For patients with sickle cell disease, Farzana Pashankar, MD, generally relies on treatments to relieve their unremitting pain during a sickle cell crisis. But three patients at Yale, including a 12-year-old girl, were cured of the disease entirely after undergoing a bone marrow transplant.
The transplant treatment is risky: 80 percent of children are cured, but 10 percent reject the transplant and 10 percent die. “It’s a difficult choice, because kids with sickle cell could live another 25 years,” Dr. Pashankar said.
The 12-year-old girl had suffered a stroke, and required monthly transfusions and intravenous chelation therapy five nights a week to remove the resulting iron buildup. She had the transplant after the discovery that her younger brother was a perfect match. Today she leads a productive life without medication.
Improving treatment with research
Dr. Pashankar is director of the Pediatric Hemoglobinopathies Program at Yale, which treats more than 200 patients with sickle cell disease and thalassemias, a diverse group of blood diseases that are genetic.
With sickle cell disease, 20 to 30 percent of adults develop pulmonary hypertension, which can be fatal, by the age of 30. Dr. Pashankar conducted the first study to identify risk factors for early detection of pulmonary hypertension, and found that elevated triscuspid regurgitant jet velocity (TRJV) – a measure for determining pulmonary artery pressure – could be a predictor. She is now conducting a multicenter clinical trial to use the drug hydroxyurea to reverse elevated TRJV.
She also treats pediatric cancer patients, and has a particular interest in solid tumors. She is a vice chair of the Rare Tumor Committee of the Children’s Oncology Group, a National Cancer Institute-supported clinical trials group, and the world’s largest organization devoted exclusively to childhood and adolescent cancer research.. Dr. Pashankar is currently working on developing a multinational research protocol for patients with high risk germ cell tumors that incorporates stem cell transplants to improve survival.
Providing care with compassion
Treating patients with cancer and seeing them regain their health and grow up is one of the most rewarding experiences, according to Dr Pashankar. But sometimes this is not feasible. “Once you’ve tried everything, I think the most important thing for an oncologist is to be able to sit down with the family and come to an understanding of what is important to them,” she said. The ability to help provide memories for a family of a child feeling comfortable and peaceful, instead of struggling and dying in pain, is crucial to her.
“The most important thing to me is to be able to help families when they’re at the most critical point,” she said. “I feel very privileged to do what I do.”
More about Dr. Pashankar
Name: Farzana Pashankar, MD
Title: Associate professor, pediatrics
Area of expertise: Pediatric hematology and oncology
Place of birth: Pune, India
College: Loyola College, India
Med School: Byramjee Jeejeebhoy Medical College, India
Training: Residency in pediatrics at Sassoon General Hospitals in India and University of Iowa Hospitals and Clinics; pediatric hematology oncology fellowship at British Columbia Children’s Hospital in Canada, and University of Iowa Hospitals and Clinics
Family: Married to Dinesh Pashankar, MD, pediatric gastroenterologist. Daughters: Rashmi, 17; Neha, 11; and Sana, 10.
What is most rewarding about your career? The ability to care for and help families in some of their most difficult times. Being in an academic environment also offers me the opportunity to do clinical research, which I enjoy.
What do you like most about your practice? We have a very collegial group, and I enjoy working with them.
Personal interests or pastimes? Reading, spending time with my kids and friends
Last book read: “Life of Pi,” by Yann Martel