Donald Pinkel: The cancer pioneer who “introduced the word ‘cure’ to cancer”

In collaboration with Donald Pinkel’s daughter, Mary Pinkel, the Cancer History Project preserves and publishes material from his personal archive.

The documents include notes on acceptance, personal letters, editorials, photos, video archives and celebrations of his life’s work. The index of the archive, as well as a conversation between Pinkel and his daughter, appear below.

Pinkel was CEO and Director of St. Jude Children’s Research Hospital from its founding in 1962 to 1973. He was also instrumental in the critical years of leukemia research at Roswell Park Cancer Center.

“Donald Pinkel introduced the word ‘cure’ for cancer,” said James Downing, president and CEO of St. Jude. “It was his courage and unwavering dedication to move forward that changed everything.”

Pinkel was the subject of an in-depth profile in Smithsonian Magazine in 2016.

Pinkel is the recipient of the Albert Lasker Award for Clinical Medical Research, the Charles F. Kettering Prize for Cancer Research and the Pollin Prize for Pediatric Research.

When Pinkel won the Charles F. Kettering Prize in 1986, he received the following article in The Cancer Letter:

Pinkel was responsible for developing the concept of total therapy for ALL. His treatment plan included four different phases, with different combinations of anti-cancer drugs used for initial and long-term therapy. He demonstrated the importance of specific central nervous system therapy in controlling the disease, using radiation therapy alone and in combination with drugs injected directly into the spinal fluid. Margaret Sullivan, professor of pediatrics at MD Anderson, has since shown that chemotherapy for spinal fluid on its own is just as effective as radiation.

One of Pinkel’s most important and controversial concepts was to stop the chemotherapy that kept patients in remission. He felt that if they were still in remission after two or three years of chemotherapy, no further maintenance therapy was necessary. He waited for his first seven pediatric leukemia patients to be treated, off therapy, and followed for another five years before publishing the results. Five of that group remain in good health, one drowned on a fishing trip and the other lived 14 years before dying of another illness.

Donald Pinkel, with his daughter Mary Pinkel

Mary Pinkel interviewed her father in November 2008. What follows is an edited excerpt from their conversation.

Mary Pinkel: When you decided to specialize in childhood cancer, did people look at you as if you were quixotic?

Donald Pinkel: Yes. (laughs) They said, “Why are you throwing your career away?”

It was felt that there was nothing you could do about childhood cancer because of the complexity of the disease and the lack of understanding of its origins. It was then the general feeling that you had to know the exact cause of the disease in order to do much about it. There were all kinds of theories, but very little information.

I thought it was very sad and very challenging. [Children] received a fatal diagnosis and were sent home to die.

I was excited by the fact that so many of these young people had been abandoned. A diagnosis was made and that was the end. The parents and the child often felt hopeless, and I felt that I could get in there and at least give them some hope and relief from the suffering.

Fortunately, in 1948, when I was a student, a drug – now called methotrexate, an antagonist of the vitamin folic acid – was shown to cause complete remission of the disease in about one-third to one-half of children with acute lymphocytic leukemia (ALL ).

But the remissions lasted only three to four months and [eventually] the child would die. That was the light at the end of the tunnel. But there was a lot of frustration because it was only temporary and the drugs were very toxic.

Considering that it was frustrating work and so risky, why did you keep working in the childhood leukemia field?

DP: Well, because … no one else was. The disease was neglected and no one did much research or actual care because they were so frustrated. I felt obliged to fill the vacuum.

[In 1954, at age 28, Pinkel contracted polio while treating patients with polio at an Army hospital in Massachusetts. Paralyzed and confined to a hospital bed for several months, he had to learn to walk again.]

While recovering from polio, you began working at Boston Children’s Hospital with Dr. Sidney Farber. Weren’t you in a lot of pain?

Donald Pinkel, with a patient

DP: Yes. I had braces and crutches, but I was improving all the time. I had excellent care in the military and the VA. Being relatively young and otherwise healthy, I had a lot of recovery, so I was able to switch to short leg braces and a pair of walking sticks.

I have been able to gain more experience [in Boston] because that was the Mecca for childhood cancer. People came from all over the world. Dr. Farber had discovered methotrexate and they were always in the lead. At the time, they probably had the number one center in the world for children with leukemia.

In the spring of 1956, I spent three-quarters of my time at Boston Children’s. I was given a new drug to evaluate…. It didn’t work well for kids with leukemia, but it did work for kids who had other cancers. It was a breakthrough.

