Nicolaus Kröger is the President of EBMT, a role he took up in 2018 and will serve in until 2022. He is Medical Director of the Department of Stem Cell Transplantation at University Medical Center Hamburg-Eppendorf (UKE), Germany. Here he talks about the unique challenges COVID-19 has posed to our EBMT meeting, and some of his own career experiences.
Q: This year has been a very strange and challenging year Nicolaus. How difficult has it been for EBMT to move its congress online this year?
A: Indeed, this year was very strange and challenging for EBMT. Until early February the EBMT board was still convinced that it could be possible to perform our annual meeting as a regular on-site meeting. Because COVID-19 developed rapidly in Europe, especially in Spain, we decided to postpone the meeting from March to the end of August in 2020. However, in May it became obvious that even an on-site meeting in the end of August would not be possible. Thus, we had to change our plans again and start to organise the meeting as a completely virtual event. But thanks to the local organising committee and the EBMT staff and all our invited speakers, we have succeeded in making this event happen.
Q: Tell us how COVID-19 pandemic has affected operations at your own hospital in Germany. Did all transplant activity stop, or have some vital treatments continued?
A: Fortunately, Germany was less affected by COVID-19 than expected. The rapid development of COVID-19 in Europe was characterised by lack of intensive care unit beds and personnel protective equipment. Thus, in Germany the intensive care beds were doubled but fortunately not all intensive care unit beds were used, and we were able to take some patients from Italy and France. In general, regarding numbers, Germany was less affected by the COVID-19 pandemic in comparison with France, Spain or Italy. Within the EBMT, we started early to give clear recommendations to our community and members. We did not recommend stopping transplant activity, but we recommended to postpone non-urgent, especially autologous stem cell transplantations. However, the recommendation for vital indication or for vital treatments of haematological diseases such as leukaemia was to continue the treatment or the transplant. Thus, overall the transplant activity in Europe went only marginally down mainly due to the reduction of autologous transplants.
Q: Tell us a bit about how your own career has developed?
A: To be honest, I started my career from scratch. After finishing school, I strongly believed that being a physician would be the optimal profession for me. However, I had difficulties to get access to the German Medical Universities. Thus, I started an education in nursing, which was very helpful and formative for my further development. Thereafter I went to Italy to learn the language and to start studying human medicine before I went back to Germany to continue my studies in medicine. After getting my medical degree my interest was to get first good basic knowledge in internal medicine before I joined a university hospital again to continue with haematology training and research. My motivation was to be part of the rapidly developing field of stem cell transplantation and cellular therapy in order to cure more patients for otherwise incurable diseases. Another strong reason to work in haematology is the more close contact and stronger interaction with patients than in other medical disciplines. I feel it is a great privilege to work as haematologist.
Q: You own research interest is focused on clinical allogeneic stem cell transplantation, the detection and treatment of minimal residual disease by adoptive immunotherapy or novel drugs, the impact of NK-cell allo-reactivity, optimising outcome with HLA-mismatched donor, and prevention and treatment of chronic graft-versus-host disease. What are some of the studies and research projects you are most proud of?
A: My main interest was always to bring new discoveries or observations from the lab or other disciplines into the treatment of our patients by performing well designed clinical studies. I am proud of clinical studies which we developed and which led to practice-changing therapies like the first prospective study on allogeneic stem cell transplantation for myelofibrosis which we performed within the EBMT community, or the development of auto-allo tandem approach in multiple myeloma, or the study in older MDS patients which clearly showed that allogeneic stem cell transplantation is better than conventional 5-azacytidine therapy. But I am most proud of the New England Journal of Medicine published multicenter, multinational study about using ATG in HLA-identical sibling transplantation which we conducted with colleagues in Italy and Spain, and which resulted in a significant reduction in chronic GvHD, and improvement in quality of life without higher risk of relapse.
Q: It must be difficult to watch many of the sessions when you are so busy as the President. But what are some of the sessions you have been most interested in this year?
A: The most interesting sessions for me this year are around the development of the CAR T-cell therapies but also the special sessions about COVID-19 and impact on our field. And I am also very interested in the increasing activities of our patient advocacy group and the exciting Nurses Programme. Because EBMT is such a vibrant and lively society covering all health care providers and aspects regarding stem cell transplantation and cellular therapy all sessions are exciting and of interest for me.
Q: What are some of the developments in our specialty that have most excited you in recent years? Is CAR-T one of the highlights?
A: Of course CAR T-cell treatment and the ongoing development of next generation of CAR T-cells are certainly highlights. But also, the next steps in gene therapy like genome editing are coming now into the clinic. Furthermore, the more widely use of haploidentical stem cell transplantation is so exciting because outcome results of this treatment are similar to matched related or matched unrelated stem cell transplantation.
Q: What final message do you have for our delegates this year, many of whom have been on the front line battling the COVID-19 crisis?
A: This year was and still is for all physicians, scientists, nurses, and health care providers really challenging because of the COVID-19 crisis. Especially all nurses, healthcare providers, and physicians around the world worked tirelessly to take care of the patients with COVID-19 infection. They deserve our thanks and respect. It is a real tragedy that many of these health care providers have been infected themselves by SARS-CoV-2 and some of them have paid the ultimate price for their dedication and selflessness.
So I hope we will have soon better control of COVID-19 through an effective vaccine and will have the option to see each other face-to-face at our next 2021 EBMT annual meeting in Madrid!
Thank you Nicolaus, and we hope you enjoyed this year’s special online congress.