Kids like Rita: A doctor’s drive to save children from deadly blood cancers

Hutch News

Kids like Rita: A doctor’s drive to save children from deadly blood cancers

Pediatric transplant pioneer Dr. Jean Sanders reflects on a lifetime of dedicated focus, all for ‘her kids’

Dec. 23, 2015
Jean Sanders

Pediatric transplantation specialist Dr. Jean Sanders has quilted as a hobby for years. Here, she is in her Bellevue, Washington home in front of a quilt given to her by friends.

Photo by Robert Hood / Fred Hutch News Service

Dr. Jean Sanders grew up on a farm in Iowa in a family bereft of anyone like her — a researcher and doctor.

“They’re all farm people,” Sanders said.

But in 1960, when the now 71-year-old pediatric transplant specialist was 16, a family crisis jolted the rest of her life into a new direction.

Her cousin Rita — who was 6 years old and one of Sanders’ favorite people — developed leukemia and died.

The death of her beloved cousin was a blow, but even more difficult was seeing the little girl suffer through her symptoms with no relief. Platelet transfusions, which use special clot-forming structures from donor blood, didn’t exist yet, Sanders said, so when Rita got a nose bleed, she just bled and bled.

And there were so few options to actually treat her disease.

“There was [the steroid] prednisone and nitrogen mustard, which is a chemotherapy agent that isn’t used at all any more, and that was it. There was nothing else,” Sanders said.

“I decided that I would do something about it someday. So that’s exactly what I did.”

During her 37-year tenure at Fred Hutchinson Cancer Research Center, Sanders led the field of pediatric transplantation, pioneering cures for children with leukemias and lymphomas.

Sanders’ career, until her retirement in 2012, cycled through major lows and highs: from the very early days of transplantation, when the majority of her patients died of relapse or complications; to helping solve those problems and seeing “her kids” grow up and lead fulfilling lives themselves; to the loss of both her legs from vascular disease in 2008; and now, seeing the nearly 100 other transplantation doctors she’s trained succeed in their careers and cure many more sick children around the world — children like Rita.

Don and Dottie Thomas

Dr. E. Donnall Thomas hired Sanders to join his Fred Hutch transplant team in 1975. A signed photograph of Thomas and wife Dottie that hangs in Sanders' home office reads, "For Jean Sanders, A superb doctor and a wonderful friend."

Photo by Robert Hood / Fred Hutch News Service

A singular focus

Sanders stayed in her home state to attend both college, where she majored in biology, and medical school. In the early 1970s, after training in pediatrics, she ended up as a medical fellow working with pediatric cancer patients at Stanford University.

By that time, there’d been some progress in pediatric oncology since Rita’s death, she said, but not much. She visited Fred Hutch for a few months in 1975, its first official year of existence, after reading some of Dr. E. Donnall Thomas’ early papers on bone marrow transplantation.

“Transplantation was very new in 1975,” Sanders said. “Yet that’s exactly what I wanted to do. I didn’t want to push drugs all my life.”

She wanted to cure the kids.

Shortly after her return to Stanford following her three-month visit to Seattle, Thomas called to offer her a permanent job. At the time, his transplant team consisted of a handful of oncologists who specialized in adult patients. Yet, because transplantation was so new and so risky, Thomas and his team didn’t treat anyone over the age of 40 — older patients were not likely to withstand the grueling pretransplant treatments — and more than half their patients were under 18. He wanted a pediatrician in his group.

Sanders jumped at the chance, joining the Hutch just a few months after her training visit. “And I’ve been here ever since,” she said.

In those days, Sanders and everyone else on the team treated adults and children alike, said Dr. Rainer Storb, a Fred Hutch transplantation biologist and one of the first members of Thomas’ team.

“She was really a colleague. There was no separation in pediatrics and adults as there is now,” Storb said. It wasn’t until the early 1990s that pediatric and adult transplant clinics and treatment teams were truly separated, he said.

Sanders didn’t exactly have an easy task ahead of her when she joined the transplant team. In 1975, prior to her arrival, there were five men on Thomas’ team — none of them at all shy about their opinions, Storb said.

“It was a group of five people who were all very outspoken, and Jean came into this environment. It wasn’t necessarily all diplomatic language. It was fighting about what to do and so on,” Storb said. But Sanders more than held her own, he said.

“She was vocal, articulate and in those early years our discussions were not terribly civilized. They were actually quite interactive … [but] despite of all our past disagreements, we remain actually good professional friends,” Storb said.

