As a first-year fellow beginning her medical training in hematology/oncology (blood cancer), Cristina Gasparetto, M.D., met a patient who upended everything she thought she knew about multiple myeloma. That astonishing encounter changed Dr. Gasparetto’s life. Today, as director of the multiple myeloma program at Duke Health in Durham, N.C., she is one of the foremost myeloma specialists in the country, working on clinical trials that are pushing forward new treatment options. Here she talks with HealthCentral about her journey from Italy to the American South, her focus on bone-marrow transplants, and the patient she’ll never forget.
HealthCentral (HC): Can you tell me about your background? I understand you grew up in Rome.
Dr. Gasparetto: Yes, that’s right. I grew up in Rome, and I went to medical school in Rome. I knew since I was young that I would become a physician — don’t ask me why! My father is a retired physician and my grandfather was a physician. In Italy the education system is a little different. We don’t have college; we go directly to medical school. The program is six years. For the first few years you learn the basics — biology, anatomy, chemistry— and the last four years are more clinical.
HC: How did you decide that your life’s work would be treating cancer?
Dr. Gasparetto: When I was in medical school I did a rotation in the hematology division, shadowing physicians and learning a little bit about everything. When I graduated I started to spend time in the different units. I was very interested in bone-marrow transplant because I felt like for some patients with leukemia or lymphoma there could be a good outcome. It is a very risky procedure, but the end point is a cure. I was also fascinated by how complicated the transplant cases could be. I liked the difficulty.
Toward the end of medical school, my mentor told me that if I wanted to succeed in academia I should do some research abroad. I ended up at Memorial Sloan Kettering in New York, working on the transplant team as a visiting student. I was learning like crazy; I was involved in a lot of studies; I was so young, and I thought: My God, I can’t go back to Italy!
But I wasn’t going to stay in the lab and not pursue my dream of becoming a doctor. So I started to study for the boards, applied for a residency, and was accepted at Duke. Then I applied to the hematology program — I wanted to focus on hematologic malignancies. The myeloma focus came after.
HC: How did your fascination with myeloma begin?
Dr. Gasparetto: When I became a fellow at Duke, in 1996, I was called on to assess a patient with a newly diagnosed myeloma — I still remember it like it was yesterday. As a first-year fellow I didn’t know much about myeloma, so I thought, before I go to see the patient, let me go to the library and read a little. God forbid the patient asks me a question and I know nothing! So I read the average patient is in their 70s; more men than women; incurable; survival, three years; chemotherapy the only treatment. But when I went to see the patient she was a 42-year-old woman. A beautiful woman. She had spent 20 years of her life in Italy, teaching at the American school, and she had two young children. Oh my God, what is this, I thought?
I wanted to do something. So I started to ask questions to understand more about the disease. I bothered everybody. I did a lot of research and reading to make the best recommendation for this patient. I became fascinated.
HC: And what did you ultimately recommend for this patient?
Dr. Gasparetto: From my research I believed she needed to have an allogeneic transplant, with donor stem cells. Back then the mortality rate for this kind of transplant for multiple myeloma was incredibly high, 40 to 50 percent, but we told her that it was the only curative modality.
My boss saw her for a consultation but he did not recommend an allogeneic transplant — he recommended an autologous transplant, with her own stem cells. So I convinced her to go to UNC (University of North Carolina at Chapel Hill). My boss still remembers that I sent the patient to UNC! And the director at UNC transplanted her successfully.
I went to see her at the hospital, of course, but she didn’t come back to see me — she realized I was just at the beginning of my career and that I didn’t know enough, so she remained at UNC. I kind of lost track of her but indirectly I heard she was OK.
HC: That’s incredible. So you have been at Duke ever since?
CG: That is correct, I have joined the faculty. I believe being a transplanter in the myeloma specialty gives you the two perspectives; if you are only a myeloma specialist you see the transplant sometimes as forbidden territory.
I wanted to develop the multiple myeloma program here at Duke, and I did. Now I have four physicians working with me with a lot of support, leading the program and running a lot of clinical trials. I have to say it is one of my proudest accomplishments.