Paying It Forward: The Importance of Mentorship in a Medical Career

For Guillermo Garcia-Manero, MD, mentors have played an invaluable role in his career. It’s why he feels so passionately about being able to provide a similar role to young fellows and physicians through his position as the fellowship program director in the Department of Leukemia in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center (MD Anderson) in Houston.

On top of his busy day-to-day as chief of the myelodysplastic syndromes (MDS) section treating patients with MDS and acute myeloid leukemia (AML) in the clinic, Garcia-Manero has been a central part of the fellowship program for 25 years. “This is going to be one of the most important things that I’ve done, because I can see all these colleagues now doing extremely well,” Garcia-Manero said. “This gives me a lot of satisfaction and pride.”

Early Influences and Unexpected Starts

Garcia-Manero grew up in the 1970s in Palma de Mallorca, Spain, which is in the Mediterranean off the western coast of the Spanish mainland. He described himself as a good student who was attracted to literature, history, philosophy, math, and biology. Although there were no physicians in his family, he credits his mother—his first mentor—for influencing his decision to pursue medicine at the University of Zaragoza in the northeast of Spain.

However, Garcia-Manero notes that his first year of medical school was “not very positive,” to the point where he considered discontinuing. Again, his mother intervened. Between his first and second year of medical school, she put him in contact with their hometown pathologist, Jaime Sard, MD.

“This man was the most prominent pathologist working [in Palma]; [he] was semiretired by then and in private practice. But he loved teaching, so I went to his lab in Palma, and he started showing me: ‘This is a microscope. This is tissue. This person has this type of cancer,’” Garcia-Manero said. He returned to Sard’s lab every summer in between medical school, choosing it in favor of the attractive and bustling island life of Palma.

Garcia-Manero’s experience at medical school in Zaragoza shifted after his first stint in the lab with Sard, and he went on to start a specialized research project with Javier Ortego, MD, of Hospital Clínico Universitario, in which they investigated colon cancer models. When he was a third-year medical student, Ortego funded a trip for Garcia-Manero to a congress at the University of Oxford in England. Although he claimed he had no idea what he was doing, this trip to Oxford began the next pivotal step in Garcia-Manero’s career. Here, he met Gillie Francis, MD, who invited him to work in her lab at the Royal Free Hospital in London, which he describes as one of the premier research institutes of its time.

Garcia-Manero stayed at Francis’s lab for 2.5 summers, and his tenure there was his first exposure to molecular pathology and hematology. This was a pivot; up until this point, he had no interest in hematology and was mostly interested in colon cancer. In fact, his plans were to go back to Spain and do a residency in anatomical pathology.

However, it was in London where Garcia-Manero met another influential mentor, Farid Hourani, MD, a physician doing a sabbatical at the Royal Free Hospital, who encouraged him to apply to a residency program at Thomas Jefferson University in Philadelphia, Pennsylvania. He was accepted and moved to the US, maintaining that he would still move back to Spain following this residency.

“I thought, ‘OK, I’ll go 1 year to Philadelphia to do some rotations, some internship, and then I’ll go back home,’ ” Garcia-Manero said. Instead, he stayed in Philadelphia for 6 years.

Paving a New Path

Philadelphia was a tempo shift for Garcia-Manero, especially working in a hospital in the early 1990s with a population heavily affected by the HIV/ AIDS epidemic. “Jefferson is a major teaching hospital. They were extremely busy, and it was a totally different system than the way we train people now. [There were] long hours in the hospital. For the first 1 to 2 years, it was tons of care and on-call every other day. In those days, we were in the early phases of treatment for HIV disease, and Jefferson is in downtown Philly, [so] there was a huge community affected by AIDS. I also became very interested in that disease,” Garcia-Manero said.

At Jefferson, Garcia-Manero’s passion for hematology- oncology solidified. “I always teach my students and fellows that you [may] have to be a little lazy in life and try to follow the track of least resistance,” Garcia-Manero said. “It was obvious to me that I [would] never succeed as a cardiologist or a pulmonary doctor. I have no qualities for this kind of job, [but] I had some type of innate attraction—and I cannot explain this, and it may sound very weird— to take care of [patients with] leukemia. It became obvious that I understood this well—maybe because of my prior training in London, but that was something that came very natural to me.”

It was at this point that another mentor, who he cites as “one of the most important people in my life,” entered: hematologist and translational scientist Jose Martinez, MD, of Jefferson. Although they were both from Spain, Garcia-Manero doesn’t believe that commonality was the source of their bond. Martinez and Garcia-Manero’s mentorship and friendship grew because they were neighbors and would walk together to and from the hospital. Garcia-Manero’s interest in humanities also offered him much in the way of communication with Martinez, whom Garcia- Manero said is a polymath.

“He knows everything. Our conversations would go from what he’s teaching me to [book recommendations] to medicine,” he said. “He is still important to me, indeed. For instance, at the [2024 European Hematology Association] meeting in Madrid, my main excuse for me to go there was just to have dinner with him every night,” Garcia-Manero said of the now-retired Martinez, who is in his 90s and still “super sharp.”

“He taught me how to do science,” Garcia-Manero added. “He was a patient person of incredible integrity, [as well as] a phenomenal physician and teacher. He had a major mark on my career, and I consider him almost second to my dad or my mom in terms of this kind of relationship.”

