Nurse's Insight Sparks Breakthrough Research in Pregnancy and MPN Care

I am writing this letter with my highest level of endorsement for Amanda Smith, registered nurse, for this award. I have worked with Smith for four years in the Hematological Malignancy Clinic at Huntsman Cancer Institute at the University of Utah. She has become an integral member of my clinical team, demonstrating exceptional growth in her understanding of diseases' clinical features, treatment options and pathophysiology. She consistently works with clinical trial patients with great attention to detail and provides deeply empathetic and thoughtful care for my patients.

My view of a truly accomplished academic institution is that its personnel should create new knowledge quantifiable by publications and their impact, and provide novel information and therapy to our patients. Amanda Smith embodies this and is truly special for the following reasons. Most RNs are compassionate and are appreciated by our patients, but here, Smith is exceptional. When she started working with me four years ago, I was immediately impressed by her eagerness to learn new things and go deeper than not only her peers, but also more than some of my colleagues and fellows. Here I will cite some evidence of her measurable accomplishments in this area.

I am considered a regional expert on myeloproliferative neoplasm (MPN) disorders, including polycythemia vera, essential thrombocythemia and myelofibrosis. I see more patients with these disorders than any other hematologist/oncologist in the U.S. Intermountain area, and most of my patients are referred by other hematologists/oncologists, not only from Utah but also from surrounding states. Patients frequently praise Smith's ability to succinctly distill the complicated information about their disease, prognosis and available therapies in a way that they finally understand.

A highlight of my work with Smith relates to her insightful input supporting both patient care and novel research. After seeing three pregnant women with MPN disorders, our clinical team recommended therapy with monopegylated interferon Ropeg (Besremi) and discussed with them the FDA warning not to breastfeed because of the potential risk to the fetus, due to a lack of research in this area. Smith then suggested the importance of quantifying the possible transport of the drug to the fetus and to breastmilk. She collaborated with the high-risk pregnancy specialist to collect umbilical blood and maternal plasma for these analyses.

We were obliged to adhere to the FDA warning and advise these mothers not to breastfeed. After Smith supported patient understanding of what we know and don't know, one of our patients elected to collect a series of breastmilk samples for the quantitative analysis of Ropeg. These data, plus data from three other pregnancies, demonstrated that virtually no Ropeg interferon reaches the fetus or breastmilk (in press in Blood Advances).

I've practiced hematology in faculty positions since 1976, first at the University of Alabama at Birmingham, then at Baylor College of Medicine in Houston, and now at the University of Utah. I have published 424 peer-reviewed articles and 214 book chapters, editorials and reviews (with an H-index of 86 and 32,584 citations). Prior to the study described above, I had never published a paper with an RN, but in this instance, she was most deserving of being a co-author on this manuscript. It would be difficult to find anybody, not only at our medical school but at any other prestigious institution, an RN who is so accomplished. I submit that Amanda Smith is the most deserving candidate for this highly meritorious prize, and she has my enthusiastic and full support.

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