Summer 2008

2008 Alumna of the year - Blood ties

Dr. Mary Horowitz oversees global network to improve outcomes of bone marrow transplants

Classes represented in this story: ’45, ’70, ’80

Throughout her career, Mary M. Horowitz, MD ’80, MS ’91, GME ’84, Fel ’89, has harnessed the power in numbers to improve outcomes for blood and marrow transplant patients. This force lives and grows within the Center for International Blood and Marrow Transplant Research (CIBMTR), at the Medical College of Wisconsin. Dr. Horowitz is Chief Scientific Director of the center, which comprises a network of more than 400 transplant centers in 47 countries that share outcomes data and a statistical center with a clinical database of more than 200,000 transplant recipients.

Accumulated, these individual cases provide knowledge that could not be gleaned in isolation. Physicians across cities, states and nations can mine the CIBMTR for successful precedent to establish treatment plans for their own patients. “This is the power of a registry,” she said, “the ability to combine data on many patients to better address important clinical and biological questions.”

Through Dr. Horowitz’s investigative, administrative and clinical leadership, the scope of the registry has expanded with new collaborations and contracts that will have a significant and enduring impact in the field of bone marrow transplant (BMT). For her vision and enormous devotion to her work, she is the Alumni Association’s 2008 Alumna of the Year.

Professional home sweet home
From her M1 year to her current role as the Robert A. Uihlein Professor in Hematologic Research and Professor of Medicine (Neoplastic Diseases), Dr. Horowitz has been a member of the Medical College of Wisconsin family. Supportive mentors, colleagues and administration have kept her here throughout. It was here as a junior faculty member that she met the late Mortimer Bortin, MD ’45, the founding director of the CIBMTR’s predecessor, the International Bone Marrow Transplant Registry (IBMTR), and a man she considers her professional father. She also developed a relationship with former Biostatistics Chief Al Rimm, PhD, who suggested she work on IBMTR data for her master’s thesis. From these roots grew a forest of opportunity, through her hematology/oncology fellowship, her joining of the IBMTR in 1986 and her appointment as director in 1991.

Academic medicine was a destination from the start, as she finds excitement in the climate of scientific inquiry, but BMT quickly revealed itself as a perfect match.

“Clinically, one cares for very ill patients, something I always liked, with the potential for cure, Dr. Horowitz said. “And one tends to have a long-term relationship with them – the appealing part to me of primary care. And it is a field where there has been incredible change and progress over the years.”

Such change, often catalyzed by Dr. Horowitz, has been evident at the Medical College, though probably never more so than in 2004 when she led the IBMTR into an affiliation with the National Marrow Donor Program to create the CIBMTR. As she describes, both entities were important forces in the landscape of BMT-related clinical research with overlapping and complementary areas of expertise.

“Together, we have been able to greatly expand our research programs –  beyond the simple sum of the two organizations’ efforts – particularly in the areas of immunobiology research and prospective clinical trials,” she said.

The collaboration also allowed the CIBMTR to compete successfully in 2006 to be the U.S. Stem Cell Therapeutic Outcomes Database, mandated by Congress to collect data on all allogeneic BMT outcomes in the United States. Dr. Horowitz is Research and Project Director of the database, which is a component of the C.W. Bill Young Cell Transplantation Program.

These institutional and systemic advances are really just means to an ends, namely the research of authorities worldwide, Dr. Horowitz among them, endeavoring to improve transplant success rates. Dr. Horowitz has published more than 200 articles in the biomedical literature related to blood and marrow transplantation, including a seminal text on graft-versus-leukemia effect in the journal Blood. The paper, for which she was lead author, examined the clinical evidence for a role of the (allogeneic) graft in curing leukemia in more than 2,000 patients and showed the important, anti-leukemia effect of donor cells in a definitive way.

James T. Casper, MD ’70, GME ’72, Fel ’74, Professor and Chief of Pediatric Hematology/Oncology has worked side by side with Dr. Horowitz in collaboration on research and clinical efforts.

“I have had the privilege of working with Mary for more than 20 years,” said Dr. Casper, who is Director of the Pediatric Bone Marrow Transplant Program at Children’s Hospital of Wisconsin and was Alumnus of the Year in 2005. “I’ve never been associated with a more dynamic, energetic, and dedicated physician and colleague. Not only does Mary have the energy of 10 people, she has ability to focus her efforts and be incredibly productive.”

Reaching ever forward
After spending much of her career doing observational research, Dr. Horowitz is particularly excited about a new effort underway in the CIBMTR – the development of the U.S. Blood and Marrow Transplant Clinical Trials Network, which is conducting large prospective clinical trials in BMT. More than 60 U.S. transplant centers have participated in these trials, which have now enrolled more than 2,200 patients, and recruitment is beginning to expand abroad. She considers the international aspect of her work a highlight.

Dr. Horowitz is also currently involved in the development of a new system for sharing clinical data electronically between research centers and networks. The system, called AGNIS (A Growable Network Information System) will allow the direct transfer of data from local databases to the CIBMTR and others on the grid, decreasing the burden of data management at the transplant centers.

If research has been the heart of Dr. Horowitz’s career, patient care has been the soul. Despite enormous leadership and investigative responsibilities, she has continued to see bone marrow transplant patients at Froedtert Hospital. Her role in her patients’ lives has taken on heightening meaning for her since she was diagnosed with and treated for breast cancer. She underwent surgery and chemotherapy in 2004.

“Getting state-of-the-art care is critical but getting it in a caring and empathetic way is also very important,” Dr. Horowitz said. “I have always tried to do that, but I learned some things from my own illness – the importance of listening, of taking enough time to allow information to sink in, of being available, of understanding that all of the tests we take for granted as we write our orders often involve discomfort or indignity.”

These are lessons she has worked to impart on the next generation of hematology/oncology physicians with whom she works as a teacher and mentor. Knowing firsthand the difference that individual health care givers can make in how a person feels about his or her situation is incentive for excellence in clinical care, a standard to which Dr. Horowitz holds herself.

“I went to medical school to be a doctor, and taking care of people is still one of the most rewarding things I do,” she said. “I always tell my fellows that they should consider it a privilege to share in such a critical time of our patients’ lives, and I really feel that.”