Blood, Sweat and Smears – Episode Summary

Episode: 5 Questions with Dr. Saara Kaviany

Date: January 6, 2025
Host: Bjorn (substituting for Dr. Brad Lewis)
Guest: Dr. Saara Kaviany, Assistant Professor of Pediatrics, University of Chicago's Comer Children's Hospital

Episode Overview

This installment of the "Five Questions" series features Dr. Saara Kaviany, a dynamic pediatric bone marrow transplant (BMT) physician with deep expertise in non-malignant stem cell transplantation at Comer Children's Hospital. The episode explores Dr. Kaviany’s journey in pediatric BMT, the unique mindset of transplanters, complexities of transplant conditioning, multidisciplinary collaboration, and the biggest diagnostic hurdles in pediatric BMT. Dr. Kaviany imparts both clinical wisdom and lighter moments, offering insights into the evolving, challenging, and innovative landscape of pediatric transplantation.

Key Discussion Points & Insights

1. The Best Part of Being a Pediatric BMT-er

• Main Insight: The thrill and challenge come from learning to "play an immunologist on TV," despite not being one by formal training.
• The Joy of Uncertainty: Dr. Kaviany values the unpredictability and the respect for the immune system, emphasizing how the field continues to evolve rapidly.
• "I do all transplants, but that’s where my heart is."—Dr. Kaviany [02:08]
• Treating Non-Malignant Disorders: She is especially passionate about treating conditions such as inborn errors of immunity, metabolic disorders, and hemoglobinopathies, highlighting the diversity and complexity of pediatric BMT cases.

“The best part is knowing I had to learn immunology as an oncologist, which I still don’t think I know… but somehow I find myself taking the most complex immune disorders to transplant.” —Dr. Kaviany [02:55]

2. What Defines a Bone Marrow Transplanter?

• Living in the Gray Zone: Transplanters navigate uncertainty constantly, using limited data and making individualized decisions.
• Collaboration and Variation: Pediatric transplant lacks the rigid protocols of oncology, with substantial variation among centers.
• Secret Society of BMT: A tight-knit community exists, with clinicians tracking down others’ experiences worldwide—often off the published record.

“It’s this ability to live in the grey zone. The art of transplant really comes down to saying, ‘We don’t know’... there’s this whole like secret transplant community, right?” —Dr. Kaviany [04:11, 06:09]

• Type A Personalities: Success in BMT often comes down to being highly detail-oriented and meticulous.

“I think the short answer though really is the transplanters are all so incredibly type A. And that’s the bottom line. Period. End of sentence.” —Dr. Kaviany [06:52]

3. Bone Marrow Conditioning: The “Brick and Hammer” Analogy

• Personalized Prep: Dr. Kaviany describes how conditioning (pre-transplant therapy) requires tactical balance—enough to make room for new cells (the "stem cell niche") but not so much that it causes irreparable damage.
• Hitting the Right Spot: Leveraging a mentor’s advice, she emphasizes individualized preparation plans, considering disease, organ involvement, and potential toxicities for each patient.

“You want to make sure that you provide enough force to get in and make those cracks with the new cells. But you don’t really want to demolish the building in the process.” —Dr. Kaviany [10:32]

• Reduced Toxicity in Non-Malignant Cases: In non-malignant transplants, minimizing complications like graft-versus-host disease (GVHD) is crucial, so conditioning strategies differ from malignant diseases.

4. Multidisciplinary Approach and Teamwork

• Reliance on Colleagues: Effective BMT requires constant collaboration inside and outside the institution, integrating infectious disease, immunology, rheumatology, GI, and more.
• Unexpected Considerations: Infectious disease assessments can turn up unique risks, like unusual pet exposures, that dramatically shift management strategies.
• Open Communication: Ongoing dialogue—frequently via email—ensures all aspects of a patient’s health are considered.

“On any given case, I would not be able to do what I do without my colleagues... Every one of the subspecialties is thinking about a different angle.” —Dr. Kaviany [11:12, 12:56]

• Memorable Moment: The story of a child who used to house a pet lizard in his mouth, highlighting the surprising details that matter in BMT ([12:32]).

5. Biggest Diagnostic Challenges in Pediatric BMT

• Spectrum of Complications: Many post-transplant syndromes (e.g., engraftment syndrome, veno-occlusive disease, TMA, GVHD) share overlapping features and stem from endothelial dysfunction caused by conditioning.
• Labeling Dilemmas: Differentiating between these complications is challenging, particularly since they may require costly and targeted therapies.
• Need for Timely Biomarkers: Fast, actionable laboratory data (e.g., cytokine profiles, CXCL9) are crucial but often delayed, complicating management.

“It’s challenging to identify those labs in an actionable time period that’s truly impactful for your patient.” —Dr. Kaviany [16:56]

• Recent Advances: She mentioned research utilizing interferon biomarkers and new drugs (e.g., emapalumab) to prevent graft rejection ([15:35]).

6. Bonus: Dr. Kaviany’s Recommendations (Personal Touch)

• Lifestyle Tip: “Tequila over wine—take me to my grave with it. Like, for sure, drink tequila, you will never be hungover again in your life; cannot say the same thing for wine.” —Dr. Kaviany [18:05]
• Sports Fandom: Predicts the Michigan Wolverines will be 2026 national champions and encourages all to become fans ([18:19]).

Notable Quotes & Memorable Moments

• “I do all transplants, but that’s where my heart is.” — Dr. Kaviany on her dedication to non-malignant BMT [02:08]
• “There’s kind of this art to being a transplanter and being okay with data extrapolation and kind of navigating the unknown to the best of your ability.” [06:32]
• “You want to make sure that you provide enough force to get in and make those cracks with the new cells. But you don’t really want to demolish the building in the process, so to speak.” [10:32]
• On pet exposure: “He would put the lizard in his mouth and the lizard would just hang out there.” —Dr. Kaviany, highlighting why detailed patient history matters [12:32]
• “It’s challenging to identify those labs in an actionable time period that’s truly impactful for your patient.” [16:56]
• “Tequila over wine—take me to my grave with it.” [18:05]

Timestamps for Important Segments

• [01:26] — What’s the best part of being a pediatric BMT-er?
• [03:40] — Why do BMT-ers so strongly self-identify? (The BMT identity and community)
• [07:28] — Conditioning and the “brick and hammer” metaphor
• [11:03] — Collaborating with other subspecialties
• [14:06] — Diagnostic challenges for pediatric BMT
• [17:47] — Bonus recommendation: tequila over wine and Michigan football

Tone and Style

The episode is candid, conversational, and pragmatic, marked by Dr. Kaviany’s mix of humor, humility, and deep expertise. Her warmth and willingness to share both professional and personal sides make this episode relatable and engaging for professionals across disciplines.

This summary has carefully highlighted the expert insights, wisdom nuggets, and memorable anecdotes shared by Dr. Saara Kaviany—ideal for anyone interested in pediatric BMT, multidisciplinary care, or the evolving field of transplant medicine.