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Hematology Portraits: prof. Antonio Almeida · EHA Unplugged

0:03
Greetings and welcome to EHA Unplug, the official podcast
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channel of the European Hematology Association EHA.
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Hello, I am Isabella Rivera, your host for EHA.
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In this Hematology portrait series, we are exploring the
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world of hematology through conversations about the career
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with leading experts in the field.
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Today we have the privilege to have Professor Antonio Almeida.
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He's the current president of EHA, but he has many other
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hearts. He's the head of the hematology
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department at Hospital Dallas in Portugal, and he's the founding
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Dean of Catholica Medical School in Lisbon, Portugal.
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So in this episode, we're going to talk about his career, his
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involvement with EHA, and his vision for the future of the
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field. Thank you for being with us
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today. It's a pleasure.
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Thank you for inviting me. So you are both a clinician, A
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researcher, and an educator. I imagine getting all those
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titles took some time. Can you tell us along this
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education path, when did you get interested in hematology first?
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So I trained in the UK. I'm I'm Portuguese originally
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and I studied in English speaking schools because my
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father is a mining engineer and we travelled quite a lot and the
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English speaking system is disseminated all over the world
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and it was easy to change schools without losing years.
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So when I finished my English speaking education, I went to
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university in the UKI trained at Cambridge and then did my
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specialist training in London. So that basically took about
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10-12 years until the end of that.
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And by the time I'd finished medical school in the UK, we did
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two years of internal medicine and general medicine.
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I did six months in a hematology ward and I to be honest, I'd
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never really thought of hematology as a speciality.
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We don't have much contact with it in medical school.
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I didn't have much contact with it in other areas of my work and
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I was fascinated by several aspects.
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Probably the first aspect is the contact we had with patients.
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So when you do internal medicine or you do emergency medicine,
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patients come in and out, they have an infection, they leave,
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they have an acute event and they go.
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Whereas in hematology, you follow patients for a long time,
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even as a junior doctor. And so the whole contact with
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the disease, with the patient becomes much more intense and
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very rewarding. The second aspect which always
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fascinated me was the laboratory side.
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So to be able to be a clinician, see patients, but also in be
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actively involved in the diagnosis, in reading bone
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marrows, reading blood films, but also involved in the all the
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other auxiliary tests such as flow cytometry, special enzyme
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tests were very, very fascinating.
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And the third thing that I really enjoyed was that
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hematology covers a huge breadth of topics.
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So we have oversee oncological diseases, myeloma, leukemia,
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etcetera, but we also have non malignant disorders such as
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sickle cell disease and then we have all the clotting disorders
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and all this breath made it very, very interesting.
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And that's when I really wanted to do hematology.
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And so when I finished that and started specialist training, I
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went straight into hematology and I was very fortunate to get
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a rotation in North Thames, which is the Hammersmith
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rotation. And I worked with fantastic
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experts who taught me the morphology, who taught me bone
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marrow transplantation, acute care of leukemia and sickle cell
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disease, all within these five years of training.
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How did you become interested in myeloid neoplasms in particular?
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Well, you know, life takes some funny turns.
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So when I was doing my specialist training in the UKI
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very much focused on sickle cell disease.
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That was the disease I was very interested in.
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I did a lot of training in red cell disorders and I actually
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worked for about a year in one of the biggest sickle cell
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centers in Europe, which is skies in Saint Thomas's, and
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then did my PhD in the UK in a very specific inherited disease.
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And in one stage, very much for personal reasons, I wanted to go
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back to Portugal. And when I looked at jobs in
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Portugal and I applied for jobs, the only job that was available
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was at the Institute of Oncology, which as the name
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indicates, did not have cystical cell disease.
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And so when I arrived at the Institute of Oncology and they
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said, oh, what do you like? And I said I like anemia.
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And he said, oh really? Oh, you must do all the MD s s
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then. So I started off by building up
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a myelodysplastic syndrome practice because of my interest
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in anemia. At the same time, in the same
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hospital they said, oh, you've been to the Hammersmith and the
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Hammersmith is a big CML center, so you should probably take the
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CML patients as well. So a little bit by serendipity
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and a little bit also by personal taste, I started
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getting involved with myeloproliferative neoplasms and
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chronic myeloid neoplasms really.
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So MDSCML and Philadelphia negative neoplasms and they're
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diseases that really fascinate me because within the same
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mutation and the same genetic profile, you get such a huge
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clinical variety. And actually they are diseases
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which are not acute but have a tendency to be acute.
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So you follow them as outpatients and there are many,
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many novel exciting therapies to be had.
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And they all have this very interesting characteristic,
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which is in general, they have a single or more genetic lesions
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that lead to a phenotype. So the correlation of genotype
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with phenotype is always present, which makes them very
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interesting diseases to follow. And as you said, most of these
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diseases are chronic or take a long time.
