Belinda R. Avalos, MD, is a professor of medicine and senior advisor to the president of Atrium Health Cancer Institute in Charlotte, North Carolina.
Did you always know you wanted to be a doctor, or did that realization come later?
I knew from an early age I wanted to be a physician. I’ve always been intrigued with science. My father was a surgeon. He came to the U.S. from Mexico in his 30s, met my mother, and they had six children. My father was deeply committed to his patients, and his passion for medicine was palpable. His patients loved him. He was a wonderful role model and encouraged me to pursue a career in medicine. Unfortunately, he died when I was 16. A biochemistry class in college and laboratory research work later sealed my interest in medicine and in a career as a physician-scientist. I can’t see myself today doing anything more rewarding.
What drew you to hematology?
During my third year of medical school at The Ohio State University (OSU), I had the incredible opportunity to work with Bertha Bouroncle, MD, a Peruvian hematologist who first described hairy cell leukemia. She was a great clinician and researcher and someone I admired tremendously. She and I just clicked. She taught me the art of patient care and of microscopic analysis of peripheral blood smears and marrows. A few times we saw hairy cell leukemia. It’s not a common diagnosis, but it was always exciting to identify these cells with Dr. Bouroncle using supravital stains of peripheral blood smears.
It was fulfilling to move from the patient to the lab and then be able to go back to an extremely ill patient with a therapy and tell them there’s a good chance of a cure. I realized hematology was a team sport because it takes close collaborations among physicians, patients and their families, nurses, social workers, and navigators.
Where did you complete your education?
I did my residency in internal medicine at OSU and then hematology fellowship training at the University of Washington in Seattle, which was a powerhouse in classical hematology and transplantation. Dr. Bouroncle had encouraged me to do fellowship training at an institution where I would be able to get experience in transplantation since OSU had not yet established a bone marrow transplant unit. For many patients at the time, transplantation was the only curative therapy for their disease, so I became very interested in transplantation.
While in Seattle, I got to work with E. Donnall Thomas, MD, who won the Nobel Prize in Medicine in 1990 and is really the reason transplantation has taken off all over the world. We worked together indirectly, but once he asked me to read a paper of his, and I was astounded he asked me to give him my opinion. I felt so honored that I kept that copy of the paper all these years as a keepsake.
After a year in Seattle, I moved back to Columbus, Ohio, and got married. I spent a year working in a lab at OSU, then went to the University of California, Los Angeles (UCLA), where I studied hematopoietic growth factors, receptors, and cell signaling with Judy Gasson, PhD, and David Golde, MD. This was an exciting time in hematology when growth factors stimulating blood cell production were being cloned for the first time. I worked on a project evaluating the effects of granulocyte colony-stimulating factor (G-CSF) on the production and function of neutrophils, which are the first cells at the scene of an infection but are also very short-lived.
We and others found that G-CSF also mobilizes progenitor cells into the peripheral blood. Rather than collecting bone marrow cells in an operating room, it was now possible to collect stem cells from the blood using a special machine for apheresis. The collected cells could then be frozen until the patient was ready for transplant, then thawed and infused intravenously.
It was extremely fascinating. I’ve been intrigued with several aspects of hematology since I started reading about them. We know so little, although we’ve worked a lot in the last few decades to learn more.
Hematology really ushered in the molecular revolution in medicine through the identification of growth factors, receptors, and signaling molecules. It’s been an ever-expanding and important field since then.
Where did your career take you from there?
After UCLA, I returned to Columbus in 1987 for a faculty position at OSU, where I worked for nearly 30 years. I helped set up the transplant program there as well as an independently funded translational research lab, and I was involved in medical education. In 2012, I accepted the inaugural position of vice chair of the Department of Hematologic Oncology and Blood Disorders at Atrium Health Levine Cancer Institute in Charlotte, North Carolina. We have grown from one building to three in the short 12-year period I’ve been there. We’ve done more than 1,400 combined allogeneic (haploidentical, matched related donor, and matched unrelated donor) transplants and 200 chimeric antigen receptor T-cell therapies.
