Hutch News

Groundbreaker from Brazil

Populous country honors pioneer who brought bone-marrow transplants back to her native land

Oct. 17, 2002
Dr. Mary Flowers

Dr. Mary Flowers examines a patient at the Seattle Cancer Care Alliance. The Brazilian-born physician started a bone-marrow transplantation program in her native country, whose oncologists honored her over the summer.

Photo by Bob Peterson

If imitation is the sincerest form of flattery, the country of Brazil has paid the center the highest possible compliment.

Thanks to efforts initiated 20 years ago by Dr. Mary Flowers of the Clinical Research Division, the most populous country in South America supports a national bone-marrow transplant center modeled after that of Fred Hutchinson.

A native of Brazil, Flowers received an award for her instrumental role in the process at the sixth Brazilian Congress of the Society of Bone Marrow Transplantation held over the summer in Rio de Janeiro.

In addition, the society named in her honor an annual award given to a scientist who has written the best paper at the meeting. Flowers presented the award to this year's recipient.

Trained as a transplant physician in the United States, including a fellowship at the center, Flowers returned to Brazil in the early 1980s with hopes of establishing a national transplant program.

"Brazil has socialized medicine, and any patient in need of a bone-marrow transplant could request coverage for this treatment," she said. "But at that time, there were no transplant centers in the country and patients were sent outside for treatment, mostly to the Hutch."

National program

Invited by the director of the National Cancer Institute of Brazil to set up a national marrow transplant program in Rio de Janeiro in the early 1980s, Flowers, who had just returned from her medical training in the United States, took on that task. Funds for the program were approved in 1982.

In 1983, Flowers visited the U.S. for a short fellowship at Fred Hutchinson, where she worked with Dr. E. Donnall Thomas, the Nobel-prize winning pioneer of bone-marrow transplantation.

Upon her return to Brazil, Flowers was committed to creating "a little Hutch" that would contain all of the support services found at Fred Hutchinson, including expanding HLA-tissue-typing, nutritional support and other laboratories that her husband, David Flowers, a research technician in the Clinical Research Division, helped her set up. She forged collaborations with basic research labs needed to create a comprehensive program within and outside the institute.

"For the cost of five transplants at the Hutch in the early 1980s, about $75,000 each, we were able to set up a complete transplant ward at the institute in Rio de Janeiro, including six rooms, two with a laminar air-flow system, a kitchen to process food for immunocompromised patients, and laboratories of immunology, cytogenetics and cryopreservation," she said.

Similar to the skepticism Thomas encountered in the early days of his transplantation work, Flowers said that initially she had difficulty attracting patients to her facility.

"We were ready, but no doctors would send their patients to us," she said.

Her first patient, transplanted in 1984, is still living and is the longest transplant survivor in Brazil for severe aplastic anemia. Flowers remained at the transplant center in Brazil until 1987, when she returned to Seattle for a sabbatical.

"Once I saw that the program could continue without me, my husband and I decided to leave Brazil and consider a permanent position in the United States," she said. "However, the only place I could ever consider working in the U.S. was at the Hutch."

Disease expertise

She joined the center as a faculty member in 1990, in the Long-Term Follow-Up program, where she gained expertise in chronic graft-versus-host disease and other late effects of transplantation.

Thanks to Flowers' efforts, dozens of medical centers in Brazil perform bone-marrow transplants today, and the country is considered a model for such cancer care in Latin America. Brazilian transplant researchers at several centers have established close ties with center researchers, with Brazilian physicians and scientists training at Fred Hutchinson and collaborative clinical trials conducted jointly, such as transplants in patients with Fanconi anemia.

A notable offshoot of Flowers' achievements has been a shift in the training of oncology nurses in Brazil. Following the Fred Hutchison model, in which nurses provide much of the care for transplant patients, Flowers helped to create a more significant role for nurses in the institute's transplant ward, an effort that has extended to nursing education in general in that country.

Flowers is deeply satisfied to have given something back to her native country.

"I feel fortunate for the opportunity I was given to help advance the treatment of cancer and hematological diseases in Brazil," she said, "but the credit for the success of bone-marrow transplantation in Brazil belongs to my Brazilian colleagues who continue to carry out the initial vision."

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