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Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution
A sweeping biography of the visionary behind bone marrow transplantation and the story of the diseases cured by Don Thomas's discovery.
In the last half of the twentieth century, Thomas himself discovered a cure for every marrow-based disease—like leukemia, lymphoma, and sickle-cell anemia—forever changing treatment for some of the deadliest illnesses. His feats were extraordinary, earning him a Nobel Prize, and the cascade of treatments he inspired have reshaped and will continue to reshape the practice of clinical medicine. Yet no one has ever written Thomas’s courageous story. Dr. Frederick R. Appelbaum, a member of Thomas’s research team, does so for the first time in Living Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution.
Bone marrow transplantation has now saved over a million lives, but when Thomas first had the idea, he was met with disbelief by the scientific community. Appelbaum, informed by decades in the field and personal connection with Thomas, tells us the secrets to Thomas’s his unique characteristics, how he created an effective team of researchers, and how he overcame the technical obstacles of marrow transplantation. Appelbaum tells a bigger story, too, of the scientific and societal implications of this achievement, which are critical for scientific and lay readers alike so that we all might be better informed of how far our medical progress has come and will go.
In the last half of the twentieth century, Thomas himself discovered a cure for every marrow-based disease—like leukemia, lymphoma, and sickle-cell anemia—forever changing treatment for some of the deadliest illnesses. His feats were extraordinary, earning him a Nobel Prize, and the cascade of treatments he inspired have reshaped and will continue to reshape the practice of clinical medicine. Yet no one has ever written Thomas’s courageous story. Dr. Frederick R. Appelbaum, a member of Thomas’s research team, does so for the first time in Living Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution.
Bone marrow transplantation has now saved over a million lives, but when Thomas first had the idea, he was met with disbelief by the scientific community. Appelbaum, informed by decades in the field and personal connection with Thomas, tells us the secrets to Thomas’s his unique characteristics, how he created an effective team of researchers, and how he overcame the technical obstacles of marrow transplantation. Appelbaum tells a bigger story, too, of the scientific and societal implications of this achievement, which are critical for scientific and lay readers alike so that we all might be better informed of how far our medical progress has come and will go.
320 pages, Hardcover
Published May 16, 2023
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May 21, 2024
Alfred Nobel’s last will and testament funded five prizes in his name—in chemistry, physics, medicine, literature, and for “advanc[ing] fellowship among nations,” the latter known more commonly known as the Peace Prize—to recognize “those who, during the preceding year, have conferred the greatest benefit to humankind.” Despite “the preceding year” provision, for the first three-plus decades of the Prizes’ existence, they were very much lifetime achievement awards. By the time Wilhelm Röntgen was awarded the physics prize in 1901, the first year they were given, it was for his 1895 discovery of x-rays. Although he made the discovery, Röntgen had little to do with the development of the technology. Scientists around world had rapidly improved his achievement to make it more effective and accessible by the time he received the Prize. Over time, Nobel’s bequests combined recognition of seminal achievement with a goal of increasing public awareness to improve and proliferate them.
A once unseemly practice of lobbying for the Prize, subtle and not-so, became more common after a worldwide campaign to confer the 1935 Peace Prize to Carl von Ossietzky, editor of a German magazine opposing the rise of Naziism in Germany. A worldwide committee that included Albert Einstein and a young Willy Brandt hoped to use the Prize to publicize the realities of Hitler’s Third Reich and save Ossietzky’s life. Ossietzky was arrested the night of the Reichstag fire. The 1935 Prize was not awarded, Ossietzky was selected in 1936. He was denied permission to travel to Oslo to receive it and died shortly thereafter due to illness exacerbated by abuse inflicted on him in the fledgling concentration camps.
Nils Hansson, a Nobel Prize historian based at the Heinrich Heine University in Düsseldorf, described this in a lecture about how not to win a Nobel Prize. He opened with an anecdote about a Stockholm-based hematologist, Gösta Gahrton, who was a member of the Prize’s selection committee between 1988-1997. “Many times,” said Nilsson, the expert “was invited to other nations to give lectures. But when he got there, he soon realized his lectures were not the reals reasons for his invitations. Instead, his hosts often had their own detailed lectures, presented after his, apparently designed to heighten their chances and lobby for the Nobel Prize." In his conclusion, Nilsson highlighted three “rules” that generally had to be met to enter that small circle of eligibility for potential Prize winners. First, “ideally, discoveries must open up a brand-new field of research.” Second, “one shouldn’t walk on well-worn paths” of fields that are filled with activity, making it difficult to differentiate between great insights or achievements. And a counterintuitive third: to not “be too visionary” or far ahead of one’s time, making the achievement comprehendible to wide audiences.
E. Donnal “Don” Thomas’s singular pioneering of bone marrow transplantation (BMT) to make incurable diseases curable embodied those preconditions. But rather than lobby for the Prize, his work and quiet leadership had been speaking for itself for more than three decades and was just beginning to take root when he received the Nobel Prize for Medicine in 1990. The practical implications of his vision were attracting interest from ambitious researchers and physicians. Institutions around the world were investing millions of dollars in new infrastructure and staff. He gave birth to a paradigm-changing revolution.
Born in 1920, Thomas was the only child of a rural Texas physician who made house calls in a horse-drawn wagon. Although self-described as “not an outstanding student,” (quotes excerpted from Thomas’s Nobel lecture) Thomas went from a one-room schoolhouse to the University of Texas at Austin to the Harvard Medical School, where he earned his MD in 1946. In Boston, he worked with Sidney Farber, whose trailblazing work on chemotherapies in childhood leukemia created the foundation for modern cancer research and treatment ( The Emperor of All Maladies explains Farber’s impact on modern cancer research and treatment). This relationship “intensified” Thomas’s focus on bone marrow and leukemia, but a difference in philosophic approaches to cancer treatment led Thomas to Cooperstown, New York in 1955, where he “began to work on marrow transplantation in human patients and in the dog.” At that time, even the idea of using animal models to develop and test drugs for human use was less than two decades old.
