The pediatric hematology/oncology fellowship program has parallel focuses on gaining clinical and research expertise. The first year is approximately 80% clinical with the goal to obtain maximum direct learning and patient exposure in both inpatient and outpatient settings. The fellow will also have an opportunity to have focused learning in hematology lab testing and hematopathology at Nemours Children's Health, Jacksonville, Wolfson Children’s Hospital and Mayo Clinic Florida. Each year there is less clinical time with a stronger emphasis on dedicated research time. In the final year of fellowship, 80% of the time is focused on research. In the first year the fellow will develop a research question which will begin the process of project design and grant preparation. The second year of training allows for increased protected research time as the fellow completes regulatory requirements and begins the recruitment/data collection process for the research project. There will also be a dedicated block to gain exposure to the role of radiation in the treatment of oncology patients. In the third year, clinical rotations are intended to be an opportunity for the fellow to master leadership/supervisory skills while having supervision by faculty in anticipation of soon being a practicing physician. During this year the research time is maximized to allow for research completion including journal submission and presentation at a national conference.

Throughout the three years, fellows will have an opportunity to work with the comprehensive clinical programs listed below in addition to caring for a wide range of hematology and oncology patients.

Blood and Marrow Transplant Program

The blood and marrow transplantation program at Nemours Children's Health, Jacksonville affiliated with the world-renowned Mayo Clinic Florida and Wolfson Children’s Hospital, brings children from all over the world to receive our life-saving care. Our program is one of only a few programs in the nation to have maintained accreditation by the Foundation for the Accreditation of Cellular Therapy (FACT) for more than ten years.

The joint program was created in 2001 to allow for greater collaboration between transplant physicians at both institutions as well as share in the design and implementation of research and clinical protocols. Since it was established, the combined program has performed more than 1,000 transplants for a variety of illnesses including leukemia, neuroblastoma, sickle cell disease, bone marrow disorders, lymphoma, brain tumors and inherited diseases.

CAR T-cell Program

CAR T-cell therapy has proven very effective at treating acute lymphoblastic leukemia. With the help of Mayo Clinic, Nemours and Wolfson were able to begin a CAR T cell program. This treatment involves harvesting stem cells from the patient and training the T-cells to recognize tumor as foreign to enhance immunoresponse to leukemia cells. This allows patients in Northeast Florida avoid traveling fat to receive this new treatment option.

Comprehensive Hemophilia and Bleeding Disorders Program

The hemophilia program is based in Jacksonville and operates a satellite clinic in Orlando. Our team includes: hematologists, a hemophilia nurse and a social worker. During comprehensive clinics we also include orthopedic surgeons and physical therapists. In total, we follow more than 75 patients with hemophilia. In addition, we follow over one hundred patients who have other bleeding disorders including vonWillebrand disease and platelet function disorders.

Comprehensive Sickle Cell Program

Our program provides care to over 350 children with sickle cell disease throughout Northeast Florida and Southern Georgia. In addition to hematologists, the sickle team includes nurses, a psychologist and a social worker who are dedicated specifically to this population. We are able to provide treatments including routine exchange transfusion and stem cell transplant when indicated. The team focuses not only on medical management but also the financial, social and psychological needs of the patients and their families. We participate in many clinical trials in our efforts to improve outcomes and the quality of care for these patients.

Comprehensive Neuro-Oncology Program

This program is a collaborative effort between pediatric oncologists, neurosurgeons, neurologists, radiation oncologists and social workers to follow our patients with brain tumors. This joint program allows the team to identify not only optimal disease treatment, but also provide long term follow up to address the late effects of treatment including neurocognitive issues.

MIBG Program

Through the successful partnership between Wolfson and Nemours, we are the only facility in Florida that provided a unique therapy for high risk neuroblastoma, particularly in the relapse setting. This treatment uses a radioactive isotope attached to metaiodobenzylguanidine, a chemical that selectively binds to neuroblastoma cells. This proceed delivers higher doses of radiation specifically to malignant cells throughout the body. We receive referrals from throughout Florida.

Oncology Survivorship Program

Our faculty and staff are dedicated to the care for all pediatric oncology patients who have completed therapy. Comprehensive visits include oncologists, survivorship nurses, social workers, psychologists and nutritionists. We also address neurocognitive, behavior and school issues. We involve all relevant subspecialists who can assist in the management of late effects of treatment including endocrinologists, cardiologists, neurosurgeons and orthopedic surgeons. Efforts are also focused on adult transition and vocational services for our adolescent patients.

Adolescent and Young Adult Program

The goal of our AYA program is to provide peer support and social activities for our oncology patients who are 13 years or older. We recognize that there are unique psychosocial needs in this age group. Youth centered activities are held regularly to bring this group together for bonding and support. The teens also provide feedback to us to help make the outpatient and inpatient facilities more teen-friendly. We also provide vocational services with goal of enhancing the academic and vocational outcomes of adolescents and young adults being treated for cancer or who are long-term cancer survivors.

We also have a Fertility Preservation Team that meets with all newly-diagnosed AYA patients regardless of fertility risk to discuss risks, fertility effects of treatment and any available options to improve chances of fertility after treatment.

Research

The training program has a strong emphasis on clinical research training, with fellows functioning as integral members of the research team. We also have opportunities for translational/bench research. Under the guidance of a faculty mentor, fellows will design and run their own projects, present their findings at regional or national meetings and prepare a manuscript for publication. Fellows are expected to identify a research project and a mentor early in the first year. The fellow will have increasing protected research time throughout the three years of training.

The Scholarship Oversight Committee is responsible for overseeing and assessing the progress of the fellow towards meeting the American Board of Pediatrics requirements for scholarly activity. The faculty and other research mentors teach and guide the fellows in experimental design, data collection and analysis. During the first year, the fellow will use his/her research time to identify a research question, review literature, meet regularly with their mentor and write up the project proposal. The fellows’ research time during the second and third year is dedicated to conducting the research project. Each fellow regularly presents a report of his/her research project to the Scholarship Oversight Committee. We anticipate that fellows will present results at a national meeting and submit a manuscript to a peer-reviewed journal during their third year of training.