Adult Blood and Marrow Transplant and Cellular Therapy (BMT/CT) Fellowship

The Division of Hematology and Oncology at the University of California San Francisco offers specialized training for physicians interested in adult blood and marrow transplantation (BMT) and cancer immunotherapies including cellular therapies (CT). This intensive one-year fellowship is designed to prepare physicians for academic careers focusing on management of hematologic malignancies using transplantation and immune effector cell (IEC) therapy modalities, including CAR-T cells, NK cells, and cell vaccines. Our transplant and cellular therapy program is very active and we have 16 departmental faculty members capable of serving as clinical preceptors and research mentors. We have active clinical and translational research programs focused on hematopoiesis, leukemia, lymphoma, multiple myeloma, myeloproliferative neoplasms and immunology.  Special interests include the development of novel conditioning regimens for transplant, investigating new treatments for graft vs. host disease, development of novel IEC therapies and cell vaccines, and management of transplant, IEC and immunotherapy complications.

Goals & Objectives:

  • Provide the foundation and tools for a successful career in blood and marrow transplantation and immune effector cellular therapy in an academic setting.
  • Offer an in-depth exposure to multidisciplinary approaches to hematological malignancies and multi-modal management strategies.
  • Provide exposure and training in BMT/IEC quality assurance, FACT accreditation, and compliance programs.
  • Conduct research in the field of hematologic malignancies, BMT, and/or cellular therapy.
  • Allow the opportunity to improve medical knowledge, and overall subspecialty competence related to the areas of Hematology and Oncology.

As there is no board certification in BMT or cellular therapy, ACGME guidelines do not apply to this fellowship training program. Graduates of this fellowship will receive recognition of the additional hematologic malignancy, BMT, and cellular therapy training from UCSF, a FACT-accredited institution. FACT is the Foundation for the Accreditation of Cellular Therapies.

Basic Curriculum

Clinical & Research Components

The BMT/CT fellowship is a one-year program and the fellows (2 positions offered) will participate in all activities of the Hematologic Malignancy/BMT group. An outline of the typical rotation schedule follows; it can be tailored slightly to fit specific career interests.

Inpatient BMT – 4 Months

  • Time spent in clinical Hematologic Malignancy/BMT service will focus on the fellow acquiring experience in the diagnosis and treatment of hematologic malignancies, preparative therapy for transplantation, blood and marrow harvesting, peripheral stem cell and blood marrow infusions, management of acute and chronic GVHD and supportive care of the transplanted patient. Additionally, administration and management of CAR-T/IEC infusions and diagnosis and management of related toxicities such as cytokine release syndrome (CRS) and CAR-T-related encephalopathy syndromes (CRES) will be emphasized. The fellow is expected to take night phone calls on a rotational basis with another fellow during this inpatient time.

Outpatient BMT – 6 Months

  • Time spent in the outpatient clinic will focus on BMT/IEC patients pre- and post-transplant as well as the management of graft-versus host disease and the general approach to the outpatient management of various hematologic malignancies. Patient selection for BMT/IEC treatments will be emphasized. This will include attendance at the bi-weekly unrelated-donor and umbilical cord selection meeting. During the outpatient rotation, experience will be gained on the Transplant Infectious Disease service, Radiation Oncology clinic, the BMT clinical laboratory, and the Tissue Typing laboratory.

Research – 2 Months

  • Fellows are expected to conduct clinical or laboratory-based research during the year of the fellowship training in an area of interest in BMT and/or cancer immunotherapy.

Meetings

  • Fellows are expected to attend the annual American Society of Blood and Marrow Transplant Tandem meeting and/or the annual American Society of Hematology meetings. Other meetings, such as ASCO, will be on an ad hoc basis.

Supervision and patient care responsibilities

  • The non-ACGME BMT/CT fellows will be supervised by an attending when seeing patients. The fellow will be responsible for follow-up on transplant patient related issues, such as changes in immunosuppression. Fellows will participate in informed consent conferences and in weekly Transplant Rounds for discussion of new and pending BMT candidates. Fellows will interact with the hematology malignancy/BMT clinic practice nurses regarding phone calls and urgent problems related to transplant patients.

