A Word from Our Director

Elena N. Parovichnikova — Doctor of Medical Sciences, world-renowned Russian scientist, leading specialist in clinical and experimental hematology and hematopoietic cell transplantation, coordinator of the Russian Research Group of Hematology Centers, Chairman of the Russian Research Group for the Treatment of Acute Leukemia, member of the Supervisory Board of the National Hematology Society, member of the European Group for the Study of Acute Lymphoblastic Leukemia, member European Association of Hematologists, Member of the Expert Council of the Higher Attestation Commission for Therapeutic Sciences, Member of the Profile Commission of the Ministry of Health on Hematology, Editor-in-Chief of the journal "Hematology and Blood Transfusions" and member of the editorial board of the journal "Oncohematology", Editorial Board of the journal "Therapeutic Archive", Chairman of the Problem Commission "Clinical research in hematology, transfusiology, hemostasis pathology, surgical hematology, anesthesiology and Intensive Care" of the Federal State Budgetary Institution "NMRC for Hematology" of the Russian Ministry of Health.

Elena Nikolaevna, first of all, please tell us about your path to hematology.

Е. P.: I joined Andrey I. Vorobyov for a residency at the Department of Hematology and Intensive Care of the Russian Academy of Postgraduate Education in 1985. I was an ambitious student who only wanted to deal with internal diseases. My teachers at the institute persuaded me to go to this department: "You should understand that absolutely all internal diseases are concentrated in this area of medicine!" They were right. Hematology turned out to be the embodiment of my dream, because a real hematologist is a universal doctor who knows all internal medicine in and out.

Who were your teachers?

I have two Russian teachers — Academician Andrey Ivanovich Vorobyov and Academician Valeriy Grigoryevich Savchenko. There are teachers abroad as well, like Professor Thomas Buchner who built a system of multicenter studies for the treatment of acute myeloid leukemia in Germany. Unfortunately, he died 5 years ago at a respectable age. He was 82 years old. Another of my teachers is Professor Dieter Helzer, who created a system in Germany for the treatment of acute lymphoblastic leukemia. We are still in close contact

During my postgraduate studies, I interned in Munster Germany, and this gave me a huge impetus for development. After returning from Germany, I started working on my dissertation, the topic of which was "Treatment of acute myeloid leukemia in people over 60 years old." I didn't have much time, only two years, and our first study covered just over 20 patients. It might have been naive, because in the USA such studies began back in the 1960s, and I defended my dissertation in 1992. But the famous American doctor Donald Pinkel, who was present at the defense, supported our initiatives, and it was a small but significant breakthrough. The most important thing is that from that point on we began to move in the right direction.

 

V.G. Savchenko and Donald Pinkel

 

Thomas Buchner, Dieter Helzer, E.N. Parovichnikova, Rolf Neth

 

Thomas Buchner, E.N. Parovichnikova, V.G. Savchenko

 

You assumed the position of Acting Director a month ago. What is happening now in the NMRC for Hematology of the Ministry of Health of Russia?

Let's be honest: I took this position as a result of tragic events. My dreams for the future were different, but life dictates its own conditions, and I had to adjust my plans to continue moving towards the goal. Through this difficult time, I have felt the support of my team every minute, and now I can safely say that our ship continues to sail its course. Yes, the captain has changed, but we are still solving the problems that we faced and are currently facing.

What are your priority tasks?

When Valeriy G. Savchenko was appointed Director of the Hematological Research Center in the spring of 2011, he gave an interview in which he briefly and simply formulated his dream: "I want to create Princeton University here." I still admire these words, and I think that it couldn’t have been said better: to create an institution in which precision medicine, excellent education and brilliant science are concentrated. A lot has been done over the years, but today my main goal is to combine the science, education and medical practice of the NMRC for Hematology with organizational work: to extend our experience to hematology departments and centers throughout the country and to make centers such as ours become more. Of course, even now there are excellent institutions — most often these are federal centers. But it is important that we have a network of highly qualified hematology centers at the regional level. Much work has already been done to create national perinatal and vascular centers in our country. I think the centers of hematology, transplantation and cell technology should be next.

It is not enough just to follow clinical recommendations and treat according to standards. It is important that doctors can analyze the results of their treatment, that they can recognize patterns and suggest new approaches to treatment. This systematic approach, which is the cornerstone of how the NMRC for Hematology functions, is just beginning to be seen in Russian regional centers.

What solutions do you see?

I have always been an apologist for cooperation between regional centers, and we started the first projects on unification and joint work more than 30 years ago. In 1989, during the times of the Soviet Union, the first international hematological symposium was held, organized by Andrey I. Vorobyov, who at that time was the director of our center. The hematological elite from all over the world came to us. After that, our joint work on the association of domestic hematologists began. This was an unprecedented step for the country — the first multicenter Russian study on the treatment of acute leukemia, initiated in 1992. And since then, we have been in constant contact with the key centers of Russia. Therefore, the administrative task assigned to us by the Ministry of Health to spread our experience throughout the country is the logical continuation of our work.

It is also necessary to focus on a very relevant and widely discussed topic —hematopoietic stem cell transplantation. This area of internal medicine has grown out of hematology and is developing on its basis, since 95% of all transplants are performed to patients with diseases of the blood system. This trend was the impetus for the development of registers of hematopoietic stem cell donors and the emergence of new biotechnological methods for the treatment of tumors, thus far mainly of a lymphoid nature, the so-called CAR-T-cell therapy. I would like for us to have a unified state register of typed donors and for there to be many more transplant centers, so that such treatment is possible not only in Moscow or St. Petersburg, but throughout all of Russia.

