Cassandra Josephson, M.D., remembers the sights, sounds and experiences of the old All Children’s Hospital in the 1990s. She did her first lumbar puncture in the hematology-oncology clinic of Jerry Barbosa, M.D. She rounded with Robert Good, M.D., Ph.D., a pioneer in bone marrow transplant. She met Anne Rossi, M.D., a mentor and friend for life who shaped her career path.
She even watched the O.J. Simpson verdict in the All Children’s intensive care unit. The memories are plentiful from her days as a medical student at the USF College of Medicine, doing her pediatric rotation at All Children’s in St. Petersburg, Florida.
“I have very fond memories of my time here,” Josephson says. “This place shaped me and my choice to go into pediatrics.”
Now, Josephson has returned home to Florida and the place her medical journey began. In July, she became director of the Johns Hopkins All Children’s Cancer & Blood Disorders Institute.
Born in Hollywood, Florida, she is grateful to return to the Sunshine State for the opportunity to lead a program where she sees outstanding potential in an institution with vision.
“All the right ingredients are here to take this to the next level. The trajectory of this department, was what attracted me to come here,” says Josephson, who will be a professor of oncology in the Johns Hopkins University School of Medicine pending academic approval. “The forward thinking of the hospital is refreshing. What's really cool about Johns Hopkins All Children’s is the appreciation and embedding of research with clinical care.”
A Crash Course
Josephson, the oldest of five kids, grew up with an interest in science that evolved into medicine. As she neared starting medical school, one of her brothers was diagnosed with Hodgkin’s disease, creating a sudden focus for her on cancer and blood disorders.
Hodgkin’s is type of lymphoma that in her brother’s case was quite serious. “He almost died because the tumor was strangling his trachea,” Josephson says.
Josephson peppered her brother’s doctor with questions, laying the groundwork for her career path and an empathy for families with ill children.
“Dr. Philippa Sprinz was just amazing with my family,” Josephson says. “She explained the disease. She was easy to understand, but my parents had to make some hard decisions about staging surgeries and chemotherapy. Everything that these families experience in the most horrible way about a child who could die, we went through.
“This really helped me think about disease, and I decided I wanted to figure out how to stop it.”
Josephson’s brother received four to six months of treatment, went into remission and was eventually cured of cancer.
But the direction of Josephson’s career was beginning to take shape.
Go to the Best
Her time at USF and All Children’s solidified Josephson’s desire to become a pediatrician specializing in oncology and hematology.
Rossi, a hemophilia specialist at the hospital who worked at Maine Medical Center before retiring, inspired her to pursue both a balanced life and a challenging career.
“She really gave me great advice about being a clinician and about having a balanced life,” says Josephson, who has two teenage sons. “She really tried to guide me not to be out of balance. She said having a family is important, but your career is important too. She's always said go to the best, the best residency or the best fellowship you can. Those are the things that are going to push you into the places you need to go. She couldn't have been more right for me.”
Josephson did her residency training at a highly regarded pediatric program at the University of Colorado/Children’s Hospital Colorado. In Denver, she drew inspiration from Marilyn Manco-Johnson, M.D., a blood disorders specialist who later would also mentor Neil Goldenberg, M.D., Ph.D., director of clinical and translational research at Johns Hopkins All Children’s.
After residency, Josephson wanted to return to Florida, but there were no hematology-oncology fellowship programs in the state, so instead she chose to attend Emory University/Children’s Healthcare of Atlanta.
Emory opened a new door of opportunity.
A Transfusion Transformation
At Emory, Josephson was introduced to transfusion medicine, an emerging field at the time. Josephson admits she didn’t initially know what it was all about, but Emory’s one-year fellowship program hooked her.
Transfusion medicine encompasses all aspects of the transfusion of blood, the composition of blood components and regulations that govern this biologic therapy. Transfusion medicine physicians evaluate and advise how and when to transfuse red blood cells, platelets, and plasma gauging the impact on the transfusion recipient and whether the blood types, dosages, age and safety profile need to be altered for the best result.
At Emory, Josephson met another role model, Christopher Hillyer, M.D., then director of the Transfusion Medicine program at Emory and now president and CEO of the New York Blood Bank.
“There was so much unknown in pediatrics with regard to transfusion, especially in preterm infants, in hematology-oncology patients, in cardiac surgery patients, in trauma patients,” she says. “My career just went in this direction.
“There's a million questions that we don't know the answers to. And I like asking questions.”
Making a Mark
As Josephson pursued those questions, her clinical research career “just sort of exploded,” she says. After her fellowships, Josephson joined the faculty at Emory, and the National Institutes of Health and others funded her research.
Blood donors are adults, and it requires special expertise when the recipients are infants or children. This is where Josephson has developed her expertise and made her mark. She has published important blood and transfusion research related to sickle cell disease, cancer treatment, blood and marrow transplantation, preterm birth, cardiac surgery patients, trauma patients and more.
“There's a lot of things going on behind the scenes in pediatric transfusion that doesn't happen in adult transfusion medicine,” she says. “There is a distinct difference between who the donors are and who the recipients are. The potential influences on the immune system and long-term outcomes of these growing children can be good and bad.”
Josephson worked her way up to professor of Pathology/Laboratory Medicine and Pediatrics and became director of Clinical Research and associate director of the Emory Center for Transfusion and Cellular Therapies.
In 2019, the NIH’s National Heart, Lung and Blood Institute (NHLBI) honored Josephson’s work as one of its Celebrated Women Scientists. They highlighted some of her important research findings, including that anemia — and not transfusions — is associated with increased risk for necrotizing enterocolitis in neonatal intensive care patients, and her work to decrease complications from red blood cell and platelet transfusions.
Josephson missed Florida and the water that surrounds it. She grew up in Hollywood, 10 minutes from the beach, not realizing her good fortune.
“I love the water and I love swimming in the ocean or the Gulf,” she says.
When the opportunity to lead the Cancer & Blood Disorders Institute came along, she seized it.
“St. Pete actually reminds me of Hollywood,” she says. “It's like old Florida. It's a weird feeling of nostalgia, almost déjà vu.”
But while Josephson may feel personal nostalgia, her professional focus is on fast-forward to the future.
She wants to build on the research and clinical collaboration at the hospital. She wants to add an apheresis program, a therapy that makes it possible to remove most of the red blood cells or plasma from a patient and replace their total blood volume with those blood components from blood donors treating the underlying condition of the patient. It also encompasses collection of stem cells to treat children with cancer, sickle cell disease, immunodeficiencies, and other diseases requiring blood and marrow transplantation for cure. Furthermore, she wants to establish an accredited hematology-oncology fellowship program, to train the future leaders in this field. In short, she desires to establish Johns Hopkins All Children’s as a premier Comprehensive Cancer and Blood Disorders Center, a designation that means the institution meets all the National Cancer Institute standards for cancer prevention, clinical services and research and comprehensively through expertise and research prevents, treats, and cures infants and children with blood disorders.
“The other piece is actually being able to reach as many patients as we can with all these things,” she says. “The outreach of what we build here is extremely important. Patients need to be able to have care close to where they live. I think that we can bring this really amazing care to those communities and deliver the care just as we can if they were to come to the mothership.”