A Village Once Celebrated Him, Now It's ASH's Turn

Fran Lowry

July 26, 2011

July 26, 2011 — Ching-Hon Pui, MD, the world-renowned pediatric oncologist/hematologist, is going to have to make more room on his very crowded mantel for yet another award.

The American Society of Hematology (ASH) has named him the recipient of its 2011 Henry M. Stratton Medal, in recognition of the significant work he has done over the past 3 decades in the research and treatment of pediatric leukemia.

Dr. Ching-Hon Pui

Dr. Pui, who is the Fahad Nassar Al-Rashid Chair of Leukemia Research and chair of the Department of Oncology at St. Jude Children's Research Hospital in Memphis, Tennessee, and coleader of St. Jude's hematological malignancies program, will accept the medal in December at the 53rd ASH Annual Meeting and Exposition, being held in San Diego, California.

"Dr. Pui has dedicated his career to advancing the cure rate of pediatric leukemia. I can think of no other person who has done more than Dr. Pui to push cure rates higher," William E. Evans, PharmD, St. Jude director and CEO, and long-time collaborator of Dr. Pui, told Medscape Medical News.

"This honor recognizes his decades of leadership contributions as a translational researcher, physician, and educator. His work has had an impact on children around the world, and is why the cure rate for acute lymphoblastic leukemia [ALL], once a deadly disease, has now surpassed 90%," Dr. Evans said.

And, if Dr. Pui has anything to do about it, the cure rate will go even higher.

Born in Hong Kong

Dr. Pui, who was born in Hong Kong, was encouraged by his high-school biology teacher to go into medicine.

It's amazing how influential a good teacher can be.

"He was a very kind teacher. I remember I was accepted by many colleges — one accepted me to do biology, another for geography — and I had no idea what I should do. So I went to see him. It was at night, I went to his home, and he encouraged me to study medicine in Taiwan. It was a 7-year course; for a high-school kid, it seemed like a very long time. It took a lot of encouragement, and I should give him the credit. It's amazing how influential a good teacher can be," Dr. Pui recalled.

Dr. Pui got his MD from National Taiwan University in 1976. He also interned there.

A Village Celebrates

His acceptance to medical school was "a big deal," he explained.

"In the 1970s, in Taiwan, if a child got accepted into medical school, the whole village would celebrate. It was a big deal, particularly to go to National Taiwan University. It's like going to Harvard. My mother and father were very happy. We didn't have a doctor in our family, and being a doctor was the most prestigious profession in Taiwan and in Hong Kong, or for that matter anywhere, in that era. I don't know if people think the same way now, but at the time, it was a very prestigious profession and every parent would be very proud if their child could get into medical school and have a chance to become a doctor."

One decision that was easy for Dr. Pui to make was his decision to become a doctor who treats children.

"During medical school, I always was interested in pediatrics. I was accepted into a pediatric program in the United States after my internship in 1976, so that's when I came."

Dr. Pui's first stop in the United States was St. Louis, Missouri. He was a resident in pediatrics at St. Louis City Hospital for 1 year, then went to St. Jude, where he has been ever since.

"I knew I wanted to do pediatrics, but I did not start out wanting to do oncology. At St. Jude, I was exposed to this environment of research in children with cancer and I got very interested in that. I was also touched by the kindness and pride of everyone here in taking care of the sick children, so I stayed on. It became my passion to take care of children with leukemia. It is the right place for me."

Cure Rate Will Reach 100%

Dr. Pui has been instrumental in devising treatment protocols for ALL, the most common childhood cancer, which has seen cure rates go from about 70% in the early 1980s to 90% today, at least in the children and teens treated at St. Jude.

Importantly, Dr. Pui has shown that cranial irradiation, once considered standard treatment for childhood ALL, is not necessary and can actually be omitted altogether.

"We improved not only the cure rate, but also the quality of life of children with leukemia. The thing I am probably the proudest of is that we have shown that we can totally eliminate the use of radiation to the head and still cure these children. This was standard treatment at one time, and it is still being used by many people for high-risk patients. We don't treat any of our patients with radiation, not just those with ALL, but also those with any leukemia or lymphoma. We proved it is not necessary if you do everything right and deliver chemotherapy optimally."

Dr. Pui's efforts have also been successful in older adolescents with ALL, a group of patients who have been notoriously difficult to treat.

"It is still a difficult group for most people, even for us, but we have a good team and have overcome most of the obstacles to have a high cure rate," he said. "We use pharmacokinetics, pharmacodynamics, and pharmacogenetics to personalize therapy to get these good results."

One day, Dr. Pui believes, the cure rate will reach 100%.

"We still have 10% of ALL patients who we are not able to cure at this time, but there is hope on the horizon, because there are a couple of promising therapies in development. I am hopeful that we can push the cure rate to 100%. It is conceivable that this will happen in my lifetime," he said.

Helping Kids Around the World

Not content to improve outcomes for the children who come to St. Jude, Dr. Pui is also working to help children with leukemia from other countries. He is medical director of the St. Jude International Outreach China Program, and helped found the International Childhood ALL Working Group to promote international research collaboration.

"For more than 3 decades I have been in the United States, helping children here, but the reality is that most children who get cancer in developing countries don't even have a chance of surviving. They don't even get treatment. St Jude has an international outreach program to help children in 16 countries around the world," he said.

Dr. Pui's efforts in China were credited for the development of catastrophic disease insurance in that country's healthcare system.

"St. Jude has a program that allows me to treat some patients with leukemia for free in China. It used to be that in China, if the family had no insurance, they just took their child home to die. With the help of a dedicated board member of St. Jude, we started a program and raised funding to treat children with low-risk leukemia at 2 of the best centers in China. It had to be at the best centers, because we had limited funding and had to have the highest return.

"We have treated over 100 patients now. It is more cost-effective to treat a child in China than if we treated that child in the United States. The Chinese Minister of Health learned how successful our program was, and started a pilot program that gradually has extended to other catastrophic diseases of children, and now, even to adults," he said.

In what little spare time he has, Dr. Pui enjoys listening to classical and choral music and exercising. He would like to sing in his local choir — "they keep on trying to recruit me" — but this is something his busy schedule will not allow. He has no children of his own, but is proud of his many nephews and nieces, 2 of whom have followed in his footsteps and become doctors.

"One is an MD, PhD at Harvard; the other is at Columbia University in New York City. Now it is their turn to carry on."

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