Dr. Emmanouil Manos Nikolousis is a UK board-certified Clinical Haematology and Bone Marrow Transplant Consultant with over 19 years of experience. After completing his specialist training in the West Midlands region of England, Dr. Nikolousis became the Clinical Director of Haematology and Stem Cell Transplantation at Heartlands Hospital, part of University Hospitals Birmingham, one of the top 5 Hospitals in the UK. Under his leadership, the Haematology Department was awarded the 2019 Team of the Year distinction for their innovative and patient-focused care for Haematology and Bone Marrow Transplant patients. Dr. Nikolousis was a member of the Acute Leukaemia Working Party in the UK for 10 years. Dr. Nikolousis has also worked in Greece and Cyprus, where he was an Associate Professor of Haematology and the Chair of Medical School at the European University of Cyprus.
In November 2023, Dr. Emmanouil Nikolousis relocated to the American Hospital Dubai. Dr. Nikolousis, alongside the excellent multispeciality team at American Hospital, is expanding the stem cell transplantation service, bringing hope to many patients with various types of blood and bone marrow cancer, such as leukaemia, myeloma, and lymphoma.
Thank you so much for your time today, Dr Emmanouil. Would you give us a brief background about who you are and your training?
Thank you so much, I’m really glad to be with you here today. I’m a Consultant Haematologist at the American Hospital in Dubai. My main interests are benign and malignant haematology, as well as bone marrow transplantation and cellular therapies. I completed my haematology and bone marrow transplantation specialist training in the NHS in the UK, in the West Midlands region. Then I worked as a Consultant in the same region, where I was head of the department for bone marrow transplants and was also promoted to a higher management role for the whole of Birmingham for different specialties, including haematology, oncology, and bone marrow transplantation. I also worked in Greece for a couple of years before relocating to the UAE. Now, in Dubai, I’m the programme director for the bone marrow transplant department at American Hospital, which is part of our cancer centre at American Hospital Dubai.
When you were looking to relocate, why was American Hospital Dubai the best match for your particular skills and experience?
American Hospital has an established reputation as one of the most advanced hospitals in the region, accredited to the highest internationally recognised standards. It also has comprehensive oncology and hemato-oncology units with excellent specialist staff and facilities. American Hospital is one of only a few centres in the UAE that carry out stem cell transplantation.
When I had the interview for American Hospital, they had a very clear vision and aims to create a comprehensive cancer centre, able to manage all aspects of treatment and side effects, and facilities for more complex cancer patients requiring a longer stay in hospital, such as acute leukaemia patients.
Last year, we had 12 acute leukaemia patients being treated at the American Hospital. The hospital was looking to expand its bone marrow transplant programme to create a more comprehensive transplant programme to include the allogeneic transplants, from donors, rather than from the patients themselves. They also had a plan to develop the cellular therapies, which have gained a lot of momentum over the last five years in haematology, and certainly, they are life-saving for the patients.
So, when I was offered this post, I saw it as a great opportunity to contribute to an expanding and much-needed service for this region. The hospital management is very supportive of innovation and education, and there is an emphasis on providing the highest standards of care, with quality management systems to ensure constant improvement and optimal outcomes for patients.
Can you tell us a bit more about bone marrow or stem cell transplantation – what kind of conditions can it be used to treat?
Bone marrow or stem cell transplantation requires significant expertise as it treats patients who have very difficult diseases affecting the bone marrow or blood cells. This treatment has great potential to save lives, but it requires a well-trained, large, multidisciplinary team. We also implement rigorous quality management systems and closely monitor and follow up with patients. We usually perform autologous stem cell transplants—using the patient’s own stem cells—for individuals with lymphomas and myeloma. The allogeneic stem cell transplants – with stem cells from a donor – are usually for patients who have acute leukaemias who don’t have their own normal stem cells available.
We also use stem cell transplants to treat other haematological malignancies, such as myelodysplastic syndrome—which can be a pre-leukaemic condition—as well as various myeloproliferative disorders and benign conditions like aplastic anaemia. We treat thalassaemia and sickle cell disease with stem cell transplants as well, although these conditions are typically managed in the paediatric age group.
Transplants can also be carried out to replace blood cells that are damaged or destroyed as a result of intensive cancer treatment. Primarily, our work, around 90%, is for malignant haematology disorders that go either for autologous or allogeneic stem cell transplant. Within approximately the next couple of months, we will have all the setup for the CAR T cells, a type of cell-based gene therapy, that will be treating patients with lymphomas mainly and acute lymphoblastic leukaemia that have been very refractory to other treatments. These patients never had hope before, and this new therapy provides hope for them. And in Dubai, we have a young patient population, and therefore, the outcomes are expected to be much better.
