Brightly colored decorations cover the chest of Col. Don Kasperik’s Army service uniform, attesting to the many honors he received during his nearly three decades as commander of military clinics and hospitals.
Kasperik, now retired, looks back on his years of service, proud of the example he set for his staff by rising before dawn to attend early-morning rounds. He was proud to serve in the same division in which his father had fought the Battle of the Bulge during World War II. He was proud to work as a command surgeon alongside four-star generals at U.S. Central Command to ensure that troops overseas had the best possible medical care.
Yet 36 years ago, Kasperik thought the lifetime he planned to commit to his country was going to be cut short.
In 1979, the 29-year-old doctor was looking ahead to his discharge after two years of required service through the ROTC program. At that time, Kasperik was a captain and the head of a military clinic in Pennsylvania. After discharge, he planned to finish his medical residency in family medicine as a civilian and then come back to the Army.
Then a lab tech at his clinic came to his office, crying. She held the results of Kasperik’s blood test — conducted as part of the physical exam for his military discharge.
“Sir,” she said, as Kasperik recalls, “I’m sorry to say that your white blood count was 106,000” — at least 17 times higher than it should have been. “I think you have leukemia.”
Kasperik’s plans for discharge came to a halt, as did his plans for the rest of his life.
“They told me I had three years to live,” said Kasperik, 65, recalling his diagnosis of chronic myeloid leukemia. “Which is frightening by itself for a young guy with a young family, two young kids.”
Kasperik was transferred to Walter Reed Army Medical Center to receive what care existed at the time. But he wasn’t satisfied with the prognosis he’d been given, and so he dug into the medical literature. There, he found hope: A place in Seattle called Fred Hutchinson Cancer Research Center was carrying out bone marrow transplants for chronic myeloid leukemia, using stem cells from patients’ identical twins.
And, as it turned out, Kasperik happened to have an identical twin.
Nick Kasperik remembers when Don asked if he would be his marrow donor.
“He’s my brother. It was instilled from our family that we support family. There was no hesitation at all,” Nick said.
The brothers grew up together in western Pennsylvania, competing fiercely, but good-naturedly, against each other in sports. They tolerated nicknames and the extra attention one gets for being an identical twin. But they never suspected how important their twinship would become.
“I felt blessed that I had a twin brother to maybe help me survive,” said Don. “And I did.”
The Army approved Don’s plan for a transplant and transferred him to Madigan Army Medical Center in Washington so he could receive the transplant at Fred Hutch. Don’s wife, Patricia, and the couple’s then-2-year-old son, Kristopher, joined the brothers in Seattle.
Don describes his 1979 transplant experience as “gruesome.” He had prepared for the procedure by getting into top physical shape during the four months he had between diagnosis and transplant. But still, the terrible nausea he experienced during pre-transplant radiation and chemotherapy was hard to endure, he said.
He remembers the comfort and strength he received from his faith, his family by his side, and the nurses. His doctors, the late Dr. Alex Fefer, a cancer immunology pioneer, and Dr. Fred Appelbaum, now the Hutch’s deputy director and executive vice president, sat with him every day when they were on their rounds to give him encouragement.
He made it through. Four months after the transplant, he was working as a physician again.
Being an identical twin saved Don’s life, but the Kasperik brothers and other identical twins also contributed to advances that have saved many people’s lives, Appelbaum said.
During the 1950s and ‘60s, the overwhelming failure of bone marrow transplants to date had caused most in the cancer field to give up that scientific pursuit. But the tantalizing hints of success from transplants between a few identical twins — those who shared a common tissue type, although that wasn’t known at the time — kept the transplant pioneers at Fred Hutch working in the lab to, ultimately, figure out how to make the procedure work. Because of their research, more than 1 million transplants have been performed to date.
In the 1970s, Don and 21 other CML patients with identical-twin bone marrow donors were part of a clinical trial, the results of which were published in 1981, testing whether transplants could successfully treat CML before it reached its terminal stage. In fact, Don was part of the group that had received one of the early-stage transplants, which the trial showed to provide better outcomes.
“The only patients we would transplant back in the early days were those with end-stage leukemia. You didn’t want to do it in someone who had early-stage leukemia because it was very, very risky. You would only do it if it was a last-ditch effort,” Appelbaum said. “But with identical twins, that wasn’t the case. It was much safer. So it was [by] using identical twins that we moved transplantation earlier in the course of disease.”
Don’s 1979 transplant cured him, but the shadow of leukemia has followed him for the rest of his life. In 1989, he relapsed and faced the tough decision of whether to go through once more with a difficult transplant. He decided he was willing, as long as his twin was. (He was.)
In 2001, he relapsed once more and went on a newly discovered oral therapy, Gleevec, to suppress his cancer. He’s been in remission ever since.
“The discipline that I learned in the military and the strength I gained to handle adversity in the military helped me deal with the leukemia — and for me to have the relapses that I’ve had, and then to deal with it,” Don said.
Despite his cancer, Don continued his career in the Army, just as he had planned as a young man. He rose in rank until he was promoted to colonel in 1994 and became commander of the Army hospital at Fort Leavenworth in Kansas.
Don loved the discipline of the military, the uniform. But it went much deeper than that for him. For Don, the military allowed him to fulfill his call to be a leader, to ensure the highest possible level of care for sick and wounded soldiers — whose perspective as patients he now had a more complete understanding.
Leukemia “influenced the rest of my life,” Don said. “To put patients first as a physician, and [to put] employees [first] as a leader. I set the example for my employees on how to take care of patients. I insisted as a military leader on how to care for patients.”
Don retired from the military in 2003 after learning his continued therapy for leukemia prevented him from being promoted to general. He was told that it was because he couldn’t be sent overseas, as a general must.
Now, he fills his days with gardening and golfing, with service to his Lutheran church community, and with his three grandchildren, who all live near Don and Patricia’s home in Round Rock, Texas.
Nick, a retired mining engineer, lives in Wyoming, but the brothers talk often on the phone and visit when they can. When Don was in the military, Nick went to all of Don’s change-of-command ceremonies.
It’s the fact that they’re still able to share these kinds of moments in their lives, both big and little, that means so much to Nick about the past decades he’s had, unexpectedly, with his twin.
“I know how proud I am of my brother, Don. And, equally, he’s proud of me,” Nick said, choking up as he spoke. “He does tell me often that I’ve saved his life. I guess what I’m really trying to say is that’s no big deal. Because that’s what brothers do when they have the opportunity.”
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Susan Keown is a staff writer at Fred Hutchinson Cancer Research Center. Before joining Fred Hutch in 2014, Susan wrote about health and research topics for a variety of research institutions, including the National Institutes of Health and the Centers for Disease Control and Prevention. Reach her at email@example.com or follow her on Twitter at @sejkeown.