A diagnosis of acute myeloid leukemia is a shocking, disorienting, terrifying event. Only a month ago, your life was unfolding as usual. Only one week ago, you sensed something wasn’t quite right, noticing just a bit more fatigue and a few unexpected bruises. Only a minute ago, you heard your doctor declare that you have leukemia. Without therapy, you are told that you will likely die in a few weeks and that the only alternative is to receive intensive chemotherapy—which itself could kill you. If, following initial therapy, you are fortunate enough to enter a complete remission, you are advised that you will need further treatment to keep the leukemia from recurring. Later, you will have to make a decision between receiving additional chemotherapy versus undergoing a bone marrow transplant, one of the most crucial and anxiety-producing decisions in all of clinical medicine. Simply, it could happen to any of us, and it did to Nancy Winn.
In Night Reflections, Robert Winn, himself a physician, describes the roller coaster events following his wife’s diagnosis of acute myeloid leukemia. The book is medically and scientifically accurate. More importantly, Dr. Winn’s story is remarkably open, unguarded, and intimate—a personal journey of discovery, friendship, love, and ultimately survival. Dr. Winn’s willingness to candidly explore and expose his own vulnerabilities provides an honest look into the tumultuous and sometimes chaotic events experienced by a caring husband and family as a loved one faces a potentially fatal illness. I believe that almost any physician, staff member, patient, patient family member, or friend will come away with new insights and understanding after reading this moving memoir.
Nancy Winn was blessed to have a supportive husband and family. She was also fortunate to be treated in the current era rather than a few decades ago. Medical advances have been significant in many ways. Although the treatment of acute myeloid leukemia still leaves much to be desired, there has been noteworthy recent improvement in outcomes. Today, the risk of dying from a complication of chemotherapy has dropped remarkably, mostly due to the development of better ways to combat infection. With this advance and the development of new chemotherapies and refinements in their use, cure rates with chemotherapy alone have increased from 15% to almost 50%. Outcomes with bone marrow transplantation have likewise improved over the last several decades, and cure rates of 65% are now regularly reported. The credit for these advances goes to the scientists and clinicians who developed and tested these new approaches. But enormous credit should also be given to the countless patients who willingly participated in the clinical trials that were required to test these new approaches and demonstrate their effectiveness.
Nancy Winn did not have a matched sibling to serve as a donor but rather received her transplant from an unrelated volunteer donor. The first transplant from a matched unrelated donor was reported in 1980. It was obvious from the very beginning that if unrelated transplants were to become widely available, a very large donor registry would have to be created. Remarkably, today over 25 million normal individuals have agreed to be typed and entered into an international registry to provide bone marrow for individuals they have never met and to do so for no financial or other reward. While Nobel prizes and honorary degrees go to leading scientists and clinicians, there are many other heroes in the fight against leukemia, including past patients, volunteer donors and societies, and supportive, loving family members like the Winns.
Frederick R. Appelbaum, MD
Director, Clinical Research Division, Fred Hutchinson Cancer Research Center
Head, Division of Oncology, University of Washington School of Medicine
President, Seattle Cancer Care Alliance in Seattle, Washington