Chapter: 13 Contributing to Advances in Treatments for Leukemia Patients: Drug Studies and the Laminar Air Flow Units
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In this segment, Dr. Bodey first explains the typical approach to treating infections in cancer patients when he began in the field: an oncologist would only start antibiotics once the type of infection had been identified, often too late to save the patient. He tells an anecdote to dramatize how ineffective this approach was, then describes starting antibiotics in a woman with abdominal pain.
Dr. Bodey next talks about the Life Islands he was responsible for at MD Anderson, explaining that an individual from the NCI approached him at a conference and asked him if he would be interested in evaluating them. Dr. Bodey explains the evolution of the Life Islands and tells an anecdote about a young father who stayed in one of the protective environments for 206 days.
Dr. Bodey then sketches some key points in his career. He notes that, over the years, he studied almost every antibiotic and antifungal available. He lists his responsibilities while serving as Chief of Chemotherapy (1975 -1983).
Dr. Bodey recalls the exciting news from the NCI that a researcher had cured uterine cancer. He explains that this announced the beginning of organized therapies that could make a difference in patients, illustrating his point with Dr. Freireich’s four-drug combinations in pediatric leukemia patients, some of whom were cured. He describes these advances as creating “an exciting and optimistic time” when researchers were able to offer leukemia patients another six months or a year to live.
Dr. Bodey briefly notes his work as Director of Clinical Research, overseeing the laminar air flow protective environments in the Lutheran Pavilion.
Identifier
BodeyGP_03_20130723_C13
Publication Date
7-23-2013
City
Houston, Texas
Interview Session
Gerald P. Bodey Sr., MD, Oral History Interview, July 23, 2013
Topics Covered
The Interview Subject's Story - The ResearcherThe Researcher The History of Health Care, Patient Care Professional Practice The Professional at Work Overview Definitions, Explanations, Translations Patients Patients, Treatment, Survivors Discovery and Success Understanding Cancer, the History of Science, Cancer Research Understanding Cancer, the History of Science, Cancer Research Giving Recognition Healing, Hope, and the Promise of Research MD Anderson History
Transcript
Tacey Ann Rosolowski, PhD:
Shall I turn it back on?
Gerald P. Bodey Sr., MD:
Yes, you can turn it on. One other important thing was that—and in the days when I first began getting involved in infections in cancer patients, a typical approach for an oncologist was that they would only start antibiotics after they knew what was causing the infection. One of the important advances was to start giving the patients antibiotics. I mean, you collected all your specimens and all to find out what was going on, but you didn’t wait until the results came before you started the antibiotics. This made a difference because if you waited until you had your results, some of those people already died, and they might have lived if you had started them on antibiotics right at the start of their fever.
Tacey Ann Rosolowski, PhD:
Why did they do that? Why did oncologists do that?
Gerald P. Bodey Sr., MD:
That was not just oncologists; that was Infectious Diseases too. I don’t know if I should tell this story or not. I won’t tell you where it happened. But the chairman of the Department of Medicine at one of the prominent medical schools was also an infectious disease expert. He would come around and make rounds with his medical staff, which consisted of a physician in charge plus the interns and residents and so on, medical students and all. He would come around to each ward a couple of times, once a week or something like that. Well, there was a woman that came into this one service with abdominal pain and fever. They worked her up, and they didn’t know what was going on. They started her on an antibiotic, and she became afebrile.
Tacey Ann Rosolowski, PhD:
What does that mean?
Gerald P. Bodey Sr., MD:
The fever went away.
Tacey Ann Rosolowski, PhD:
Okay.
Gerald P. Bodey Sr., MD:
Within twenty-four hours, and in that twenty-four-hour period, the chairman came around on his rounds and they presented this case to him. He insisted that they stop the antibiotics until they had the results of the cultures, even though this woman had clearly responded. She died, and she would have lived if she had stayed on those antibiotics. So that was the general environment in infectious diseases when I first went to medical school—that you just didn’t treat people with antibiotics until you knew what it was that you were dealing with. Now, the other thing—we’ve already discussed pretty much the laminar air rooms and protected environment units and all that. Just a little addition there—the first life island was started at the National Cancer Institute. Unfortunately, I forget the name of the man who developed them. But they had two units there, and it happened to be at a time when I was no longer at the NCI. I had gone back to my residency training. But when I came to MD Anderson, they had now gotten two of these life islands there, and I became responsible for those. Then someone from the National Cancer Institute came to me one day when I was attending a meeting there and asked me if I was interested in evaluating a laminar airflow room. We talked about it a bit, and I said, “Yes.” So we were the first people to have laminar airflow rooms. It was a little difficult talking the administration into putting these in, because you had two laminar airflow beds, whereas regular beds, we had three. So we were losing some income over that. But we started there, and then we moved over to the other building. We did that in part because they had developed portable laminar airflow rooms. We had five or six of them in the Center Pavilion unit.
Tacey Ann Rosolowski, PhD:
Now, was it the NCI that was responsible for developing the portable ones?
Gerald P. Bodey Sr., MD:
No. It was some private person who actually did it. But they were supporting it. There were—we were not the only ones that were doing it, but we had the largest unit for a while there at the Center Pavilion. It was an interesting experience.
Tacey Ann Rosolowski, PhD:
Last time you gave me some pictures of it.
