Central figure in finding a cure for children with leukaemia
PROFESSOR DONALD PINKEL, who has died aged 95, was at the forefront of the revolution which turned childhood leukaemia from an invariably fatal disease in the 1950s to one that can now be cured in more than 90 per cent of sufferers.
After the Second World War, a better understanding of how bone marrow produces blood led to the development of anti-folate drugs such as methotrexate, which were used by Sidney Farber in Boston to treat children with leukaemia.
Further compounds were developed and several drugs, including corticosteroids, became available. However, responses to single drugs were short lived and the leukaemia relapsed.
The major breakthrough came from the St Jude children’s research hospital in Memphis, Tennessee, where Pinkel took the bold step of giving combinations of drugs – an approach he called “total therapy”.
In Pinkel’s early “total” studies patients went into remission, but after a while the leukaemia would return and often in unexpected places – in and around the central nervous system and the cerebrospinal fluid, and in boys the testes. Pinkel called these “sanctuary sites” where the nascent leukaemia cells seemed to be protected from the anti-leukaemia drugs, which were given either intravenously or by mouth.
Novel ways of treating leukaemia in these sanctuary sites were found, initially by injecting drugs into the cerebrospinal fluid through a lumbar puncture and by giving irradiation to the brain and spinal cord. This was the big breakthrough which brought better long term survival rates and cure.
But Pinkel and other pioneers of the time faced hostility from established doctors whose arguments, Pinkel recalled in 2008, went as follows: “Childhood cancer is hopeless, until we know its cause, and besides cancer is an adult disease, not a paediatric problem. Don’t give those poisons; let the children die in peace. Don’t waste your career pursuing a hopeless cause.”
Pinkel and his fellow pioneers persisted, though, with the result that the majority of children with leukaemia are now cured.
Donald Pinkel was born in Buffalo, New York, on September 7 1926, to
Lawrence, a hardware salesman and Anne, a housewife. After high school he enlisted in the US navy and was allowed to study at Cornell University. He later qualified in medicine at the University of Buffalo and joined the US Army Medical Corps.
During his service he contracted polio. He slowly recovered but was left with a limp. During his recovery he worked with Sidney Farber in Boston and developed a fascination with leukaemia.
In 1956 he was appointed Chief of Paediatrics at Roswell Park in Buffalo, but did not like the harsh climate, and when a new hospital, St Jude’s, opened in Memphis in 1962 Pinkel was recruited as Professor of Paediatrics as well as chief executive.
It was there that he tested his ideas for leukaemia treatment, and St Jude’s remains one of the world’s leading children’s cancer research centres.
Pinkel moved on to Milwaukee and Houston before retiring in 2001. He completed his career by teaching biology at a local state polytechnic.
In 1974 he was invited by the British Paediatric Association to give the Windermere Lecture at Harrogate. This alerted British paediatricians to the fact that leukaemia in children was now treatable, and prompted a step change in attitude for referral of leukaemia cases to the rapidly developing children’s cancer centres.
Pinkel, who received many awards for his work on leukaemia, married Marita Donovan in 1949 and they had eight children. The marriage was dissolved and he married, secondly, Cathryn Howarth, an English paediatric oncologist whom he had met on his visit to Harrogate and with whom he had another child.
Donald Pinkel, born September 7 1926, died March 9 2022