Initially, the transplant was a success. However, about two years later, Laura’s leukemia returned and ultimately caused her death. The Graves family’s story inspired other families to reach out to them, seeking help to find HLA matches for their children. That sparked an idea in Graves to develop a national registry of potential bone marrow donors, but it seemed unreasonable to raise enough money to HLA type hundreds of thousands of donors.

During this time, researchers were improving bone marrow transplant outcomes by developing more effective drugs for bacterial, viral, and fungal complications that often killed patients in the first few months post-transplant. In 1980, O’Reilly extended the possibilities of bone marrow transplants to half-matched donors by depleting T cells from donor transplants (9). “It worked in two kids and then a whole flock of kids with severe combined immune deficiency, who are out there doing all sorts of interesting stuff to this present day,” said O’Reilly. The therapy also worked for patients with leukemia, and demonstrated by removing T cells, researchers could prevent graft versus host disease.

In 1984, George Santos, an oncologist at Johns Hopkins University pioneered the use of the chemotherapy drug cyclophosphamide as a less damaging alternative to total body irradiation by mitigating host versus graft disease. Santos’ work quickly became the new standard in bone marrow transplantation (12).

Several years after Laura’s death, Appelbaum got a call from one of his colleagues about a patient named Elmo Zumwalt Jr., who had lymphoma and needed a transplant. Zumwalt Jr. was the son of Admiral Elmo Zumwalt, who led the entire naval operation in the Pacific during the Vietnam War. He ordered the release of the herbicide Agent Orange, which was later revealed as a carcinogen, to defoliate riverbanks and prevent hidden attacks.

“His son, who was coming to see me, had been a boat captain in Vietnam and had been heavily exposed to the Agent Orange that his father had ordered. They both knew that is probably why he go this lymphoma,” said Appelbaum. While Zumwalt Jr. did not recover, Admiral Zumwalt asked how he could help with the bone marrow transplantation efforts. Appelbaum introduced him to Thomas, who then introduced him to Graves. Together, Zumwalt and Graves convinced the United States Department of Defense to put forward millions of dollars to start the National Marrow Donor Program in 1986, which now lists millions of potential donors.

“Mr. Graves was just extraordinary in terms of getting funds and interest in the development of banks of volunteers who would potentially give a marrow transplant,” said O’Reilly. “Now you have literally millions of volunteers around the world who are HLA typed, who said if needed, they would give their marrow. And we’re now doing thousands of those transplants a year.”

Appelbaum further expanded the field in 1986 with the first documented autologous bone marrow transplantation, in which he replaced localized lymphoma cells with the patient’s own healthy cryopreserved cells (13). “We did that in a small group of patients, and of the first eight, three of them turned out to be cured of their lymphoma. Today, there are 15,000 transplants for lymphoma done, and probably 40,000 autologous transplants done worldwide,” said Appelbaum

In 1988, Joanne Kurtzberg, a physician at Duke University Medical Center, transplanted a young patient with Fanconi anemia using umbilical cord blood from his soon-to-be-born younger sister (3). As of 2019, more than 35,000 umbilical cord blood transplants have been performed worldwide (14).

Today, researchers continue to advance the field, but in the early years, the collaborative competition among researchers across the globe made huge leaps and pushed the field forward. While they argued ideas, they propelled each other and recognized good science.“It was something where everybody sort of knew the common goal,” said O’Reilly. “Now, we’re looking at long term survivals with healthy kids 95 percent of the time.”