Dr. Erba sits in his home office in North Carolina.
Harry Paul Erba, MD, PhD, is the leukemia program director at Duke Cancer Institute in North Carolina and chair of the SWOG Leukemia Committee.
Where did you grow up?
I was born and raised in New Haven, Connecticut, which was a large port city for Italian immigrants in the early 1900s. All my grandparents came from Italy, and I am as close to 100% Italian as you can get.
My mom was a bookkeeper and worked for Lender’s Bagel Bakery. Harry Lender started the bakery in a garage in New Haven, and my mom was their first bookkeeper. There’s this picture of her sitting on three sacks of flour and doing the books on a crate. She stayed with the company for 30 years.
She raised me and my three siblings and kept our family together. My dad was a truck driver — when he had a job. He had a brilliant mind for math, but he applied it to gambling. He was kind of a rambling guy and not around a lot during my childhood.
How did you become interested in medicine?
I was actually going to be a scientist. In high school, I was interested in science and was also interested in a girl who was about two years younger than me. By then we were living in North Haven, a bedroom community often home to Yale professors, and her father Joseph Gall, PhD, was a professor in biology.
He saw I was interested in science and asked if I wanted to work in his lab during my senior year of high school. I jumped at the opportunity. This was in 1974, during the advent of recombinant DNA technology and the beginning of modern molecular biology. After school, I took the bus down to the Kline Biology Tower at Yale and would work there until my mother picked me up on her way home from work. I helped graduate and post-doctoral students with their work and got to do some cool things in the lab. I really enjoyed it, and it turned me on to molecular biology.
After high school, I got into Yale, and my mentor Dr. Gall – who only just retired from the Carnegie Institute in 2022 at the age of 92 – let me continue working at the lab as part of my work-study program, taking care of cultures, cleaning out the amphibian tanks, and doing experiments with the post docs and grad students.
Over the summer, he taught a course at Cold Spring Harbor, which is a big research laboratory in Long Island, and I was his teaching assistant. It was just amazing. I got to meet James Watson, PhD, Frances Crick, PhD, Barbara McClintock, PhD, Janet Rowley, MD, and many others. I worked with Elizabeth Blackburn, PhD, when she was doing her initial studies on telomeres in a protozoan, Tetrahymena. I would prepare the cultures for her studies. She went on to receive the Nobel Prize for her work on telomeres.
It wasn’t until after I graduated and was on a year-long research fellowship in England as a Fulbright Scholar that I decided I wanted to do something more applicable to medicine.
Dr. Erba, at 23, sits at a lab bench before medical school in 1980.
What led you to that decision?
Studying the structure of chromosomes in the oocytes of amphibians is really cool but not what I wanted to dedicate my life to, so I applied for medical school and took the MCAT in London.
After the fellowship, I came back to New Haven and did a year as a research associate back in Dr. Gall’s lab before getting accepted into an MD/PhD program at Stanford University. I fully expected to go there, learn about human disease, and then work in some high-powered molecular biology lab.
I was even assigned to lab with Paul Berg, PhD, who was a Nobel prize winner in molecular biology. But something weird happened, and I found I just loved medical school. I loved anatomy, I loved physiology, and I really liked taking care of people. I also loved teaching.
Dr. Berg and I mutually agreed that it wasn’t going to work out for me in his lab because of my draw toward clinical medicine. I decided to work with Larry Kedes, MD, who was doing research at the Palo Alto Veterans Affairs hospital. I got my MD/PhD in 1988 and then went to Brigham and Women’s Hospital in Boston for internship, residency, and fellowship.
When did you decide to focus on hematology?
The program director at Brigham and Women’s knew that they had too many interns to fill all their senior resident slots, so he suggested all the MD/PhD graduates short track and get into our fellowships after our junior residency year.
I had to choose what to do my fellowship in, and I loved everything about hematology – not necessarily cancer medicine, but hematology. That was my first love. Boston was one of the birthplaces of hematology as a discipline, and many of the men and women who gave rise to it were there and served as my instructors. I made the decision to do my fellowship in hematology and also train in medical oncology at the same time.
Was it difficult to manage your medical responsibilities with your personal life?
My first wife and I got married in 1983 and started having children around 1990 when I began my fellowship. She developed post-partum problems with agoraphobia and obsessive-compulsive disease to a point where she couldn’t leave the house or work anymore. It got really bad and she wasn’t ready to get any help for her illness.
I ended up doing a lot of the cooking, cleaning, and housekeeping for our three children. I had to moonlight twice a week in urgent care and was an instructor in medicine at Brigham and Women’s. I was trying to continue my lab research and take care of patients. Eventually, I realized I couldn’t do it all and had to choose what’s important to me. I decided that keeping my family together and taking care of my kids was my most important job.
