Tribute: The American Society of Pediatric Hematology/Oncology (ASPHO) 2012 distinguished career award goes to Dr. Victor Blanchette

The most easterly island of the Caribbean is Barbados. It is a small island, 21 miles long and 14 miles wide, with a population of <300,000. Initially Spanish, then Portuguese, Barbados became a colony of the British Empire in 1625. Almost 350 years later, in 1966, Barbados became an independent state within the Commonwealth of Nations, an association primarily of former members of the British Empire. Its culture and educational system have remained decidedly British. Victor Stanley Blanchette was born in 1945 into a family of Bajans (short for Barbadians). His father, Sir Stanley Blanchette, a prominent businessman, and mother Pearl created in the family a happy home with an environment of culture and education. Young Victor attended Harrison College, an all boys' school, with a British Headmaster. Victor not only excelled academically but for many years he also held the high school records for the half-mile and full mile run. This skill has served him well, as will become apparent throughout this story. In fact Victor has yet to stop “running.” Victor's experiences in a society that included both wealthy and distinctly poor people shaped the person he became and many of us have come to know. Victor is generous in sharing his many gifts with all around him, he is genuinely concerned with the well being of his patients, the staff, students, and his colleagues, and he sets no limits when it comes to the care of others. All this has become evident in his ability to work collaboratively with colleagues in many disciplines in the Hospital for Sick Children, in Canada and around the world. Given his academic talents, Victor's parents felt that his education should continue and at the age of 19, he entered Cambridge University where he completed undergraduate and medical education. For the next 5 years he completed postgraduate training in London, England, leading to Membership of the Royal College of Physicians (MRCP) as well as other degrees. It is during these training years that he reconnected and subsequently married Yvonne Yearwood, a Bajan whom he knew from Barbados and who was in London training to become a nurse. Theirs has been a happy marriage; Yvonne has been the constant support of Victor throughout his career and for their family of four boys and now three granddaughters. In 1975, the Blanchette family moved to Baltimore, Maryland, where Victor entered a pediatric residency at Johns Hopkins Hospital. Two years later, he became a fellow in pediatric hematology/oncology at McMaster University in Hamilton, Canada, where one of us (AZ) first met this devoted, intelligent, fine physician and warm and caring human being. Having finished his training, Victor moved to Ottawa to take up a position as a staff hematologist at the Children's Hospital of Eastern Ontario in Ottawa and at the Canadian Red Cross (Ottawa Centre). In 1983, he was recruited by Dr. Alvin Zipursky to join the Division of Hematology/Oncology at the Hospital for Sick Children (SickKids) in Toronto were he headed the Comprehensive Care Hemophilia Program. From 1998 to 2011, Victor served with great distinction as the Chief of the Division of Hematology/Oncology at SickKids where he developed an outstanding program and established collaborative national and international programs for the study and care of children with hematologic and oncologic disorders. As Division Chief, Victor's accomplishments were many and of significance. He increased the number of full-time faculty from 15 to 30 and the number of fellows in training from 24 each year to 49 in 2012. This growth also allowed the Division to establish subspecialty programs. Victor divided Oncology into three programs: Neuro-Oncology, Solid Tumors, and Leukemia/Lymphoma, and Hematology into three programs: Thrombosis and Hemostasis, the Hemoglobinopathy, and an Inherited Bone Marrow Failure and Myelodysplasia program. This has allowed the Division to provide highly specialized care and education and focus on some key areas of research. Victor recognized the particular importance of developing the field of pediatric hematology. Together with the late Dr. Maureen Andrew he created a pediatric thrombosis and hemostasis fellowship, a training program relatively unique in the world and one that was greatly needed. To date there are 14 graduates of that program, practicing medicine in 10 countries around the world. This group of pediatric hematologists constitutes a unique network with Victor in the center; together they are involved in collaborative studies and publications. Currently they are creating a Handbook of pediatric thrombosis and hemostasis. A major achievement of Victor was to establish within the Royal College of Physicians and Surgeons of Canada (RCPSC), the official body that sets the standards for specialty education, conducts certifying examinations, and accredits specialty residency programs in Canada, the specialty of Pediatric Hematology/Oncology. Until 2008, pediatric hematologists/oncologists became board certified in Canada by taking a RCPSC adult hematology only examination administered by the adult Hematology Specialty Committee. In 2001 the RCPSC requested Dr. Blanchette to establish a Task Force to recommend specialty training requirements and specific standards of accreditation for residency programs in Pediatric Hematology/Oncology. Ensuring the support from (adult) hematologists, pediatric hematologists, pediatric oncologists, and pediatric bone marrow transplanters from eastern Canada to western Canada, from English speaking to French speaking Canadian constituencies, the Task Force, under Victor's leadership, succeeded in obtaining the formal recognition of a new specialty in Canada, that of Pediatric Hematology/Oncology. In the spirit of true collaboration, Victor recognized the need to link the programs at Sickkids to other pediatric hematology/oncology programs in Canada. As the Chief of the largest hematology/oncology program in Canada, his attitude of true inclusive collaboration was central in the successful establishment of a national organization. He solicited the input of all other pediatric hematology/oncology