Although he had little tangible success in the form of surviving patients, Thomas’s research at Cooperstown in the late 1950s to early 1960s drew researchers from around the country to see observe what he was doing and learn. Colleagues invited him to speak, to share his theories and lab results. He didn’t have a lot of positive results to report, but they recognized, to put a reverse spin on Gertrude Stein’s aphorism about Oakland, that there was definitely some there there.
From the advent of the history of medicine, it has been recognized the immune system could be assisted. Herbs and plants had been known to have medicinal qualities for centuries. In the late 19th/early 20th century, therapeutic syrups and pills using new discoveries in chemistry began to proliferate. Acetyl-salicylic acid became aspirin, arguably the most used drug in history. Paul Ehrlich’s discovery of chemically synthesized salversan to treat syphilis fed an optimism that many more “magic bullets” to treat disease would be identified inevitably. While there were discoveries and applications over the first half of the 20th century, the pace was frustratingly slow. A young Don Thomas posited that there might be a better way: to somehow manipulate bone marrow by taking some from a healthy patient and introduce it to another whose immune system was weak or compromised.
BMT transplants do not have the immediate, visceral recognizability of organ transplants that can be visualized by lay persons. The “action,” so to speak, takes place at the genetic and cellular levels. Bone marrow creates all the components of blood which, in turn, are the engine of the body’s innate immune system. Macrophages, monocytes, neutrophils, platelets, and other cells generated by bone marrow act as emergency responses to protect, identify, and repair damage caused by genetics, viruses, or injuries. Together, they form the communications network of the body. The primary function of lungs, to take just one example, it to breathe in order to process oxygen; blood is the delivery system that allow it to do so and connect it to the functions of other organs. Sometimes this system does not respond as it should or is inadequate, which can be impaired for a variety of reasons. The trick for therapy was to make the immune system adaptive. Manipulating the function B cells and T cells, for example, to identify and fight disease.
Transplanting bone marrow from one person to another, known as allogeneic transplant, proved to be “very difficult.” The donated marrow often became an aggressive, incompatible “invader” of sorts, causing graft-versus-host-disease (GVHD), a common side effect in which donated marrow would attack not only disease, but healthy tissues and organs with potential with toxic, often fatal consequences. But his research found promise in patients who were identical twins. The graft, the donated marrow, would become part of the host, working in concert, not at cross purposes. Once Thomas began to understand, implement, and have success with a handful of BMT transplants using identical twin donors to potentially cure incurable diseases like aplastic anemia, leukemias, and certain types of renal (kidney) failure.
Serendipitous events and a growing reputation took Thomas to Seattle’s Public Health Service Hospital in the early 1960s, allowing him to continue and expand his work. Thomas’s entire lab moved to the Fred Hutchinson Cancer Center (The Hutch) in 1975 when the federal government decided to close the nation’s public health hospitals. It was one of eight comprehensive cancer centers first created by President Nixon’s War on Cancer initiative and was focused almost exclusively on BMT research and treatment. Around the same time, progress being made by worldwide in identifying and learning how to separate stem cells—the blood-generating elements in plasma cells in bone marrow—known as autologous stem cell transplant, in which a patient’s own cells were extracted and manipulated before being reintroduced into the same patient as therapy.
Growing understanding and acceptance of transplant procedures spurred medical institutions throughout the United States and Europe to invest billions in facilities, staff, and education. The Hutch became the worldwide Mecca for patients seeking transplants, and more significantly, for physicians to spend time in Seattle to bring knowledge and experience back to their clinics.
GVHD continued to be a stubborn, Medusa-like enemy. And much like Perseus, Thomas had the single-minded focus to take on the challenge of its oft fatal complexity. But it required more than a single stroke to conquer; it required a coordinated team, time, money, and, most of all, a persistent vision. His leadership attracted a staff who cherished and carried out their assignments. One of his closest collaborators, Rainer Storb, a German researcher-scientist, joined him on a Fulbright scholarship in 1965 and never left despite dozens of offers over the years from universities throughout the U.S. and Europe. Storb was freed from what he saw as useless administrative drudgery to do lab work with a kennel of dogs and translate his experience into treatment of patients. Thomas also found key administrators, physicians, lab assistants, and most importantly, dedicated nurses who became as and more valuable than any clinicians. One of them was Fred Appelbaum, this book’s author.
Appelbaum doesn’t shy away from criticisms and controversies Thomas encountered during his career. His narrative also provides a cursory insight into new cellular therapies like CAR T and bispecific antibodies, different methods to assist the bone marrow to function as advertised. They and other related therapies are beginning to enter clinical practice and may, one day, make BMT obsolete. But that day is not today. The success of BMT as therapy has spawned programs like Be the Match and other national marrow donation programs throughout the world. Through them, people can register their own bone marrow type and be linked with suitable patients anywhere in the world. Today the registries have more than 40 million participants willing to donate their own marrow to complete strangers. It was less than one million when Thomas received the Nobel Prize. For some diseases, like multiple myeloma, generally resistant to allogeneic transplants except in the case of identical twin donors—which is still the best BMT therapy known—autologous transplants have become standard treatment many patients. In general, however, cost is as much of an access issue as it has ever been. One must be well-insured or have wealth to access them.