Sanders wasn’t slowed down by being the only pediatrician — and only woman — on the team when she first joined the Hutch.

“I had to teach all these guys about taking care of kids. That was great fun,” she said.

Lows and highs

Sanders remembers the struggle of her early career, when — despite the curative potential of bone marrow transplants — patients were dying all around her and the rest of the team. Many patients would die of severe infections, relapse, or bad graft-vs.-host disease. In transplantation’s early days, there were few treatments for many of these complications.

There is one patient that still haunts Sanders today. A woman in her early 20s had just had a baby and developed aplastic anemia during her pregnancy, a rare complication of pregnancy in which the bone marrow no longer produces enough blood cells. The woman received a transplant with marrow donated by her brother, but then developed a serious fungal infection and died.

In those days, there was nothing Sanders could do to help the young mother or many other patients like her.

“Here they have this brand new baby,” Sanders said. “It was an awful situation. I thought … I just can’t do this.”

What kept the doctor going? The potential she saw for those few patients who could avoid such deadly complications, patients who would almost surely die of their disease without the transplant.

“I knew, for the patients that we could get through, that their chance was being able to be cured,” she said.

Thomas, Sanders and the rest of the team published a revolutionary paper in 1977 on the first 100 patients who’d received transplants under their care — 13 of those patients survived free of disease.

“Those survivors really made everything worthwhile,” Sanders remembered. “They came back to see us, so grateful to be alive and being able to pick up their lives and live.”

In the following decades, the Hutch team and their colleagues in the field made advance after advance to boost that survival rate — from powerful microbicides that prevent or treat many deadly infections to improved pain control to better matches between donor and patient. And Sanders started to see more and more of her pediatric patients, whom she always refers to as “my kids,” picking up their lives and living.

Once it was clear that the transplant doctors could truly cure many of their patients, Sanders began focusing on what happened after, when her kids went back home to the rest of their lives.

“I thought to myself, 'OK, we’ve got a 5-year-old that’s going to live a long time, I hope,'” she said. What would happen to that child; how would their arduous and potentially toxic treatments play out in the following years and decades?

Sanders started tracking all facets of her patients’ growth and development — her office walls were covered with growth charts, she said — and launched the field of long-term survivorship research for childhood transplant recipients. Thanks to Sanders, the Hutch now houses a long-term follow-up database of the more than 2,000 childhood patients she helped treat during her career. Her work led to advances in overcoming some of transplantation’s long-term side effects, such as using growth hormone therapy to combat growth defects due to the treatment.

She also inspired and helped establish Hutch School, a fully accredited K-12 school program for school-aged patients and family members of patients receiving treatment at Seattle Cancer Care Alliance. Most of her patients and the family members of transplant patients couldn’t attend regular schools, Sanders said — they’d be exposed to too many infections, dangerous to themselves or to their family member undergoing treatment.

“These kids needed to be in school,” Sanders said. “A camaraderie developed between these kids that all had one thing in common and that was they had a sibling or a parent that was going through a transplant. So they had somebody they could talk to.”

Although she quickly learned not to get too emotionally invested in her patients’ stories — she never would have been able to keep working with so many sick or dying children, she said — Sanders stayed very involved with many. Professionally, she tracked their growth and health throughout their lives. Personally, she’s stayed in touch with many of her former patients for the past four decades, and names their successes as one of the best parts of her career.

“The high points for me are seeing my 10-year-old kids graduate from law school or medical school or [otherwise] become successful adults, and to know that I did something to help them along their way from an otherwise fatal disease,” she said.

'Tough but not mean'

When colleagues and friends talk about Sanders, one word always seems to spill out: Tough.

“Her reputation was that she was very tough,” said Dr. Ann Woolfrey, one of Sanders’ trainees in the early 1990s and now a Fred Hutch transplantation researcher. “All of her corrections of people were based on her focus that the patient had to have the best possible care. It was to make sure that we were doing the right thing. She was tough but not in a mean way, in a way that was to help you learn and become the best doctor that you could be.”

Sanders agrees with that assessment. “I’m a perfectionist. I expect those that I’m working with to also strive to be a perfectionist and to pay attention to all of the details,” she said. “I don’t view myself as a mean person. But yeah, I expect people that I work with to uphold the same kinds of high standards I uphold myself to.”

Her son, now a computer programmer with two children of his own, once asked Sanders if she minded if he didn’t grow up to be a doctor.

“I said, ‘I don’t care what you do, whatever you do, do it well.’ That’s all that matters,” she said.

