Bloomfield Challenged Status Quo for Patients With Leukemia and Women in Science

Clara D. Bloomfield, MD

One day after school, a second-grader informed her mother that she was going to be a nurse when she grew up. To this, her mother responded, “You’re going to be a nurse? Then you might as well be a doctor.”

That moment helped lead to a monumental career path in myeloid neoplasms for Clara D. Bloomfield, MD, whose accomplishments include contributing to the discovery of the Philadelphia chromosome in patients with acute lymphoblastic leukemia (ALL), describing the rearrangement of chromosome 16q22 in acute myeloid leukemia (AML), and discovering that AML could be cured, even in elderly patients.

A World of Academia

Those achievements took place on a road not easily traveled and often filled with criticism. Yet today, the veteran oncologist and Giants of Cancer Care® award recipient is known for not only changing practice in her field, but also for being an influential mentor who knows how to push past the tightest of boundaries.Leukemia influenced Bloomfield early on in her childhood. “When I was in grade school, I had classmates who died of leukemia,” explained Bloomfield, who grew up in Champaign, Illinois. “When the child was diagnosed, he or she would be sent off to the National Cancer Institute, because that was really the only place that was great for taking care of kids with leukemia.”

Time would pass, and Bloomfield and her classmates would be informed that another peer had died. “This seemed, to me, like something that would be a great thing to be able to do something about—that I could really make a difference, that I could basically cure this incurable disease,” she said. “That is how I got interested in it.”

After her father’s service in World War II, he began his academic career as a professor of labor and industrial relations at the University of Illinois. Bloomfield, then 4 years old, spent much time on the campus as she grew up. “When you grow up in academia, and you know what it’s all about—asking questions and discovering new things—it’s a big advantage,” Bloomfield said.

Exploring the Field

She attended the University of Wisconsin for her undergraduate work, where an interest in genetics peaked during her junior year studying fruit flies. She attended the University of Chicago for medical school. After she completed medical school and her internship, she moved to the University of Minnesota for her second-year medicine residency and a fellowship in medical oncology.Even if she did not recognize it, Bloomfield decided early in her career to research leukemias and lymphomas. During the second year of her fellowship, she was in the running for a national scholarship from the American Cancer Society. She was to be interviewed by a physician who treated patients with leukemia and had to describe her future research goals.

“I have to tell you, I never thought about it,” Bloomfield recalled. “I thought, ‘I’m going to look terrible. I better come up with something in a hurry.’”

Bloomfield told the researcher she was interested in the characteristics of individual leukemic and lymphoma cells and how those might predict outcomes in response to treatment.

As it turned out, “that’s what I did, and have done the rest of my life,” Bloomfield said.

Her first project was to review 10 years of cases of adults with AML. “All of the patients had died. But, I learned things that were very important that I immediately then began to investigate and publish on,” said Bloomfield.

One of these findings included Bloomfield’s discovery that patients with AML could be treated aggressively and eventually cured. The disease was, at the time, believed to be incurable, especially in elderly patients.

Instinctively, the young, female researcher challenged this belief in a paper published in the Journal of the American Medical Association. “Suddenly, there was someone they had never heard of saying that not treating older AML patients was wrong, which was sort of a big deal,” Bloomfield said.

It was an even bigger deal when she was proved right. In light of her finding and while still a fellow, the University of Minnesota tapped Bloomfield to lead the Leukemia/Lymphoma Service at the institution, which she headed until her departure in 1989. The center also promoted her from assistant to full professor within 7 years, making her the first female full professor of medicine at the university.

Roswell Park Cancer Institute in Buffalo, New York, was Bloomfield’s next career stop as the chair of the Department of Medicine. In 1997, she joined The Ohio State University Comprehensive Cancer Center (OSUCCC) and James Cancer Hospital and Solove Research Institute, in Columbus, Ohio, where she became the third woman to ever direct a National Cancer Institute-designated Comprehensive Cancer Center.

At 74, she is one of the most accomplished researchers in medicine at OSU, where she is a distinguished university professor and the William G. Pace III Professor of Cancer Research, and a member of the OSU President’s and Provost’s Advisory Committee.