Any visitor to The Hutch today cannot help but be overwhelmed by the simple, tasteful entrance, an appropriate shrine to the impact of Thomas and the people who made his work tangible for posterity. Appelbaum joined Thomas in the mid-1970s, eventually being elevated to a leadership role at The Hutch and instrumental in many roles in the cancer community. His at times charming account of Thomas’s work and influence covers all the essential bases for lay and professional readers, a rarity in medical writing. He chronicles and puts into context how Thomas stubbornly and deliberately trod his intellectual footprints, where the various practical paths led, and how still more continue to be discovered and understood. Appelbaum’s book conveys this emotion; one doesn’t have to go to The Hutch to experience it. Cancer patients and experts are not the only audiences for this story. Anyone curious about medicine should consider picking up a copy. Its lessons are precisely what Alfred Nobel hoped his legacy would enlighten.
A once unseemly practice of lobbying for the Prize, subtle and not-so, became more common after a worldwide campaign to confer the 1935 Peace Prize to Carl von Ossietzky, editor of a German magazine opposing the rise of Naziism in Germany. A worldwide committee that included Albert Einstein and a young Willy Brandt hoped to use the Prize to publicize the realities of Hitler’s Third Reich and save Ossietzky’s life. Ossietzky was arrested the night of the Reichstag fire. The 1935 Prize was not awarded, Ossietzky was selected in 1936. He was denied permission to travel to Oslo to receive it and died shortly thereafter due to illness exacerbated by abuse inflicted on him in the fledgling concentration camps.
Nils Hansson, a Nobel Prize historian based at the Heinrich Heine University in Düsseldorf, described this in a lecture about how not to win a Nobel Prize. He opened with an anecdote about a Stockholm-based hematologist, Gösta Gahrton, who was a member of the Prize’s selection committee between 1988-1997. “Many times,” said Nilsson, the expert “was invited to other nations to give lectures. But when he got there, he soon realized his lectures were not the reals reasons for his invitations. Instead, his hosts often had their own detailed lectures, presented after his, apparently designed to heighten their chances and lobby for the Nobel Prize." In his conclusion, Nilsson highlighted three “rules” that generally had to be met to enter that small circle of eligibility for potential Prize winners. First, “ideally, discoveries must open up a brand-new field of research.” Second, “one shouldn’t walk on well-worn paths” of fields that are filled with activity, making it difficult to differentiate between great insights or achievements. And a counterintuitive third: to not “be too visionary” or far ahead of one’s time, making the achievement comprehendible to wide audiences.
E. Donnal “Don” Thomas’s singular pioneering of bone marrow transplantation (BMT) to make incurable diseases curable embodied those preconditions. But rather than lobby for the Prize, his work and quiet leadership had been speaking for itself for more than three decades and was just beginning to take root when he received the Nobel Prize for Medicine in 1990. The practical implications of his vision were attracting interest from ambitious researchers and physicians. Institutions around the world were investing millions of dollars in new infrastructure and staff. He gave birth to a paradigm-changing revolution.
Born in 1920, Thomas was the only child of a rural Texas physician who made house calls in a horse-drawn wagon. Although self-described as “not an outstanding student,” (quotes excerpted from Thomas’s Nobel lecture) Thomas went from a one-room schoolhouse to the University of Texas at Austin to the Harvard Medical School, where he earned his MD in 1946. In Boston, he worked with Sidney Farber, whose trailblazing work on chemotherapies in childhood leukemia created the foundation for modern cancer research and treatment ( The Emperor of All Maladies explains Farber’s impact on modern cancer research and treatment). This relationship “intensified” Thomas’s focus on bone marrow and leukemia, but a difference in philosophic approaches to cancer treatment led Thomas to Cooperstown, New York in 1955, where he “began to work on marrow transplantation in human patients and in the dog.” At that time, even the idea of using animal models to develop and test drugs for human use was less than two decades old.
Although he had little tangible success in the form of surviving patients, Thomas’s research at Cooperstown in the late 1950s to early 1960s drew researchers from around the country to see observe what he was doing and learn. Colleagues invited him to speak, to share his theories and lab results. He didn’t have a lot of positive results to report, but they recognized, to put a reverse spin on Gertrude Stein’s aphorism about Oakland, that there was definitely some there there.
From the advent of the history of medicine, it has been recognized the immune system could be assisted. Herbs and plants had been known to have medicinal qualities for centuries. In the late 19th/early 20th century, therapeutic syrups and pills using new discoveries in chemistry began to proliferate. Acetyl-salicylic acid became aspirin, arguably the most used drug in history. Paul Ehrlich’s discovery of chemically synthesized salversan to treat syphilis fed an optimism that many more “magic bullets” to treat disease would be identified inevitably. While there were discoveries and applications over the first half of the 20th century, the pace was frustratingly slow. A young Don Thomas posited that there might be a better way: to somehow manipulate bone marrow by taking some from a healthy patient and introduce it to another whose immune system was weak or compromised.
BMT transplants do not have the immediate, visceral recognizability of organ transplants that can be visualized by lay persons. The “action,” so to speak, takes place at the genetic and cellular levels. Bone marrow creates all the components of blood which, in turn, are the engine of the body’s innate immune system. Macrophages, monocytes, neutrophils, platelets, and other cells generated by bone marrow act as emergency responses to protect, identify, and repair damage caused by genetics, viruses, or injuries. Together, they form the communications network of the body. The primary function of lungs, to take just one example, it to breathe in order to process oxygen; blood is the delivery system that allow it to do so and connect it to the functions of other organs. Sometimes this system does not respond as it should or is inadequate, which can be impaired for a variety of reasons. The trick for therapy was to make the immune system adaptive. Manipulating the function B cells and T cells, for example, to identify and fight disease.
