Week 1- Maggie Elpers

During my clinical immersion, I will be working with Dr. Jing-Mei Hsu in the Hematology and Oncology department at Weill Cornell. Dr. Hsu works with leukemia, lymphoma, and multiple myeloma patients undergoing autologous or allogeneic stem cell transplants. Dr. Hsu’s group also specializes in CAR-T therapies for patients with diffuse large B-cell lymphoma (DLBCL). This week I shadowed Dr. Jorge Monge, who was the attending on service for patients admitted for autologous stem cell transplants. Before rounds, the attending physician meets with the team of PAs assigned to each patient, and then we review their charts before going to check on each patient. I was able to observe a patient receive a clinical trial CAR-T therapy for DLBCL, and I also learned how patients on clinical trials are assessed and “graded” to determine at what time points they can receive additional treatments/infusions according to how severe their symptoms/ reactions to the treatment are. This particular patient experienced cytokine release syndrome (CRS) post CAR-T therapy and will be graded each day according to the clinical trial grading scale to determine future treatments according to the clinical trial protocol. 

After morning rounds, I spent time in the clinic with Dr. Hsu. I was able to observe patients undergoing photophoresis to treat graft versus host disease (GVHD) which is a common complication post stem cell transplant. Photophoresis is a type of photo-immune therapy in which blood is taken from a patient, white blood cells are separated and treated with UV light and methoxsalen, and then the blood is reinfused into the patient. I also observed a bone marrow biopsy of a patient with acute myeloid leukemia (AML) at the patient’s 6-month post-transplant checkup. 


For my research project, I’ll be evaluating prognostic indicators of DLBCL patients who received CAR-T therapy. Specifically, we are interested in determining if the timing of antibody treatment before CAR-T treatments affects the outcome of patients and if certain immune cell populations prior to CAR T collection have any indication of patient outcomes. 


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