So you can treat children for bone marrow transplantation as well as adults?
At the moment, in our department, we treat only adults. As a part of my specialist training in the UK, I had about a year of training in paediatric haematology and bone marrow transplantation.
But there are, and very rightly so, strict rules about how you perform the transplants. We would need to have a paediatric bone marrow transplant consultant as well, which at the moment we are looking to appoint somebody, because paediatric cancers are less common than adult cancers. You have children with acute lymphoblastic leukaemia, some of them with acute myeloid leukaemia, but you also have more of the benign disorders that I mentioned earlier, the thalassemia and sickle cell, for which, under certain circumstances, stem cell transplants can greatly improve quality of life, or even be lifesaving.
How is stem cell transplantation expanding at the American Hospital in Dubai?
So, before, between 2021 and 2023, there were about 17 autologous stem cell transplants performed at the American Hospital. From March 2024 until now, we have done five, with the sixth allogeneic transplant patient currently undergoing treatment, and we have done about 13 autologous transplants patients. So we’re close to 20 within a year, which is really good. It’s made possible because the hospital management is very supportive, from the CEO to the CMO and the chief operating officer. Also, within our department, we have Dr Maroun El Khoury and Dr Faraz Khan, who have been there for many years, and they have different leadership roles, and also the director of our clinic, Mahmoud, is helping a lot.
The staff all work as one team. It’s really important to have a well-trained team with the right expertise and experience to achieve the best outcomes for the patients. On top of that, the DHA recently published standards on allogeneic stem cell transplantation, and we at the American Hospital played a major role in developing this project.
It’s also very important that we work with colleagues from other hospitals across Dubai, and that we work as a team. It’s not about us doing the transplant only, it’s about the referrals, preparation, and follow-up also. For example, you have Dubai Hospital, you have Al-Zahra Hospital, Clemenceau, Saudi German, and all the other hospitals that are referring patients to us.It’s very important that these hospitals do an excellent job because they refer patients to us, and we know they treat these patients well, following international guidelines and protocols. This approach makes the transplant more effective for each patient. So, as you can see, teamwork in a very broad sense is important for success.
Ensuring Comprehensive Patient Support and Multidisciplinary Collaboration
The patients also have to be well informed and educated, because transplants can have complications. If there is a complication, they need to go quickly to our ER department. We are 24/7 on call for the transplants, apart from the general haematology and oncology patients. We are in constant communication and training with the emergency department. Also, very importantly, we have an excellent ICU department as well. And of course, all the other specialities, including radiotherapy, which is one of the essential components of the conditioning regimen, before you do the transplant. The radiation oncology department is very advanced within American Hospital, with Dr Tarek Dufan and Dr Salim Chammas. We’re working very, very well together, and the patients are getting the best treatment.
So, how did the hospital management support you in developing and expanding the stem cell transplantation services at the American hospital?
They helped a lot, firstly, by setting up the aim and the vision, which gives us a strategic plan and targets. The management consulted me on project planning, especially about the facilities required. So we have set up a separate bone marrow transplant unit and cellular therapies centre. We are expanding from two rooms to four rooms. Then, as we expand further, the plan is to expand the bone marrow transplant department, maybe to cover a separate floor. Also, when I approach the management about staffing, they are very supportive, because we need to have a well-trained team that works well together.
If you have a weak link, then the whole chain is actually destroyed. So that’s where it’s very important to select the right members of staff with the right expertise and also the right training. And we have communicated this with the management team, and they’re very supportive of setting up training programmes.
How would you say the patient population is different here in the UAE, compared to the UK or Europe, for example?
So I can give you a very simple example: in the UK, I’ve done a transplant for a 75-year-old. Here, I’ve probably seen two patients in total with some haematological problems who are above the age of 75, not for transplants. So the population in Dubai is a very young population, the majority are less than the age of 60. In younger patients, we don’t see many comorbidities, and this reduces some of the risks that are associated with the transplant, which is excellent.
On the other hand, you have a very diverse ethnic population, and for allogeneic transplants, you need to have a donor. So, a fully matched donor would be the ideal scenario to reduce the risk of complications. Initially, we look into the family and especially the siblings, as each sibling has a 25% chance of being a full match. Then, if we don’t find any sibling matches, there are two options.
