
see how their experiments turn
out, then watch their careers
move forward. It’s nice to be in
a position now where things feel
like they’re finally starting to come
together.
Is there any advice that you
pass on to trainees that you
learned from your mentors?
I have had incredibly encouraging
mentors and colleagues through-
out all stages of my career, inclu-
ding Drs. Hickman, Kornfeld, Ley,
Dr. Wartman at work in the lab.
and John DiPersio, MD, PhD,
who heads the oncology division
at Washington University – and is
my doctor. Dr. Ley was incredibly
supportive when I was struggling
to get back on my feet after my
first relapse and transplant and
then became instrumental as a
role model and a friend.
They all have taught me to
be a nice, honest, hardworking
person. That’s what I try to do,
and that’s what I try to instill in
my trainees. Working hard is part
of what we do, but I want them
to lead balanced lives so that they
look forward to coming to work
the next day.
How do you spend your
time away from the lab?
I have a partner and two Shiba
Inus, so they all keep me pretty
busy. Honestly, it’s been a bit of a
struggle returning to the normal
things I did before the second
transplant. The GVHD interfered
with many of the activities I
liked to do: I used to be an avid
runner, and now I’m not running
anymore. I like to see live music,
but I haven’t been doing that as
much – and maybe part of that is
just me getting old …
But I have been feeling
better over the past year, so I am
intentionally trying to resume
what I like to do. That means
taking the dogs out for walks,
spending a lot of time in the park,
trying to see more plays and
concerts, reading more fiction,
and basically remembering that I
have other interests outside of the
hospital. ●
April 2019