Creating a Community Improves Outcomes in Myeloma

Sagar Lonial, MD

Since he arrived at Emory University School of Medicine and Winship Cancer Institute in Atlanta, Georgia in 1997, Sagar Lonial, MD, has lived by his belief that a strong community that builds rapport among its members can have a positive impact. A community can be defined by any number of characteristics. In Lonial’s case, he has built a community of physicians who’ve come together to treat patients with multiple myeloma.

“It’s not just what you do as an individual,” he said. “It’s about creating a team that can magnify and amplify your work even more. I am very fortunate that the team I work with at Emory, at all levels, has coalesced around the common mission of achieving excellence ultimately to improve outcomes.

“In myeloma, my future goals are not mine to achieve alone,” he said. “Our community at Emory, and beyond, is going to be setting and reaching those goals together.”

From the start, Lonial sough to change the prevailing mindset toward myeloma. As recently as 15 years ago, the median survival for patients with multiple myeloma was only 3 years. Lonial wanted to establish a team at Winship that improved outcomes through innovative research and clinical care. In a relatively short time, he and others in the field made advancements that boosted survival to as long as 15 years postdiagnosis.

Clinical research has been a mission through-out his career. Lonial was the lead investigator on 3 clinical trials involving innovative monoclonal antibodies in the treatment of multiple myeloma. Two of those agents, elotuzumab (Empliciti) and daratumumab (Darzalex), are now approved in multiple stages of treatment. The FDA approved daratumumab in November 2015, making it the first anti-CD38 monoclonal antibody indicated for patients with cancer.

“My involvement with those trials and see-ing the positive results is something that I take great pride in because I know how much of an impact each of them can [have] and is having for patient outcomes,” Lonial said. “Being able to be an integral part of the trials that led to the approval of daratumumab and elotuzumab and bring these immune-based treatments to patients was really a career high point for me.”

Seeing People, Not Just Science

That aspect of translational medicine, going from bench to bedside, is what drew Lonial to medicine as a potential career during undergraduate study.

“My parents always instilled in me the principle of hard work and doing good for others,” he said. “These studies are part of the ultimate fruition of that goal, but there remains much more work to do.”

As an undergraduate at Johns Hopkins University in Baltimore, Maryland, Lonial worked under the tutelage of professor emeritus Judith E. Karp, MD, and Philip J. Burke, MD, who ran the leukemia service. Upon graduation, he was accepted at the University of Louisville School of Medicine, back in his home state of Kentucky. Lonial’s parents emigrated there from India before he was born.

On the first day of medical school, he was assigned to be lab partners with his future wife, Jennifer Culley, MD. They went through residency together at Baylor College of Medicine in Houston, Texas, where their oldest child Hallie was born in 1996. Their son, Benjamin, was born in 2000.

Culley, an internist with the Atlanta Veterans Affairs Medical Center and an assistant professor of medicine at Emory, remains a driving force in Lonial’s success. His accomplishments, he said, would not be possible without her strength, resolve, and support. Their partnership helps him balance the demands of his career with the demands of raising a family, and if one set overwhelms the other, she has always helped ground him to regain equilibrium.

A Chance Encounter Shapes the Future

Lonial's career exploring myeloma very nearly didn’t happen. A chance run-in with Kenneth C. Anderson, MD, during the 2001 American Society of Hematology conference changed the course of Lonial’s career. Anderson, the 2014 Giants of Cancer Care® award winner for Myeloma, asked the younger physician about his career plans. Lonial had only studied leukemia to that point. Lonial’s answer must not have been good enough because Anderson told him, “You’re coming with me to an investigator meeting.”

Eventually Anderson would go on to help set up Lonial’s laboratory to conduct myeloma research, their institutions would partner together, and he’d help arrange mentorship opportunities for Lonial to develop as a myeloma researcher. The importance of a “monumental figure” such as Anderson taking an interest in a first-year faculty member in this moment was not lost on Lonial.

“I’ve been very fortunate to have had great mentors, friends, and colleagues who supported me throughout my career,” he said. “I hope to be the same to many junior colleagues.”

Research Before the Mountain

Finding his niche in myeloma research led to a career of surmounting great clinical summits.However, his dedication to investigating smoldering myeloma almost led to one unaccomplished feat—climbing Mount Kilimanjaro with his son, Ben.

The trip sponsor recommended beginning training to build strength and stamina several months prior to leaving for Tanzania. But Lonial was unusually busy leading up to the trip so train-ing took a backseat. He jokes that he was randomized into the nontraining arm of the climbers. It was a daily battle with soreness and fatigue, but he was able to eventually reach the summit.

Although watching his son accomplish this goal and taking part in it alongside him brought him a great deal of joy, Lonial admits that he is not a camper. He also realized that he would not have been able to reach the summit without the help of many people, from porters to guides, much like his academic career. “Nothing we do, we do in isolation. We do it as part of a group,” Lonial said. “This applies at home, at work, and on the mountain. Taking this trip was a great opportunity to test myself in a very different way than I am accustomed to. This challenge took me completely out of my comfort zone and pushed me in ways that really helped to focus me. Doing this with Ben was such a special chance to celebrate his graduation and to have father-son time chasing a common goal.”