From Pakistan to the Front Lines of Multiple Myeloma Research

A childhood rooted in history and migration

Born in 1979 in Pakistan, Saad Z. Usmani, MD, MBA, FACP, FASCO, and the 2025 Giants of Cancer Care Myeloma inductee, grew up in a middle-class household whose story was inseparable from the shifting political and cultural currents of South Asia. His parents’ families came from different regions of India—his father’s side from Uttar Pradesh in the north, his mother’s from Hyderabad in the south. Both migrated to Pakistan during the 1947 Partition when British colonial rule ended and the Partition created Pakistan and India.

“My dad’s side of the family moved to East Pakistan, which later became Bangladesh, and then in 1971, they came to the Pakistan we know today,” Usmani recalled. “My mom’s family came to Karachi, so I grew up in a home where both sides had different cultural influences, even though there were similarities.”

His earliest years were spent in a joint family household with grandparents, aunts, uncles, and cousins all living together under one roof. “I was told at a very early age that you have to lead by example, even when I was 2 or 3 years old,” he said. “That’s how I grew up. You were never alone. You were always surrounded by people.”

The result? A cultural blend that played out daily. “My mom’s side of the family was very formal in conversation and interaction,” he said. “My dad’s side was more relaxed and interactive. And the food? I got the best of both worlds.” His mother became a culinary bridge, mastering dishes from both traditions after learning from each grandmother. He admitted his own cooking skills are limited to “mostly weekend barbecues now,” but said that during his early years in the US, “I used to cook more…I think for a lot of people in research or academia, experimenting in the kitchen just comes naturally.”

Because of his father’s career, the family moved every 2 to 3 years within Pakistan, providing Usmani with the kind of adaptability that would serve him well later in life. “It was kind of like a military family lifestyle,” he said. “At the time it didn’t seem like it, but it really helped me later in life [because I] learned to interact with new people, find commonalities, and make friends quickly.”

Although he considers Lahore his home—it’s the city where he attended high school and medical school, met his wife, and married before moving to the US—Usmani carries a deep connection to the variety of communities that shaped his early years.

Living in a large extended family also instilled enduring values of teamwork, giving more than you receive, and viewing success as a collective achievement. “Family was always at the center of everything,” he said. “Yes, you’d have your personality clashes, but you learn to give more than you take. That’s something that’s stayed with me as a leader.” He still smiles when recalling mango season in Pakistan, a cherished family occasion that reflected those values. “We’d buy crates of mangoes from the big market, sort them by ripeness, and keep them cool in water buckets,” he said.

“In the evenings, everyone would get together and enjoy them. It was like a celebration. No matter what our means were, it always felt abundant.”

Choosing medicine and building a life in the US

In Pakistan, academic achievement often determined a student’s path. “If you were really good, you were pushed toward the sciences,” he said. “You could be a doctor or an engineer if you were good at math. Everything else was considered less prestigious.”

He was an outstanding student but also a talented cricket player, competing at the club level as a teenager. “I was really getting good,” he said. “My aspirational goal was maybe I could pursue this professionally. Then medical school happened, and that laid that aspiration to rest.”

By the late 1990s, he was drawn to oncology, inspired by the development of targeted cancer therapies like imatinib (Gleevec). “I really wanted to be a physicianscientist,” he said. “Pakistan didn’t have those opportunities, so I knew I wanted to come to the US for graduate medical education.”

He graduated from Allama Iqbal Medical College in 2002 and married his classmate Zainab Shahid, MBBS, who is now a transplant infectious disease expert in 2003. Together they navigated the competitive US residency match as an international medical graduate couple. The process was complex: taking the USMLE (United States Medical Licensing Examination) exams, applying broadly, interviewing where possible, and submitting a joint “rank order list” in hopes of matching to the same program.

“In the post-9/11 era, it was hard,” he said. “[However], we came here not just to build careers for ourselves, but to have a good platform for our kids to succeed and be productive members of society.”

Their first home in the US was near extended family, a decision grounded in the need for practical and emotional support. Both began internal medicine residencies in 2004, juggling long hours, call shifts, and the adjustments of life in a new country. “Work-life balance was never perfect, and it still isn’t, but we learned to push through the stressful stretches together,” he said. “It’s not always easy when both people are in demanding medical careers, but the understanding and mutual support make all the difference.”

They later pursued fellowships in their chosen specialties, carefully coordinating timelines and locations to remain together, an effort he described as “a logistical challenge, but worth every bit of effort.”

Mentorship, leadership, and emotional intelligence

Fellowship proved transformative, thanks to 2 key mentors. In the lab, Zihai Li, MD, PhD, now founding director of the Pelotonia Institute for Immuno-Oncology at The Ohio State University Comprehensive Cancer Center– James in Columbus, introduced Usmani to immunology research, particularly the study of heat shock proteins and the unfolded protein response in multiple myeloma models. In the clinic, Robert Bona, MD, now director of the classical (benign) hematology program at Yale School of Medicine in New Haven, Connecticut, shaped his patient-care philosophy.

