Where Are They Now?: Allison Rosenthal, DO
Dr. Allison Rosenthal, DO is a lymphoma specialist at the Mayo Clinic in Phoenix, Arizona.
My childhood ambition was to be a doctor which I can only explain by my innate desire “to help.” Despite aiming for a career in orthopedic surgery when I entered medical school, a diagnosis of acute promyelocytic leukemia during my second year reshaped my path. Though it took some time for me to recognize the opportunity I had been given to serve others diagnosed with cancer, I now know a career as an oncologist allows me to live my purpose. Navigating cancer as a young adult patient and then trying to figure out what it means to be a survivor is something I am passionate about helping my patients with. While in my hematology-oncology fellowship, lymphoma captured my attention. I found lymphoma as a specialty combined all the things I was looking for diverse patients and presentations, enough acuity that allowed both an inpatient and outpatient practice, varied outcomes, lasting patient bonds, rapidly evolving science, and a focus on
I was junior faculty at Mayo Clinic, Arizona when I was accepted into Lymphoma Research Foundation’s
Lymphoma Scientific Research Mentoring Program (LSRMP) in 2018.
My project focused on clinical validation of an assay called “MCL35” in mantle cell lymphoma. This assay had been shown to risk stratify younger MCL patients who were receiving RCHOP based therapy into high-standard and low risk groups with varying outcomes. Through this study, we assessed whether the MCL35 assay predicted
outcomes in untreated mantle cell lymphoma patients who were over the age of 60 and receiving bendamustine and rituximab. This project required both analytical and clinical validation of this assay. The summary of this work has been submitted for publication and we continue to try and identify biomarkers that could help us choose optimal therapies for MCL patients.
In the past 5 years, the treatment landscape for lymphoma and CLL has changed dramatically. Immunotherapies have become an integral set of treatment options for patients with lymphoma. We have seen approval of CAR T cell products for relapsed or refractory aggressive lymphomas, mantle cell lymphoma, and follicular lymphoma. We also now have several new targeted therapies for B cell malignancies including bispecific antibodies and antibody drug conjugates. Despite this rapid progress, sequencing these therapies and understanding long term toxicities are ongoing challenges. With a better understanding of resistance mechanisms, a new generation of BTK inhibitors has emerged. Novel combinations like checkpoint inhibitors and antibody drug conjugates paired with chemotherapy appear to improve outcomes. As treatments become more targeted and personalized, there is a growing emphasis on patients’ quality of life during and after treatment, minimizing side effects and long-term
I would not be where I am today without LRF’s support and the mentorship I received during the LSRMP. This program helped me understand the difference between predictive and prognostic biomarkers and how translational studies can be designed to answer vital research questions. The network of mentors, colleagues,
and peers I have within the lymphoma community has been vital to many of my accomplishments so far. I have
been fortunate to be part of subsequent LRF initiatives – most recently those centered on improving collaboration
and outcomes for adolescent and young adult (AYA) patients with lymphoma.
I have been indirectly involved in the development of targeted therapies for lymphoma/CLL as a clinical investigator participating in several studies in this space. I do think targeted therapies such as bispecific antibodies, antibody drug conjugates or small molecule inhibitors are representative of a new frontier in the treatment of lymphoma and CLL. Unlike chemotherapy, which often affects both healthy and lymphoma cells, targeted therapies are designed to pinpoint specific markers, molecules or pathways that are crucial for cancer cell growth and survival. We must recognize that while targeted therapies offer significant promise, we still face challenges including the potential for resistance and the need for continued research to optimize treatment
combinations and sequencing. As the landscape of targeted therapies continues to evolve, I hope we will see more effective personalized and less toxic treatment options for our patients with lymphoma.
I have participated in two workshops focused on issues related to lymphoma in adolescent and young adult (AYA) lymphoma patients. Working with the AYA population and being invested in the development of trials and outcomes research for them is really where my passion lies. I am extremely excited about continuing to contribute to those efforts. I also really enjoy opportunities to educate patients, their caregivers, and colleagues. I have had numerous opportunities through LRF to give presentations at regional and national patient educational meetings and on webinars. Additionally, I am grateful to have been invited to be a member of the steering committee for National Lymphoma Rounds. I have had the pleasure of being a Grand Marshall for the local LRF walk to raise funds for LRF programs and have continued to engage in efforts to raise awareness about the incredible things LRF does.
The work the Lymphoma Research Foundation does is INTEGRAL to funding lymphoma research, providing patient education and support, and for raising awareness about lymphoma. LRF provides grants and funding to early career scientists, junior investigators and established lymphoma researchers that furthers our ability to understand the disease, develop new treatments and improve patient outcomes. Equally impactful is all the online resources, webinars, support groups and educational materials LRF maintains to help patients and their loved ones navigate a lymphoma diagnosis. When talking about raising awareness about lymphoma, LRF does this not just within the healthcare community but also with policymakers where they advocate research funding and improved patient care. Finally, LRF builds sense of community and fosters collaboration amongst physicians, scientists, patients, survivors, and their caregivers.
I am most excited about being given the chance to develop and implement an Adolescent and Young Adult Cancer program at Mayo Clinic. AYA cancer programs are vitally important to address the distinct needs of adolescents and young adults with cancer. Within such programs we can better ensure this unique patient group gets optimal care, support, and age-appropriate resources from diagnosis through survivorship. With an organized program we can contribute to better outcomes, improved quality of life and increased awareness about the issues AYA cancer patients face. One AYA specific intervention we are exploring is the development and implementation of a survivorship skills course. The transition from being in treatment into early survivorship is one that many of our patients struggle with and we hope to equip them with the tools they need to move successfully and confidently into the next stage of their life. I am also currently involved in a number of trials involving targeted therapies including novel CAR-T cell approaches, immunotherapy combinations and early phase therapeutics.
I am particularly excited about the rapid evolution in treatment choices for patients with relapsed or refractory aggressive lymphomas. The prospect of reducing or even eventually eliminating the reliance on chemotherapy excites me as I look forward within my career in lymphoma. This shift seems feasible thanks to quick strides in comprehending the biology of some lymphomas and the concurrent developed of targeted therapies. With my focus on the AYA lymphoma population, I am equally thrilled about the recent inclusive approach taken in designing trials that span the entire age spectrum. This intentional effort holds the promise of answering critical questions about optimal treatments for young patients with lymphoma. As a result, disparate approaches for adolescent and younger adult patients in pediatric vs adult clinics may become a thing of the past.