Dear friends and colleagues of the AUB community,
BMT 1000 a landmark in cancer care
Leukemia, or cancer of the blood and lymph system, was once among the most feared medical diagnoses—but developments in bone marrow transplantation (BMT) are creating dramatic reversals in treatment of this malignant disease. BMT has grown exponentially since the 1990s and has been available in Lebanon for 20 years. The BMT program at
AUB Medical Center (AUBMC), the
Naef K. Basile Cancer Institute (NKBCI), and the affiliated
Children's Cancer Center-Lebanon (CCCL) has been at the forefront of advancing this life-saving intervention and recently celebrated the milestone of 1,000 transplantations, 80% of whose recipients are adults and 20% children.
As a physician-scientist who has spent my career seeking to alleviate the worst effects of cancer, I wish we could talk categorically about BMT as a “cure." But treating refractory Hodgkin's and non-Hodgkin's lymphoma with auto-transplant (using the patient's own stem cells) is “curative," raising success rates from 10 percent without BMT to 50-70 percent. Patients with multiple myeloma frequently relapse but only after gaining precious years with their loved ones and living normal lives. Acute leukemia cases—treated with allogeneic transplant from a compatible stem cell donor—are now cured around two-thirds of the time, more than double the efficacy of non-BMT treatments. But no clinical researcher or physician treating cancer will rest until those rates are brought below one percent mortality.
A decisive victory against cancer is unlikely through a single breakthrough, but rather with myriad skirmishes. A major step in this direction has been the development of AUB's world-class blood and bone marrow transplant program, established and led by Ali Bazarbachi the last two decades, with survival results that rival those of the world's premier programs. The BMT program picked up further momentum when Ali successfully recruited another incomparable hematologist in Jean El Cheikh. Although AUBMC is Lebanon's only accredited center with capacity to search the International Donor Registry, thanks to its affiliations with the US National Marrow Donor Program, donor cells matching Middle Eastern characteristics are rare, leading our teams to collaborate on developing alternative solutions such as haploidentical stem cell transplant between close family members, where you have 50% similarity between donor and patient and almost every patient has a donor.
AUBMC is also helping change the concept of allogeneic BMT as treatment of last resort, due to the fact that methods of improving post-transplantation survival rates also tend to increase the onset of subsequent relapse. Our team has joined a global effort to treat a common form of acute myeloid leukemia (FLT3 mutation, affecting 30% of AML cases) using BMT as a platform for adoptive immunotherapy using oral pharmaceuticals normally used post-relapse as a prophylaxis. This has increased the cure rate from about half to 75% of patients, with overall survival rates of 80% (including patients who ultimately relapse). This near-elimination of the counterbalance between survival and relapse represents a revolution in the management of AML patients and has been presented at the American Society of Hematology annual meeting and confirmed by a randomized trial in Germany.
No doubt BMT is a discipline with immense potential to further transform our treatment of cancer and other hematological conditions. But it is complex and remains a very expensive procedure, unsupported by many insurance providers, which lump BMT with other more traditional organ transplantations. The same providers are happy to pay for repeated chemotherapy treatments that outweigh the cost of a once-and-only BMT. This needs to change and we are doing active work with the Ministry of Public Health to improve patient coverage, but in the meantime, NKBCI and CCCL will continue to support such innovative interventions through our needy patient funds.
Tobacco-free success and new SUP frontier
Although some cancers are inherited from our parents' genes, it is well known that most occur from carcinogenic exposure in the environment. The most widespread and preventable exposure is, of course, tobacco smoking, which is why AUB took the pioneering decision—for Lebanon and the MENA region—to go completely
tobacco-free in 2018. Although the policy was not universally popular, many people have remarked how much the amenity of campus has improved, as former smoking zones opened up to non-smoking congregations and the noxious haze of tobacco fumes that non-smokers were forced to inhale second-hand has dispersed.
Rather than relying on such subjective observation, the
AUB Tobacco-Free Task Force has conducted a pre-post evaluation of attitudes, perception, and smoking behavior among students, whose data can be used to support and empower other universities going tobacco free in this pro-smoking environment. Although not yet published, the survey shows a growth in positive attitudes towards the policy one year post-implementation, especially among smokers—nearly 60% of whom now support the policy compared with 42% last year. Nearly three-quarters of smokers said the policy had been beneficial in decreasing their smoking frequency, and 10% said that included time during which they were away from university. The “holy grail" objective of impacting the number of students who take up smoking at AUB has not yet been proven beyond doubt given the size of the sample, but signs of a reduction in new student smokers are promising.
