Pulling Back the Curtain: Lukas Wartman, MD

Lukas Wartman, MD
Assistant professor in the Department of Medicine in the Division of Oncology at Washington University School of Medicine in St. Louis, Missouri

In this edition, Lukas Wartman, MD, discusses his decision to go into medicine and his life as a doctor and a patient. Hear more from our interview with Dr. Wartman in Sound Bites.

Dr. Wartman relaxing at home with his Shiba Inus, Kitsu (left) and Kazu (right).

What did you think you would be when you grew up?

Starting in middle school, I helped my grandfather and uncles as an electrician’s assistant during breaks from school. Electrical work was the family business. I saw the potential for living a pretty good life as an electrician, but I didn’t end up following in their footsteps, and neither did my two younger siblings.

My sister is a teacher [as was our mother] and my brother started off as a teacher but now works for a company that many physicians hold in ill regard: the electronic health record vendor Epic.

When did you start thinking about medicine as a career?

There weren’t any doctors in my family, but we did have connections to medicine: My dad was a nursing home administrator and spent most of his career working in small group homes for the mentally disabled. As a kid, I saw that he was doing valuable work there.

Also, my grandfather was a veterinarian. I looked up to him and I loved animals, so going into college, I thought about becoming a biologist or veterinarian, or maybe even a doctor.

Over the course of my undergraduate studies, however, I realized that, while I loved biology, I also loved working with people. Becoming a physician seemed like a good fit for my interests; I could satisfy my scientific curiosities, learn interesting things, and also make a direct contribution to helping people to improve their health.

I wanted teaching to be part of my career, and I knew that it would be part of my life as an academic physician. I graduated college one semester early and taught seventh grade for a teacher out on maternity leave during a break before medical school. I got to work in the same school as my mom, which was an amazing experience.

Why did you decide to pursue hematology? 

There’s a simple answer and a complicated answer to that question.

The simple reason is that, from an intellectual standpoint, I was attracted to the idea of precision medicine and targeted therapies. I liked learning about the connection between underlying molecular abnormalities and how these abnormalities were driving cancer, especially leukemias. In my second year of medical school, I took a hematology course that I loved. I liked looking at peripheral blood smears and bone marrow biopsies, and the course master, Scot Hickman, MD, was very passionate about malignant hematology. I rotated through his clinic during my fourth year, and that experience – the combination of learning about the science and taking care of patients – solidified my choice to pursue malignant hematology.

The complicated answer is that a few months after that rotation, I was diagnosed with acute lymphocytic leukemia (ALL). I can’t deny that that experience shaped my career path.

There’s a bad joke that I like to tell to explain it: I’m a leukemia doctor, a leukemia researcher, and a leukemia patient, and my name is Luke – I’m a simple person with a one-track mind.

How did the diagnosis and treatment affect your career path? 

During the initial nine months of intense chemotherapy I was pretty sick, so I took time off from medical school.

As I transitioned to maintenance chemotherapy, I felt better and began doing research in the hematology lab of Stuart Kornfeld, MD. I spent a year doing research, completed my maintenance treatment, and then jumped back in, with just a month of medical school left to finish. I was able to start my residency immediately after that.

My story takes a lot of twists and turns from there. I relapsed after my first year of fellowship, had a stem cell transplant, recovered, and was able to start working in the lab with Timothy Ley, MD, at Washington University in St. Louis. Then, five years after my initial diagnosis, my disease relapsed again. Salvage chemotherapy failed to put the disease back into remission, so then I had the lethal combination of relapsed and refractory adult ALL.

At that time, Tim and other colleagues at Washington University’s McDonnell Genome Institute had started sequencing patients with acute myeloid leukemia. They had just opened a protocol for ALL and offered to comprehensively sequence my leukemia genome.

My DNA sequencing results did not reveal an actionable target, but RNA sequencing showed that the gene FLT3 was greatly overexpressed in my leukemia cells. This aberration could be targeted with the tyrosine kinase inhibitor sunitinib; although we had no knowledge of any other adult ALL patient having been treated with the drug. I started sunitinib a couple weeks later, along with mild chemotherapy, and my disease went into complete remission. I underwent a matched unrelated stem cell transplant in 2011 and, thankfully, my ALL has remained in remission since then. (Editor’s note: In July 2012, The New York Times told Dr. Wartman’s story and the discovery of FLT3 in “Genetic Gamble: In Treatment for Leukemia, Glimpses of the Future.”)

Did you ever think about switching to a different, less demanding career? 

Looking back, I’m sometimes surprised that I didn’t consider choosing another career path – or at least another area of research that would have given me some distance from my own illness. People I respect would suggest that I switch to radiology or dermatology or another specialty; I know they had my best interests at heart, but I never seriously entertained the idea. There was nothing else that I was truly passionate about.

Do you share your diagnosis and history with your patients? 

It depends. It’s not something I do routinely, but if I’m with a patient who is struggling with his or her diagnosis or treatment and its side effects and I think that sharing my own story will help, then I’m happy to talk about it.

How has your daily life been affected by the diagnosis – and the treatment?

After I recovered from the second transplant, I developed graft-versus-host disease (GVHD) and other complications related to the transplant itself. For a few years after the procedure, my oncologist and I weren’t optimistic about finding a treatment that would work and that I would be able to tolerate, but now we are seeing more active drugs come into play for the treatment of ALL. That includes chimeric antigen receptor T-cell therapies that have revolutionized the treatment of ALL, as well as two other drugs – blinatumomab and inotuzumab ozogamicin – that are now approved for the treatment of relapsed disease. Knowing that we had new options that were active and that I could potentially tolerate, we performed a bone marrow biopsy to look for minimal residual disease a couple of years ago. Fortunately, the panels didn’t show any.

I’m absolutely relieved that the test was negative and, since then, the disease isn’t something that I need to follow up on every year. I make sure that my blood counts are stable; as long as I’m staying at my baseline, I try not to worry about it too much.

For the past few years, I’ve been focused on building my research laboratory. A typical day involves working with graduate students and postdocs in the lab and doing my own research as well. That’s been fulfilling; it’s exciting to work with trainees, see how their experiments turn out, then watch their careers move forward. It’s nice to be in a position now where things feel like they’re finally starting to come together.

Is there any advice that you pass on to trainees that you learned from your mentors?

I have had incredibly encouraging mentors and colleagues throughout all stages of my career, including Drs. Hickman, Kornfeld, Ley, and John DiPersio, MD, PhD, who heads the oncology division at Washington University – and is my doctor. Dr. Ley was incredibly supportive when I was struggling to get back on my feet after my first relapse and transplant and then became instrumental as a role model and a friend.

They all have taught me to be a nice, honest, hardworking person. That’s what I try to do, and that’s what I try to instill in my trainees. Working hard is part of what we do, but I want them to lead balanced lives so that they look forward to coming to work the next day.

How do you spend your time away from the lab?

I have a partner and two Shiba Inus, so they all keep me pretty busy. Honestly, it’s been a bit of a struggle returning to the normal things I did before the second transplant. The GVHD interfered with many of the activities I liked to do: I used to be an avid runner, and now I’m not running anymore. I like to see live music, but I haven’t been doing that as much – and maybe part of that is just me getting old …

But I have been feeling better over the past year, so I am intentionally trying to resume what I like to do. That means taking the dogs out for walks, spending a lot of time in the park, trying to see more plays and concerts, reading more fiction, and basically remembering that I have other interests outside of the hospital.