A giant in BMT survivorship

Photo of Dr. Mary Flowers examining a patient — Dr. Mary Flowers examines Ted Ave'Lallemant, a patient in the Long-Term Follow-Up program at Fred Hutchinson Cancer Center. Flowers cared for bone marrow transplant survivors over three decades. Fred Hutch file photo

Small in stature but giant in her impact, Dr. Mary Flowers, longtime medical director of the Long-Term Follow-Up program, a comprehensive survivorship program for blood and marrow transplant recipients, is retiring from Fred Hutchinson Cancer Center.

Flowers, a native of Natal, Brazil, credits the pioneers of Fred Hutch’s BMT program, including Nobel Prize recipient Dr. E. Donnall Thomas, for training and equipping her to establish a national clinical and research BMT program in Rio de Janeiro. At the time, the country’s socialized medicine system required Brazilians to request that their government pay for them to travel to the U.S. for a transplant.

In 1987, six years after Flowers’ three-month stint at Fred Hutch with Thomas, she immigrated to Seattle with her husband, David Flowers, who had been hired as a research lab technician. Flowers did not have a job, but one day, she recalled, Thomas called her at home, where she was caring for her 1-year-old daughter. He asked her to come help on the BMT ward because a fellow was out sick. That marked the beginning of a stint as a visiting physician, followed by a one-year fellowship during which she worked in Dr. Rainer Storb’s lab.

Eventually, she was hired as a staff physician and ultimately became director of the Long-Term Follow-Up (LTFU) clinical program, whose comprehensive care for transplant survivors became a model for other institutions including MD Anderson and Memorial Sloan Kettering Cancer Center, as well as centers from South America, Europe and Asia, which sent their doctors to visit, observe and train with her.

Photo of Dr. Mary Flowers speaking on stage at the 2022 Blood and Marrow Transplant Reunion on the Fred Hutch campus. — Dr. Mary Flowers speaking on stage at the 2022 Blood and Marrow Transplant Reunion on the Fred Hutch campus. Fred Hutch file photo

When Flowers began working at the LTFU program, the clinic saw five patients a week. That number has increased more than six-fold since then, in no small part due to Flowers’ efforts. The clinic is tracking 6,500 patients post-transplant, including a 47-year survivor.

“I love the Hutch,” Flowers said. “I was lucky to land in the Hutch LTFU, originally established by Keith Sullivan as a clinical research program, and privileged to have had great mentors throughout my career including Paul Martin and so many more. Hutch is my identity. It's my home, where I really learned about the power of science and its translation into excellent patient care. I will carry the Hutch with me forever, and I’m leaving the program very robust with very good people who will do so much more to advance the field.”

Physician-scientist Dr. Stephanie Lee, who is the research director of the LTFU program, noted that Flowers was involved in the first randomized trials of treatments for chronic graft-versus-host disease (GVHD), a common BMT complication that can result in problems including skin thickening and decreased joint movement, painful mouth ulcers that make it difficult to eat and dry eyes that feel like sand is in them.

"She was doing research in this field way before others became interested,” Lee said. “She was a pioneer. When I entered the field in the mid-90s, her name was on so many of the papers reporting observational research and treatment trials.”

Unlike some researchers who can be proprietary about the subjects they’re studying, Flowers took the opposite approach, training and welcoming others to research chronic GVHD and survivorship. “Mary thinks the more, the merrier — all hands on deck to try to address these issues,” Lee added. "She is collaborative and shares what she knows and really helps set the tone for this field."

Flowers credits the opportunity to meet, train and collaborate with physicians from all over the world with teaching her "to be humble and open to new ideas.”

Photo of Dr. Stephanie Lee in a black blazer and maroon turtleneck

‘She was doing research in this field way before others became interested. She was a pioneer.’

— Fred Hutch's Dr. Stephanie Lee, research director of the Long-Term Follow-Up program

At a recent Fred Hutch reunion of BMT survivors, Flowers introduced pediatric transplant survivor Juliana Lanza Neves, her patient from 30 years ago. Neves recovered and became a pediatric oncologist at a BMT unit in a cancer center in her native Brazil, cementing her bond with Flowers. “In Brazil, I am a doctor,” Neves said before the event. “But in Seattle, I am a survivor. This moment is very important to me.”

Ted Ave’Lallemant, who received a transplant 17 years ago, also credits his health to Fred Hutch. A Wisconsin resident, Ave’Lallemant came to Seattle upon his oncologist’s recommendation. Although he could have accessed annual check-ups closer to home, he felt so bonded to his transplant team, including Flowers, that he returned each year for his annual assessment at the LTFU clinic before he was formally discharged in 2018. “Dr. Flowers would come into the room at the end of every visit and size me up,” he says. “She was always very comforting, even though she’s this tiny woman and I’m a big guy."

“At every visit, I would say, ‘Dr. Flowers, am I cured?' and she would say, ‘We don’t really use that word a lot.’ At the 10-year mark, I asked her, ‘How about now? Am I cured?' She said she just couldn't commit.”

At Ave’Lallemant’s last visit, he asked yet again. This time, he got a different answer. "She put her little hands on my cheeks and said, ‘Ted, you’re cured.’”

Caring for patients like Ave’Lallemant and Neves has been the honor of her career, says Flowers. “I have learned so much from every patient as each is so unique,” said Flowers. “It’s a privilege to be so close to people who once had a death sentence and help them navigate post-transplant life.”

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