We also learned that we can shrink a large tumor so that you can surgically remove it. That became a standard therapy, a very important step forward, not only because the drug was effective, but also because it ushered in a whole new way of thinking about cancer treatment.

Then you worked at Roswell Park?

DP: I had this income from the army, an army pension. But they just weren’t paying enough in Boston. I have an offer from Buffalo. Roswell Park expanded. They had never had pediatrics there.

I was offered a job to start a new department of pediatrics at Roswell Park Cancer Center in Buffalo. The salary was better.

The Pinkel Family, Memphis 1965

What was the salary in Buffalo?

DP: They offered me $ 7,000 a year. The maximum I could get in Boston was $ 5,000. I said I need more than that. Mary Lasker had a fund there. From that fund they found another $ 2,000 per year. So I went there for $ 9,000 a year. Not a great amount for a family of six, but we got along well because I had the pension. We moved back to Buffalo.

Have you been to Buffalo for five years?

DP: Then winters started to come to me. Every winter I would swear I had to get out of Buffalo. Finally, the last year we were there, I got pneumonia. I couldn’t shake it off. I really didn’t feel well while continuing to work. I started looking around. As it turned out, the University of Colorado was interested in me.

At the same time they got wind of me in Memphis. They were just building St. Jude Hospital. They wanted someone with childhood cancer, especially leukemia. And there weren’t many people in the field. (Laughs) That’s one thing about getting into a vacuum!

Denver was a very beautiful situation, a beautiful place, a treasure of opportunity. I started to think about it. Memphis was such a sad place medically, very segregated, where not much was happening scientifically. It would be a real challenge.

They’d had a lot of trouble finding a director for St. Jude. Most people thought number one, it’s Memphis; they didn’t want to go there. Number two; it’s a great Hollywood spectacle because it was supported by Danny Thomas and a lot of Hollywood people. And they didn’t want to get involved in that.

The disease was neglected and no one did much research or actual care because they were so frustrated. I felt obliged to fill the vacuum.

Donald Pinkel

I asked, who are the real forces behind St. Jude? They came up with Mr. Ed Barry, Chairman of the Board of Directors and a true rock of a man who was a great philanthropist and great civic leader. And the other was Michael F. Tamer, who was the head of the American Lebanese Syrian Associated Charities. He did all the fundraising that would support St. Jude, in partnership with Danny Thomas of course.

We talked all day about our philosophies, points of view. Like me, Ed Barry was trained by Jesuits. We had common ground. Amazingly, they were liberal. They said there would be racial integration – a big deal for me – and that I would have quite a lot of free rein.

The main motivation for me was the great vacuum, in terms of civil rights, science and the provision of a service that was not met in that part of the US for both white and black children.

What was your greatest professional achievement?

DP: Seeing children heal from cancer and living a good life … like the patient in the book White Blood, a boy who had acute leukemia when he was two. He [grew up], went through college, dual science major, and was awarded a full scholarship to a first-class medical school.

I saw many other kids – some of whom barely survived the first few weeks of leukemia – and they took it through. They have gone on not only to survive but to survive with a good quality of life. [But] you must always weigh the risks of long-term harm against the benefits. You are always gambling, you could say. You don’t want people to live longer, but to live well.

[In 2008, Dr. Pinkel wrote about his journey as a pediatric oncologist in White Blood, a book edited by noted British scientist, Mel Greaves. Donald Pinkel, “A Pediatrician’s Journey” White Blood (London: World Scientific Publishing Co. Pte. Ltd. 2008) pages 13-46.]

Archives kept at the Cancer History Project:

In his own words

Video

Archives

We celebrate Donald Pinkel

Donald Pinkel’s research indicates leukemia in children

Aur RJ, Simone J, Hustu HO, Walters T, Borella L, Pratt C, Pinkel D. Central nervous system therapy and combination chemotherapy of childhood lymphocytic leukemia. Blood. Mar 1971; 37 (3): 272-81. PMID: 4322483.Pinkel D. Five-year follow-up of “total therapy” of childhood lymphocytic leukemia. JAMA. 1971 Apr 26; 216 (4): 648-52. PMID: 5279904 Pinkel D, Simone J, Hustu HO, Aur RJ. Nine years of experience in “total therapy” of acute lymphocytic leukemia in children. Pediatrics. August 1972; 50 (2): 246-51. PMID: 4505343.

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