Outside the center, Bloomfield has worn a collection of hats, including co-chair of the World Health Organization’s Clinical Advisory Committee on the 2008 and 2016 classification of neoplastic diseases of the hematopoietic and lymphoid systems. Moreover, she has served as co-chair of the European LeukemiaNet AML Guidelines for patient management, which is said to have become the most widely accepted guidelines in the tumor type. A third co-chair role is with the AML Global Portal.

Pushing the Envelope

Bloomfield weaved through her remarkable and challenging career without any mentors. Not one. “The focus that is on mentoring these days just did not exist when I was young, especially having a concept of something like this for women,” said Bloomfield. “It was more often a battle between men and women.”Proving that patients with AML could be cured was not Bloomfield’s only battle in fighting for what she believed in. “There were a number of things I discovered that no one else had found before,” said Bloomfield. “My discoveries, a couple of them, were so unexpected and unaccepted that no one believed them. Those were really important for me, because I was immediately, at a very early stage in my career, in the middle of national controversy. It is good, from an academic point of view, when you turn out to be correct.”

Cue Bloomfield’s key role in the 1975 discovery of the Philadelphia chromosome in ALL, which emphasized the biologic heterogeneity of ALL. It showed that molecular characteristics had an impact on personalized therapy and other treatments.

When examining a patient with ALL who was believed to have chronic myeloid leukemia (CML) because they had the Philadelphia chromosome, Bloomfield knew she was observing something important.

“This was something that was so unusual. This got me to study chromosomes,” she said. “I started to look for the Philadelphia chromosome in particular in patients with ALL, and as it turned out, I found a lot of them.”

Challenging the existing wisdom that the chromosome was only prominent in CML, Bloomfield again faced criticism from the oncology community, adding it was even worse than her earlier findings with AML. “Researchers would say, ‘she doesn’t know what she’s talking about.’ But of course, as soon as they started to look, they found it them- selves,” she said. “It put me on the map rapidly.”

Her strong-willed attitude came in handy again when she described the rearrangement of chromosome 16q22 in AML. “The main point was that it was found in a very specific type of AML,” Bloomfield said. “In this case, I subsequently discovered that this type of AML was particularly sensitive to high-dose cytarabine treatment compared with many other AML subgroups. Going along with that is the discovery that high-dose cytarabine is more important in AML with translocations involving chromosomes 8 and 21. We are talking of a cure rate now approaching 80%.”

These pivotal moments were all part of Bloomfield making her way through a male-dominated field. “It takes a certain personality to go against the grain, just being a woman at that point in medicine,” she said. “It was going against the dogma. It’s not like today, where 50% of your medical school class is women. Women just didn’t belong in medicine; it was considered a man’s field. So, I was pretty used to fighting the establishment from that point of view.

“This didn’t bother me at all. When you see something and you’re sure you’re right, then you stand up for that. Don’t worry about what the dogma is at that time. I still spend a lot of time teaching trainees and younger faculty that that’s what they have to learn to do,” she said.

Bloomfield credits this drive to her academic background. “It definitely makes you more comfortable continuing to believe in additional things that others may not believe in,” she said. Her take-charge initiatives have also had an impact in gender equality in the medical field, such as equalizing salary for women.

“I was able to see that women were put on important national committees and have gotten awards,” Bloomfield said. “When I chaired the American Society of Clinical Oncology (ASCO) program committee, I made it 52% women.”

Although she pursued her research goals with no mentors of her own, mentorship is important to Bloomfield and she teaches senior faculty how to fight the status quo. It goes along with her favorite saying: “Believe what you see or find, not what others have claimed.”

She still has many goals for the field of myeloid neoplasms, such as to witness the majority, if not all, patients with AML being treated with appropriate curative therapy. Her vision is that AML will become a mainly cured disease. “When I started, the average survival for 1 type of AML, acute promyelocytic leukemia, was 2 weeks. Now, 90% are cured,” Bloomfield said. “I think that’s possible for the rest of AML and we just need to work on it.”

Although she has limited free time, the pioneer who has always pushed the envelope has no plans to slow down. “Maybe I’d take a half day off a week,” Bloomfield laughed. “I’m always working, and I’ve never learned how not to work.”