Blood cancers

Push for better prognosis in follicular lymphoma

Can you describe the aim of this project in 10 words?

Integrating immunity and genetics into prognostic scores for follicular lymphoma.

Where are the main gaps in knowledge about follicular lymphoma?

Although follicular lymphoma is described as a slow-growing disease, 20% of patients have early relapse after treatment and this reduces their life span. These patients would benefit from alternate precision-based treatment options. By this, I mean determining unique markers that would help identify patients that are more likely to have early relapse. If we can identify these patients at the time of their diagnosis of lymphoma, we could improve their treatment options and survival. But currently there is no definitive way to identify these patients at initial presentation.

What have you discovered so far in this area?

I have been involved in a number of observational studies in malignant haematology. These include ongoing epidemiological studies and published papers related to autologous stem cell transplantation. These projects have provided me with a good platform to embark upon my PhD in 2019 where the research will be more large scale and intensive.

There is currently limited data on how the diversity of intra-tumoural T-cells in the tumour microenvironment impacts cancer outcomes.  We will be investigating the tumour-cell receptor repertoire in the tumour microenvironment of follicular lymphoma patients and its prognostic relevance. We will also investigate for relationships between chromatin modifying gene mutations and the tumour microenvironment. Detailed immuno-biological profiling of pre- and post-therapy follicular lymphoma samples will be performed with the hope to design a new, unified genetic, immune and clinical prognostic score.

What aspect of this research interests you the most?

The central tenet of my research with Professor Maher Gandhi is to expand upon existing prognostic models in follicular lymphoma by integrating how one’s immune system reacts and responds to the lymphoma. We also hope to incorporate the genetic mutations within the lymphoma into the development of a new prognostic scoring system that is fit for the modern era. It will be extremely satisfying to bring fresh insight and answer some of the core questions about follicular lymphoma. I also enjoy working with a team where everyone can contribute to developing innovative research ideas.

What are the potential clinical implications for patients with follicular lymphoma?

I hope to contribute to our field by expanding upon our current knowledge of follicular lymphoma, and better understand why and how the disease behaves differently amongst different people. I hope that our team’s analysis will act as the ground work toward creating novel prognostic tools and thereby lead to new treatment options.

We hope that the findings from our work will not only be shared within the academic scientific community, but incorporated into routine practice worldwide. We are aiming to discover something new that will be useful for practitioners and have a real impact on the investigation and management of all persons with follicular lymphoma.

How long before this work impacts patient care?

I hope that findings from our research can be incorporated into clinical trials. We anticipate having results three years from now.

What’s your Holy Grail – the one thing you’d like to achieve in your research career?

The ability to use precision medicine in the management of lymphoma patients: applying patient-specific immunological, molecular and genetic markers to better predict the behaviour of one’s disease at the time of their diagnosis. This can help individualise treatment options from the outset of a patients’ diagnosis.

What is your biggest research hurdle?

I think most clinician-researchers would say that funding is one of the biggest hurdles to overcome. I count myself extremely fortunate for the scholarship and support provided to me by the Leukaemia Foundation and Haematology Society (HSANZ). Without the grant support it would have been very challenging to pursue my research ambitions. I understand that with this opportunity comes responsibility. I hope my research contributes to improving the outcomes of our patients with follicular lymphoma.

Who has inspired you in work or life?

I did my first two years of haematology training at the Townsville Hospital in North Queensland where I met and worked with a great team of haematologists who have been my inspiration. I am inspired not just by their intellect but also their passion and humility. Furthermore, the team at Townsville Hospital were always happy to help me whenever I had a question or a concern.

Dr Ian Irving, at Icon Wesley in Brisbane and previously at the Townsville Hospital, has been my mentor over the past few years. We continue to actively collaborate in numerous ongoing research projects.

What interests, outside haematology, help you create work-life balance?

I thoroughly enjoy travelling. I find travel broadens the mind through your exposure to different ideas and cultures. It keeps you fresh and excited with everything new you approach. Keeping active is also very therapeutic for me. I have recently got into running and I find it a great way to keep fit, keep my mind clear, see nature and even catch up with friends.

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