Medical Miracles: Cracking Cancer’s (Genetic) Code
When leukemia threatened the life of a St. Louis oncologist, his colleagues came to his aid by putting him under the microscope.
Photography by David Torrence
Dr. Lukas Wartman stared at the slide. After studying blood samples at St. Louis VA Medical Center years earlier, he’d devoted his career to oncology and hematology. Now, as he approached graduation from Washington University School of Medicine in early 2003, Wartman instantly recognized the cells: leukemia. Seeing the slide firsthand left no room for doubt or denial. It was painfully clear why, at age 25, he’d started to experience overwhelming fatigue, night sweats, and fevers.
Wartman set out to learn more about the disease. He’d carry stacks of papers into his leukemia specialist’s office, peppering his physician with questions. He endured nine months of intensive chemotherapy and
15 months of maintenance chemotherapy, starting a clinical fellowship at Wash. U. after the cancer went into remission. Then, in 2008, Wartman relapsed. Doctors ordered intensive chemotherapy, followed by a bone-marrow transplant from his younger brother. Though the cancer went into remission, Wartman knew the odds: Only 4 or 5 percent of those who have relapsed survive.
There was hope, though. As a college student, he’d listened to Dr. Timothy Ley and Richard Wilson talk about a new type of research that involved sequencing cancer genomes. As Ley had explained it, physicians were simply looking beneath the lamppost, studying what they already knew, rather than examining the unknown beyond—the very makeup of an individual. Some in the medical community were skeptical, arguing that the research was a waste of time and effort, that it was too expensive or wouldn’t translate into practical treatments.
Yet to Wartman, who’d studied mouse genomics in college, the science held the potential to change personalized medicine. He joined Ley’s lab as a research fellow in 2008, just as scientists at The Genome Institute were working to sequence the first acute myeloid leukemia patient’s DNA. Over time, Wartman began to feel stronger, running 6 or 7 miles every other day.
Then, in spring 2011, Wartman relapsed a second time. The day before he entered the hospital for salvage chemotherapy, his colleagues took a blood sample, then set to work sequencing his genetic makeup. In the meantime, he underwent a clinical trial of chemotherapy and hormones, as well as another infusion of his brother’s bone-marrow cells—all to no avail.
Just as it seemed every door had shut, in August 2011, the data came back from The Genome Institute. The DNA results showed myriad mutations, none of which were treatable. An analyst at The Genome Institute, however, noticed an overactive gene, FLT3, in Wartman’s RNA. Better yet, the gene could be targeted with Sutent, a drug used to treat advanced kidney cancer. Wartman’s insurance company refused to pay for the medicine, but he scraped together enough money for a week’s supply.
Within days, his blood counts improved. Colleagues in his division pitched in to buy him a month’s supply of the drug. Two weeks later, a biopsy revealed Wartman’s bone marrow was clean, and other tests showed the same results: The cancer cells had disappeared. That night, Wartman celebrated with his partner over a glass of champagne. Though his health allowed only a few sips, he says nothing had ever tasted sweeter.
He went on to share his story with The New York Times, TV interviewer Charlie Rose, morning talk shows. And though he’s experienced common complications from a subsequent bone-marrow transplant, Wartman remains in remission and cautiously optimistic. Today, the 35-year-old is back at work, seeing patients at Alvin J. Siteman Cancer Center and researching leukemia in a lab at Wash. U. He hopes his story is just the beginning.