Bone marrow transplantation in leukemia is one of the great success stories in the history of oncology, as is that of the late Nobel Laureate E. Donnall Thomas, MD, the pioneering clinical researcher whose name is synonymous with life-saving marrow transplantation. Dr. Thomas, who was born in the sun-scorched rural town of Mart, Texas, where he went to grade school in a one-room schoolhouse, is a central character in a new book called Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution. The author, Frederick R. Appelbaum, MD, a mentee of Dr. Thomas’, is an expert in the research and treatment of blood cancers and Executive Vice President of Fred Hutchinson Cancer Center, Seattle.
A History That Reads Like a Novel
Organized into 25 chapters, Living Medicine is largely a history of bone marrow transplantation. Dr. -Appelbaum begins with a captivating preface. “Even though I’ve been doing it for decades, every time I perform a bone marrow transplant, it seems like magic,” he writes. He describes a case history of Kent Klingman, a 34-year-old father of two young girls, who is dying of leukemia. Dr. Appelbaum is an accomplished writer who has mastered the art of storytelling, imbuing real-life drama into this clinical tale.
“Over the coming months (post-transplant) Kent will fully recover, becoming a healthy chimera, a person who is 85% himself and 15% the cells of someone else. These 15% produce Kent’s blood and his immune system and, perhaps most surprisingly, serve as a living medicine, constantly patrolling his body for any residual leukemia and destroying it,” writes the author, as he alludes to the book’s title.
Title: Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution
Author: Frederick R. Appelbaum, MD
Publisher: Mayo Clinic Press
Publication Date: May 2023
Price: $27.99, hardcover, 320 pages
The book’s opening chapter takes readers back to World War II and the inception of the Manhattan Project, moving deftly into the atomic bombing of Hiroshima and Nagasaki. His writing brings you right into the horror of atomic warfare. “When the bomb exploded, it unleashed a spray of radiation traveling at the speed of light, penetrating every human body in its path, oxidizing cell membranes, damaging proteins, and mutating DNA along the way, silently, instantly.”
However, it was discovered that a year or so after these atomic bombings, several physicians in Hiroshima and Nagasaki noted a markedly increased rate of leukemia in children living near the hypocenters. This finding was the genesis of blood cancer research, leading to marrow transplantation, similar to the World War II bombing of the John Harvey, an American Liberty ship carrying a secret cargo of 2,000 mustard bombs, which serendipitously led to the emergence of chemotherapy and the field of medical oncology. This is not only a fascinating medical history, it gives insight into the sometimes-serendipitous way scientific advances are made.
An Intimate Look at a Hero
In chapter 3, we get up close and personal with the book’s hero, Dr. Thomas, who points out that his life “spanned the period from horse-and-buggy house calls to genetically engineered T cells.” Dr. Thomas’ life reads like a novel, as he works his way out of rural Texas to Boston. There, he attended Harvard Medical School, traveling with his new bride, Dottie, and arriving in a massive blizzard, where one of the young couple’s first purchases was a muskrat coat to keep Dottie warm.
During his internship, Dr. Thomas cared for several patients with leukemia, and this experience changed his life. “Looking back on it, I just found leukemia inherently interesting. It was an alarming, frightening disease. The diagnosis was a death sentence, usually within just weeks or months. I felt I owed it to the patients to try and do something about it,” noted Dr. Thomas. And the rest, as they say, is history.
A Famous Collaboration
Dr. Appelbaum gives an extravagant world-class description of the development of bone marrow transplantation. This description does a deep dive into the science of blood and transplantation, never once shying away from the science needed in this complex subject but always writing with clear, muscular prose that accelerates the narrative instead of bogging it down in excessive verbiage. No easy task.
Famous collaborations are noted throughout the history of cancer research, and ranking high among them is the working partnership of Dr. Thomas and Dr. Joseph Ferebee, who recruited Dr. Thomas to Imogene Bassett Hospital in Cooperstown, a small village about an hour and a half drive west of Albany. To readers, it might seem a strange destination for Dr. Thomas, who at the time, was a rising star at Harvard with strong research ambitions. However, Cooperstown offered hiking, hunting, and fishing, which were major parts of his life. It ended up being a very fortuitous move, as the research of Drs. Thomas and Ferebee proceeded at breakneck pace, to the seminal point of doing the first-ever, in-human marrow transplantation. To me, it is one of the best sections in the book, as it demonstrates how iron will and determination can overcome any obstacles, and this dynamic duo certainly had their share.
The descriptions of the first marrow transplants in children (which after early success ultimately ended in death) are a keen reminder of the physical and emotional sacrifices early researchers and their patients went through.
Another Fortuitous Invitation
In 1963, the famous endocrinologist Robert Williams, MD, invited Dr. Thomas to join the faculty of the University of Washington School of Medicine. From there, we are treated to a who’s-who tour of the famous researchers who collaborated with Dr. Thomas and changed the face of leukemia forever. Dr. Thomas joined the Fred Hutchinson Cancer Research Center in 1974, serving as its first Director of Medical Oncology and later as Director of the Clinical Research Division. The center has become a world leader in bone marrow transplantation.
Even though much of this fine book focuses on Dr. Thomas and his work in bone marrow transplantation, it is certainly not limited to that. Moreover, its power lies in the capable storytelling hands of its author, and that is put on full display in chapter 21, where we get one of the finest explications of the emerging field of immunotherapy in print today.
Living Medicine is a big book about big ideas and the big people who hatched and fought to make those ideas a reality. And, in doing so, they elevated the field of oncology research and saved countless lives. This book is highly recommended for readers of The ASCO Post, who will find it a page-turning book of inspiration.