Her fascinations are T cells and listening to her patients

Madeleine Duvic, M.D., is a clinical investigator with many interests.

Her eclectic portfolio of biomedical pursuits and successes has incorporated study of and treatment for AIDS-related dermatological conditions, hair loss due to alopecia areata, and significant research and treatment contributions to T cell lymphomas and skin cancer.

At the center of all she does is close communication with her patients.

“A clinician-scientist keeps his or her eyes open and they sometimes make remarkable discoveries based simply on talking to patients,” Duvic says. “I have learned to listen to my patients a lot.”

Perhaps it’s such inspiration that has resulted in her life-enhancing advances in cutaneous T cell lymphoma (CTCL), leading to therapies being made available to patients with an “orphan” disease often overlooked by the pharmaceutical
industry.

Duvic, professor and deputy chair of Dermatology, first took interest in the confounding world of T cells in the late 1970s while enrolled in a National Institutes of Health course on the subject. It spurred her interest enough to specialize in immunology at Duke Medical School, and she found herself at the forefront of the emerging AIDS epidemic. When she joined MD Anderson in the early 1980s, the dramatic loss of T cells in AIDS patients resulted in her running one of the first AIDS clinics in the country and ultimately led to her life’s work in developing therapies for CTCL.

As a medical student and intern, Duvic saw patients who had an aggressive leukemic form of CTCL known as Sézary Syndrome, which caught her interest early on. CTCL occurs when T cells known as Sézary cells become cancerous,
generally affecting the skin, causing skin lesions.

Sézary cells are found in the skin, lymph nodes and blood, and cause red, severely itchy skin that covers large areas of the body. Other signs and symptoms include thickened skin on the palms and soles of the feet, hair loss, abnormalities of fingernails and toenails, and difficulty regulating body temperature.

Sézary Syndrome, which generally strikes people over age 60, is rare, accounting for only 2 to 3% of the estimated 16,000 to 20,000 CTCL cases seen each year.

Duvic has treated more than 3,000 CTCL patients and sees about 200 each year, many who travel from far outside of Houston. A laboratory scientist as well as a doctor, she’s been instrumental in helping develop the five drugs currently on the market to treat the disease.

Last November, she and colleagues published an article in the journal Nature Genetics that identified genetic mutations in patients with Sézary, which she hopes will lead to additional therapies.

The common thread throughout her career has always been about improving her patients’ lives.

“When you relieve suffering and help patients participate in life again, that’s what it’s all about,” says Duvic.

Other Interests

In 1987, Duvic created Texas’ first photopheresis center at MD Anderson. During photopheresis, blood is taken from a
patient’s vein and separated into its different components. White blood cells are treated with a medication, exposed to ultraviolet light, and then returned to the patient, along with other blood cells. These treated cells stimulate the immune system, which helps the patient’s body fight CTCL.

“Our lab has been studying the mechanisms behind photopheresis,” says Duvic. “In particular, how does it work in both CTCL and graft versus host disease, since they are polar opposites?”

Duvic operates the world’s largest clinical program for patients with another form of CTCL known as mycosis fungoides.

In its most advanced stage, the disease causes skin tumors that may develop ulcers and become infected. Duvic and her team identified three areas within Houston where incidences of mycosis fungoides were unusually high. Those findings were published in Cancer.

She also developed an interest in alopecia areata, which occurs when the immune system mistakenly attacks hair follicles, resulting in significant hair loss. She created and oversees the Alopecia Areata Registry, the world’s largest database of genetic samples from alopecia areata patients.