The First Cell by Azra Raza

Author:Azra Raza
Language: eng
Format: epub
Publisher: Basic Books
Published: 2019-10-14T16:00:00+00:00

I HAD MY eureka moment as I signed her death certificate. JC died because her leukemia was too advanced by the time I saw her. It had taken her a year to cross over from preleukemia to leukemia. I should have treated her at the earliest, preleukemic stage of the disease. Surely, it would be easier to control MDS rather than AML. From that day on, I announced to Harvey that evening, because of JC, I was going to concentrate on studying and treating MDS. Even at the ripe old age of thirty-two, it was clear to me that the animal models were far too simplistic and artificial, utterly incapable of recapitulating a fraction of the complex disease I had seen evolve in JC’s case. The only hope of dealing with so deadly a foe was to detect it at its earliest stage and apply the best available scientific technology to find ways to arrest it before all hell broke loose. If I studied both MDS and AML stages of the disease, I thought, I could define the biologic milestones that mark how preleukemia cells cross over to the frankly leukemic stage. From that, a better understanding of the natural history of the malignant process would emerge, hopefully, yielding novel potential therapeutic targets on the way.

Harvey’s response was, “Az, your idea is spot-on, but I can warn you right now, you will never get a grant funded. MDS is too rare a disease. No one can even pronounce it properly, let alone support your work.” Of course, I did it anyway. And also got grants funded. Had I gone to school in this country, my research would have involved attempts to reproduce the disease in mouse models or to create tissue-culture cell lines from patients’ malignant cells. Being an outsider, I had the audacity to follow instinct rather than custom. I would save every cell I could from every future patient I saw and study them thoroughly. It never occurred to me to do otherwise. While Harvey always provided his intellectual and moral support for my work, he never got interested in MDS and continued his AML work as before. Ours proved to be a great complementary partnership as the two of us were studying different stages of the same disease and compared notes constantly, learning from each other, providing unique new insights for experiments we designed independently and jointly.

To that end, I began my tissue repository, collecting sequential samples from each of my patients throughout the evolution of each patient’s disease. The repository was and is backed by a computerized data bank containing detailed clinical and pathologic information on each patient. The repository is unique in that it provides the ability to look back on survival data spanning three decades. Such a retrospective view of the disease is critical to understanding what makes some MDS patients develop AML or why some succumb to MDS within two years while others survive five, ten, or even twenty years. The serial samples

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