Gerald P. Bodey Sr., MD:
I should mention—I don’t think I told you this the first time around, but when I first got back to MD Anderson and we had just these two life islands, we had a man—I would say he was probably in his late 30s. He had a wife and two children. She was British. He went into that unit, and he was determined he wasn’t going to leave until he went into remission. He stayed in there 206 days. Then finally his blood counts got better, and it looked like he may have been going into remission. We had to get him out of there at some point. I’ll never forget when I pulled the zippers off the side, then his two little children just reaching and talking and touching daddy. They hadn’t been able to do that for so long. He didn’t get infected in there except some minor infections the whole time he was there, but unfortunately he died within a week after he left the unit.
Tacey Ann Rosolowski, PhD:
Was it from an infection then?
Gerald P. Bodey Sr., MD:
No, it was just his leukemia. We tried everything we had, and there wasn’t anything more to offer. But 206 days living in a tent—I mean, that’s really incredible. So over the years we studied just about every antibiotic that became available. We studied more than twenty new antibiotics in the leukemic population over the years, and some of them were in specific classes like the cephalosporins, and the aminoglycosides like gentamicin, and then the penicillins. But then there were some other drugs that came along like ciprofloxacin and clindamycin and so on. Then as time went on, too, we became more involved in studies of antifungal agents, because our leukemic patients in particular were susceptible to getting fungal superinfections once they had a bacterial infection. We studied clotrimazole and fluconazole and the liposomal form of amphotericin B. So we were involved in a lot of antibiotics over the years. In addition to my interest in the infectious diseases, I was made the chief of chemotherapy in our Department of Therapeutics from 1975 to 1983. During that time we had about thirty new antitumor agents that we studied.
Tacey Ann Rosolowski, PhD:
What was your responsibility during that time?
Gerald P. Bodey Sr., MD:
That’s a good question. It’s been so long I’m not sure. To make sure that we had protocols and that the protocols were being followed and keeping track of toxicities and benefits and so on. And I had been—the National Cancer Institute had an investigational drug committee, in which they had people who were in charge of investigational chemotherapy at several different institutions around the country. We would meet at regular intervals and discuss studies and what things were becoming available and things like that. So that was part of my activity at that time. It was very interesting to be involved in learning these new drugs and what their side effects were. Then in some instances, it turned out and really had some significant benefit. Then the patients—we’re not curing patients—they would go into remission of their cancer and be able to go home and live for several months at least.
Tacey Ann Rosolowski, PhD:
I get the feeling, as you’re telling me about all of these different dimensions of your activities, that this was really a period of time when cancer research was suddenly becoming organized—that there were all these parts of it, and many of them were ground-breaking, and suddenly you were just organizing how it happens so you could understand the results—really quantify the results and get systematic about it.
Gerald P. Bodey Sr., MD:
There were some figures in cancer therapy that were well established in various institutions and we were beginning—Well, actually probably one of the most important factors was the treatment of choriocarcinoma with methotrexate, which is cancer of the uterus. It was at NIH, where I think his name was—I don’t remember his name anymore unfortunately, but this doctor who was the head of that area of cancer chemotherapy began using this methotrexate and curing women of their cancer. I mean, that was a really exciting time. I wish I remembered his name. He is a Chinese man. And that put a different perspective on things. Now we knew that if we had the right thing we could possibly cure people. So that was a real important advance, and I’m embarrassed that I don’t remember him because that really was a milestone. There were several giants in cancer therapy at that time that were working with different drugs and so on and making some progress—not curing people but at least having them go into remission. So it was really the beginnings of organized therapy and therapies that were making a difference. For years, there wasn’t anything, and the drugs that became available were not very effective and often very toxic. But now we were beginning to see some drugs like methotrexate that did have some effect and we could do something. Dr. Freireich got involved in a four-drug combination, and nobody had ever heard something like that. It was called POMP. It was methotrexate and 6-mercaptopurine and prednisone and vincristine. That was very effective and it was used in children. I think some of those children were actually cured. So then that was another component of things that were changing—using combinations rather than just one drug. Originally, you would start with one drug. If that didn’t work, then you had the next drug and so on. Dr. Freireich was one of the pioneers in saying, “Let’s take a couple of the drugs and put them together.” As a matter of fact, some of us thought he was a little crazy when he first did this POMP regimen, but it worked. So there were all sorts of things that were happening in cancer. There were some new drugs that were coming out. Then again, in the field of infectious disease, we were now able to treat some of these infections. In fact, I believe before there wasn’t anything that really worked very well. So there were a whole lot of things going on at this time that made it a much more exciting area, and you were optimistic, like, “Now I got this new drug, maybe this is going to really make a big difference.” And some of them did.
Tacey Ann Rosolowski, PhD:
That must have kept you working, too, that sense of optimism that there was something new, maybe something better just around the corner.
Gerald P. Bodey Sr., MD:
It was really quite a warming experience, when you had somebody with acute leukemia and they were able to get in remission and go home and maybe live another six months or year. So it was really an exciting time. Then I became the medical director of the Cancer Clinical Research Center and assistant to the Director of Clinical Research in 1977. I don’t know. I’ve had more positions over the years.
Tacey Ann Rosolowski, PhD:
What was involved in that?
Gerald P. Bodey Sr., MD:
Part of that was when we had the Lutheran Pavilion construction. The top floor was a laminar airflow facility and those sorts of things. I already mentioned that I was a member of this Phase 1 and 2 cancer drug committee at that National Institutes of Health.
Recommended Citation
Bodey, Gerald P. MD and Rosolowski, Tacey A. PhD, "Chapter: 13 Contributing to Advances in Treatments for Leukemia Patients: Drug Studies and the Laminar Air Flow Units" (2013). Interview Chapters. 997.
https://openworks.mdanderson.org/mchv_interviewchapters/997
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Open