Woolfrey laughingly recounted one of her strongest memories of Sanders, when the doctor would teach her trainees to harvest bone marrow from donors for transplantation. Sanders was so fast and precise, Woolfrey said, that even as she was explaining every step of the process, “you just couldn’t keep up with her.” And then Sanders would grab a sterile marker and start drawing diagrams and numbers on the drapes to help explain, while still continuing the procedure, “and you still couldn’t keep up!” Woolfrey said.

Sanders’ grit helped not only her trainees become the best they could be, but her patients as well.

“She always had your back,” Woolfrey said. “She did that for her patients too … She loved her patients and her patients loved her.”

Jennifer Aspelund first met Sanders in 1996, shortly after her son, North Aspelund, Jr., had received a bone marrow transplant for his leukemia at 8 years old. North Jr. is now 28, two decades post-transplant, and has had many complications from his disease and the transplant, including chronic graft-vs.-host disease and two secondary cancers.

Sanders has been with the family every step of the way and helped solve many of North Jr.’s health problems, Aspelund said, even after her retirement.

“Jean is amazing … she’s my lifeline,” Aspelund said. “She’d always say, ‘We’re going to fix this.’”

Aspelund and Sanders are now good friends, but the mother of two remembers her first impression of the doctor as “a stern attending,” she said. She quickly came to appreciate that part of Sanders’ personality, though.

When the family had an appointment with Sanders, Aspelund remembers the doctor admonishing her son to look at her when she was talking. “She didn’t mean it in a mean way, she meant, ‘Look at me, I’m going to help you.’ … She’d go, ‘I’m not going to just talk to your mom and dad, I’m going to talk to you, look at me when I talk to you,’” Aspelund said.

“In a way, with her sternness, she taught us to advocate for North,” she said. “Which was huge.”

Sanders and Sugar

Sanders at home with her dog, Sugar.

Photo by Robert Hood / Fred Hutch News Service

'So what if I can’t walk down the hall?'

Starting in her teenage years, Sanders barely slowed down in her pursuit of a career saving children from cancer. But in 2008, she had to hit pause on her work life — she’d developed peripheral vascular disease, a circulation disorder, and in February of that year she had to have both her legs amputated.

Sanders spent two months in the hospital and one month at home recovering, which started to drag, she said.

“Doctors do not make good patients, but I tried to be patient,” she joked.

Seven years later, she still sometimes mourns the loss of her legs — and the loss of the fashion they afforded her. Sanders had very narrow feet, she said, and filled her closet with stylish Salvatore Ferragamo shoes, the only fashionable shoes that fit her well.

“That’s the saddest thing about losing my legs, because I loved my shoes,” she said, gesturing at her prosthetic limbs. “They don’t make pretend feet narrow enough for me to be able to wear them.”

Coming to terms with spending the rest of her career and life in a wheelchair wasn’t simple, Sanders said, but ultimately she gave herself a pep talk — and got back to work.

“The challenge was mental more than anything else,” Sanders said. “I just decided, ‘Screw it, my brain’s intact, there’s nothing the matter with it, so what if I can’t walk down the hall?’ And that’s how I dealt with it.”

Her colleagues all marveled at Sanders’ strength after her surgery, Woolfrey said.

“She went through this life-threatening illness, lost physical parts of her body, and yet came back to work, picked up virtually the same workload that she had left — and never complained, ever,” she said. “It’s a testament to what Jean is.”

This strength has carried her into retirement. Since stepping away from research and clinical care three years ago, Sanders has stayed very involved with the Hutch and other clinical and charitable organizations. She’s a member of several Hutch clinical research committees, edits a transplantation society's monthly newsletter and travels around the country as a consultant for the Foundation for the Accreditation of Cellular Therapy, an organization that maintains quality control for transplant centers. And she’s also parlayed a longtime hobby, quilting, into doing good for children in need. Sanders has made 50 quilts to date for the Moyer Foundation’s Camp Mariposa, a free weekend camp for children affected by family substance abuse.

“There’s no stopping her,” Aspelund said.

Are you one of the many people Dr. Jean Sanders has worked with or cared for? Tell us about it on Facebook.

Rachel Tompa is a staff writer at Fred Hutchinson Cancer Research Center. She joined Fred Hutch in 2009 as an editor working with infectious disease researchers and has since written about topics ranging from nanotechnology to global health. She has a Ph.D. in molecular biology from the University of California, San Francisco and a certificate in science writing from the University of California, Santa Cruz. Reach her at rtompa@fredhutch.org

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