Procedural Skills

  • Lumbar puncture
  • Central Line Removal
  • Chemotherapy
  • Bone Marrow aspiration and biopsy (diagnostic)
  • Apheresis procedures
  • Blood transfusion
  • HLA tissue-typing interpretation
  • Bone marrow harvest
  • Hematopoietic cell cryopreservation
  • Skin biopsy
  • Hematopoietic cell infusion
  • Chimeric antigen receptor T-cell infusion

Didactic component

All fellows attend a weekly Hematology/Oncology Clinical Case Conference and a weekly Hematology/Oncology Journal Club, as well as monthly Morbidity and Mortality conference, and a monthly Research in Progress lecture. Fellows present an average of one conference per year (i.e. two lectures per year). Fellows are also expected to attend the monthly hematopathology conference and the monthly unrelated-donor selection meeting. Additional research seminars are readily available throughout the Helen Diller Family Comprehensive Cancer Center. Fellows are expected to present one talk on their research and related BMT/CT topic at the ‘research in progress’ lecture series and/or present their research at the annual Hematology/Oncology divisional research retreat.

Cognitive skills

Specific training and documented competency in each of the following areas:

  1. General Knowledge
    • Indications for blood and marrow transplantation or immune effector cell therapy
    • Documentation and reporting of patients on investigational protocols
    • Understanding the role of the Institutional Review Board and the ethical conduct in clinical trials
    • Pre-transplantation patient education
    • Identification and selection of stem cell source including use of donor registries
    • Methodology and implications of HLA typing
    • Understanding of chimerism analysis
    • Knowledge of leukapheresis procedure
    • Knowledge of blood and marrow processing and cryopreservation procedures
    • Management of ABO incompatible hematopoietic progenitor cell products
    • Administration of high-dose chemotherapy
    • Management of BMT/IEC toxicities
  2. Diagnosis and management
    • Chemotherapy and radiation therapy-induced toxicities
    • Veno-occlusive disease of the liver
    • Interstitial pneumonia
    • CMV infection and disease
    • Other viral infections in immunocompromised hosts
    • Fungal disease
    • Hemorrhagic cystitis
    • Acute and chronic graft-versus-host disease
    • Cytokine release syndrome
    • CAR-T-related encephalopathy syndrome
    • Late complications of blood and marrow transplantation and IEC

Eligibility and Application

Candidates must be board certified in Internal Medicine and be board eligible or board certified graduates of an accredited US Hematology and/or Medical Oncology fellowship program. Due to funding restrictions, applicants must be U.S. Citizens, U.S. Permanent Residents or have a J1 Visa (H1B Visas are not accepted). Applicants must be eligible for a California Medical License.

Positions Available

  • Two fellows per year.

How to Apply

Download application and submit completed application in PDF form to Sophia Zimmermann ([email protected]).

Letters of reference should be addressed to Dr. Tom Martin, Program Director. We require the following supporting documents to be submitted before your application will be considered:

Required Documents for Advanced Adult Hematologic Malignancies and Blood and Bone Marrow Transplant Fellowship

  • Applicants must be U.S. Citizens, U.S. Permanent Residents or have a J1 Via (H1B Visas are not accepted)
  • Completed Application (application)
  • Curriculum Vitae
  • Personal Statement, specifically addressing your academic goals and research interests as well as intent to single board in Hematology or Oncology or double board in Hematology and Oncology
  • Two letters of recommendation: One letter should be from your current Program Director, Department Chair or Residency Training Program Director. At least one letter should address your clinical abilities and medical knowledge.
  • For applicants with prior research experience, one letter should be from your research advisor. (The research advisor should mention the background and interest in academic Hematology and Medical Oncology as a career and a view of your competence to engage in scientific research)
  • Examination Requirements:
    • US Medical School Graduates – USMLE Parts I, II, and III or FLEX and be board certified in Internal Medicine.
    • International Medical Graduates – UCFMG Certificate, FMGEMS, and, if not a Citizen or Permanent Resident, a copy of a current Visa, documentation of successful completion of the language skills exam and be board certified in Internal Medicine.
  • Photos are appreciated
  • Women and Minority Recruitment: The Fellowship Program actively recruits both women and minority candidates.

Inquiries regarding the Program can be directed to:

Sophia Zimmermann
Education Manager, Division of Hematology & Medical Oncology
[email protected]