Long-Term Follow-Up

Mary Flowers, MD

Dedication to patients long after transplantation makes a difference

Mary Flowers, M.D.

Dr. Mary Flowers leads a team at Fred Hutchinson and the Seattle Cancer Care Alliance (SCCA) that continues to care for adult patients long after they leave the hospital.

Dr. Flowers is the director of the Adult Clinical Care Long-Term Follow-Up Program (LTFU), which supports approximately 3,500 bone-marrow and stem-cell transplant survivors, helping patients and their primary physicians to manage post-transplant complications as they recover and resume their lives.

Dr. Flowers delights in seeing patients as they return for checkups and visits — some of them 20 years or more after their transplants. "I'm thrilled at seeing these people, knowing that they wouldn't be here without a transplant," said Dr. Flowers. "Going through a transplant changes a person's perspective about life in a profound way, and that's an inspiring thing to see. Patients and families are very grateful for life and the care they receive here."

As the Clinical LTFU director, Dr. Flowers divides her time between patient care, clinical research and administration. Recently, the center's Clinical Research Division presented Dr. Flowers with the annual Dr. Ali Al-Johani award for excellence in clinical care. "This award is very special to me because it came from Fred Hutchinson, an institution I am so proud to be part of," said Dr. Flowers.

Originally from Brazil, Dr. Flowers first came to the center in 1983 for a short fellowship, where she worked with Dr. E. Donnall Thomas, the Nobel Prize-winning pioneer of bone-marrow transplantation. Afterward, she returned to Brazil to develop a bone-marrow transplant program in Rio de Janeiro.

Dr. Flowers came back to Fred Hutchinson in 1987 after her husband, an American biochemist she met during a previous fellowship at the University of Colorado, expressed a desire to return to the U.S. "The only way I would leave Brazil was to come to the best center in bone-marrow transplantation — Fred Hutchinson," she said.

Dr. Flowers became LTFU Clinical Service Director in 2000. "It has been gratifying to see the growth of the clinical services of the Long-Term Follow-Up program," she said, noting the number of patient visits has risen during the last 10 years from 250 to over 600 visits per year. The Clinical LTFU program also provides free telephone consultations to patients and their primary physicians. "The phone never stops ringing," said Dr. Flowers.

The focus of Dr. Flowers' clinical-research is the management of chronic graft-vs.-host-disease (GVHD), a post-transplant complication caused by donor cells that attack the recipient's tissues, and the management of recurrent malignancy after transplant with donor lymphocytes infusions (DLI).

Prednisone is the primary treatment of chronic GVHD, but this medication has many side effects, including weight gain, hypertension, diabetes, osteoporosis, insomnia, and depression, among others. She is involved in several clinical trials for chronic GVHD, including treatment with extra-corporeal photophoresis (ECP). This clinical trial is assessing if ECP is effective in controlling chronic GVHD and if it will decrease the need for prednisone in patients with refractory chronic GVHD.

The ECP procedure involves collecting the patient's donor-derived white blood cells and treating the cells with the drug UVADEX and exposing them to ultra-violet light. The treated cells are then returned to the patient. "Although it is not entirely clear how ECP works in controlling chronic GVHD, this therapy affects circulating donor-derived white cells making them incapable of attacking the patient's tissues," explained Dr. Flowers.

As fascinating as Dr. Flowers finds clinical research, she said the most satisfying part of her job is "seeing the gratitude of our patients for the care they received here, and working with Dr. Paul Martin (Director of LTFU Research) and the LTFU Program staff whose commitment and dedication are so inspiring."