Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Thanks so much for joining us today. We're speaking with Dr. Girish Dhall, Director of the Division of Hematology, Oncology, and the Blood and Marrow Transplantation here at Children's of Alabama.

Dr. Dhall, thanks so much for your time.

Girish Dhall, MD: Thanks for having me Conan.

Host: So you've been here since 2019 and I want to talk a little bit about, going back to the beginning of your time here, what made Children's of Alabama the right fit for you? What made this an appealing position for you?

Girish Dhall, MD: So, I think it was, it was multiple things. so, if you, when I moved to this country, I moved to New York, I was there for 10 years, then I moved to Los Angeles from there, I was there for about 13 years, and then to Birmingham and Children's of Alabama. So when I moved to Los Angeles, it was not a love at first sight. and the city actually grew on me with time.

But when I came to Birmingham, to be honest, this city just felt really easy to get used to. And, and not just because of the city, because of the people. and also I think the people here at the, at Children's of Alabama and UAB. I was really impressed by the facilities here. I was, I was really impressed by the caliber of the faculty who were in the division and the leadership was really, I was really impressed with the leadership as well. So, they really had the heart and mind and, in a great place. And their the only, I've sensed that their only mission was to improve the care for children with cancer and blood disease in the state of Alabama. So that was, it was really appealed to me and just made the decision very easy.

Host: So I guess you sort of walked into a situation where you've got a lot of people, you've got a lot of good things going on, and you just kind of want to build on that and keep it going in a good direction.

Girish Dhall, MD: Absolutely. Absolutely.

Host: And I know one of the things that you've really brought a focus on is getting Children's involved in more consortiums. Let's talk a little bit about that. Can you explain first what a consortium is and the role it plays in the world of medicine?

Girish Dhall, MD: So I think the cancer, luckily for us, in children is a very rare disease. and what the way we learn about, curing cancer or, is by doing clinical trials. and so when we do clinical trials, you need numbers. Now, we know from our COVID experience that the more numbers, when you do randomized trials, when you compare one treatment to the other, you, that's the only way to, to do, to learn about these treatments.

And, you need a large number of patients. And for us in children, we just don't have those number of patients if we did studies or clinical trials as a single institution, for example. Even the largest institutions in the country, they don't have enough patient numbers to do a clinical trial on their own.

So we get together as a group, as Children's Hospitals, to do these clinical trials. And that group of Children's Hospitals, that conducts the clinical trial, that's kind of called a consortium. So, so we have multiple groups in the country and multiple consorti consortiums that are focusing on different types of clinical trials for children with cancer.

Host: And so when you got here, you wanted to get Children's of Alabama involved in more of those. How do you feel about the progress you've made on that?

Girish Dhall, MD: Yeah, I think so. We, this was, when I got here, we, it was a very strong clinical program. We had a lot of clinical trials for children who are newly diagnosed with cancer through our largest consortium in the country called Children's Oncology Group. But the, the clinical trial options, were limited for patients who, who relapse or who have a disease progression and I think so that we needed access to those kind of clinical trials. So when I got here, we started, excuse me applying to these consortia for membership, to get access to these newer therapies and cutting edge clinical trials, and, because of the strength of our program, which is a very strong, we, for example, we have every specialist, in the hospital focusing on different types of diseases. We have neuro oncology, neuropathology, neuroradiology, we have a new proton center, we have great neurosurgeons, we have orthopedic surgeons, and so on.

So, because of the strengths of our, not just the program, but also our faculty, we were admitted into, these, these consortia, and what that did is gave us access, suddenly access to a large number of clinical trials for this really kind of, group of patients that we don't have great options for.

Host: How do you sum up the difference that that makes? not only for our patients here in the state of Alabama, but for cancer patients all around the world that we're involved in that and contributing to it and benefiting from it.

Girish Dhall, MD: Absolutely. So for our children, in Alabama, I think the biggest advantage is that previously, they would have to go out of state, whether they had to go to St. Jude, whether they go to Atlanta, they go to, Sloan Kettering in New York City, they, to get access to these trials. And that was, that was only, accessible for some families who have the resources to do it. And, for a large number of our patients that was not possible. But now, having these clinical trials here in our own state, our patients don't have to leave the state.

They can get access to these trials right here at home, in Birmingham. And, and they, and that's, I think, a huge, huge benefit, and that goes, for our surrounding states as well. So I think, so we get patients from Mississippi, from Louisiana, from, North Florida, from around the Gulf Coast, and even from Georgia and Tennessee.

So I think this, the impact of having access to these clinical trials is great for this region. we have, we get, referrals from even out of the country, from other parts, other states as well, which are far and beyond. and, it's just, so it's a good challenge to have to accommodate all those patients and, and provide access. So I think it's been great, yeah, not just regionally, but, not just locally, but regionally as well.

