It's all in the details: How Blume advanced cancer care

Pioneer in bone marrow transplantation laid the foundation for a new era in cancer treatment

Steve Fisch Photography

Karl Blume trained the physicians who now run four of the top bone marrow transplantation programs.

Upon retiring as professor of medicine in 2003, Karl Blume embraced a task that had stymied others at Stanford on and off for two decades: He began working on Stanford's application to join the 39 existing programs across the United States that have been designated as Comprehensive Cancer Centers by the National Cancer Institute. These centers have greater access to NCI resources and funding.

Previous efforts had never managed to produce a finished proposal, as many at Stanford felt the benefits of NCI designation weren't worth the hard work of putting together an application. But almost three years to the day from when Blume took on the project, Stanford submitted a roughly 1,200-page, 5-inch thick application.

Robert Negrin, MD, professor of medicine, said the proposal bears Blume's hallmark perfection. "The breadth, the scope, the internal consistency, it's all him," Negrin said. He recalls once bemoaning a less-than-stellar grant and having a colleague retort "what do you expect, it's not a Blume proposal."

To pull together this proposal, Blume persuaded many skeptics to rethink the value of being NCI-designated and contribute to the effort. Few others could have pulled that off, said Bev Mitchell, the deputy director of the Stanford cancer program, noting, "It required someone who had been here and has the respect of the community."

Blume's accomplishment was the latest in a long career that has helped to shape and advance the treatment of cancer at Stanford and at medical centers around the nation. In a field where some view research as a sort of rugged individualism, he has stood out as the quintessential collaborator, bridging gaps between young and old, Stanford and other institutions and between basic and clinical researchers.

"What counts for a physician-investigator leading a research program is that you can bring people together and make progress in your field," Blume said. "You want to look back on your career and feel that you have made a difference."

Mentor to many Blume works from a secluded office, hidden behind a nondescript door in the hospital. Inside, the antique furnishings and view of a courtyard give the impression of an old world library, with wall-high, glass-front cabinets, parlor chairs and a formidable desk. Sitting on top of the cabinet is the Lifetime Achievement Award he received earlier this year from the American Society for Blood and Bone Marrow Transplantation, an organization he helped to found in 1994.

This serene setting shows how far Blume has come since 1987, when he arrived at Stanford with the directive to build the school's bone marrow transplantation program. At the time, only four children with life-threatening blood cancers had received such transplants. Now the division is regarded as one of the best bone marrow transplantation groups in the country—an honor best illustrated by its being among the 10 schools funded by the NCI.

Blume noted that of the 10 NCI-funded programs, he founded one and mentored the people who now head up three of the others.

"I think that reflects on the program we built here," Blume said. He said it's satisfying to see his influence spread through people he mentored and then on to the next generation of scientists.

One of those people Blume mentored is Negrin, who took over as chief of the Bone Marrow Transplantation division when Blume stepped down as director in 2000. Negrin said that what stands out about Blume is his ability to lead groups and develop individuals, and his incredible organization. "Everything I've learned about how to lead a group I learned from him," Negrin said. That includes making time for colleagues and fostering the careers of junior faculty.

Although Blume was well-known for his own research, Negrin said Blume also built collaborations with other groups and took the time to help junior researchers. "He has always been enormously generous with his time," Negrin said. That generosity stands out in a field where individual accomplishments are how researchers get ahead.

Another physician who trained under Blume, Nelson Chao, MD, now chief of the Division of Cellular Therapy/BMT at Duke University, said that Blume led by example. "People probably went farther for him than they would have otherwise," he said. "He has the ability to bring out really good qualities in people." Chao said Blume encouraged him to write papers and grants that he might not otherwise have attempted.

Part of the example Blume set was his empathy for patients and his meticulous preparation. "When something went out it was polished," Chao said.

From bench to bedsideBlume was born in Germany and received his MD from the University of Freiburg in 1963. He had been doing research in red blood cell biochemistry with the leader of that field when at a meeting in Europe he met Ernest Beutler, MD, now professor and chair of the department of molecular and experimental medicine at the Scripps Research Institute but then at City of Hope National Medical Center near Los Angeles. "Even at that time I think that he recognized that bone marrow transplantation had a more important future than studying red cell metabolism," Beutler said. In 1971, Blume took a sabbatical from his assistant professorship at the University of Freiburg to work with Beutler.

Based on Blume's early work, Beutler said he was not surprised at how Blume has since advanced. In 1975 when Beutler saw the need for a bone marrow transplantation program at City of Hope Hospital, he recruited Blume to get it off the ground. "He was very well-organized," Beutler said. "He had really good people skills."

Beutler recalled how in an early transplantation, Blume had organized the procedure to the most minute detail. "Nothing was left to chance. There was no whoops factor," Beutler said.

At that time bone marrow transplantation was in its infancy. Starting a program meant more than simply recruiting and training doctors and researchers. Blume needed to train nurses in how to care for the immune-compromised transplant patients, arrange for tissue typing of donated marrows, convince other physicians of the merits of bone marrow transplantation and work with a reluctant administration. All of which he did with great skill, said Beutler.

"I really have felt very proud of his career," Beutler added.

Blume's success at City of Hope brought him to the attention of Stanford officials, who were eager to develop their own bone marrow transplantation program. After arriving here, one of Blume's first steps was to pull together the few transplantation doctors and the blood and bone marrow researchers, a move that laid the foundation for the program's development. Having collaborations among the bench scientists and surgeons, Blume explained, was essential to moving the field forward. "We served as a good example that what was developed in the lab could be translated to therapies," he said.

That concept of translational medicine is now a staple of research initiatives at Stanford and elsewhere. "He saw that before it was fashionable," Negrin said. One aspect of Blume's approach that was unusual was his interest in learning basic biological principles from the patients whom he treated. "He really pushed the idea that we can learn a lot from the patients," Negrin said.

But Blume's primary interest in patients is as human beings, not as research subjects. Compassion remains his priority. With the CCC application behind him—a final decision is expected from the NCI later this year—he plans to develop a cancer fellowship program to train future doctors and to help build relationships with local hospitals to bring more cancer patients to Stanford. Having established a world-class transplantation program, Blume wants to increase the numbers of patients who benefit from it.

When asked what he is most proud of in his career, Blume responded that it is the patients he treated. "They are what is important in the end," he said.