Transplanting bone marrow from one person to another, known as allogeneic transplant, proved to be “very difficult.” The donated marrow often became an aggressive, incompatible “invader” of sorts, causing graft-versus-host-disease (GVHD), a common side effect in which donated marrow would attack not only disease, but healthy tissues and organs with potential with toxic, often fatal consequences. But his research found promise in patients who were identical twins. The graft, the donated marrow, would become part of the host, working in concert, not at cross purposes. Once Thomas began to understand, implement, and have success with a handful of BMT transplants using identical twin donors to potentially cure incurable diseases like aplastic anemia, leukemias, and certain types of renal (kidney) failure.
Serendipitous events and a growing reputation took Thomas to Seattle’s Public Health Service Hospital in the early 1960s, allowing him to continue and expand his work. Thomas’s entire lab moved to the Fred Hutchinson Cancer Center (The Hutch) in 1975 when the federal government decided to close the nation’s public health hospitals. It was one of eight comprehensive cancer centers first created by President Nixon’s War on Cancer initiative and was focused almost exclusively on BMT research and treatment. Around the same time, progress being made by worldwide in identifying and learning how to separate stem cells—the blood-generating elements in plasma cells in bone marrow—known as autologous stem cell transplant, in which a patient’s own cells were extracted and manipulated before being reintroduced into the same patient as therapy.
Growing understanding and acceptance of transplant procedures spurred medical institutions throughout the United States and Europe to invest billions in facilities, staff, and education. The Hutch became the worldwide Mecca for patients seeking transplants, and more significantly, for physicians to spend time in Seattle to bring knowledge and experience back to their clinics.
GVHD continued to be a stubborn, Medusa-like enemy. And much like Perseus, Thomas had the single-minded focus to take on the challenge of its oft fatal complexity. But it required more than a single stroke to conquer; it required a coordinated team, time, money, and, most of all, a persistent vision. His leadership attracted a staff who cherished and carried out their assignments. One of his closest collaborators, Rainer Storb, a German researcher-scientist, joined him on a Fulbright scholarship in 1965 and never left despite dozens of offers over the years from universities throughout the U.S. and Europe. Storb was freed from what he saw as useless administrative drudgery to do lab work with a kennel of dogs and translate his experience into treatment of patients. Thomas also found key administrators, physicians, lab assistants, and most importantly, dedicated nurses who became as and more valuable than any clinicians. One of them was Fred Appelbaum, this book’s author.
Appelbaum doesn’t shy away from criticisms and controversies Thomas encountered during his career. His narrative also provides a cursory insight into new cellular therapies like CAR T and bispecific antibodies, different methods to assist the bone marrow to function as advertised. They and other related therapies are beginning to enter clinical practice and may, one day, make BMT obsolete. But that day is not today. The success of BMT as therapy has spawned programs like Be the Match and other national marrow donation programs throughout the world. Through them, people can register their own bone marrow type and be linked with suitable patients anywhere in the world. Today the registries have more than 40 million participants willing to donate their own marrow to complete strangers. It was less than one million when Thomas received the Nobel Prize. For some diseases, like multiple myeloma, generally resistant to allogeneic transplants except in the case of identical twin donors—which is still the best BMT therapy known—autologous transplants have become standard treatment many patients. In general, however, cost is as much of an access issue as it has ever been. One must be well-insured or have wealth to access them.
Any visitor to The Hutch today cannot help but be overwhelmed by the simple, tasteful entrance, an appropriate shrine to the impact of Thomas and the people who made his work tangible for posterity. Appelbaum joined Thomas in the mid-1970s, eventually being elevated to a leadership role at The Hutch and instrumental in many roles in the cancer community. His at times charming account of Thomas’s work and influence covers all the essential bases for lay and professional readers, a rarity in medical writing. He chronicles and puts into context how Thomas stubbornly and deliberately trod his intellectual footprints, where the various practical paths led, and how still more continue to be discovered and understood. Appelbaum’s book conveys this emotion; one doesn’t have to go to The Hutch to experience it. Cancer patients and experts are not the only audiences for this story. Anyone curious about medicine should consider picking up a copy. Its lessons are precisely what Alfred Nobel hoped his legacy would enlighten.
September 21, 2023
Strong science writing about a Noble laureate who persevered and remained confident that stem cell transplants could work--and all the intersections of discoveries.
August 22, 2023
Really interesting, and while a bit “science-y” in spots, it was for the most part written so a lay person could understand. Science is amazing and we have come a long way!
March 20, 2025
Enjoyed this thoroughly! Such an understandable read of the history of bone marrow transplant and how the field got to where it is today! As someone who works for a research institute, I found he definitely favors his roots in the field, but that didn’t slow me down! I met Dr Appelbaum at a medical conference and loved his talk on the history of bone marrow transplant. Great read!
November 2, 2023
Discover a thrilling exploration of the pioneering journey behind bone marrow transplantation with the book Living Medicine.
In the ever-evolving landscape of healthcare system development, the story of bone marrow transplantation stands as a testament to medical progress and innovation. Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution by Frederick Appelbaum expertly chronicles this journey. In this review, we will explore how the book addresses the development of healthcare systems, with a specific focus on the evolution of bone marrow transplantation. Join us as we uncover the challenges, triumphs, and enduring impact of this transformative medical procedure.
Author’s background
Frederick Appelbaum M.D., holds the distinguished position of Metcalfe Family Professor at the Fred Hutchison Cancer Center.
His extensive body of work spans from investigating fundamental molecular irregularities related to the disease to overseeing both national and international research endeavours focused on its treatment. Dr. Appelbaum has previously held the role of chair for the National Cancer Institute’s Board of Scientific Advisors and is an esteemed member of the National Academy of Medicine.
What is the book about?