His first faculty appointment at the University of Arkansas for Medical Sciences in Little Rock placed him under Bart Barlogie, MD, PhD, a pioneer in myeloma research, and the 2018 Giant of Cancer Care in Multiple Myeloma. “That transformed my whole outlook and approach,” he said. “It shaped much of my career from that point onward.”

From these mentors came a crucial lesson: “Work proactively on your emotional intelligence. Be honest, work hard, and be self-aware. Leadership is about giving a lot more than you receive,” Usmani said.

The importance of emotional intelligence became clear when, within a year of finishing fellowship, he was promoted to a leadership role. “I went from focusing on my own work to being responsible for other people, some of [whom were] more established than me,” he said. “It’s tough, but over time I became more comfortable being a giver than a taker. That’s when you start finding peace with where you are, without feeling you have to prove something to anyone.”

He also credited fatherhood with strengthening his patience and perspective. “Kids teach you so much,” he said. “Being a dad made me better at my job. It helps you prioritize what really matters and to give grace to others and to yourself.”

Setting a new standard for multiple myeloma treatment

When Usmani began his career, multiple myeloma treatment options were limited, consisting of oral melphalan and steroids, thalidomide, bortezomib (Velcade), and lenalidomide (Revlimid), with therapies often used in conjunction with stem cell transplantation for eligible patients. Median overall survival was just 2 to 3 years.

At the University of Arkansas, his research focused on identifying high-risk patients and exploring why some patients developed second primary malignancies. As director of Developmental Therapeutics, he oversaw earlyphase drug studies, many of which failed, others of which would later prove transformative.

His move to Levine Cancer Institute in Charlotte, North Carolina, in 2013 allowed him to build a myeloma program from scratch. There, he applied his experience honed at Arkansas to launch early-phase trials and integrate translational research. A breakthrough came with daratumumab (Darzalex), a monoclonal antibody that would redefine treatment standards and serve as the backbone for many modern-day regimens.

“We had to figure out how to manage infusion reactions, how to shorten the time from hours to something patients could tolerate, and then how to make it even easier with a subcutaneous formulation,” he said.

His team also tested combination regimens and advanced quadruplet induction therapy, setting the stage for many current clinical and investigational standards. Usmani recalled one patient from that period who remains unforgettable: a man who traveled hours from the mountains to meet him at a patient support event.

“He’d exhausted all options, including transplant,” Usmani said. “I told him we were opening a trial [with daratumumab] the following week and to come see me. He enrolled, achieved complete remission quickly, and became MRD [minimal residual disease] negative. He stayed in remission for years.” That case also deepened scientific understanding. “We noticed a big increase in his lymphocyte counts, which at first worried us,” he said. “It turned out to be an increase in cytotoxic T-cell activity, [which is] an extended mechanism of action for the drug. Connecting those dots in real time with your patient is incredibly rewarding.”

The patient went on to enjoy years of remission, long enough to see grandchildren graduate and to spend more time fishing. However, these successes did not come without setbacks. “Drug development is more failure than success,” he said. “You need resilience to keep pushing forward. But when a treatment works and you see the impact on someone’s life, it’s all worth it.”

Family, legacy, and the road ahead

Outside the clinic, Usmani’s life centers around his wife and children: 2 daughters who are in college, and a son in middle school. The family loves to travel, spend time outdoors, and participate in fundraising events. “Inspired by a patient, I started doing endurance events to raise money for myeloma research,” Usmani said. “We did the Mount Everest base camp trek and marathons; my oldest daughter ran the New York [City] Marathon with me to raise funds.”

The tradition has continued even after the loss of a close patient and friend due to COVID-19. “It’s a good excuse to take care of my health and a way to keep his legacy alive,” Usmani remarked about continuing to run in his honor.

For Usmani, giving back is nonnegotiable. “You never do anything alone,” he said. “The farther you grow in your field, the more you should give. I’m always happy to take a call from someone who needs advice, whether they’re from my institution or not.”

Looking ahead, his professional ambition is clear: “I want to see functional cures for both standard and high-risk [patients with] myeloma within my academic lifetime. I also want to see the people I’ve trained succeed [because] that’s as satisfying as my own achievements.” Personally, he is focused on his children’s future. “Everything you do is for your family,” he said. “I want to see my kids figure out what they want to do in life and then watch them succeed.”

Now, living and working in New York City, where he serves as chief of the Myeloma Service at Memorial Sloan Kettering Cancer Center, Usmani draws on his upbringing in large, bustling cities. “We love New York,” he said. “You don’t have to plan anything. You can just wake up, go out, and there’s always something to do.” For him, the city mirrors the qualities that have defined his journey: diversity, resilience, and the endless possibility of what’s to come.