By Steve Blanchard - May 15, 2023
Navigating the intricacies of allogeneic transplants is a specialty of Dr. Nelli Bejanyan. The program leader of Blood and Marrow Transplant and the head of the Leukemia/Myeloid Section of the Department of Blood and Marrow Transplant and Cellular Immunotherapy at Moffitt Cancer Center is renowned for her expertise in transplanting healthy donor (allogeneic) stem cells into patients with blood cancers such as acute leukemia.
It’s a skill and an expertise that isn’t available everywhere around the globe. But with the specialized BMT training program at Moffitt, Bejanyan hopes to change that. She wants to start with her home country of Armenia.
This year, Bejanyan invited hematologist Dr. Nerses Ghahramanyan from Yeolyan Hematology Center in Yerevan, Armenia, to learn as much as he can about allogenic transplantation at Moffitt. The goal is to take that knowledge and experience back to Armenia, where adult patients have no access to curative allogeneic bone marrow transplants.
“In my country I treat blood cancers like leukemia, lymphoma and myeloma,” Ghahramanyan said. “I am here to gain expertise in BMT, specifically allogeneic transplants. In Armenia, there are challenges also with research and clinical trials. It’s part of my dream to establish a strong allogeneic BMT program and develop research in that field in my country.”
Gaining Guidance and Education
Access to clinical trials in allogeneic BMT and broad exposure to transplant cases are big advantages for Ghahramanyan while visiting Moffitt. The guidance provided by Bejanyan is also crucial to his education and his ability to relay what he learns to fellow doctors in Armenia when he returns home later this summer.
Bejanyan and Ghahramanyan met in 2019 at the 5th International Medical Congress of Armenia. In 2021, Bejanyan spoke with Moffitt leadership about offering a training program to Armenia, and since then every week, she has been mentoring Ghahramanyan online.
Leadership at Moffitt was supportive of a hands-on training program, and Ghahramanyan was on the short list of physicians considered for the opportunity. He accepted immediately.
Bejanyan has personal experience with the importance of having access to lifesaving allogeneic transplants. It was the lack of that option that led to the passing of her cousin in the early 1990s and inspired her to pursue a career in blood and marrow transplant, Bejanyan said.
“My cousin was 28 and had acute myeloid leukemia,” Bejanyan said. “She had two kids, one of those children was only 40 days old when she died.”
Her cousin did not have access to the appropriate care such as leukemia chemotherapy and allogeneic transplant.
“This was in the early 1990s and I always thought, ‘Maybe I should learn this,’” she said. “I would hear heartbreaking stories like hers and it was just too expensive to move patients elsewhere for transplants.”
Since moving to and pursuing post-graduate education in the United States more than 20 years ago, Bejanyan has worked to hone her expertise, as well as teach other physicians the techniques that can save the lives of leukemia patients.
Learning All He Can
Ghahramanyan, 28, has already established himself in the blood and marrow transplant community of Armenia. He spends 90% of his time in the clinic, he said, because there are not many opportunities to conduct research.
“So, I really haven’t done much research in my home country,” Ghahramanyan said. “I am really surprised and impressed with the number of clinical trials going on here in the United States. Part of my dream is to develop research in hematology and BMT in my country. It’s an essential part of developing successful treatment.”
Bejanyan is not only giving Ghahramanyan a chance to see how research is conducted at Moffitt, she’s also giving him an opportunity to see all aspects of patient care, from the clinicians, nurses and pharmacists on the floor to the researchers in the lab.
According to Bejanyan, Moffitt performs 450 transplants a year on average, and she is working to expand the cancer center’s program.
“We provide excellent care, and we have the experience,” she said. “Our one-year survival exceeds the expected national requirements.”
"We provide excellent care, and we have the experience. Our one-year survival exceeds the expected national requirements."- Dr. Nelli Bejanyan, Department of Blood and Marrow Transplant and Cellular Immunotherapy
Moffitt’s one-year survival rate for patients who undergo allogeneic transplant is at 78%, she said.
“If we look at the entire patient population receiving allogeneic transplant, we can cure 50 to 60%,” she said. “There is still a risk of recurrence for disease and a risk for mortality from the transplant. But in many cases, if you don’t do the transplant, you won’t survive.”
And that is exactly why Ghahramanyan wants to take what he is learning at Moffitt and make it available in Armenia. Providing an option that is unavailable will save countless lives.
“For Armenia, my team there is well-equipped,” Ghahramanyan said. “I hope to get back to my team, start performing allogeneic transplants for blood cancers and transfer the knowledge I’ve gained here to my colleagues.”
Ghahramanyan said he doesn’t know of any other cancer treatment plan that is more complex than allogeneic transplants.
“My hope is that my experience will change lives — change patient care — for my whole country,” he said.