We look into the international registry of bone marrow donors, which, at the moment, has about 35 million donors worldwide. The issue is that the Asian representation within this bone marrow transplant donor registry is quite low. So there are discussions about setting up regional bone marrow transplant registries, but also it’s about educating the public that being a stem cell donor is something that is very simple. It doesn’t involve any surgery.
Building a Global Centre of Excellence in Dubai
About five weeks ago, we did the first unrelated adult donor transplant in the UAE. By registering more donors from diverse backgrounds and leveraging Dubai’s young population with fewer comorbidities, we are actively establishing a centre of excellence—an international reference centre. We recently registered with the European Bone Marrow Transplant Organisation (EBMT) and are now actively pursuing accreditation from FACT, the American organisation for stem cell transplantation.
The stem cells from a donor located in Germany were imported to Dubai for an Egyptian lady with acute leukemia who was living and working in Dubai. The patient was discharged and is doing well. Of course, there’s a long way to go, but so far, she’s done amazingly well. She was diagnosed with acute leukaemia four months after she delivered her first baby, after a routine blood test. So you can imagine how stressful it would have been for her. Thirty years ago, it would have been a completely different story, but now the chance of being cured is about 60 to 70%.
By registering more donors from diverse backgrounds and leveraging Dubai’s young population with fewer comorbidities, we are actively establishing a centre of excellence—an international reference centre. We recently registered with the European Bone Marrow Transplant Organisation (EBMT) and are now actively pursuing accreditation from FACT, the American organisation for stem cell transplantation. This is the highest accreditation you can have, and we hope to achieve this by July or August this year.
Do you see many patients who travel to Dubai from other countries for treatment?
Yes. We have patients who mainly come from Asian countries such as India or Pakistan. We also have many patients coming from African countries. Apart from South Africa, access to stem cell transplant centres and fully comprehensive cancer care is very limited on the continent. So that’s why we have the patients coming here. American Hospital Dubai has an international reputation for quality, with strict criteria, expert clinicians and nurses who have worked in top centres across the world, and quality management. We are constantly looking at the data to make improvements. Plus, the fact that we have a collaboration with the Mayo Clinic in the USA, which is one of the top three healthcare brands in the world, especially for cancer care. We have the opportunity to consult with experts at the Mayo Clinic for difficult cases. There are also plans for more collaboration in the future, even in education.
So, since working at the American Hospital in Dubai, have you been able to get involved with teaching and research?
That’s a very good question. When I was in Cyprus, I was the head of the medical school, so I’m really passionate about teaching. In Dubai, we have students from local medical schools who come to the American Hospital, and it is a great learning environment with all the departments and a wide range of complex services. We do teach the resident doctors as well, from different specialities, and I think that has a positive impact on looking after the patients. Teaching is an important part of our work, training and mentoring the doctors of the future. Education, I think, is the foundation of becoming a good doctor.
Research, Clinical Trials, and Medical Education in Dubai
Regarding research, we recently started clinical trials in our department. Currently, we have sent two papers to the European Haematology Association and are in the process of submitting a couple of papers to journals for publication. We are aspiring to have more phase three clinical trials in the American Hospital. From the healthcare economics perspective, it is also beneficial for patients. Cancer medications are quite expensive, and not all patients have the top insurance.
Clinical trials are not like being a guinea pig. In most cases, we compare the current medication or standard of care with a new one that researchers have already tested in phase one and phase two trials, so we know it is safe. So we are comparing which of the two is better to decide whether the standard of care will remain the same or change. There is scope to develop more phase 3 clinical trials in the UAE with the right framework and infrastructure, and support from pharmaceutical companies. There are very strict criteria that you have to fulfil for clinical trials, which is right. You need to have staff experienced in research, including the trials unit manager, the data manager, and people to write up the research correctly.
And how was your experience working with Allocation Assist?
The experience has been great from the beginning. From our first meeting to proceeding with the right hospital, matching my skills and experience. If you have transplant experience, there’s no point going to a hospital without the right infrastructure, where you can just give mild forms of chemotherapy and not more complex treatments.
I think that’s where Allocation Assist has done a great job, because rather than placing you anywhere, they match you with the right hospital for your skill set. Then, you helped with information about relocation and the different areas in Dubai, such as the economic breakdown about the rents, about the pros and cons of different places in Dubai where you can live. So, you know, even this has made my life very easy to adapt to the environment. Plus, the fact that Dubai has amazing services, in order to have a great quality of life. Relocating to work in Dubai was one of the best decisions I have made. I am so happy to be here. Thank you for making it possible.
Thank you, Dr Emmanouil, we are so happy you are here.
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