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So it builds in with you're interested of seeing patients
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for a long time. Yes, I mean you, you follow them
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for a long time, they have directed therapies, which means
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that there's a huge satisfaction in treating the patients and
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entertaining results. But also I think one of the
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things that is nice is that patients obviously are ill, but
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they're not acutely sick. And so the whole establishing
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relationship and way that you work with them is a little bit
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different from an acutely sick patient on a ward.
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And I prefer that person. So you still see patients until
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today? Yes, I came back from the UK in
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2006 and worked in the Institute of Oncology for 11 years.
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And in 2017 I moved to my current hospital which is a big
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general University Hospital called Hospital the Luge where I
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built a hematology service from scratch.
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And so we are now 6 hematologists and we do
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everything from non malignant to malignant.
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We don't have transplantation, we do laboratory.
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So I do my own bone marrows and report my own bone marrows and I
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still see patients I don't have as focused clinics as I did in
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my previous job. My clinics are more general and
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include a little bit of everything, but I do focus
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mostly on myeloid neoplasms. So you managed to go back to
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other aspects of hematology also?
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Yes, exactly. So I've started doing non
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malignant diseases again, which I very much enjoy.
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And you're also very involved in education.
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You are the Dean of university. You were involved in funding.
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How did you get so interested in Education I.
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Mean education's always been a sort of activity I enjoyed.
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Yeah. Ever since I was a junior
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doctor, I lectured in various courses, mainly about red cell
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disorders and I was involved also in courses in preparation
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for the entry exam to the specialty in the UK, teaching
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hematology. So I've always enjoyed
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education, but I must say that big step for me in my education
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list role was with EHA. I was part of the initial group
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that set up the master class of EHA.
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And in that initial group we had fascinating people such as
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Gunnar Bergergaard and Janet Strivens who were
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educationalists in the pure sense of the word and really
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brought in modern education concepts such as peer-to-peer
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learning, problem based learning, sequence repetition.
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And it was fascinating setting up these clinical cases and
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setting up a system in which junior doctors could use
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clinical cases for peer-to-peer learning and would have a mentor
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that was very non interventional, but monitored
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and guided them through their paths.
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And so this really brought me into the world of education.
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And at one stage I was invited by the Portuguese Catholic
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University, which is who I work for, to start a new medical
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school. So they had quite an exciting
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partnership with the University of Maastricht, which is quite a
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forward thinking university in terms of education and and
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medical education. And we implemented A curriculum
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that is very much focused on teaching by system, so
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integrated teaching and using a problem based learning and
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student centered learning as as an objective.
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So our students have clinical skills from the first year, but
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they also have clinical reasoning from the first year,
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resolving problems and spiralling up their knowledge
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throughout the years into their clinical years.
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And it's been a very, very exciting project, very
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challenging because you know, as the Dean of the school, you're
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not only involved in the educational side, but you're
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also involved in all the management and all these things
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that really take you out of your comfort zone.
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But also it's very exciting to see not only how the project
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grows and how people get involved in in buy in, but also
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how the students are excited by this way of learning, how they
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really enjoy learning in this way, How it becomes much more of
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an adventure rather than the conventional learning that we
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have in which they need to learn things off by.
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Hard to go to an exam. And I've always been involved in
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postgraduate training. And gradually I've been bringing
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more and more of these participative and student
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centered techniques into my training programs to make them
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more interesting and also more effective in terms of
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educational experiences. So you have already touched on
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how you became an active member of EHA because you you came to
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EHA to education field, you got involved in the education
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department, but now you're the president.
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How have you evolved within the association?
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Well, I think the first thing I must say is the EHA has bought
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me an awful lot. I mean, it really has been a key
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player in all the competences that I have acquired throughout
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my career and also in developing my career to the I've been
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involved in the EHA for a long time, even before in my more
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active participation. I've always gone to EHA
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congresses. From my first year as a trainee,
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I went to present things at the EHA congresses.
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I was invited to specialist groups on red cell disorders by
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my mentors, by Professor Sally Davis and the other mentors that
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I had in the UK. So there was a lot of
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involvement, but one stage when I got back to there was a call
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in my head of departments said they want someone to pilot the
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master class, would you like to be part of this pilot?
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And I said yes. And so we had a very interesting
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group which was really part of the curriculum committee at the
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time, in which we started this master class pilot as a good
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educational activity. But at the same time, my
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involvement in the master class led to me being invited to be
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part of the curriculum committee.
