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You Must Remember Meeting Clara: Remembering Clara Derber Bloomfield (1942–2020)

2020; American Association for Cancer Research; Volume: 80; Issue: 9 Linguagem: Inglês

10.1158/0008-5472.can-20-0959

1538-7445

Michael A. Caligiuri,

Nursing Education, Practice, and Leadership

A very good friend recently said to me, “I judge a person's importance and their impact by whether or not I can remember meeting them for the first time.” By that statement alone most people would agree that Clara Derber Bloomfield, a beloved daughter, sister, spouse, friend, physician, leader, and scholar who recently and tragically passed away, was an extraordinarily impactful person. Virtually everyone remembers meeting Clara for the first time.For me, it was the summer of 1989 when Clara called me to come interview at Roswell Park Cancer Institute (Buffalo, NY). I had never met her and when I walked into an evening recruitment dinner consisting of senior faculty and their spouses, I was unsure who Clara was. That lasted for about 15 seconds, and from that moment on, I came to know and love the most remarkable person I have known in my 64 years.Clara Derber Bloomfield was born in New York City but grew up in Champaign-Urbana, IL, where her father Milton was a professor of labor relations at the University of Illinois (Chicago, IL). Clara's mother Zelda was a lawyer, but more importantly in the 1940s, she was a feminist and fiercely believed in and advocated for women's rights on the basis of the equality of the sexes. When Clara showed an early interest in medicine and considered being a nurse, her mother asked whether she would consider becoming a doctor. Clara asked, “Can girls do that?” “Yes Clara,” replied Zelda, “you can do anything, and more than a boy can do.” To say that Clara took her mother's words of encouragement to heart and lived up to the expectation through her lifetime achievements would be an understatement.When Clara was 8 years old, she fell off her bike and broke her arm. Both Clara and her brother Charles told me she defied the doctor's orders and was back on the bike within the week; her parents did not try to stop her. From a young age, Clara would not let other people or challenges limit her quest for excellence in achievement. This would be a life-long relentless pursuit, an unsaturable, unstoppable drive to succeed as a world-class physician and scientist with virtually no other distractions. So many of us would come to benefit from her success because, as important as scientific discovery with clinical relevance was to Clara, equally important to her was mentoring the next generation of clinicians and scientists.When Clara was growing up, dinner at the Derber household was always family time. Oftentimes the table conversation was not about grade school or high school scholastic performance, as expectations for Clara's high academic achievement were set and considered a fait accompli. Rather, her brother Charles described mealtime as more of a graduate seminar, consisting of science, politics, literature, and other subjects that were relevant to Milton and Zelda but inclusive of Clara and Charles who were full participants. Those intellectually enjoyable conversations never left Clara, as throughout her life she was a brilliant, thoughtful, and entertaining conversationalist who always left you thinking about an alternative perspective on almost any topic that had been so firmly established as dogma in your own mind.As Clara grew so did her determination to become a physician. Despite a stellar high school record of scholastic success, Clara insisted on attending a state university to be sure there were sufficient funds for the family to send younger brother Charles to an Ivy League college. She attended the University of Wisconsin, Madison (Madison, WI) from 1959 to 1962, but a first marriage at the age of 21 took her to San Diego where she graduated at the state college in 1963 summa cum laude. Medical school at the University of Chicago (Chicago, IL) came next. She graduated Alpha Omega Alpha in 1967, then remained there for internship and residency in internal medicine. It was during this time that Clara first met Dr. Janet D. Rowley, who later in the 1970s helped develop methodologies to study chromosomes in leukemia, a subject that subsequently caught Clara's interest and ultimately became her field of study for the decades to follow, establishing her as one of the world's leading international authorities in hematologic malignancies.Following her residency, Clara followed her husband to the University of Minnesota (Minneapolis, MN), where she completed a chief residency year in internal medicine and a 2-year fellowship in medical oncology. She joined the faculty in 1972 and was named a full professor of medicine in 1980, the first woman to do so at the University of Minnesota (Minneapolis, MN). When she went to request her salary increase, the chairman of medicine told her there would be no pay increase because her husband was paid handsomely for his work on the basic science faculty (and he was not kidding). That was her first exposure to gender bias in academic medicine. Sadly, I witnessed several instances of such discrimination against her over the next three decades. Despite that, she remained at the University for a total of 18 years, during which time she was in charge of the leukemia service and developed a reputation as an extraordinary and tireless clinician.Clara made some of her most impactful discoveries during her time in Minnesota. She had discovered the Philadelphia chromosome in acute lymphoblastic leukemia and the rearrangement of 16q22 in acute myeloid leukemia (AML), both of which have had immense importance in predicting outcome to standard therapies. She was considered by most to be the world's authority on how chromosome changes influence treatment and outcome in adult acute leukemia, a forerunner of what today is known as precision medicine. Interestingly, it was an editorial in 1968 that declared it malpractice to treat AML that inspired Clara to in turn declare that AML was indeed a curable disease in adults, a prediction that she tirelessly worked to prove true for younger and eventually older adults receiving standard induction and consolidation therapy or allogeneic bone marrow transplantation.Clara left the University of Minnesota (Minneapolis, MN) and moved to Buffalo in 1989 and was appointed chair of the Department of Medicine at Roswell Park Cancer Institute (Buffalo, NY). I was fortunate to be one of her very first recruits. In my first job after fellowship, my father-in-law offered me a few words of advice—try to get to work before your boss and leave after your boss goes home. I explained to him, without exaggeration, that Clara came to work Monday through Saturday at 4:00 am, returned home at 7:00 pm and did not take vacations. At that point in her life, there was only work, and her goal never wavered—to continue to achieve excellence locally, regionally, nationally, and internationally in everything she did. Roswell Park Cancer Institute (Buffalo, NY) was not going to be the exception.Clara came to Roswell at a low point in its storied history. Many