Mentorship in hematology: A multigenerational perspective on its role in shaping the future of the field

Abstract

Mentorship is often described as the transfer of knowledge from one generation to the next. Our experience suggests that it is much more than that. As three individuals connected across three generations by a shared passion for advancing the care of patients with thalassemia, we have found mentorship to be a relationship built on trust, honesty, and shared purpose. It has shaped not only our scientific careers but also how we contribute to improving patient care, collaborate with colleagues, and think about our responsibilities in the scientific community as physicians and researchers. In this perspective, we reflect on our own mentorship journey in thalassemia and why we believe these relationships have been as important to advancing the field as scientific discovery itself.

Maria Domenica Cappellini, mentored by the late Professor Gemino Fiorelli and the late Professor Sir David Weatherall, represents the generation that laid the scientific foundations of modern thalassemia care. Ali Taher, mentored by Professor Victor Hoffbrand and Professor Cappellini, advanced that work by further characterizing different aspects of the disease, bridging research between the Middle East and global networks, and establishing regional scientific societies to foster local expertise and international collaboration. Rayan Bou-Fakhredin, the third generation of this mentorship lineage, began his clinical research journey in thalassemia with Ali Taher in Lebanon, who then introduced him to Maria Domenica Cappellini. He subsequently moved to Milan to pursue his PhD within Maria Domenica Cappellini's group, continuing his work in clinical and translational science in thalassemia. With the support and encouragement of both his mentors, who helped open doors to new opportunities and international collaborations, he was able to undertake part of his PhD training in the United States, gaining exposure to different research environments and broadening his scientific perspective. After completing his PhD, Rayan chose to take his experience beyond academia and pursue a career in industry, bringing his scientific expertise in hemoglobinopathies into a broader strategic context.

Looking back, what connects our three careers is not that we followed the same path, but that each mentor encouraged the next generation to find their own. Each one of us ultimately grew in a different direction while remaining connected by the same values and commitment to improving care for patients with thalassemia. For Ali Taher, mentorship became real through everyday interactions rather than formal teaching. When he invited Professor Cappellini to Lebanon after first meeting her at the 2005 EHA Congress, he could not have anticipated that the visit would become the beginning of a collaboration and friendship that has now lasted more than two decades.¹ Their close scientific collaboration began with influential studies such as OPTIMAL CARE, which helped shape the understanding of non-transfusion-dependent thalassemia and its morbidity profile, with important implications for the management of these patients worldwide. This scientific partnership has continued to evolve, with both now leading clinical trials of novel therapies targeting different aspects of thalassemia pathophysiology, including correcting the α/β-globin chain imbalance, targeting ineffective erythropoiesis, and improving iron overload. For Rayan Bou-Fakhredin, mentorship by Ali Taher and Maria Domenica Cappellini meant being trusted with responsibility and being encouraged and challenged to write and develop abstracts, present at international meetings, and lead and co-author manuscripts and book chapters early in his career, while pursuing his master's and PhD degrees through research focused on thalassemia. It also meant being supported when he chose a non-traditional path: when he decided to transition from academic research to the pharmaceutical industry, his mentors viewed this not as a departure from science and medicine, but as an extension of the field's reach.

Although our experiences differed across generations and career stages, the mentors who shaped us shared a common approach. They challenged us when we needed to improve, encouraged us when we doubted ourselves, introduced us to collaborators and opportunities we would not otherwise have found on our own, and always provided constructive feedback that fostered personal and professional growth. Over time, we came to realize that these qualities are not innate. They can be learned, developed, and strengthened. Structured programs today, such as those established by the American Society of Hematology and the European Hematology Association, have also helped cultivate these skills.^{2, 3}

We also learned that effective mentorship extends beyond research, academic training, and career planning. During difficult periods, whether dealing with self-doubt, burnout, or uncertainty about the future, our mentors were often the people who reminded us why we chose this career path in the first place. One experience from our own journey stands out. Early in his research career, Rayan Bou-Fakhredin questioned whether his contributions to thalassemia research studies were enough to justify authorship. Rather than simply reassuring him, his mentors took the time to explain why his work deserved to be recognized and why his contribution mattered, while also discussing the systemic pressures that can lead early-career scientists to undervalue their own contributions. That conversation did not make imposter syndrome disappear, but it made clear something important: a mentor's role is not only to provide professional guidance but also to support the person behind the professional achievements.

The challenge of mentorship is amplified in low- and middle-income countries (LMICs), where hematology services are often sparse, mentors are few, and structural barriers, ranging from funding scarcity to institutional isolation, can constrain the formation of mentoring relationships. A 2024 global qualitative evidence synthesis commissioned by WHO/TDR identified critical gaps in research mentorship capacity in LMIC institutions, noting that trainees in these settings often face a scarcity of senior mentors, limited institutional support, and far fewer opportunities for mentor training compared with their counterparts in high-income countries.⁴

These structural limitations have been shown to have measurable consequences for both research output and global scientific visibility. Despite the high burden of hemoglobinopathies in LMICs, research originating from these regions remains underrepresented in high-impact hematology journals.⁵ Many factors contribute to these disparities, but mentorship is one area where change is possible. Senior investigators who choose to collaborate, share opportunities, and invest time in colleagues from LMICs can have an impact that extends well beyond a single publication or project.