What steps are necessary for the situation to start changing?

I think in any situation you need to start with yourself. Of course, we need to continue all of our current scientific and clinical multicenter research, formulate new scientific tasks, increase dissertation activity, receive grants, and work with foundations. On top of the infrastructure we have already created, we must work on the development of new technologies, as well as extend our experience and developments to the regions of Russia.

There is another area for work — I would really like to find mutual understanding and make optimal decisions on a number of interdisciplinary issues. Of course, we will work on these issues together with all of our colleagues and, of course, with the Ministry of Health.

The most important thing, from my point of view, is to reach agreements on the prospects for the creation and development of such a structure that would combine hematology, stem cell transplantation and cell therapy. It should be understood that advanced hematology is closely intertwined with the development of transplantation. This requires honing the most science-intensive branches of medicine that require molecular and genetic studies, complete genomic sequencing, communications with the international donor registry, the active development of the Russian registry and the development of new biotechnological methods of treatment. At the moment, there are certain difficulties with this, but we continue to work tirelessly to resolve the situation.

What can you say about the plans for international cooperation?

It can definitely be said that the time has come for the NMRC for Hematology to become more open to communication, including international. We have achieved so much. We have developments and discoveries that we can be proud of, and this should be known both in Russia and around the world. So far, we are not publishing enough in the international arena, and in Russian medicine there is a general tendency to lock ourselves inside of our own environment. On the one hand, absolutely amazing ideas are sometimes born in a closed system: for example, the Ilizarov apparatus, a unique know-how invented in the Soviet Union, that is now used around the world. On the other hand, nowadays international communication is one of the most important conditions for development. English has long been the international language of science, and at the NMRC for Hematology we are trying to create all conditions for young doctors to learn the language and feel free in a professional environment. I know that the Rogachev National Medical Research Center has been inviting doctors from Germany and the USA for many years, who not only give lectures, but also work together with departments. I would like to implement a similar scenario with us. This will help young doctors to see how experts who grew up in a different healthcare system work. For example, there are already plans for joint research work with Robert Peter Gale.

In general, the problem of integration into the international medical community is one of the most important tasks that we will solve. Over the past years, we have managed to change many things, but there is still room for improvement. We are ready not only to continue learning in our own arena, but also to talk about our successes and share our experience with colleagues, both domestic and foreign.

What successes in international communication are you ready to talk about now?

There are many achievements. For example, I am very pleased with the success of Grigory A. Efimov and his staff in the Laboratory of Transplantation Immunology, who publish virtually all of their scientific discoveries and developments in the international press and collaborate with a number of laboratories in the USA and Europe. During the severe epidemiological situation, the laboratory developed test systems for the determination of antibodies and T-cells to SARS-CoV-2 in record breaking time. These are now used by several institutions and laboratories in the country.

Another reason for pride: the NMRC for Hematology is the only scientific organization in the world that includes pregnant women in clinical studies on leukemia. Most recently, in May, an article prepared by Vera V. Troitskaya and I on the treatment of pregnant women with acute lymphoblastic leukemia was published in the journal Leukemia Research.

I am also a member of the European Working Group for the Study of Lymphoblastic Leukemia and the working group of the European Leukemia Network. The staff of the NMRC for Hematology are participants in joint projects with the European Leukemia Network for the study of CML, CLL, are experts in the development of international recommendations for the treatment of infectious complications in the treatment of diseases of the blood system, and more.

It is impossible not to touch on another very relevant topic — medical ethics.

Recently we were visited by a group of journalists, and I was asked the question: "Why is everyone greeting each other in your center?" This surprised me, and I thought: how else? We really do greet both doctors and patients. This is normal behavior of intelligent people. Well, the internal culture of a doctor is decency, the ability to be friendly, to help people, to have the ability not just to give advice, but to help, direct, and meet halfway. For us, these are basic things. Our institute is indeed a big friendly family where many people have been working for many years. And I can't imagine it being any other way!

Patients who are in an emotional crisis come to us. When a terrible diagnosis has been given and his whole world has collapsed, we must reach out and say: "Don't worry, let's work together." After all, success is not solely dependent on how doctors communicate with each other or follow clinical recommendations. Contact with the patient and the patient's trust is no less important. This is by no means patronage, this is partnership with the patient, mutual respect, understanding of the situation in which the person finds himself, and the desire to help him get out of this crisis. These are key principles. We were taught this way 30 years ago, and we also teach young doctors who come to us now. This is what our school is all about. Moreover, I will say that it is impossible to work in our field in any other way, otherwise it will burn out a person in a few years.

Tell us about your recipe for professional success?

When I came to Germany for an internship many years ago, there was a piece of paper on the wall of my teacher Thomas Buchner with a printed poem by Walter D. Wintle "Thinking"

“If you think you are beaten, you are…
If you think you’ll lose, you’re lost…
But sooner or later the man who wins, Is the man who thinks he can!”

Если ты думаешь, что тебя победили, ты побежден.
Если ты думаешь, что проиграешь, ты уже проиграл.
…Но рано или поздно побеждает тот, кто думает, что может!

These lines have supported me throughout my life.

 

E.N. Parovichnikova with the staff of the NMRC for Hematology of the Ministry of Health of Russia