Host: And really by contributing to this research, being involved in the clinical trials that come along with the various consortia that we're involved in, our research is contributing to, a global impact in the, in the fight against cancer, right?

Girish Dhall, MD: It absolutely is because as I said, when I mentioned the caliber of our faculty, we have a number of our Oncology faculty who are running, who are chairing these national and international clinical trials. I'm not talking about one. I have about five, we have about five or six faculty who are leading national or international clinical trials. So I think that some of these clinical trials have been completed. Some are still ongoing and we have already shown that for some of these diseases, we have improved outcomes. So we're, we're working, on a national stage and trying to improve the outcomes of children, not just locally, but nationally, we recently also recruited, a, a basic scientist from, from, Lurie Children's, a Northwestern University in Chicago, is Dr. Hashi Zumi, and, his focus of his research focus is to try and improve, cure rates for a uniformly fatal disease in children called DIPG, and also trying, novel ways to, to treat these children.

For example, he's really focusing his research on trying to deliver treatments through the nose to the brain. So, I think, so if that, that, it would be so much easier to just inhale a chemotherapy drug or a, or a cancer drug, instead of taking it by mouth or getting an IV and so on. So, so I think a lot of exciting things happening. Yeah.

Host: A lot of fascinating research going on in the, in the world of the fight against cancer.

Girish Dhall, MD: There is, yeah.

Host: What does it mean to you to see the national and international impact that we're having here at UAB and Children's of Alabama?

Girish Dhall, MD: All I can say is I'm really proud of the contributions that we're making. so this is, this is really a proud moment for me. It's great to be here and great to be able to contribute.

Host: And we were talking about clinical trials earlier. I know we're involved in one called the Head Start Trial. Can you tell me what that's all about?

Girish Dhall, MD: Yeah. So, the, one of the most challenging group of patients is really infants and young children, like kids who are diagnosed in the first year of life or, or less like less than three years of age and so on, because if you think about treatments for cancer, if, if you and I or any adult has cancer, there are three types of treatment. One is surgery, one is radiation therapy, and then there is chemotherapy. For most malignant diseases and in older children and adults, radiation therapy is, is used very commonly, routinely to treat these patients.

But when you give that kind of radiation to the brain of an infant or a young child who's less than 3, 4, 5 years of age, the impact on their, because the brain is still growing, so the impact on the development of the brain is, is kind of permanent and lifelong. And this kind of halts the development of the brain and really leads to severe intellectual, disability as the kids grow up. So one of the idea behind Head Start is to, give high dose or intensive chemotherapy up front so that we can either avoid giving radiation completely to these infants, and, or be able to give really reduced dose and volume of radiation, and keeping in mind that just we want to maintain the survival that we see with radiation, but with much less long term side effects.

So that's the concept behind the Head Start, studies. So, right now we are on the first study opened in 1990, and then right now we're on Head Start 4, and I co chair that study, with Dr. Jonathan Finley. And, so this is now Head Start, this is the, it's an international clinical trial, so it's open at about 60 or 65 institutions across, not just across the U.S., but Canada, Australia, New Zealand, and some centers in Europe. so I think we, I recently, so we had, we treat low risk patients and high risk. I recently reported on a group of patients last year at a meeting in Germany, on a group of patients called, Desmoplastic medulloblastoma.

It's a highly malignant, disease, grade four cancer. And we showed that using this approach of high dose chemotherapy, we were able to cure 95% of patients and not even one patient received radiation therapy to the brain. So that was completely without the use of radiation therapy. So that actually moves the field, significantly forward.

And it's, it's, and as a follow up to that clinical trial now, so we're, the next, successor study, if you may, for this group of patients is going to be an international study that I'll be co chairing, with the one of the investigators in Germany. And, that trial will open either at the end of this year or early next year and will be open at about 215 institutions across 16, countries. So we hope to expand that experience and have a global impact, of this treatment.

Host: So, a lot of promise, you think, for the future, for, for this type of, type of treatment?

Girish Dhall, MD: We hope so. We certainly hope so. Yeah.

Host: I know you've, accomplished a lot of things, in the time that you've been here at Children's of Alabama. What does the future hold for, for this division?

Girish Dhall, MD: I, I'm really, the future is bright. I just hope that, we're all, as, as I mentioned, we're hopefully we're making an impact, not just locally, but nationally and globally. But, I, my hope and goal is that for us to become like a destination center, for, for research as well as clinical trials for not just our state, but also, nationally. So I, I think that would be the goal and that would be my hope.

Host: All right. Well, thanks so much for your time and for all the things you're doing here.

Girish Dhall, MD: Thank you very much for having me, Conan.

Host: Thanks for listening to Inside Pediatrics. For more podcasts like this one, go to childrensal.org.