Living Medicine by Frederick Appelbaum offers a captivating account of the remarkable journey undertaken by an oncologist and haematologist Dr. Don Thomas in pioneering bone marrow transplantation as a viable treatment for various forms of acute leukaemia and genetic bone marrow disorders. This narrative delves into the challenges and hurdles faced by Dr. Thomas, shedding light on his unwavering dedication to replacing defective marrow and his deep concern for both individual patient well-being and the broader implications of his research.
Dr. Thomas’s groundbreaking efforts, which built upon Nobel Prize-winning discoveries made by others, culminated in his own Nobel Prize recognition in 1990 for his pioneering work in bone marrow treatment. The book masterfully combines the personal and scientific aspects of this journey, making it accessible and engaging for readers with varying levels of medical knowledge.
For the author, this story holds a personal connection, as he tragically lost a niece to lymphoma, who had been eligible for a bone marrow transplant at the Cancer Research Center where Dr. Thomas worked. Living Medicine provides valuable insights into the criteria for such transplants and the critical importance of finding compatible donors, shedding light on the author’s own frantic search for their niece’s biological family.
Readers should be aware that the book does not shy away from the realities of medical research, including the significant suffering and sacrifices endured by both humans and animals in the pursuit of advancements in bone marrow transplantation.
Three key takeaways from Living Medicine
1. Pioneering marrow transplantation: Don Thomas’s vision
Don Thomas’s groundbreaking work in bone marrow transplantation began in the 1950s when he envisioned the possibility of using marrow transplants to treat hematologic diseases. Despite facing scepticism and obstacles, Thomas’s unwavering dedication to the idea led to the first successful marrow transplant in 1960 from an identical twin, paving the way for further breakthroughs in HLA-compatible transplants. His vision and persistence laid the foundation for the revolutionary field of bone marrow transplantation, which has since saved countless lives.
2. Balancing hope and risk: early challenges in marrow transplantation
In the early days of bone marrow transplantation, the procedure offered hope to patients with end-stage leukaemia, albeit with significant risks and challenges. The treatment’s success rate was low, and patients often faced complications such as infections and mucositis.
The ethical dilemma of whether to pursue transplantation with limited chances of success or opt for palliative care raised complex questions. This period reflects the tension between medical innovation and patient well-being, emphasising the importance of patient choice in life-threatening situations.
3. The multifaceted revolution: beyond marrow transplantation
Don Thomas’s work extended beyond marrow transplantation, encompassing the development of comprehensive supportive care measures. His approach involved assembling multidisciplinary teams to address the major complications associated with transplantation, including infections, malnutrition, and social disruptions.
Thomas’s emphasis on nurses as a “secret weapon” and his dedication to creating specialised wards demonstrated the holistic approach required for successful transplantation. His legacy not only transformed marrow transplantation but also catalysed a broader revolution in cell therapy, changing the landscape of modern medicine.
Strengths and weaknesses, according to readers’ reviews
Strengths:
• The book seamlessly blends science and history, making it not only a valuable science book but also an engaging history book.
• The book is meticulously researched, ensuring the accuracy and reliability of the information presented.
• The inclusion of real patient stories, both triumphant and tragic, adds a human touch to the narrative, making it emotionally compelling.
Weaknesses:
• The book contains technical jargon and medical terminology that could be challenging for some readers to grasp.
Best quotes from Living Medicine
“When Thomas first developed allogeneic transplantation, the roles of central tolerance and negative selection weren’t understood. Early after transplantation, donor B and T cells within the transplanted marrow possessing receptors that recognize the patient’s cells become activated.”
“One of the better-known spontaneous remissions occurred in 1885 in a patient named Fred Stein, a thirty-one-year-old with a sarcoma (a tumor arising from muscle, bone, or fat) growing in the left side of his neck. Surgery was unsuccessful in removing the tumor, and after the operation, the surgical wound became infected with Streptococcus pyogenes, an often deadly complication of surgery in the pre-antibiotic era. Infections with S.pyogenes can result in erysipelas, a syndrome in which patients develop a fiery red rash, raging fever, and unrelenting cycles of chills and sweats, often ending in death. According to the hospital records, not only did Stein eventually recover from erysipelas, but as he did, his tumor melted away. The story of Fred Stein might also have melted away if it hadn’t caught the attention of a surgeon, William Coley.”
Final takeaway
Living Medicine by Frederick Appelbaum offers a profound and captivating history of bone marrow transplantation and the dedicated individuals who shaped its evolution over the last seven decades. This book is a must-read for anyone intrigued by the journey of a small idea blossoming into a transformative medical treatment. It brilliantly combines the scientific intricacies of the field with compelling human stories, providing readers with both a comprehensive understanding of marrow transplantation and a deep appreciation for the dedicated professionals who have made it a reality. Whether you have a medical background or not, this book offers a remarkable exploration of scientific innovation and human compassion, making it an enriching and enlightening read for all.
In the ever-evolving landscape of healthcare system development, the story of bone marrow transplantation stands as a testament to medical progress and innovation. Living Medicine: Don Thomas, Marrow Transplantation, and the Cell Therapy Revolution by Frederick Appelbaum expertly chronicles this journey. In this review, we will explore how the book addresses the development of healthcare systems, with a specific focus on the evolution of bone marrow transplantation. Join us as we uncover the challenges, triumphs, and enduring impact of this transformative medical procedure.
Author’s background
Frederick Appelbaum M.D., holds the distinguished position of Metcalfe Family Professor at the Fred Hutchison Cancer Center.
His extensive body of work spans from investigating fundamental molecular irregularities related to the disease to overseeing both national and international research endeavours focused on its treatment. Dr. Appelbaum has previously held the role of chair for the National Cancer Institute’s Board of Scientific Advisors and is an esteemed member of the National Academy of Medicine.