At the end of his fellowship in 1999, around the time his first son was born, Garcia-Manero had the opportunity to move to Houston to work at MD Anderson Cancer Center, facilitated by his “most fundamental mentor and colleague for now over 25 years,” Hagop Kantarjian, MD, chair of the Department of Leukemia at MD Anderson. Again, Garcia-Manero thought he would only stay in Houston for 1 to 2 years before returning to Spain.

“I felt that I needed some experience as an attending before going back to Spain. I didn’t know that Houston was going to become my home, and that my family was going to grow up here,” he said. “Now I’ve been here for 25 years.”

Care and Compassion

No 2 days are the same for Garcia-Manero. At MD Anderson, he is also involved in clinical trials in MDS open at the institution, of which there are approximately 30. He also has 2 clinics per week, in which he estimates 50% to 70% of his patients are on clinical trials designed at MD Anderson.

“I love taking care of my patients. This is a very difficult disease and needs an integration with multiple programs,” Garcia-Manero said. “These patients tend to be older with comorbidities, [and today the disease is] probably incurable for many patients, so it’s challenging. But I enjoy it, and I’m totally devoted to this.”

Colleague Alessandra Ferrajoli, MD, a hematologist/ oncologist practicing in the Department of Leukemia at MD Anderson, credited Garcia-Manero for creating and guiding the institution’s state-of-the-art MDS program. “He assembled a large team of skilled scientists and physicians [who] have made seminal discoveries in the biology and treatment of this disease. The helm of the MDS boat at our center could not be in better hands,” she said.

Garcia-Manero’s major contributions to the fields of AML and MDS, which began when he first joined the faculty at MD Anderson, include helping to develop azacitidine and decitabine, which are now standards of care in these disease states. The FDA approved azacitidine in 2004 and decitabine in 2006, along with the approval of lenalidomide (Revlimid) in 2005. Garcia-Manero felt the field of treating MDS was “on a roll” with the introduction of 3 new drugs that had shifted the treatment landscape. However, there was essentially no progress in developing new treatments for the next decade.

“It was tough,” Garcia-Manero said. However, around 2010, research then turned to the incorporation of next-generation sequencing and the discovery of clonal hematopoiesis, which paved the way for more progress in AML and MDS treatment. This led to BCL2, IDH, and FLT3 inhibitors, as well as better regimens for anemia, such as luspatercept (Reblozyl), as well as the development of oral hypomethylatig agents. Garcia-Manero shared his gratitude to the MDS Section team at MD Anderson for their collaboration and research.

“We have very solid knowledge of what these diseases are. We have a lot of new targets, and we’re starting to see those translating into the approval of new drugs,” Garcia-Manero said. “We still have issues; for instance, in patients with TP53-mutated diseases [and] in older patients [who] may not be candidates for cell transplant. But I see that this knowledge is translating into better outcomes for our patients, and I’m very proud of that.”

Connecting to Roots

Reading has been a passion of Garcia-Manero’s since he was a child, starting with his first book around 6 or 7 years old. “I never stopped,” he said, crediting this as a major pillar of his success and career. His extensive library is composed of an eclectic mix of fiction, nonfiction, and poetry in English, Spanish, and Catalan.

Another pastime in Garcia-Manero’s life hearkens back to his upbringing in Palma. “I grew up on an island surrounded by sea, and I love the sea, so I’m a sailor,” he said. He feels lucky to live in Houston, where he’s just a short trip from his sailing club. Being out on the water with his fellow sailors offers a totally different experience from his day-to-day life.

A Legacy of Mentorship

Of all his appointments at MD Anderson, Garcia- Manero takes pride in heading up the fellowship program that he helped to begin 25 years ago with Kantarjian and Jorge Cortes, MD, previously faculty at MD Anderson and now director and professor in the Department of Medicine at the Medical College of Georgia at Augusta University. “I’m not an expert on didactic tools and how to teach. From an innate perspective, I was helped so much by so many people that I really enjoy [mentoring],” Garcia-Manero said.

The pride Garcia-Manero has for the fellowship program is evident in the way he speaks about his fellows and recounts their accomplishments. “If I am remembered for anything, it will probably be because we have trained 10 fellows every year for 25 years. Many of these individuals are now becoming superstars at MD Anderson or…at other faculty centers all over the world,” he said. “We try to select these people not only for…their potential but also [whether] we can [tell] that they will be part of this cohesive group. They become like family members, actually.”

Garcia-Manero’s mentorship resonates with his fellows. Sangeetha Venugopal, MD, MS, started her fellowship at MD Anderson in 2017 and credits Garcia- Manero as a mentor. “I emulate him, especially in terms of how I speak with patients, how I do my research work, and how I pose myself to patients and colleagues alike,” said Venugopal, assistant professor of medicine in the leukemia program at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine in Florida. “Whenever we see patients, we have a thoughtful approach. What is going on with this patient? How can we help this patient be better? That’s something I learned from him.”

Garcia-Manero maintains that it’s his mentors, starting with his mother and countless others, who shaped the physician he is today. “I don’t know why they wanted to help me, [but] I was able to complete my studies successfully and start understanding this [because of them]. I’m very grateful to them.”