Today, as a professor of medicine and senior advisor to the president of Atrium Health Levine Cancer Institute, my days are a mix of administrative tasks, research, mentoring, and supporting transplantation and cellular therapies.
What have been some of your most significant career highlights?
My lab was the first to demonstrate that a specific mutation in the gene for the receptor for G-CSF (called CSF3R) caused abnormal growth signaling in cells from patients with severe congenital neutropenia who subsequently developed acute myeloid leukemia. We showed that the aberrant growth signals induced by distal CSF3R truncation mutations delayed CSF3R internalization and degradation and led to enhanced growth signaling. I vividly remember my post-doc presenting the original data and the president of ASH that year telling us it was the best presentation he had heard that year. I felt incredibly honored.
We’ve also demonstrated that mutations localizing to more membrane proximal regions of CSF3R can be inherited and cause chronic neutrophilic leukemia (CNL). We’ve shown that transplantation can be curative for familial CNL.
It’s been exciting to start the first transplant program in Charlotte, as well as the first subspecialty programs here in leukemia, lymphoma, myeloma, and classical hematology. Our sickle cell enterprise has more than 1,000 patients.
I can say without a doubt I could not have made a better career choice.
What influence has ASH had on your career over the years?
ASH has played an integral role in my career. I consider the annual meeting a “must have” to gain the latest and greatest insights into classical and malignant hematology. I attended my first ASH meeting in 1985 when I was pregnant with my first child and had an abstract selected for oral presentation. I’ve attended nearly every year since then and been involved in abstract reviews, grant reviews, advocacy, and committee work. I’ve also served on the Health Equity Task Force, on the Executive Committee as a Councillor, and as editor-in chief of ASH News Daily.
ASH has been a great convener bringing hematologists together to do bold things to improve patient outcomes. ASH has been a pioneer in advancing diversity, equity, and inclusion. Meetings today look significantly different from 30 years ago with greater diversity of attendees. ASH has done a fantastic job on the global front as well.
While serving as chair of the Committee on Diversity, Equity, and Inclusion, we created a number of new awards under the Hematology Inclusion Pathway (then known as the Minority Recruitment Initiative) to offer opportunities to students and trainees who are underrepresented in medicine and science to conduct research with guidance and supervision from both a research mentor and a career development mentor. It’s amazing to see and hear in-person presentations given by awardees at the annual meeting.
The 13-year unbroken pathway of awards created by ASH is an important step forward to ensure a diverse and inclusive hematology workforce.
Dr. Avalos (far left) enjoys traveling
with her husband, Ed Copelan, MD
(far right), to visit her children, Olivia,
Max, and Alex.
Which ASH initiatives are you most excited to work on during your ASH presidency?
I’m interested in further expanding ASH’s global reach through award programs. This is particularly personal to me because I am a first-generation Mexican-American and am strongly motivated to give back. I think it’s important to give people opportunities to learn more and seek additional training.
What do you see as some of the biggest challenges facing the field of hematology today?
Equity and accessibility remain major challenges, which unfortunately have a significant impact on our patients. We have a lot of new therapies on the market, like gene therapy for patients with sickle cell disease, that are very expensive and not within reach for many patients. Drug shortages continue to be problematic. Research funding is critical. We’ve made great strides in hematology, but much work remains.
What kind of things do you like to do to unwind and relax?
I love to spend time with my family. I have a wonderful husband, Ed Copelan, MD, three incredible children, Alex, Max, and Olivia, and five granddaughters and one grandson. As often as I can, I try to see them. This can be challenging since they all live in different cities.
Dr. Avalos (back row, second from left)
with her husband, children, and four of
her six grandchildren in Miami over
the 2023 holidays.
Luckily, I also like to travel. When our children were younger, we took them pretty much everywhere we went because we thought it was important that our kids appreciate other cultures and see how other people live. We’ve continued to take yearly family vacations and have added our grandkids to the list.
When I have time, I enjoy running, swimming, and baking.