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And in that I was part of revamping the curriculum and
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revising one of the versions and also implementing the European
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exam. So all of these activities made
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me more and more active within the HA, and so I did a lot of
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educational activities and obviously spoke at meetings and,
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you know, helped out a lot until one point in 2019, I was elected
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onto the board and as a board member, I also became head of
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the sponsor and fundraising committee, which is a very
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interesting experience because it's much less educational.
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But you bring all that educational and clinical side
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into speaking with sponsors and trying to see the value of EHA
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and show the value of EHA in what is very much a business
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world. You know, I think it's very
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clear that sponsors want the visibility that EHA has and also
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they want to collaborate and to become more involved in the
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hematology world. So that opportunity was very
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exciting through my involvement with the board, and I was very
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much encouraged by John Gribben to run for president and I was
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very lucky to be elected. So as president of EHA, what
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would be the most significant challenges you see in hematology
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at the moment? Well, hematology is such a
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diverse subject that it's very difficult to identify one
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challenge. Perhaps the biggest challenge is
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to have a united and concerted description and vision of what
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hematology is because we treat, as I said, malignant and non
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malignant disorders. We treat red cell clotting,
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white cell disorders. We are involved in diagnostics,
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we are involved in blood transfusion.
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And so the breadth of this is not to be underestimated and
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it's not the same in every country.
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Different countries in Europe have different concepts of what
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hematologists are and what hematologists do.
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And so the biggest challenge that we have is that maintaining
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hematology as a subject, also being able to cater for all the
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needs that other hematologists have.
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Think the second big, big challenge is that we are a very
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expensive specialty because we've been so progressive in our
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scientific research as a community.
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Many of our patients and many of the diseases that we treat have
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very well characterized genetic profiles and protein profiles.
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And therefore many of them have very directed therapies, small
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molecule inhibitors, immunotherapies.
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And this also means that the cost of these therapies is huge.
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And so access is a big challenge.
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And I think we need to think carefully in the future of how
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we really have fair access for everybody, not only to
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treatment, but also to the diagnostics without which we
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cannot get treatment. And, and, and I think EHA has
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done an awful lot for that. We do a lot in terms of
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education and in terms of harmonizing education.
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We promote a lot of research through dedicated mentorship
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programs, but also through research grants.
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And I think this vision that we have of promoting hematology and
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improving the knowledge of the community also goes a long way
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towards ensuring access to treatment and diagnostics and
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also ensuring that people see hematology in all the glory that
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it is. So if you could magically solve
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one of these major challenges overnight, which one would you
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choose? Oh, I think that the biggest
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challenge to do magically solve would be access.
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I think solving access to diagnostics and medication has a
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very direct impact on patients, but it also has a very direct
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impact on how healthcare workers can provide the care that they
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want for their patients. And I think the more you are
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able to have adequate diagnostics, the more you are
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able to characterize diseases, the more you're able to have
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better treatments and solving that issue would really be of
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huge benefit to everybody. So you're managing all these
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responsibilities. What do you enjoy the most in an
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everyday basis? Well, it's difficult to say that
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I enjoy one thing more than another.
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I love seeing patients and I have a very fulfilling clinical
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life in both in terms of diagnosis, but also in following
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patients and in treating patients.
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And I love education and I think education is very much part of
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patient care and being able to follow and set up and you
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actually see students enjoy medicine and develop a passion
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for medicine and not just an obligation and another job is
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something that's very, very gratifying.
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Having said that, the umbrella position that I have within the
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HA also gives me a very different vision and a very
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different way of looking at things and also being able to
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help and to solve problems that the hematologists have in their
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day-to-day life. So probably the most gratifying
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thing I could say is really that I have the possibility through
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very different roles, education, clinical as in in working for an
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association to bring out this passion for hematology in, in
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various people and to really help develop hematology and
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benefit both those who work in it and the patients.
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So what advice would you give a younger medical student that is
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choosing now their path? Well, I think the biggest advice
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I can give is be open. Things happen in life, paths
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change, and if you're set on one idea, you may not see other
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different ideas that are there. So be open and be available and
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take up challenges that are given to you because they may
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open doors that you'd never imagined.
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I mean, I never imagined starting off in the master class
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and finishing up as the HA president, and I've never
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imagined starting an education and finishing up as a Dean.
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So you know, these opportunities that are put in our paths are
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there to be grabbed and to be enjoyed.
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Secondly, think it's very important to enjoy what you do.
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Yes, life is hard. Yes, life as a doctor is hard
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and there are many sleepless nights and there are many
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difficult moments and there are many challenges along the way.
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But we need to keep the passion for what we do alive and we need
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to enjoy the path as we go along and not just be worried with the
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next exam and the next challenge.
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Well, thank you very much, Professor Almeida, for this
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insightful conversation and for sharing your valuable experience
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with us. Thank you to all of you for
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listening and stay tuned for our next episodes.