MD, CM; Medicine; McGill University, Montreal, Quebec; 2003
Internal Medicine; Duke University Medical Center, Durham, NC; 2006
Hematology; McMaster University, Hamilton, Ontario; 2008
Hematopoietic Cell Transplantation; Hôpital Maisonneuve-Rosemont and Université de Montréal, Montreal, Quebec; 2015
MSc in Epidemiology; McGill University, Montreal, Quebec; 2015
Dr. Krakow’s clinical expertise is in blood and bone marrow transplantation for patients with cancers like acute myeloid leukemia and lymphoma.
Dr. Krakow pursues two primary areas of research. In one, she is working to develop safe and effective immunotherapy approaches using unrelated donors. These approaches aim to bring the anti-cancer effects of “mismatched” donor immune cells to patients who might not be eligible for bone marrow transplantation.
She also uses traditional and novel statistical methods, such as machine learning techniques, to analyze complex longitudinal data that could help select highly personalized, adaptive treatment strategies for cancers and for complications of bone marrow transplantation, such as “graft-versus-host disease.” The goal is to optimize each sequential therapy for an individual patient, taking into account how that patient’s attributes change over time, including the patient’s response to prior treatments.
Novel transplantation and cellular immunotherapy strategies
Dr. Krakow is collaborating with the Fred Hutch’s Dr. Pamela Becker and investigators at Brown University and Johns Hopkins University to evaluate approaches to harness the cancer-eradicating power of donor-derived immune cells without causing dangerous graft-versus-host disease in which the donor cells also attack healthy tissues. She is especially focused on approaches in which patients receive relatively low doses of chemotherapy (but no immunosuppression) before receiving donor stem cells. Sometimes called “microtransplantation,” these strategies may one day allow older and sicker patients to safely undergo potentially life-saving immunotherapy treatment. Dr. Krakow founded the Microtransplantation Interest Group, which now includes over 40 members from approximately 20 institutions across the globe, working together to develop optimal procedures and to identify patients most likely to benefit.
These strategies use donor cells that are not highly “matched” to the patient’s blood system. Mismatched donor cell infusions may offer powerful anti-cancer effects, but are also very likely to be rejected by the patient’s immune system because deliberately immunosuppressive therapies are not used. Even though the direct donor cell effect is therefore transient, a number of recent studies have shown that meaningful anti-cancer effects can occur. As Dr. Krakow and colleagues learn more, they hope to be able to make these approaches ever more effective and safe.
Adaptive treatment strategies in hematology/oncology/transplantation
Many cancer patients are treated with sequential therapies over long periods of time, but the optimal choice and/or sequence of therapies is usually not clear. Dr. Krakow is developing ways to optimally personalize therapy, taking into account how the patient’s disease and health characteristics change over time and with particular therapies. She showed that data from the Center for Blood and Marrow Transplantation Research registry could be used to devise highly personalized recommendations for prevention and treatment of acute GVHD. She is now working to refine these treatment-selection methods using the vast array of data available at the Hutch regarding patients treated for GVHD. Eventually, she hopes to test these methods that could be used to develop better treatment plans for individual patients.