Our experience across Italy and Lebanon, reflecting the clinical realities of thalassemia across the Mediterranean and Middle East and North Africa (MENA), illustrates how cross-border mentorship can develop and thrive. Maria Domenica Cappellini's presence and engagement within the MENA region were particularly important in creating opportunities for collaboration, education, and exchange, and in strengthening connections among colleagues and young hematologists. Together, she and Ali Taher helped connect the MENA region with the broader international thalassemia community. This was put into practice through educational programs in thalassemia, including preceptorships, workshops, and hospital visits, which provided opportunities to engage directly with young hematologists from across the region and share clinical experience and expertise. The collaboration also extended to initiatives focused on the patient voice, supporting campaigns that brought the experiences and perspectives of thalassemia patients to the forefront. It also supported thalassemia advocacy and prevention programs, which broadened the impact of these efforts beyond clinical education and research. At the same time, global guidelines for the management of thalassemia were adapted to reflect the specific needs, resources, and clinical realities of different settings in the MENA region, helping to make recommendations more relevant and applicable in local practice.

The greatest mentors aspire to be surpassed. This is not the failure of a legacy but its fulfillment. The cycle through which mentees become mentors is one of the ways scientific fields continue to grow and evolve. In the case of thalassemia, this process has contributed to transformative advances, from the first molecular characterization of thalassemia to the current era of gene therapy and novel therapeutic agents. Many of these advances were made possible through mentorship relationships in which experienced investigators recognized and supported the curiosity and potential of younger colleagues.

Our own mentorship journey reflects this tradition within the thalassemia community. The foundational molecular characterization of thalassemia as a disorder of globin synthesis by Sir David Weatherall and John Clegg in the 1960s and 1970s emerged from a tradition of scientific mentorship in which questions were transmitted alongside methods. That tradition directly shaped the next generation of investigators, including those represented among the authors of this paper. Professor Cappellini's own training under Professor Fiorelli and Professor Weatherall—both scientists known for their intellectual rigor and willingness to support younger colleagues—formed the values that she in turn conveyed: a commitment to asking clinically meaningful questions, an insistence on honesty and integrity, and a conviction that science in rare diseases must be driven by the patient experience, not by publication metrics. When she encouraged Professor Ali Taher to pursue his independent research program in the Middle East rather than simply continuing collaborative studies from Italy, she was not diminishing the relationship; she was strengthening its impact by enabling independence and scientific growth. The subsequent growth of scientific contributions to thalassemia research from Lebanon and across the MENA region is visible today in publications, society leadership, and clinical practice guidelines, reflecting, in part, the importance of fostering independent scientific expertise in the region.

What stayed with us most was not simply the knowledge our mentors shared, but the values they embodied, including intellectual honesty, the willingness to admit uncertainty, the courage to challenge and pursue questions, and the commitment to science that serves patients rather than metrics. These are not taught in courses. They are learned through example, in laboratories and clinics and conference halls, by people who understand that their most lasting contribution to the field is not any single paper but the careers they helped to build.

When we look back across our three generations, the publications and scientific advances are only part of the story. The relationships and collaborations behind them have mattered just as much. Every opportunity that shaped our careers began because someone invested time, trust, and encouragement in another person. That experience has convinced us that mentorship deserves far greater attention within hematology. It cannot be left to chance or to individual personalities. Like research and education, it should be recognized as a responsibility shared by institutions, societies, and individuals.

As physician-scientists and researchers in hematology, our role extends beyond advancing knowledge or treating disease; it includes mentoring and nurturing the next generation, who will one day redefine how disease is understood, studied, and ultimately cured. In doing so, we ensure that progress in hematology is not only scientific but also profoundly human. These reflections represent the legacy we hope to leave and the principles we hope will inspire future generations of physician-scientists and researchers in hematology, regardless of their career paths.

Rayan Bou-Fakhredin: Writing—original draft; writing—review and editing; conceptualization. Maria Domenica Cappellini: Writing—original draft; writing—review and editing; conceptualization. Ali Taher: Writing—original draft; writing—review and editing; conceptualization.

A.T. reports receiving consultancy fees and research funding from Roche, Agios Pharmaceuticals, Novo Nordisk, Bristol Myers Squibb, and Pharmacosmos. M.D.C. is a member of the advisory boards of Agios Pharmaceuticals, Bristol Myers Squibb, Sanofi-Genzyme, and Vertex. R.B.-F. declares no relevant financial relationships or conflicts of interest.

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Data sharing is not applicable to this article as no datasets were generated or analyzed in this work.