Mohamad Mohty’s three loves are his family, his patients and his work – this is abundantly clear as he conducts his interview with our newsletter on a Saturday evening, when many other colleagues might be doing anything else to try and relax. “I really don’t consider my work as work,” he explains. “It is my passion. I get up early each morning, go to the hospital, and do what I love. The time I get with my patients, my team and among colleagues in congresses, is really as rewarding as any other social interaction could be.”
His mother had always wanted him to be a doctor, but unlike many senior haematologists, he focussed on specialising in this area very early in his medical studies, after a close family member died from a haematological disease. Rather than zone in on the injustice of this loss, he made it his mission to help make sure other families did not suffer as he had.
We could have spent the interview talking about his many published papers in high impact-factor journals and the many guidelines or initiatives he has played his part in writing or building. Instead Mohty talked with passion about all the transformative events haematology has seen, and the hope he always feels even when patients appear to be facing a bleak outcome. He has built an internationally renowned centre and team at his current base of the Saint- Antoine Hospital, Sorbonne University, Paris, France. He compares the experience of connecting to a patient and their family like all being out at sea together in a small boat. “We are all working together, the patient and the family are part of the journey. Whatever happens, happens to us all,” adding that his centre is the one many patients come to when they feel their options are exhausted. “We are always looking for a solution for that patient, whatever their situation might be.”
His own training took place at University Hospital Montpellier, where, already interested in haematology, not surprisingly, he managed to do all of his rotations in the haematology ward and used to spend his holidays as a student at the key haematology congresses. He then spent almost a decade at the Paoli-Calmettes Institute, Marseille, France, working with mentors like Professor Didier Blaise, and was promoted to senior consultant in haematology at the extremely young age of 31. He also did a year’s post-doc at Imperial College, Hammersmith Hospital in London, another pioneering centre for bone marrow transplantation. He then moved on to Nantes University Hospital, to lead the transplant program in the department of another famous and visionary haematologist, Professor Jean-Luc Harousseau, and there was promoted to full Professor at the age of 37 years, one of France’s youngest ever medical professors.
Yet one of the words he uses most commonly in our interview is ‘privileged’. “Since my early rotations, I have worked now for almost 30 years in haematology, and I am so privileged that my career has overlapped with so many incredible advances,” he explains. When his career began, chronic myeloid leukaemia was the number one indication for bone marrow transplantation. Then TK inhibitors arrived, and the need for these transplants ended. “During my residency in Montpellier, I also saw the first patient treated with rituximab – which became a revolutionary treatment for non-Hodgkin lymphoma,” he explains. Other changes include autologous stem cell transplantation for multiple myeloma, something that was just being trialled when Mohty began his training in 1993. “Since then, we have phased out conventional chemotherapy in multiple myeloma patients thanks to IMIDS, proteasome inhibitors, and, more recently, monoclonal antibodies.” Also in Marseille, at the end of the 1990s, he was part of the generation that introduced reduced intensity conditioning regimens to allow allogeneic bone marrow transplantation in patients who were elderly, had comorbidities, or both. “50 years old was considered a limit for this back then, but now we can offer transplants to patients aged 75 and beyond,” he explains. “The age limit, the possibilities, keep increasing.” Then, after the initial positive reports from Johns Hopkins using post-transplant cyclophosphamide, there followed the era of haplo-identical stem cell transplantation. Mohty was also on board very early as he managed to obtain, in 2006, a national grant to perform the first prospective phase 2 trial in France using haplo-identical donors and post-transplant cyclophosphamide.
And of course, he speaks with passion about one of the most recent advances in immunotherapy, CAR T cell therapy to treat malignancies. “Across the spectrum of haematology, we really have made massive progress. I feel I have been so lucky to be part of such a transformation,” he exclaims. But he also adds a dose of realism to his positive reflections. “Of course, by making progress in these many conditions, there are the more difficult cases where progress has not been so rapid,” he says. “But I will not stand back and say these cases will always be this way, or they will have a negative outcome. Instead, I see all haematology cases as one train on the tracks – yes, some carriages will arrive in the station first, but those at the back will also get there – just later, but the quicker the better.”
It will come as no surprise to those who know Mohty that his working weeks are often 7 days from before dawn to long after dusk. That same passion for haematology saw him become EBMT President from 2014 to 2018, the youngest ever to be elected to that position at age 42. He plays a role in many other advocacy organisations and medical societies, as well as being Editor-in-Chief of Bone Marrow Transplantation and is on the editorial board of many other journals. “I’ve always wanted to be ahead of the curve because treating blood cancers requires reactivity and agility, and that’s why with the support of my mentors and many colleagues, I have achieved many things at a relatively young age,” he explains. “But I still feel I have another 25 years or so left in my career. I am still hungry for the revolution in treatment to continue. For many more patients to overcome these conditions.”
Of course, he loves and pays tribute to his wife Anne-Marie who diligently orchestrates and coordinates the family life while he is totally “absorbed” in his “haematology world”. Unlike other kids, his three children would frequently ask him about the latest “haematology news”, or would comment on the formatting and colours of his slides while he is preparing them during the weekend. “Mission haematology” has penetrated the heart of the family. Sarah the eldest daughter, is already a medical student. “Will she later become a haematologist? Time will tell!” Mohty says with pride.
I press Mohty to admit to one thing that he likes doing outside of his work and family life. Finally, he admits to liking reading history and politics books, and to loving the travel opportunities that come with work. “Alright, if I go to another place to meet colleagues – (and travel is always for work, he laughs) - you can draft a superb review article on a 10- or 12-hour flight, the sky is the best place to concentrate! Then I will allow a few hours to go and see some of the big attractions. But not long after it is back to work!” He loves to meet up with colleagues to discuss the great haematology issues of the day. “But I want to learn about other cultures, and how that blends with what we are doing with our patients. All of these experiences are a learning curve, and I learn every day.” He is also mid-way through writing a book with one of his patients about their shared journey, an experience he is finding as fascinating as being a doctor.
Mohty believes some of the next biggest steps to come in haematology are to banish all conventional chemotherapy for all haematological conditions, as new drugs and therapies emerge to make it redundant. “Chemotherapy is such a drain on the quality of life of patients, and we have to say goodbye to it, whenever possible!” He also wants to see a push for more curative treatments, not just treatments that ‘chronicise’ diseases, and allow patients to survive for a bit longer without being a true cure. “My aim is for all patients with these conditions to become fully well again – and back to a normal life.”
When Mohty began his training, the average survival of multiple myeloma patients was two years -that same patient can now live for at least a decade more. For primary refractory acute myeloid leukaemia, almost all patients were facing a rapid death. Now thanks to allogeneic stem cell transplants, some 30% of patients are alive after three years. “These kinds of numbers, these successes – which areas of medicine have witnessed such massive changes as we have seen in haematology? But, I cannot ever be satisfied. I want the revolution, the improvement, to continue, because we will ‘never yield to the apparently overwhelming might of the enemy’” he concludes - quoting Winston Churchill, one of the heroes he admires.