What is the book about?
Living Medicine by Frederick Appelbaum offers a captivating account of the remarkable journey undertaken by an oncologist and haematologist Dr. Don Thomas in pioneering bone marrow transplantation as a viable treatment for various forms of acute leukaemia and genetic bone marrow disorders. This narrative delves into the challenges and hurdles faced by Dr. Thomas, shedding light on his unwavering dedication to replacing defective marrow and his deep concern for both individual patient well-being and the broader implications of his research.
Dr. Thomas’s groundbreaking efforts, which built upon Nobel Prize-winning discoveries made by others, culminated in his own Nobel Prize recognition in 1990 for his pioneering work in bone marrow treatment. The book masterfully combines the personal and scientific aspects of this journey, making it accessible and engaging for readers with varying levels of medical knowledge.
For the author, this story holds a personal connection, as he tragically lost a niece to lymphoma, who had been eligible for a bone marrow transplant at the Cancer Research Center where Dr. Thomas worked. Living Medicine provides valuable insights into the criteria for such transplants and the critical importance of finding compatible donors, shedding light on the author’s own frantic search for their niece’s biological family.
Readers should be aware that the book does not shy away from the realities of medical research, including the significant suffering and sacrifices endured by both humans and animals in the pursuit of advancements in bone marrow transplantation.
Three key takeaways from Living Medicine
1. Pioneering marrow transplantation: Don Thomas’s vision
Don Thomas’s groundbreaking work in bone marrow transplantation began in the 1950s when he envisioned the possibility of using marrow transplants to treat hematologic diseases. Despite facing scepticism and obstacles, Thomas’s unwavering dedication to the idea led to the first successful marrow transplant in 1960 from an identical twin, paving the way for further breakthroughs in HLA-compatible transplants. His vision and persistence laid the foundation for the revolutionary field of bone marrow transplantation, which has since saved countless lives.
2. Balancing hope and risk: early challenges in marrow transplantation
In the early days of bone marrow transplantation, the procedure offered hope to patients with end-stage leukaemia, albeit with significant risks and challenges. The treatment’s success rate was low, and patients often faced complications such as infections and mucositis.
The ethical dilemma of whether to pursue transplantation with limited chances of success or opt for palliative care raised complex questions. This period reflects the tension between medical innovation and patient well-being, emphasising the importance of patient choice in life-threatening situations.
3. The multifaceted revolution: beyond marrow transplantation
Don Thomas’s work extended beyond marrow transplantation, encompassing the development of comprehensive supportive care measures. His approach involved assembling multidisciplinary teams to address the major complications associated with transplantation, including infections, malnutrition, and social disruptions.
Thomas’s emphasis on nurses as a “secret weapon” and his dedication to creating specialised wards demonstrated the holistic approach required for successful transplantation. His legacy not only transformed marrow transplantation but also catalysed a broader revolution in cell therapy, changing the landscape of modern medicine.
Strengths and weaknesses, according to readers’ reviews
Strengths:
• The book seamlessly blends science and history, making it not only a valuable science book but also an engaging history book.
• The book is meticulously researched, ensuring the accuracy and reliability of the information presented.
• The inclusion of real patient stories, both triumphant and tragic, adds a human touch to the narrative, making it emotionally compelling.
Weaknesses:
• The book contains technical jargon and medical terminology that could be challenging for some readers to grasp.
Best quotes from Living Medicine
“When Thomas first developed allogeneic transplantation, the roles of central tolerance and negative selection weren’t understood. Early after transplantation, donor B and T cells within the transplanted marrow possessing receptors that recognize the patient’s cells become activated.”
“One of the better-known spontaneous remissions occurred in 1885 in a patient named Fred Stein, a thirty-one-year-old with a sarcoma (a tumor arising from muscle, bone, or fat) growing in the left side of his neck. Surgery was unsuccessful in removing the tumor, and after the operation, the surgical wound became infected with Streptococcus pyogenes, an often deadly complication of surgery in the pre-antibiotic era. Infections with S.pyogenes can result in erysipelas, a syndrome in which patients develop a fiery red rash, raging fever, and unrelenting cycles of chills and sweats, often ending in death. According to the hospital records, not only did Stein eventually recover from erysipelas, but as he did, his tumor melted away. The story of Fred Stein might also have melted away if it hadn’t caught the attention of a surgeon, William Coley.”
Final takeaway
Living Medicine by Frederick Appelbaum offers a profound and captivating history of bone marrow transplantation and the dedicated individuals who shaped its evolution over the last seven decades. This book is a must-read for anyone intrigued by the journey of a small idea blossoming into a transformative medical treatment. It brilliantly combines the scientific intricacies of the field with compelling human stories, providing readers with both a comprehensive understanding of marrow transplantation and a deep appreciation for the dedicated professionals who have made it a reality. Whether you have a medical background or not, this book offers a remarkable exploration of scientific innovation and human compassion, making it an enriching and enlightening read for all.
May 21, 2023
A fascinating recounting of the challenging path that the oncologist/hematologist Dr. Don Thomas forged to develop bone marrow transplantation as a workable treatment for various 'flavors' of acute leukemia and genetic bone marrow flaws. Although the path was full of full of potholes and diversions, Dr. Thomas recognized the inevitable result without replacing the defective marrow, and thus had a strong focus on both the well-being of individual patients, and the big-picture issues associated with the research projects. Dr. Thomas' efforts and results were appropriately recognized with a Nobel Prize, and the financial reward that he received was synergistically "re-invested" in continuing medical research. Dr. Fred Appelbaum did a great job with making the book both interesting and educational to a medical layman like me, helping me to understand our complicated human immune system and hematology.
