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Against the Odds

When Lukas Wartman, MD, began medical school at Washington University, he knew he wanted to study cancer and treat patients. What he didn’t know was that by his fourth year of school, he would end up battling the disease he was studying. In 2003, he was diagnosed with acute lymphoblastic leukemia (ALL), a cancer of the blood that is treatable in children but often fatal in adults.

Two years of chemotherapy put the cancer into remission, and Wartman finished his clinical training. In 2008, he relapsed and was treated with chemotherapy and a stem cell transplant from his younger brother. Again in remission, he began fellowship work in the lab of Washington University and Siteman Cancer Center researcher Timothy Ley, MD, chief of the Section of Stem Cell Biology in the Division of Oncology.

In 2011, Wartman relapsed again. While the chances of an adult with ALL surviving one relapse are slim, there are no statistics to suggest surviving a second. Another round of chemotherapy did not induce another remission, and time was running out.

In an attempt to beat the clock, Ley proposed sequencing the genes of Wartman’s cancer cells and normal cells. Researchers also analyzed his RNA, the cellular material that works with genes to orchestrate protein production.

Participants in gene-sequencing research studies do not usually experience a change in treatment based on study findings. However, in sequencing Wartman’s genes, scientists found a normal gene that was producing massive amounts of a certain protein that might be contributing to Wartman’s cancer growth. And they identified an existing drug that could target the hyperactive gene. Once again, Wartman had defied the odds. After treatment, his cancer is again in remission and, though he has since had another stem cell transplant with some adverse side effects, he is doing well.

The ability to sequence the genome and RNA of an individual with cancer did not exist when Wartman’s leukemia was diagnosed. And while this approach to treatment is not yet generally available, researchers envision a future when it becomes routine. Malachi Griffith, PhD, the Washington University researcher who analyzed Wartman’s RNA, says, “We want to be able to take the tumor of every patient that comes into the clinic, sequence the genome and produce a clinical report, just like when a physician orders a blood test.”

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