Physician Profile: Major Advances in the Treatment of Hematologic Neoplasms

Dr. Santiago Pavlovsky.

A hematologist who has followed in his father’s footsteps, Santiago Pavlovsky understands that in the battle against cancer, clinical research is paramount. Named Doctor of the Year 2000 by Argentina’s National Ministry of Health, Dr. Pavlovsky has served since 1989 as Medical Director of FUNDALEU, the foundation devoted to fighting leukemia and operating within the Angela Ocampo Hospital and Clinical Research Center. This center, recognized for its high level of medical care, participates in national and international protocols, the data from which forms part of Argentina’s national registry and supports the work of two medical groups he established as a young physician — GATLA and GATHEM — both dedicated to the development of clinical research programs in hematological malignancies in Latin America.

“My father was one of the most outstanding hematologists of his time,” says Dr. Pavlovsky. Alfredo Pavlovsky, a first-generation son of a Russian immigrant, founded the International Society of Hematology two years after World War II. In 1956, he established the Leukemia Foundation in Argentina where Santiago Pavlovsky is now director.

“During my childhood I was able to meet most of the pioneers in hematology from around the world,” Dr. Pavlovsky recalls. “In my father’s time, and when I graduated in medicine, hematological malignancies were incurable. The best you could do was to establish a diagnosis. There was very little chemotherapy available. Today, these diseases are highly curable. In four decades, we’ve gone from a no cure rate to a 75% cure rate in acute lymphoblastic leukemia, a 90% cure rate in Hodgkin’s lymphoma and childhood non-Hodgkin’s lymphoma, and a 50% cure rate in adults. I’m pretty optimistic about the future.”

Dr. Pavlovsky attended the University of Buenos Aires, earning his medical degree in 1964 and his doctorate in 1968. He completed post-graduate studies in hematology in Paris before returning home to launch the onco-hematology department at the Instituto de Investigaciones Hematologicas (IIH). As he sought to better understand advances being made in onco-hematology, and to share his own research efforts, he pursued several study-travel opportunities, including those with the International Agency for Cancer Research, the International Union Against Cancer and the Programa de Intercambio de Hematologos Latinoamericanos.

Throughout his 40 years in cancer medicine, Dr. Pavlovsky has witnessed not only the development of new drugs, but better combinations of new drugs and the establishment of national and international protocols. “Now we can very quickly finish a protocol, learn about the results, and then establish a new protocol that improves the outcome,” he says. “This experience has been the same in most countries in the world.”

Dr. Pavlovsky predicts that, more and more, hematological disorders will be treated with specific drugs that target the molecular disorder of the disease, and avoid the side affects of toxicity. Doctors today are using targeted treatment for chronic myeloid leukemia in place of bone marrow transplantation. “The drug, Gleevec, is given by mouth with excellent tolerance, and the response is fantastic,” Dr. Pavlovsky remarks. “This is the most outstanding advancement in the field, and a good example of what we can expect in the future. Instead of a cocktail of toxic chemotherapy, we can have a single drug attacking a cancer on the molecular level.”

Of all his accomplishments, Dr. Pavlovsky takes the greatest satisfaction in having organized cooperative trials and improved the level of care in Argentina and throughout Latin America, by establishing protocols that treat all hematological patients in the same way. “The improvement of survival and cure rates was the same all around the country,” he says.

In the case of Hodgkin’s lymphoma, Pavlovsky conducted a landmark study in 1978 demonstrating that long-term survival rates were quite good when chemotherapy alone was used to treat patients in early stages of the disease, compared to chemotherapy plus radiotherapy.

His work generated great international respect. In 1983, Dr. Pavlovsky was nominated Cancer Advisor of the Pan American Health Organization and coordinator of the Collaborative Cancer Treatment Research Program, a project sponsored by NCI and the Pan American Health Organization, with the aim of supporting clinical research projects and disseminating cancer information throughout Latin America. Among his many international medical committee assignments, he served as a consultant to WHO’s Cancer Program in Developing Countries, as a member of the International Blood and Marrow Transplantation Registry, as founding member of Global Organization Against Leukemia, and as a member of the Advisory Board of INCTR and as chairman of the International Affairs Committee of ASCO.

Marcia Landskroener for INCTR