Get to Know ... Claire Harrison, MD

Dr. Harrison, Professor of Myeloproliferative Neoplasms (MPN) and Deputy Chief Medical Officer (Research, Data, and Analytics) of the Guy’s and St. Thomas’ NHS Foundation Trust in the United Kingdom, discusses her current clinical research, how she builds community with MPN Voice, and the nun who inspired her to pursue a career in medicine.

Where did you grow up, and what do you like about being a hematologist?

I’m British and was born in Wales, but I grew up in Yorkshire. My dad worked for a big, multinational company, and we moved to Africa when I was in my early teens. That’s where some of my inspiration for science came from, because I was taught by the most amazing science teachers in a missionary school in Nairobi.

Hematology as a discipline is very scientific and diverse. You can be involved in the clinic, see your patient, take a blood or bone marrow sample, look at it down a microscope, and make a diagnosis. Nowadays, things are much more complex, but you can still be involved in the lab and the bedside.

I enjoy the ability to dive deep into a specialty and get involved in chronic disease management for my patients. I value that capability, as well as the opportunity for international collaboration and the development of new medicines.

Were there any mentors who shaped your career path?

This week, I was in touch with one of my teachers, Sister Pauline, from Nairobi. She was very dedicated and disciplined but also fair, honest, and highly supportive. As a young person, Sister Pauline inspired me to think about how I wanted to be as a person and, later, as a clinician. It was important for me to be able to write to her and say 40 years later, “Thank you, because my journey was inspired by what I learned from you and the amazing science in that small school.”

Over time, many people have inspired and helped me on my journey, and I’m still in touch with a lot of them. I also get a lot of inspiration from my husband, who is a general physician and, of course, my children.

As someone who looks after patients with chronic disease, some of whom I have known for more than 20 years, this has been a privileged journey. It’s really a partnership, and I’ve been involved in building those partnerships during my career, particularly through developing patient advocacy.

Most recently, we set up a collaboration with young patients across the globe and evaluate their outcomes with these diseases and lived experience of specific issues they face, some of which we presented at the American Society of Hematology (ASH) Annual Meeting & Exposition. We want to develop guidelines and involve patients in that process. We set up a patient support group that connects those who were younger than 25 at diagnosis. We can’t fix everything, but we can connect patients in this population and ask them as a community to come to us with solutions.

Can you elaborate on the community-building efforts you are involved in?

When I started as a consultant 21 years ago, the internet existed, but only in a small way. Many patients were coming to our center because they didn’t understand their condition. They’d never met anybody else with it. If you read about MPN in a medical textbook, it might say your average life expectancy is 18 months, which is inaccurate and highly concerning for patients. I started out with one of the nurses from our center and a group of patients, and working with the hospital charity, we set up an advocacy group. Somebody wrote the content for the website at their kitchen table one evening. We drew on expertise and the experiences of patients, and then gradually more clinicians and nurses became involved. We set up MPN Voice, which has a website in the United Kingdom and is linked through the National Health Service (NHS) IT system, and patients can find information there through NHS Choices. It also links internationally. There have been MPN Voice get-togethers in Hong Kong and Australia and many hits from around the world. Several thousand patients meet virtually or face-to-face via this community every year.

As a clinician, you get many important insights from your patients, but you also draw your strength, vision, and determination from them. This work has been incredibly valuable for me on a personal as well as professional level.

How did you become interested in MPN?

I met a patient who had an MPN when I was early in my hematology training, and I was struck by how little we knew and how complex the diagnosis was for her. She was quite advanced in her disease course. I went back to the center I trained in, which was University College London. At that time, thrombopoietin, which is the “platelet hormone,” had just been discovered. I was talking to one of my mentors, who was a proper hematology professor. He said, “Oh, I’d like you to come and do research, and I would like you to think about doing it in myeloproliferative diseases, and particularly in essential thrombocythemia and looking at thrombopoietin.”

It was a bit of a chance. I set up a specialist clinic and began to do research in the field, and I found it rewarding. After I finished my research, I went back to clinical practice and decided I didn’t want to be primarily a laboratory-based academic. Instead, I wanted to be a clinical academic. This term has many definitions, but for me, it’s somebody who is involved in research but still works substantially as a clinician. You can be doing some basic science, but it’s very hard to do basic science as a clinician. My work involved multiple collaborations—collaborating in the discovery of mutations, being involved in targeted therapies such as Janus kinase (JAK) inhibitors, doing academic studies, increasingly integrating the voice of the patient and the community, and collaborating internationally.

Can you talk about your current research?

My current research responsibility includes looking after research and development for the hospital and the interface with the university and trying to increase our translational medicine footprint, which I find rewarding.

My own personal research is currently centered around the young people I mentioned earlier. We recently presented some data at ASH from this collaboration led by colleagues in Switzerland, France, the United Kingdom, and across the European Hematology Association, which showed the event rate for young people, in terms of risk of blood clotting and transformation of disease and death, can be altered using interferon.

Recently, I led a big, randomized study of JAK inhibitors in polycythemia vera. For the first time, we showed that a 50% reduction in the amount of JAK2 mutation translates into an overall survival benefit.

That study involved a massive team collaboration, including 38 hospitals in the United Kingdom and a university clinical trial center, 10 years of work, and lots of scientific input from people who know science much better than me. I see my role as a convener and facilitator.

We’re also currently looking at the immune profiling effects of JAK inhibitors and how they can differ, and how we can predict responses for patients. We’re potentially looking at immunological therapies. For the first time in my life, I’m venturing into first-in-human trials looking at CALR-directed therapies, which is interesting but also a bit terrifying.

What do you hope to see in the field over the next 10 years?

I think personalized medicine is a bit of a passé term, but I would like to see us move toward personalizing therapy for patients and knowing the therapy is going to have benefit because of the patient’s mutational or immunological profile. I would like us to have therapies that deliver meaningful benefit for patients, by which I mean they live longer with less disease burden.

I’m not sure we need to focus so much on cure at all costs. Only around 5% of my patients would have a stem cell transplant. It’s an incredibly risky procedure to undertake, but it’s an important one for some patients. Fifty percent of patients will be cured at five years. A lot of patients miss out on that opportunity, and I would like to be able to deliver a therapy that we know should work based on the patient’s profile, that will put their disease into a minimal disease state and allow them to live a better life without so many worries about disease. I would also like to do more collaboration and education, both for patients and clinicians. I’ve got lots of work to do yet.

What advice would you give to younger physicians or trainees in the field?

If you’re going to do research, look carefully at the environment you are going into. Get to know your mentor and the people they work with. Don’t just jump at a subject because someone offers it to you. It worked well for me, but it may not work for you.

Research can take many forms. Start looking at data, data analysis, and artificial intelligence. I think that’s going to be a huge thing in the future. You don’t just have to do wet lab; you can also do dry lab research. Take inspiration from people around you, and don’t be afraid to reach out. I think people can be afraid to send an email to someone they don’t know, but I’m often pleased to hear from people and would support them.

What hobbies or activities do you enjoy outside of work?

I’m a mom, so my kids are important to me. But they’re not kids anymore—they’re in their twenties. I love spending time with them, because it’s great to have seen them grow up and be independent young men now. I am so proud of them both. I also love being outdoors. I like exercising. I have a dog, a black Labrador called Maya. We both enjoy long walks.

 

Claire Harrison, MD, is a Professor of Myeloproliferative Neoplasms and Deputy Chief Medical Officer of the Guy’s and St. Thomas’ NHS Foundation Trust.