The survey showed concerns remain over the impact of the policy in the neighborhood—from sidewalk crowding and second-hand smoke, to discarded cigarette litter (despite clearly marked collection points). Meanwhile the task force has taken steps to address the situation with engaging publicity drives to reduce littering and encourage recycling of filters that poison the environment and represent one of the most significant plastic pollutants worldwide.
An elegant apogee of the
anti-littering awareness campaign was reached on September 17 with the official launch of the
hasskeh—a.k.a. stand-up paddleboard (SUP)—made from recycled cigarette butts safely encased in environmentally-friendly resin. This unique yet functional vehicle was created
by Lebanese surfing and SUP craftsman Paul Abbas, founder of Lebanon’s Surf Factory with support from the
task force and AUB
Neighborhood Initiative. Its inaugural voyage from AUB Beach to Dalieh was undertaken by national SUP champion Ziad Yazbeck and Recycle Lebanon NGO founder Joslin Kehdy for an in-sea cleanup with a flotilla of conventional SUPs.
Every year about five trillion cigarette butts are discarded around the world, with Lebanon contributing more than its disproportionately higher share of these than expected for such a small country. We recognize one university—or one SUP, albeit made from 12,000 cigarette filters—will not solve such a massive problem, but it is a major step in the right direction. Phase two of this initiative is to investigate other recycling options,in an AUB course offered by NI, with the artist Charbel Samuel Aoun and Recycle Lebanon. Fundamentally, it is vital to set an example, to remind people that carelessly dropping a cigarette butt is not a harmless habit. It has consequences and cost to our environment. And thanks to AUB, there is something we can do—recycle toxic cigarette butts and turn them into something safe and useful.
Increasing our diversity and affordability
Most of us can cherish our own magical early memories of AUB, entering the gates for the first time, taking in the sights and sounds, exhilarating encounters with our peers and mentors, and finding our own campus “nest" from which to explore the brave new world we have joined. Compelling as it was for those of us who grew up in Beirut or its environs, can you put yourself in the shoes of new students arriving from far-off lands with different cultures? Last November, we announced the
Education for Leadership in Crisis (ELC) program to enroll women freshman and sophomore students from Afghanistan on full scholarships. These remarkable young scholars are now among us, experiencing all the university has to offer and bringing their own stories to add to the rich tapestry of AUB.
Like many other scholars from security-challenged communities, the 15 ELC scholars deserve our admiration for overcoming daunting obstacles to claim their elite higher education. Afghanistan is a proud, but beleaguered, nation that faces some of the same negative attitudes towards educating women today that AUB and its mold-breaking first female students fought to dismantle in Lebanon in the early 1900s. In addition to opposition from some family members and the wider society, these brave young women have crossed dangerous terrain and hazarded fake education scams to be here today, and we are delighted to welcome them and see them fitting in as ambassadors for their rich culture and heritage in Beirut.
They join a growing diversity of scholarship students from sub-Saharan Africa on the
Mastercard Foundation program (which also serves Lebanese nationals, and Palestinian and Syrian refugees), Arab students on the Abdulla Al-Ghurair STEM Scholars Program and the US-Middle East Partnership Initiative Tomorrow's Leaders (TL) program, and the USAID-funded
University Scholarship Program (USP)—the largest comprehensive program at AUB—whose main focus is underserved areas of Lebanon.
The word “university," derived from the Latin word
universitas meaning “the whole," highlights the comprehensive and universal nature of higher education—but we are not fully worthy of the name unless we also seek to serve the whole of humankind. This means doing everything possible to open doors to more underserved populations and pushing the boundaries to include an ever-more diverse demographic—no easy task with the spiraling costs of higher education. In AY 2017-18, comprehensive scholarships amounted to $13.1 million, including about 22% cost share from our budget. In the same year, $32 million was disbursed as financial aid to more than 3,000 undergraduates, while master's students have continued to be supported through graduate assistantships and tuition waivers and PhD students through full tuition cover and a monthly stipend.
The quest to make AUB the university for the intellectually elite, not just the economically elite, remains our priority. This new academic year saw us making good on the promise by enrolling two top-scoring Syrian students on full scholarships, three Lebanese students who scored above 20/20 in the French Baccalaureate and a significant proportion of the highest-achieving Lebanese Bacc. graduates—15 of the top 28 who stayed in Lebanon in a scheme supported by the National Council for Scientific Research (CNRS) in Lebanon. We congratulate all the outstanding new scholarship students entering AUB in fall 2019 and look forward to seeing their success, impact, and leadership developing over the next few years.
Fadlo R. Khuri, MD