In 1973, Keith Sullivan, MD and his just married bride, Kristine, found themselves in Belgium.
Fresh off his second year of residency at the University of Washington, Sullivan was called up under the Berry Plan (a Vietnam era doctor draft) to be the chief of medical polyclinics at the NATO hospital. Before heading to Europe, he had rotated on the Seattle bone marrow transplant (BMT) unit led by famed physician E. Donnall Thomas – the father of cellular therapy.
Sullivan wondered what his next steps might be once he left Army Medical Corps. He liked internal medicine, but was drawn to an early rotation in Thomas’ BMT unit at the PHS Hospital in Seattle. Among Thomas’ team were some of the giants of transplant and cellular therapy, and at that time, they were just scratching the surface of what the field could do.
“Don wrote to me while I was overseas, asking about my plans for fellowship after I returned,” Sullivan said. “ I wrote back and said that I wanted to go into intensive care medicine. And true to form, he concisely wrote back: ‘Keith, it doesn’t get more intensive than this. Come join us.’”
Sullivan’s career is nothing short of impressive. From working with some of the biggest names in the field to helping establish ASTCT (then known as ASBMT), Sullivan has contributed so much to this discipline. That’s why he was named the 2020 recipient of the ASTCT Lifetime Achievement Award.
“I’m honored—stunned,” he said. “It’s truly an honor.”
Mentors Who Matter
Like many of his peers, Sullivan didn’t plan on studying hematology or cellular therapy. It wasn’t until he met Thomas and his colleagues (photo) that he realized his passion for it. He watched the relationships among Thomas, Alex Fefer, Paul Neiman, Dean Buckner and Rainer Storb (his primary mentor) —all his beloved mentors—and was impressed by not only their intelligence, but their personalities as well.
“Each was entirely unlike the other,” he laughed. “All had strong personalities and opinions.” But he respected how they worked together to solve problems, how they let ideas form and bubble to the top no matter what they were. And, importantly, they supported each other during the hard times.
He formed a close bond with Thomas’ wife Dottie, too, who always helped check Sullivan’s manuscripts for scientific writing .
“Don and Dottie would spend a lot of time on your paper—and this was before modern word processors—so one would go down the left margin making scientific comments in red ink and the other down the right margin with improvements for English in green. Your paper looked like a Christmas tree when it returned!”
The couple’s dedication to him—and to the many others they mentored along the years—showed Sullivan just how devoted people in the field were. It pushed him to be better, he said, and he worked to have the same sense of thoroughness the Thomases had.
Once they did return a manuscript with no marks at all except their initials at the top: “OK, EDT and ok dt”. It was his first paper in the New England Journal of Medicine.
Starting A Society
By the early 1990s, Sullivan was making his own mark in the field. He was the medical director of the outpatient department at Fred Hutchison Cancer Research Center and established the first multidisciplinary long-term follow-up unit (photo). He and Mark Walters conducted the first multicenter trial of BMT for severe sickle cell disease. As he met more people in the field, he became part of a small group that was starting to consider what the future of cellular therapy would look like.
His friend Richard Champlin, MD, suggested they start their own society, one focused on BMT and stem cell therapy. Sullivan agreed, as did the dozen or so other physicians who made up their group.
Thus ASBMT—the American Society for Blood and Marrow Transplantation—was born.
“ASCO and ASH were huge, but we needed to grow our own field of stem cell transplantation and represent it externally to individuals or groups, whether they were patients, practitioners, regulatory agencies or insurers,” he said.
Sullivan was the second president of the society—now known as ASTCT, or the American Society for Transplantation and Cellular Therapy. He was tasked with starting the new journal for the society, the Biology of Blood and Marrow Transplantation with Richard O’Reilly and Karl Blume as first co-editors.
“You had a dozen individuals who were pioneers in their own right all shedding their ego and coming together to collectively make the field better. We knew that if that occurred, we could not fail,” he said. “And you know, societies fail, journals fail. That can happen, but it didn’t. And that’s part of the pleasure and the honor of being part of this work, because not only do you have the opportunity to intersect in a patient’s life at the most critical of moments, you also have the opportunity to become fast friends with likeminded, hardworking physician investigators here and abroad.”
Seeing the society grow for last 25 years has been one of his proudest accomplishments, he said. “This has been terrific sustenance to keep us all going,” he said. “Knowing we’re combining strengths and supporting one another.”
A New Chapter
For the past 20+ years, Sullivan has also been working on a project he’s extremely passionate about: how stem cell transplants can improve autoimmune diseases—specifically, scleroderma. It’s a devastating disease hardening the skin and connective tissues. It can also present internally, causing fibrosis and failure of vital organs. Systemic sclerosis is both morbid and mortal and expert rheumatologists consider it the worst of the autoimmune diseases, Sullivan said.
For decades doctors believed the only course of treatment for someone with severe scleroderma was some form of immunosuppression and supportive, palliative care. In the mid-1980s, Sullivan came across two research papers in PNAS, one by Robert Good and the other from Dirk van Bekkum.
Both were using animal models of autoimmune diseases and giving full body irradiation before transplant. Good performed allogeneic marrow transplants, which arrested the inherited autoimmune disease, and in some instances, dramatically improved the organs damaged by the disease. Van Bekkum used animal models of antigen induced autoimmune disease employing total body irradiation or chemotherapy alone, followed by an autologous stem cell transplant. Autologous transplant also had a beneficial effect and Sullivan thought to himself: this could be done in humans.
For the first 20 years of his career, he published on late complications of allogenic marrow transplantation and chronic graft-versus-host disease which can induce sclerodermatous skin disease. In naturally occurring scleroderma, the immune system goes hay-wire and attacks the skin and other organs. He wondered if an autologous transplant could right the immune system and improve naturally occurring scleroderma.
He got funding and the greenlight for a pilot study.
“Within months of myeloablative autologous transplant, the skin went from being encased,” he said, “to being elastic. The NIAID-supported pivotal phase III trial confirmed improved clinical outcomes and survival”
Sullivan and his team—both at Fred Hutchinson Cancer Center and later at Duke University, where he currently works—have researched the mechanisms of how stem cell transplants can improve autoimmune diseases. Since arriving at Duke, more than 30 centers nationwide have participated in these clinical and mechanistic trials.
The Next Generation
While successes professionally have been very gratifying, Sullivan said it has also been rewarding to see how the field has changed. And what’s even better is that he’s had mentors, colleagues, friends and family around him for every step.
Proud of their three grown children, Laura, Melissa and Peter, and their families and accomplishments, he and Kristine deeply value the importance of mentoring the next generation. For each of the past 18 years they and 18 other faculty have conducted three-day research skills workshops to help prepare fellows and their families for successful careers as physician scientists. Over 700 fellows from 12 universities have participated in these Outer Banks programs.
“I can say with pride that the field of hematopoietic stem cell transplantation and cellular therapy attracts outstanding trainees and continues to reinvent itself,” Sullivan said. “I am quite honored to have watched, and to have been part of, that evolution. For those of us in the field it’s terrific, because it means there’s always the next discovery that can be brought forward to improve patient care and make transplants safer and better.”