January 16, 2024
For those with some background in cellular biology and how that field applies to medical treatment, this is an excellent book. Specifically it shows how bone marrow transplants have become the ultimate cure for numerous seemingly disparate human diseases. It is particularly good at explaining the logic of doing so and the historical development of this process. At the same time it does not ignore the potential side effects of the procedure. For those with a strong background in immunology, genetics and cell biology, it serves mainly as a user friendly review of topics one probably already knows. I enjoyed the book most when it was specific for such things as descriptive case studies, cut-off points, costs of treatment, chances of success, etc.
December 1, 2023
Definitely more of a niche read. Fascinating history of development of bone marrow transplant. Reads a bit like a biography until the end and then it is more about cancer research in general.
May 5, 2025
Another great medical history book that I loved reading. I enjoyed learning about the man behind bone marrow transplantation and how it progressed from its early and unsure beginnings to the awe-inspiring therapy it is today. I learned much more from this book than I thought I would have ranging from the discovery of HLA types to the graft versus leukemia effect to the role of bone marrow transplant in sickle cell and thalassemia. When I can come away from a book not only learning about the fascinating yet grueling history of a subject, but also further my understanding of medical concepts, I am incredibly impressed and thankful. Dr. Applebaum does an impeccable job sewing in multiple different medical concepts, personal stories, study design principles, and more in this masterpiece while focusing on the main concept of the chronicle of bone marrow transplantation. This is a book that should be read by anyone interested in oncology and medicine in general.
June 1, 2024
Excellent overall. I love well explained technical details and the two-page preface hooked me. The closing chapters (there are 25 chapters total over 270-ish pages) offer hope and encouragement for cancer patients or anyone concerned about cancer in their family.
If there is a stumble, it's the early chapters about Don Thomas' family life. These sections read differently than the rest of the book--in a style that reminds me of a homespun obituary page posting. A little more editing and stylistic consistency would have elevated everything here. Most chapters offer reading that's highly informative and easy to understand. A super detailed index, notes, and selected bibliography provide the reader with access to more technical details and materials.
Proceeds from book sales go to the Fred Hutchinson Cancer Research Center. ❤️
If there is a stumble, it's the early chapters about Don Thomas' family life. These sections read differently than the rest of the book--in a style that reminds me of a homespun obituary page posting. A little more editing and stylistic consistency would have elevated everything here. Most chapters offer reading that's highly informative and easy to understand. A super detailed index, notes, and selected bibliography provide the reader with access to more technical details and materials.
Proceeds from book sales go to the Fred Hutchinson Cancer Research Center. ❤️
August 16, 2025
THIS is the book I’ve been looking for over the last month.
I got the urge to learn everything possible about marrow transplantation when my name recently got selected from the national registry to be an allogeneic donor. This book covered all of the history, emerging research, emotional toll, obstacles (past and present) that I wanted to learn more about.
It’s definitely very “sciency” at points but gives an excellent history of the doctors, nurses, patients, and donors that have come before us to bring this field to where it stands today. The testimonials toward the end from transplant survivors had me crying. There is so much love and care and sometimes heartbreak poured into this book that it makes me want to meet the author and thank him personally for putting it all together in one place.
I got the urge to learn everything possible about marrow transplantation when my name recently got selected from the national registry to be an allogeneic donor. This book covered all of the history, emerging research, emotional toll, obstacles (past and present) that I wanted to learn more about.
It’s definitely very “sciency” at points but gives an excellent history of the doctors, nurses, patients, and donors that have come before us to bring this field to where it stands today. The testimonials toward the end from transplant survivors had me crying. There is so much love and care and sometimes heartbreak poured into this book that it makes me want to meet the author and thank him personally for putting it all together in one place.
May 30, 2023
I loved this book. Not only is it a great science book with crystal-clear explanations, it is also a great history book. The images painted of Dr. Don Thomas are excellent as is the author’s own journey. The patient stories are amazing, some happy, some tragic. Dr. Appelbaum gives an honest appraisal of bone marrow transplant, talking about the successes and failures. Dr. Appelbaum is also great at giving credit where credit is due, and is also excellent in acknowledging the teamwork necessary to bring bone marrow transplant into reality. The footnotes were also worth reading, with additional explanations. This book is well worth reading. Thank you to Edelweiss and Mayo Clinic Press for the digital review copy.
September 11, 2023
This is a fascinating history of medical developments in marrow transplantation and cell therapy. It has some detailed technical information which is easy to skim if it’s too much. It emphasizes the patient stories, the collaboration and competition among research scientists, the funding dilemmas, and the myriad problems that have to be solved in order to achieve a medical breakthrough. As someone with a connection to Fred Hutchinson Cancer Center, it was especially poignant to hear about the patients and families, and what they were willing to risk in order to move the science forward. I recommend it to anyone who wants a good history of marrow transplantation and the people who worked to make it happen and make it better over the last 75 years or so.
July 5, 2024
This book is the impetus that will encourage me to start reading more medically heavy and dense material. I thought I was going to read more of a memoir about Dr. Thomas who innovated bone marrow transplantation in humans. But I learned so much more than that. I’ve gained a vast breadth of knowledge that, honestly, I didn’t fully comprehend. I wish I had bought the book so I could highlight, bookmark, and write my notes inside it. Either way, I’m going to buy it.
I didn’t know hematology and hematologic disease could be so captivating and immensely interesting. I’ve learned more from this book than I learned in all my biology course in college. Now, on to bigger and better. There’s always more to learn.
I didn’t know hematology and hematologic disease could be so captivating and immensely interesting. I’ve learned more from this book than I learned in all my biology course in college. Now, on to bigger and better. There’s always more to learn.
