The spirit of a pioneer

Long-Term Follow-Up

The spirit of a pioneer

Dr. E. Donnall Thomas built his career fighting an unrelenting killer. As he turns 90, we revisit his legacy and ponder the future of cancer care.

Spring 2010

To understand how monumentally far Dr. E. Donnall Thomas and his colleagues had to travel to reach a time in which tens of thousands of patients worldwide receive bone marrow transplants each year, context is everything.

Consider that when Thomas was a medical student more than 60 years ago, most doctors believed it was impossible-or, at worst, unethical-to try to extract one person's bone marrow, the spongy tissue inside larger bones that makes our all-important blood cells, and deliver it safely to someone else. Our bodies, after all, are naturally inclined to reject such foreign matter.

Consider that a general pessimism was swelling as some in the medical community endeavored, nevertheless, to make such a procedure work. Leukemia unquestionably represented a death sentence, and the disappointing outcomes of early transplant efforts weren't building confidence about rosier prospects. By the 1960s, most researchers in the field were abandoning their inquiries altogether-but not Thomas.

Finally, consider that just as Thomas and his tenacious colleagues were overcoming some of their medical hurdles, a completely unrelated obstacle blindsided them. In 1972, President Richard Nixon threatened to close public hospitals across the United States-including the U.S. Public Health Services Hospital in Seattle where Thomas and his team tended up to eight patients at a time. They scrambled to relocate their sick patients to a new space without further weakening them, managing to find a temporary home before moving to the newly constructed Fred Hutchinson Cancer Research Center.

As Thomas recalled in the autobiographical introduction to his 1990 Nobel Prize lecture, "We did face problems that at times seemed almost insurmountable."

A pioneering spirit

It seems fitting that the father of bone marrow transplantation, as Thomas has come to be known, was born to a pioneer.

As a youngster in 1874, his father, Edward Thomas moved with his family in a covered wagon to a village in frontier Texas, where Don was born on March 15, 1920. His father practiced medicine there, sometimes bringing along his son on "horse and buggy house calls," as Thomas put it.

He ultimately pursued medical training of his own, but not before he met and married Dorothy "Dottie" Martin, who would work in critical roles by his side throughout his research career. Longtime colleagues have quipped that if Thomas is the father of bone marrow transplantation, then Dottie is certainly its mother. Intrigued by the science of bone marrow and leukemia during his years at Harvard Medical School, Thomas began in 1955 to work on marrow transplantation with Dr. Joseph Ferrebee at Mary Imogene Bassett Hospital in Cooperstown, N.Y. They quickly discovered, however, that transplanting bone marrow from a human donor to an unrelated patient would be difficult to achieve.

Sometimes transplants outright failed, as the stem cells failed to grow into new, healthy blood cells. At other times, transplants took hold as desired, but the recipients contracted graft-vs.-host disease, which occurs when the transplanted cells attack the patients' tissues, causing life-threatening complications in some cases.

But Thomas wasn't about to give up. When he and his family moved to Seattle in 1963, where he had accepted an invitation to lead the young University of Washington Medical School's oncology division, Thomas assembled a brilliant team that carried on with careful research.

The few marrow recipients that became longer-term survivors offered glimmers of hope to Thomas and his team. But a daunting challenge remained: figuring out what caused these successes or failures.

Long-term survival

Things took a somewhat more encouraging turn around the time that Thomas and his team secured a permanent, world-class treatment home at the Hutchinson Center in 1975. Two years later, they were able to report that a mixture of chemotherapy, radiation and a bone marrow transplant from a related donor had led to long-term survival for 13 patients suffering from advanced leukemia. Although overall survival rates were still relatively dismal, it was gradually becoming possible to speak of a "cure."

In 1979, the team completed the first successful transplant to treat a patient with leukemia using marrow from an unrelated donor-a milestone because only about one-fourth to one-third of patients who need a transplant have a sibling whose tissue matches closely enough. That patient's experience sparked the founding of the National Marrow Donor Program, a now-sophisticated system that works to match patients in need with millions of unrelated potential donors. The modern era of bone marrow transplantation had officially launched.

Since then, "progress has been slow and steady," Thomas said in his Nobel lecture. Members of Thomas' original transplant team and others who later trained with him, including Drs. Rainer Storb, John Hansen and Fred Appelbaum, have continued to make major contributions that have transformed bone marrow transplantation from a radical experiment to a standard treatment method for different types of diseases and patients.

Perhaps equally important, the scientific discoveries behind transplantation have also given rise to immunotherapy, an evolving treatment method that harnesses the body's natural disease-fighting abilities to fight cancer and other diseases with fewer side effects than treatments that rely on chemotherapy and radiation.

Throughout his journey, patients have always been paramount in Thomas' mind, whether he was delivering radiation treatments in a dark military bunker-his team's makeshift research site-during the early research days, or flying to Stockholm two decades ago to accept his Nobel Prize as a seasoned investigator.

As he wrote in an essay reflecting upon the history of marrow transplantation, his team found inspiration in "those courageous patients who were willing to take some risks to try for a new approach when all of the conventional therapy only offered short-term benefits."

Dr. E. Donnall Thomas has been retired for a few years now, but his thirst for knowledge is as voracious as ever. Ask any of his colleagues, and you'll get a sense that Thomas remains engaged in the ongoing work at the Hutchinson Center. And now, he has reached a new milestone. On March 15, 2010, Thomas celebrated his 90th birthday.

Dr. E. Donnall Thomas, recognized as the father of bone marrow transplantation, died on Saturday, October 20, 2012, at the age of 92. Learn more about his life and work and share your remembrances .