Chiefs in Canada and agreed to an exploratory meeting in Calgary, hosted by one of us (MJC). During a memorable dinner at the home of the host, the foundation was laid for the establishment of what was to become the Council of Canadian Pediatric Hematology/Oncology Directors (C17, referring to the 17 participating programs, subsequently reduced to 16 following the merger of two programs). C17 is composed of the institutionally appointed heads of the pediatric hematology/oncology programs across Canada and each academic institution has one vote. Accordingly it represents the interests of children and adolescents with cancer and blood disorders and acts as an authoritative voice in Canada and beyond. Dr. Blanchette was the first co-chair of this important coalition with one of us (MJC). His leadership in bringing this group together cannot be overemphasized. While taking his responsibilities as Division Chief seriously both locally as well as nationally, Dr. Blanchette's greatest passion and expertise remains within the field of hemostasis (ITP, hemophilia and related bleeding disorders). He recognized that research and clinical care in these areas demanded critical experimental studies and considerable collaboration. In 1986, Victor organized pediatric hematologists from several Canadian centers to undertake two randomized trials of management approaches to ITP. These multi-center prospective studies in children with newly diagnosed ITP remain the definitive trials in comparing IVIG, steroids, IV anti-D, and observation alone in the management of children with newly diagnosed ITP. Initially known as the Canadian ITP study group, the group broadened its mandate and became the Canadian Pediatric Thrombosis and Hemostasis Network (CPTHN) an incorporated association with its own Board of Directors and numerous subcommittees. Victor is its current Chair. With regard to hemophilia, Victor spearheaded a study to evaluate a unique approach to prophylactic clotting factor therapy to very young boys with severe hemophilia. Because these are relatively rare patients again a collaborative study was necessary and as a result a Canadian Hemophilia Primary Prophylaxis study was initiated. The study is ongoing as these boys are now in their mid-teens and continue to be followed to assess long term joint health, compliance, and quality of life. As part of this longditudinal study the economic impact of prophylaxis will be assessed by comparing the cost associated with prophylaxis to that of controls. This important work has the potential to have a major impact on the management of young boys with hemophilia. Reflecting his leadership skills, Victor played a pivotal role in the creation of the Association of Hemophilia Clinic Directors of Canada (AHCDC) in 1994. They AHCDC acts as the medical voice for individuals with hemophilia and related bleeding disorders living in Canada. The Association comprises 25 comprehensive care hemophilia programs (pediatric and adult) spread across Canada. It has facilitated the establishment of the Canadian Association of Nurses in Hemophilia Care, the Canadian Physiotherapists in Hemophilia Care and the Canadian Social Workers in Hemophilia care. Dr. Blanchettes's national leadership in ITP and hemophilia has been considerable and as mentioned has resulted in the development of several collaborative networks across Canada. However, his urge to provide the very best care to these patients through clinical research and education was not limited to efforts in his new home country. In 2001, Victor helped establish the International Prophylaxis Study Group (ISPG), and became its inaugural Chair. The coordinating office remains at the Hospital for Sick Children under Victor's direction. In addition, Victor has had a major role in advising and supporting the development of hemophilia programs in China in collaboration with the Hemophilia Clinic Centers Collaborative Network of China. He helped initiate the training of physiotherapists to use the Hemophilia Joint Scoring tool developed by the ISPG and assisted in the introduction of a Quality of Life measurement tool: the Canadian Hemophilia Outcomes—Kids Life Assessment Tool (CHO-KLAT), for use in boys with hemophilia. However, we would be remiss not to highlight the person behind the contributions described above. One of his fellows from over two decades ago describes him as “a humble warrior.” Once he has put something in his head, good luck to anyone not giving him what he feels his patients need. He becomes relentless at pursuing his goal, but what sets him apart is the way he goes about it. It is never about him. Rather he is capable of convincing you why the cause he is bringing to your attention deserves unconditional support. He will listen carefully to what you have to say, acknowledge the good points you are making, even complimenting you on these points, only to use your own arguments a few minutes later as a reason to support his request. His modesty and good nature, his humbleness and integrity, and his patience and perseverance, makes many of us follow his lead voluntarily. This world could use more leaders like Victor. One of his recent fellows describes him as follows: What sets Dr. B apart are not his numerous publications, his position and honors, or even his world-class expertise in the field of hemostasis. His achievements go far beyond that and are due to the human/personal qualities of Dr. B that truly have distinguished him. His outstanding leadership, his exceptional mentorship which resulted in the development of many quality clinicians and scientists distributed around the globe, his refreshing humility and his sincere compassion that have for many years touched children he took care of and their families, are all examples of what I have experienced. This is the story of a great Canadian from a small island in the Caribbean who has, through intelligence, boundless energy and devotion made major and unique contributions to the study and care of children and teenagers with hematologic and oncologic disorders in his institution, his country, and in our world. The authors thank to the many colleagues who provided us with information that helped us write this Tribute.

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