November 5, 2024
I loved 'Living Medicine," by Dr. Fred Appelbaum. With no background in science or medicine, it was difficult for me to understand all the details of the various cancer treatment schemes developed over the years, but I was able to get the gist. His descriptions of the challenges involved in bone marrow transplants are heart-breaking and exciting at the same time. The personal stories were compelling and the outcomes thrilling. And Dr. Appelbaum had a front row seat to all this. Amazing what can be done with proper medical funding and years of intense research. Positively heroic, in fact! A great read.
October 5, 2025
My husband has had multiple myeloma for five years, and has been through a stem cell and a CAR – T transplant. I found this book absolutely fascinating.
We just assume that the amazing medicine we have today has always been here, but so not true. Dr. Applebaum does an amazing job of tying together all of the brilliant people all over the world who brought us to where we are today.
I think Dr. Applebaum does a great job of explaining the science, but that might be a little much for some people so you can just skim over those parts. The book concludes with descriptions of their survivor reunions. 🥹Amazing!
We just assume that the amazing medicine we have today has always been here, but so not true. Dr. Applebaum does an amazing job of tying together all of the brilliant people all over the world who brought us to where we are today.
I think Dr. Applebaum does a great job of explaining the science, but that might be a little much for some people so you can just skim over those parts. The book concludes with descriptions of their survivor reunions. 🥹Amazing!
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November 21, 2025I recently tried exosome therapy at Vitality https://vitality-stemcells.com/exosomes/ and wanted to share my impressions. I was hesitant at first, but after the consultation, I felt more at ease: everything was explained in simple terms. I was particularly interested in how exosomes help cells function more effectively and maintain their normal condition. After the course, I noticed my skin became smoother, the dryness subsided, and my face looked more vibrant. Plus, my overall well-being has improved, and I feel less tired. I'm glad I decided to take this step—the results were better than I expected.
February 14, 2024
Very interesting (to a Hematology NP and admitted nerd) and well researched. I have an admitted bias against allogeneic transplant due to my skewed perception of seeing the worst of its effects. This book was a great lesson in the decades of research and trials to bring transplant to the current improved cure and safety profile it currently has, and its ability to be used for more than just hematologic malignancies (new info to me). I appreciate the transparency in the book about the toxicities, fatalities, and real world issues such as cost and socioeconomic barriers for many patients. 4.5.
July 4, 2024
Fascinating reading for anyone connected to blood cancers
This very readable story of the development of bone marrow transplantation and treatment of blood cancers fascinated me. Seeing the trials, innovations, original thinking and years of hard work what went into all this medical development is amazing. I appreciate the new treatments and accomplishments all the more for reading about the real people and events that brought them about. This book is well worth reading if you have any interest in the topics or in how medical research is developed.
This very readable story of the development of bone marrow transplantation and treatment of blood cancers fascinated me. Seeing the trials, innovations, original thinking and years of hard work what went into all this medical development is amazing. I appreciate the new treatments and accomplishments all the more for reading about the real people and events that brought them about. This book is well worth reading if you have any interest in the topics or in how medical research is developed.
January 5, 2024
Just finished “Living Medicine.” What an excellent read!
I’m about as far from science as one can get, but Applebaum made it so very readable AND understandable. Fascinating research, discoveries and insight into the process of allowing creative thinking to merge with scientific reasoning. I also got glimpses into the world of cancer research, bone marrow transplantation and even a smattering of stem cell discoveries as a result.
A book for laymen / laywomen and scientists both.
I’m about as far from science as one can get, but Applebaum made it so very readable AND understandable. Fascinating research, discoveries and insight into the process of allowing creative thinking to merge with scientific reasoning. I also got glimpses into the world of cancer research, bone marrow transplantation and even a smattering of stem cell discoveries as a result.
A book for laymen / laywomen and scientists both.
December 29, 2025
One of the best science books I have read in a long time. Written with a personal touch, as Appelbaum was a physician and researcher on Don Thomas' team, this book is equal parts a scientific primer and an exploration of principled scientific discovery. The history of bone marrow transplantation highlights how dangerous and difficult the pursuit of game-changing therapies can be, and how remarkable Don Thomas was to persevere through decades of failure based on the smallest glimmers of hope.
August 6, 2023
A very informative, interesting book! Well written so for the most part can be understood by myself, a nonmedical person. The history of the first ideas and trials if marrow transplantation was amazing and a very good presentation of how a small idea grows to become an accepted treatment of today. Congratulations to Don Thomas and his staff
September 24, 2024
How do you write a book about miracles
Starting with nothing but an idea that everyone told you was impossible these scientists made small incremental findings that changed the world.
Each persons contribution, from the environmental staff who make it possible to do research without causing the investigators to become sacrifices to the cures.
Starting with nothing but an idea that everyone told you was impossible these scientists made small incremental findings that changed the world.
Each persons contribution, from the environmental staff who make it possible to do research without causing the investigators to become sacrifices to the cures.
July 14, 2024
Fascinating! Other than being a bit in the science weeds in places where it was hard for me to stay engaged (despite having a science background), it was well organized and I loved the storytelling aspect to this magnificent medical work.
June 21, 2025
An absolute must to understand the courageous and serendipitous journey of the people - researchers, scientists, doctors, patients, donors - who were relentless in finding cures through bone marrow transplants. I am standing on shoulders of giants indeed.
July 4, 2023
Absolutely excellent!
October 25, 2023
Fascinating history
July 4, 2025
Very well written book about the fascinating history of bone marrow transplants. Written in “easy to understand” language with lots of personal stories.
December 28, 2024
I think the book did a beautiful job of explaining the barriers to success for stem cell transplantation, as well as the confluence of events that led to its ultimate success. Enjoyable read on the history of stem cell transplantation, and the key figure behind seeing it to fruition.
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