faculties had departed or retired, clinical services were depleted, and it was time to rebuild. Clara brought in over 25 new recruits at all levels, restarted the bone marrow transplant program, and took the leukemia service to new levels of quantity and quality through her reputation and experience, respectively. When attending on the leukemia service, she would round for 10 hours a day on no more than 15 patients, 7 days a week for a month. By the time her month of service was completed, clinical care had substantially improved at all levels. Like most everything she did, Clara taught and led by example. As such, she left an indelible impression of excellence on anyone smart enough to listen and learn. Roswell Park benefitted from her enormous imprint long after she had left Buffalo, as several of her recruits remain there carrying on the tradition of excellence in clinical care that Clara established.As Clara moved her research interest from cytogenetic to molecular prognostication in AML, I was able to collaborate with her and experience first-hand her amazing abilities as a mentor. In my 30 years of friendship with Clara, she never saw a first draft of a presentation or a manuscript that she liked, and she would let you know it. However, there is no one who would work harder for you to improve the quality of your work. Twenty versions of a manuscript back and forth over a year was not an unfamiliar saga. However, once you saw the finished product and the journal in which it was published, you were hooked. It would be impossible for me to remember one-fourth of the mentees whose names I heard throughout our three decades of work together. As I grew older the names became less familiar, that is, younger and younger people that Clara would devote hundreds of hours to improve the quality of their work. If you look at Clara's 624 peer-reviewed original publications, you will encounter well over 100 first authors who benefitted from the tireless mentorship of Clara Bloomfield. Hopefully each and every one will pass those traits on to the next generation of clinician scientists.While it would be impossible in the pages allowed here to capture even one-tenth of Clara's contributions to the betterment of clinical outcomes in AML, there are three noteworthy international endeavors that could briefly be mentioned. First was her central role in the International Workshops on Chromosomes in Leukemia, initiated in 1977 by both Janet Rowley and Albert de la Chapelle. This effort was indeed a forerunner of today's precision medicine in every sense of the word. Second, Clara had a pivotal role in the French-American-British classifications, publishing critical consensus articles that for decades served as “the bible” on how clinicians were to classify and treat AML. Finally, was her extensive collaborative work with the Germans, starting with Hartmut Döhner doing a postdoctoral fellowship in her laboratory at Minnesota in the late 1980s through countless trainees and collaborators from the finest institutes in Germany and other European countries, right up to and including several such fine fellows working in her research group today at Ohio State University (OSU; Columbus, OH). Ask any of them about their time with Clara and you will hear stories filled with love and laughter. Clara loved to laugh.Clara took immense joy in the success of those around her and that was never more obvious than when it came to the love of her life, her husband and renown geneticist, Albert de la Chapelle, MD, PhD. They married in 1984 and were as happily obsessed with each other as they were with their professional work. When Albert, one of the most prominent scientists in Finland, decided to leave his academic career at the University of Helsinki (Helsinki, Finland) and take up a position as the founding director of the Division of Human Cancer Genetics at the Ohio State University in 1997, Clara decided to join Albert and live together for the first time in a new home deep in the woods of rural Ohio. I was fortunate enough to come along and witnessed their productivity as Albert brought talent and scholarship in human cancer genetics to the University and Clara took the cancer center, then barely on life support, to a highly successful recompetition for its designation as a comprehensive cancer center (CCC) by the NCI before handing the reigns over to me in 2003. During our 21 years at OSU, Clara established the foundation to recruit over 350 physicians, scientists, and physician–scientists to the cancer program, raise the bar for the quality of care and the quality of the clinical science, push for a $1.1 billion cancer hospital, and ultimately bring the OSU CCC in to land a perfect score on their cancer center support grant from the NCI in 2015. As I grew into the leader of hematology–oncology, then the cancer center director, and finally the CEO of the cancer hospital, Clara was there as mentor, advisor, critic, and friend. Whenever I was confused about what road to take, I would ultimately follow Clara's advice, for her compass was always true north; Clara could only do what was in the interest of academic excellence, even if it meant a decision that was not in her own interest. Clara exemplified the selfless leader.Clara was immensely proud of her father Milton, mother Zelda, and brother Charles. As her parents aged, I helped move them first to Buffalo where her father passed away and then her mother to Columbus where she passed away. I discovered a quality of Clara that few knew. No matter how busy she was in leading, researching, or caring for patients, this international superstar would spend 10–14 hours a day, every day, first with her sick father and then with her sick mother, at the bedside making sure that the care provided to them in the retirement home or the hospital was meticulous and thoughtful. She would use her watch to be certain medicines were administered precisely when ordered and personally ambulate her loved ones regularly to prevent blood clots from forming. When Albert was beset by illness, Clara would not leave his side until a full recovery was virtually guaranteed, then she attended every single clinic visit. It was the only thing that would keep her from her work, and I watched in awe on countless occasions as she would transform from a selfless leader of the academic mission to the selfless daughter or spouse when there was a need for her love and support.Clara was a truly remarkable person in the way she combined her amazing talent with immense discipline to create a deep and lasting impression on anyone she met as she marched along life's journey. She was an absolutely superb clinician–scientist who only knew the relentless pursuit of excellence as she helped realize her vision to cure acute leukemia. She was an amazing mentor, leaving behind legions of us around the globe to emulate her passion for discovery and mentorship with the hope of continuing a legacy that lasts until the end of disease. And she was a beautiful loving wife, daughter, sister, and friend who fiercely challenged the status quo while maintaining a deep love, understanding, and support for those in need. I am certain you remember meeting Clara. She will be missed but not forgotten.