5 Questions for Alexander Ciurej, MD

This question-and-answer series explores the motivations, inspirations and accomplishments of current and former students at the St. Jude Children’s Research Hospital Graduate School of Biomedical Sciences. Alexander Ciurej, MD, is a Pediatric Hematology-Oncology Fellow at St. Jude Children’s Research Hospital and is participating in the Graduate School’s Clinical Investigations program. 

1. What inspired you to pursue pediatric medicine?

I knew in my first year of undergrad that I wanted to pursue a career in oncology. By the early days of medical school, I had narrowed that further to pediatric medicine. It is really rewarding to not only be able to treat the patients, but to be there for the parents and families. When pediatric patients are in the hospital, it’s a huge life event for their loved ones. To help treat a child is special, but so is forming a bond with the parents. Those were some of the most rewarding experiences in my time as a medical student.

I wanted to do more research when I got to St. Jude because of its emphasis on pushing the field forward. St. Jude is world-renowned for cancer research, and there have been so many advances in so many different diseases because of the work that people have done here.

Through my experiences in the hospital and from speaking with my mentors, I knew I wanted to understand what clinical research looks like better and how it is formed from the ground up. I wanted formalized training to get that foundational knowledge and to be able to know the language so I could have conversations with different investigators, biostatisticians and others with whom I would be working over the next two years for my fellowship. Now that I have my foot in the door, I’d like to potentially have an impact on future patients and progress the field forward.

2. What are you exploring in your fellowship and what do you hope to accomplish?

I’m one of the Pediatric Hematology-Oncology fellows. It’s a three-year program. The first year is primarily clinical work, so we’re in the hospital in services like leukemia, bone marrow transplantation and hematology. We also have one clinic day per week. 

In the final two years of the fellowship, there is a shift in how we spend our time. We still have our one day of clinic per week, and then the rest of our time is dedicated to performing research. That can be either clinical research, like I’m pursuing, or a laboratory-based approach. 

On my non-clinic days, I’m looking over raw clinical data as part of my research projects. I’m also attending different meetings and lectures to help me understand more about the research process. On Tuesdays and Thursdays, I have classes for the master’s program. It’s certainly a change from my first year. I think I’m just as busy, but in a different context now.

3. What got you curious about bone marrow transplantation, cell therapies and related toxicities?

I spent time in medical school with a bone marrow transplant physician, and I saw it as a combination of my biggest interests: oncology and immunology. There’s an aspect of immunology in most areas of oncology, but with bone marrow transplantation, immunology plays a much larger part, and that has held my interest for many years.

Bone marrow transplant patients can experience many toxicities. The onus is on us as physicians to figure out how to not only perform successful transplants that cure them of disease but also do so in a way that reduces the toxicities, which can be lifelong and life changing. My research investigates one of those toxicities: transplant-associated thrombotic microangiopathy, or TA-TMA for short. It can damage small blood vessels, leading to low red blood cell and platelet counts, and can cause long-term organ damage. We’re trying to figure out who would most likely develop TA-TMA after transplant. Our hope is that we can intervene sooner to mitigate risk and improve long-term outcomes.

4. What mentor or mentors most shaped your career trajectory and how did they make an impact?

Earlier in my training, I worked with a pediatric oncologist in Nebraska. He was such a large personality; he really got me excited to specifically pursue pediatric oncology. I must thank him for guiding me into the pediatric space.

There was also a cardiologist during medical school that I went to quite a bit when I was applying for fellowship. Having people outside your own silo can help by giving an outside perspective.

At St. Jude, I’ve worked with so many different attending physicians who lead clinical trials. For example, Hiroto Inaba, MD, PhD, Department of Oncology, is the program director of my fellowship and has been a large presence for the leukemia trials. My research mentor, Akshay Sharma, MBBS, MSc, Department of Bone Marrow Transplantation & Cellular Therapy, with whom I’m working for the next couple of years, has been a guiding force in keeping me focused and productive.

I’ve been lucky to meet a lot of impactful people here whom I’m comfortable bouncing my thoughts and ideas off, and they’ve given me good insights not only on research or for my patients, but as career mentors as well.

5. What factors went into your decision to pursue a fellowship at St. Jude?

There are so many good oncology and hematology fellowships across the country, and I applied and interviewed for many of them. St. Jude grabbed my attention for a couple of reasons. One was the emphasis on research. I knew I would be among some of the most world-renowned physicians and scientists who have pushed the field forward. It was especially attractive to learn from those people and to play a role in some of the clinical trials.

Second was its clinical strength. We take care of patients from all around the world who often have very treatment-resistant disease. There is so much to learn from these patients, whether it’s understanding the standard of care for a specific cancer or disease, the other options that we need to explore if those standards of care are not working or simply having the chance to collaborate with so many different experts in the field. It was an easy decision to choose St. Jude, and I would make that choice time and time again.