As much as I loved bench science and clinical medicine equally, I didn’t feel I could do a great job at both and care for my kids. One day I realized my mentors who were laboratory investigators no longer spent any time at the bench. They were writing grants and papers and managing people, and that’s not the part of science that I liked. When I looked at my mentors in clinical medicine, they remained clinically active but also had to understand the latest science and molecular biology of cancer in order to take care of patients. I decided that was the route I wanted to go.
I really love taking care of patients and teaching, and I knew there would be a need for physicians who had that understanding of molecular biology.
What was your next career move?
I ended up getting recruited to the University of Michigan in Ann Arbor to build a clinical leukemia program. There was no existing leukemia program there at the time. They decided to create one after a National Cancer Institute (NCI) review of the cancer center highlighted the gap. Larry Baker, DO, a sarcoma doctor who had been instrumental in recruiting me, really taught me how be a clinical investigator but also stressed the importance of patient care. He became the Chair of SWOG and invited me to serve as his executive officer for the hematologic malignancies.
I built this huge leukemia program and did a lot of clinical trials along the way, and that’s really who I am now. I define myself as an educator and a clinical trialist, but for me, patient care has always been number one.
Dr. Erba presents at a Presidential Plenary Session at the 2022
European Hematology Association Congress in Vienna.
Do you enjoy specializing in leukemia?
It’s funny how you end up where you belong. I love taking care of patients, and as a leukemia physician, I get to take charge of the treatment plan and don’t often have to negotiate with multiple other disciplines.
I like being the whole doctor to a patient. Oftentimes that is what happens in leukemia. The patients are so sick that they don’t have time to go to other doctors, and their other medical problems become much less important. So as the leukemia specialist, I become the internist at the same time.
I see patients daily who are facing end-of-life decisions, and those patients need a doctor just as much as people you are going to cure, if not more. They need somebody who is going to help them through that decision making, present their options – whether it’s an experimental study, one more round of chemotherapy, or palliative care alone. I help them decide how long to fight the cancer and when to keep fighting with a different focus, one where they are working to preserve their quality of life and concentrate on the time they still have with their loved ones.
How long were you in Ann Arbor?
I spent 16 years building the leukemia program there before moving to the University of Alabama at Birmingham to serve as the director of the hematologic malignancies program.
When a friend and leukemia expert asked me to come to Duke to join him and serve as the leukemia program director, it seemed like a great fit. I have also served as chair of the SWOG Leukemia Committee since 2012.
How has your family life evolved?
While in Ann Arbor, my first wife did get help and got better. But when her illness came back later in life and my kids were older, we ended up separating and divorcing.
I found true love and married again. My second wife and I just celebrated our 10-year anniversary, and my family got bigger because her two children became my two children. I’m very happy with where I am today.
Dr. Erba and his wife Amanda pose
with their golden doodles, Piper (left)
and Roo.
What do you like to do when you’re not at work?
I love spending time with my wife and doing things together. We love to travel, binge on television together, and have date night every week. We also love taking care of our grandkids.
I also spend an hour a day working out and exercising. While I used to run, now it’s elliptical, weight training, and core exercises.
What’s next for you in the years ahead?
I definitely want to keep traveling. I’ve been involved in some clinical research that I hope is going to change outcomes for people with acute myeloid leukemia (AML), and I would love to be invited to different countries to present the work and then experience different cultures with my wife.
Professionally, I’m the co-chair, along with Mark Litzow, MD, of a new NCI precision medicine initiative called MyeloMATCH. The initiative involves scientists, clinicians, and patient advocates from the leukemia committees of the ECOG-ACRIN Cancer Group, SWOG, the Alliance, and Canadian Cancer Trials Group who work with NCI staff and industry partners to develop and activate clinical trials more efficiently for patients with AML and myelodysplastic syndromes (MDS).
It’s taken years working alongside Rich Little, MD, at the Cancer Therapy Evaluation Program to develop this precision medicine initiative, but it’s finally coming to fruition, and this year we’re going to launch our first clinical trials. Every patient in the initiative will go into different studies, led by different cooperative groups, but it’s all a collaborative effort. I hope that MyeloMATCH will allow us to evaluate new therapies more quickly and help bring these advances to people with AML and MDS.
Otherwise, I want to continue to care for patients, study new targeted therapies for acute leukemia and MDS, and teach. I am nowhere near ready to retire. I am having too much fun.
Dr. Erba enjoys a glass of wine
during a 2022 trip to Tuscany to
celebrate his 10-year wedding
anniversary with his wife.
This interview has been edited for length and clarity.
