The International Immunocompromised Host Society Lifetime Achievement Award

Dr Philip Pizzo, Stanford University, United States, Recipient of the ICHS Lifetime Achievement Award

During the past four decades, Dr. Pizzo has distinguished himself as an internationally renowned leader in the field of infectious diseases support of care in Pediatric and Adult Oncology as well as a pioneer in the field of Pediatric HIV/AIDS. Having joined the Pediatric Oncology Branch of the National Cancer Institute in 1976, Dr. Pizzo rose to become Senior Investigator and Head of the Infectious Diseases Section, and finally to become Chief of Pediatrics of the National Cancer Institute. Throughout that twenty-year period at the National Cancer Institute, Dr. Pizzo made extraordinary advances in the field of infectious disease supportive care in Pediatric Oncology. For example, he was among the first investigators to identify the transition of emerging infections in patients with cancer from Gram-negative to Gram-positive bacterial pathogens. He developed rational evidenced based strategies for antimicrobial interventions based upon the duration of antibiotic therapy in patients with fever and neutropenia. These included demonstration of the benefit of empirical antifungal therapy in patients with persistent fever and neutropenia. These critical observations led to subsequent studies of empirical antifungal therapy that became standards of care in the prevention and early treatment of invasive fungal infections in persistently febrile neutropenic patients.

The innovative protocol for empirical antifungal therapy in persistently febrile neutropenic patients provided a strategy for prevention of invasive fungal infection in high risk patients, as well as early treatment of deep mycoses before becoming clinically overt and potentially fatal. The strategy for empirical antifungal therapy has been utilized worldwide and later shown to be effective in a wide range of persistently febrile neutropenic patients with caspofungin (as a model echinocandin), liposomal amphotericin B (developed to reduce nephrotoxicity), and voriconazole (as a model mould-active triazole). This strategy for empirical antifungal therapy also established the foundation for pre-emptive therapy, where biomarkers and diagnostic imaging further defined patients who would benefit from antifungal therapy. Empirical antifungal therapy also provided broader anti-infective support to patients receiving antifungal prophylaxis complicated by breakthrough triazole-resistant yeast and mould infections.

Dr. Pizzo also has made other key contributions to Medical Mycology in being the first to describe the natural history, clinical manifestations, diagnostic imaging, and therapeutic interventions of hepatosplenic candidiasis (chronic disseminated candidiasis). He also contributed to the establishment of novel animal models of disseminated candidiasis and pulmonary aspergillosis, as well as to development of innovative diagnostic methods for detection of these frequently lethal infections.

Among Dr. Pizzo’s other key contributions was the pivotal study demonstrating that empirical monotherapy with a third generation cephalosporin (ceftazidime) versus combination therapy with beta-lactam plus aminoglycoside was equivalent but less toxic as empirical antibacterial therapy of febrile neutropenic patients at risk for life-threatening infections. This particular study revolutionized the management of empirical antibacterial therapy in febrile neutropenic patients from that of a dependency on beta-lactam plus aminoglycoside to that of a less toxic but equally effective third-generation cephalosporin. This seminal study and subsequent clinical trials provided the standard of care, which continues as an enduring contribution that has permitted tens of thousands of patients to avoid the nephrotoxicity and ototoxicity of aminoglycoside therapy during chemotherapy-induced neutropenia. Recognizing that many patients with solid tumors and some lymphomas had shorter durations of neutropenia with less risk for infectious complications, Dr. Pizzo also laid the foundation for oral antibacterial therapy for the treatment of relatively low risk febrile neutropenic patients in lieu of intravenous antibacterial therapy. Again, this strategy achieved widespread international usage as a cornerstone in managing relatively low risk febrile neutropenic patients.

Dr. Pizzo also further addressed other critical gaps of knowledge in the infectious diseases supportive care of children with cancer. These studies included defining the role of lung biopsy versus empirical therapy in immunocompromised patients, as well as understanding the relative risks and benefits of antibacterial prophylaxis in pediatric oncology. With the advent of HIV/AIDS and the ensuing global epidemic of this tragic disease, Dr. Pizzo marshaled vast resources to rapidly develop antiretroviral therapies in HIV-infected children.

Under his direction, the first clinical trial of antiretroviral therapy was conducted in HIV-infected children followed by important trials in the use of AZT, ddC, ddI, 3TC, as well as protease inhibitors and other novel agents in this vulnerable population. In further developing an understating of the pathogenesis of HIV infection in children, Dr. Pizzo and his staff developed new insights into the immunopathogenesis and neuropathogenesis of pediatric HIV/AIDS. Rising to the status of a world leader in pediatric HIV infection, Dr. Pizzo served as co-editor of three editions of the definitive textbook - Pediatric AIDS.

Throughout his career, Dr. Pizzo has been a mentoring role model who epitomizes a compassionate patient caregiver guided by leading edge laboratory and clinical science. In addition to his groundbreaking research in infectious diseases supportive care, as well as in pediatric HIV/AIDS, Dr. Pizzo has contributed significantly to the education and mentoring of numerous trainees. He has mentored more than ninety postdoctoral fellows, as well as leading key training initiatives in pediatric oncology and pediatric AIDS at the National Institutes of Health, the pediatric residency program at Children’s Hospital in Boston, and the medical student education curriculum at Stanford University.

Dr. Pizzo also has contributed fundamentally to the pillars of ICHS as one of its founding members. His dynamic leadership in its early development was critical to the current success of the society that we enjoy today. Dr. Pizzo’s lifetime career epitomizes the highest values espoused by the ICHS for patient care, teaching, and research that has profoundly improved survival, outcome, and quality of life for immunocompromised patients worldwide. In summary, Dr. Pizzo is unequivocally one of the foremost leaders in pediatric infectious diseases, oncology supportive care, pediatric HIV/AIDS, and medical education of our time. His creative vision, extraordinary productivity, heartfelt compassion, and inspiring leadership have saved and improved the lives of thousands of children as well as transforming our understanding of basic disease processes and implementation of novel therapeutic strategies.