Lymphoma science meets patient care

ABSTRACT: Researcher Alexandra M. Levine, MD, never forgets the human connection.

As a young candy striper at a Los Angeles hospital, lymphoma researcher Alexandra M. Levine, MD, MACP, experienced a portentous moment, although she didn’t necessarily realize it at the time. An older patient, feeling alone and lonely, waved the teenager to his bedside for a chat and she obliged. “He thanked me profusely for having helped him,” she said. “I didn’t understand what I had done, but it was one of those moments that was huge.”

Obviously, Dr. Levine left the candy striper uniform behind some time ago, but the chief medical officer at City of Hope National Medical Center in Duarte, Calif., continues to imbue her work with that same level of compassion. Dr. Levine met with Oncology News International to talk about her life as a clinician and a medical researcher.

Short-term stint in oncology leads to long-term career
Born in Berkeley, Calif., and reared in North Hollywood, Dr. Levine actually chose medicine as a career while she was still in grammar school. “I’ve always been very, very thankful that there was something inside of me that pushed me to medicine,” she said. “A doctor is exactly what I should have been.”

After graduating from high school, she worked for the summer in a research laboratory at City of Hope. She earned her medical degree, and did her internship and residency, at the University of Southern California (USC) School of Medicine. It was those early research experiences that put her on the path to academic medicine. Dr. Levine enjoyed “asking questions and finding answers.” On the other hand, “there was no way I was just going to be in the lab-the human connection was so important to me,” she explained.

An unfortunate family history of cancer (her parents and several other family members all died of various forms of the disease, although none had hematologic cancers) might make it seem that oncology would be a natural fit for Dr. Levine. But her shift into oncology was almost by chance: In 1973, she agreed to a one-month stint in USC’s fledgling oncology department in exchange for status as an attending physician in the intensive care unit. “I enjoyed every bit of it,” Dr. Levine said of her time in oncology. “I enjoyed the patients; I could learn from all of the wisdom they had to offer if I was willing to spend time talking with them, and I became interested in the patients and in oncology.”

The following year, Dr. Levine accepted a fellowship in hematology/oncology at Emory University School of Medicine. It was at the Atlanta institution where she had her first encounter with her mentor, Robert J. Lukes, MD, USC’s chief of hematopathology.

“While I was at Emory, his paper on lymphoma came out,” she recalled. “I remember sitting in the library and reading the paper over and over. All of a sudden a synapse fired and I got it. I knew then I wanted to work with Dr. Lukes.” Dr. Levine did exactly that when she returned to USC in 1977 as an assistant professor of medicine. Over the next decade, she had many opportunities to work alongside the famed physician, eventually building upon his work and completing her own groundbreaking research. A photo of Dr. Lukes hangs on Dr. Levine’s office wall at City of Hope.

Healing the body and the soul
Dr. Levine eventually served as distinguished professor of medicine and chief of the division of hematology at USC, as well as the medical director of the USC/Norris Cancer Hospital and deputy clinical director of the USC Norris Cancer Hospital and Research Institute. Then she decided to make a change.

“In 2007, I received a call from the City of Hope,” she told Oncology News International. “I had a history at City of Hope: My grandmother was a patient here so it was a very special place to me.”

For Dr. Levine, City of Hope offered the best of both worlds: the ability to interact and connect with patients along with top-notch clinical research opportunities.

“The concept of real caring for the full patient, the family, and caregivers is very much a part of the DNA of this institution,” Dr. Levine said. “One of the founders said there’s no point in healing the body if you destroy the soul, and that is part of who we are. That philosophy is still deeply valued-and I know it’s true. It’s important to understand, though, that City of Hope is also a very serious, impressive research institute.”

As chief medical officer, Dr. Levine is responsible for ensuring that a high level of care is given to all patients. In that capacity, she ensures quality performance, works with department chairs to develop academic and clinical programs, and helps facilitate academic work. On the research side, she has several major areas of interest, including defining disease as it relates to lymphoproliferative malignancies; therapeutic protocols involving hematologic neoplasia; issues of patient education and compliance; and AIDS and malignancies associated with AIDS.

Dr. Levine calls the 21st century the most exciting time to be a hematologic oncologist, as medical science gains ground in understanding how cancer cells work.

“In a general sense, hematology has traditionally been at the leading edge of discovery in oncology,” she said.

A key clinical moment
Dr. Levine became involved in the AIDS epidemic early, before the disease even had a name. Her research work has involved the clinical, epidemiologic, and pathologic aspects of AIDS-related malignancies as well as investigation of optimal therapies for patients with AIDS-related lymphoma.

As principal investigator in a study funded since 1993 by the National Institutes of Health, she also is investigating HIV disease in women-in particular the clinical and biologic risk factors for malignant disease among HIV-infected participants and their HIV-negative comparators.

In 1982, Dr. Levine saw a patient with a large lymph node. The expectation was that the person had lymphoma or Hodgkin’s disease. Dr. Levine reviewed the lymph node biopsy specimen under the microscope with Dr. Lukes, who said the biopsy revealed something he had never seen before.

“If Dr. Lukes hadn’t seen it before, that meant to me that it probably didn’t exist before,” Dr. Levine said.

The duo questioned the patient and learned that his partner also had an enlarged lymph node-they were experiencing benign changes in the lymph glands that are one of the hallmark symptoms of HIV infection.

Dr. Levine also began to see unusual malignant lymphomas in the same population groups. “I was able to prove in time that lymphoma was part of the AIDS epidemic,” she said. “It all came down to allowing myself to walk through a new door, going in a new direction, believing what I was seeing, and asking why.”

The candy striper who listened
Over her long career, Dr. Levine has received numerous honors, including her election as a master of the American College of Physicians in 2009, of which she is particularly proud.

“I have an ability to open my eyes and see what’s there in a very subtle way, to believe it, and to try to figure out why,” she said. “I hear what the patient says and what the patient does not say. That’s what I was doing with that man when I was a young candy striper. He needed to talk, and I was willing and eager to listen. If I can do that with all of my patients, then I know I’ve given my best.”