Pediatric Leukemia Pioneer Emil J. Freireich Dies at 93

Emil J. Freireich, MD, DSc, a founding father of modern clinical cancer research and the 2015 Giants of Cancer Care award winner for Lymphoid Neoplasms, has died at age 93. The University of Texas MD Anderson Cancer Center, where he was a faculty member for 50 years, announced his death February 1.

Dr Freireich was known for his confidence, passion, and occasional ferocity. He was fired 8 times in his career and his friends were amazed that number wasn’t higher. Bart Barlogie, MD, one of Dr Freireich’s protégés and the 2018 Giants of Cancer Care award winner for Multiple Myeloma believes, for all the honors in Dr Freireich’ career, his mentor deserves even greater recognition for his efforts.

“If they gave the Nobel prize in medicine for clinical advancements, rather purely scientific discoveries, would have been on at least 3 different prize-winning teams for the work he did at [the National Cancer Center],” said in 2015. “The thing is his run did not end there. After he jumped to MD Anderson in ’65, he put together a team that leveraged his insights in combination chemotherapy and other areas to create treatments that have become curative for many other cancers.”

Dr Freireich is credited as the originator of combination chemotherapy for acute lymphoblastic leukemia (ALL), the primary architect of the first cure for a systemic cancer, and a major contributor to the cures for half a dozen other systemic cancer. Early in his career, he helped to invent a device to treat the uncontrolled bleeding common to ALL, the most common childhood leukemia.

He played a key role in transforming MD Anderson from a minor facility to one of the world’s leading cancer centers. Dr Freireich worked at MD Anderson from 1965 to 2015 and led the Leukemia Research Program there for decades. In 2005, the cancer center established the Emil J. Freireich Award for Excellence in Education in recognition of his teaching contributions as a founding member of The University of Texas Academy of Health Science Education.

“Dr Freireich was a giant of modern medicine whose impact on the field of cancer is beyond compare. His passing will be felt around the world and within the MD Anderson community,” MD Anderson President Peter WT Pisters, MD, said in a news release. “For more than 60 years, he pushed boundaries and devoted himself to saving young lives and relieving suffering. Dr Freireich’s compassion and empathy, with a focus on the holistic needs of individual patients, was fused with scientific creativity and perseverance. This rare blend of exceptional qualities has created a lasting legacy that will forever be part of the history of cancer research and that of MD Anderson.”

In 1955, Dr Freireich joined the newly-established National Cancer Institute (NCI) where he was assigned to care for children with leukemia. He noticed that most patients bled to death before undergoing treatment and hypothesized that the bleeding was caused by insufficient platelets. That led him to develop and patent the first continuous-flow blood cell separator.

He went on to partner with Emil “Tom” Frei III, MD; Charles Gordon Zubrod, MD; and James F. Holland, MD, the 2016 Giants of Cancer Careâ award winner for Hematologic Malignancies; to begin investigating chemotherapy drug combinations to treat childhood leukemia. They hoped to harness some of the same techniques that had recently cured tuberculosis.

Dr Freireich and his colleagues administered methotrexate, vincristine, 6-mercaptopurine (6-MP) and prednisone—now known as the VAMP regimen—to patients with ALL in a 1961 trial. The medical establishment feared the 4-drug regimen would be as fatal as the disease.

“Instead, 90% of them went into remission,” Dr Freireich said in an interview. “It was magical.”

Freireich later developed the POMP regimen, the first “curative therapy” for metastatic cancer in childhood ALL. The American Cancer Society today says the five-year survival rate for pediatric ALL is about 90% overall.

MD Anderson recruited Drs Freireich and Frei to launch a chemotherapy program in 1965. They formed the Department of Developmental Therapeutics and hired scientists to develop drug combinations that cured various cancers based on the same methods used to treat childhood leukemia.

Dr Freireich went on to perform leukocyte transfusion and demonstrate engrafting of peripheral blood stem cells, providing allogeneic bone marrow grafts. Further, he developed allogeneic platelet transfusion and treatment strategies for infectious complications.

“He truly is the father of modern leukemia therapy, being the first to test leukemia drugs and to drive innovation in a disease that no one else had the courage to confront with his force,” Hagop Kantarjian, MD, chair of leukemia at MD Anderson and the 2014 Giants of Cancer Careâ award winner for Leukemia, said in a news release. Kantarjian met Freireich in 1978 as a fourth-year medical student and eventually joined him on staff. “He encouraged us to dare and challenge existing dogmas in cancer research. He inspired my passion to work toward cures for patients and to change the face of this disease.”

Dr Freireich is survived by his wife, Haroldine, their 4 children, 6 grandchildren, and 3 great-grandchildren. Details are pending for a virtual service in his memory. In lieu of flowers, the family would appreciate donations to MD Anderson via mdacc.convio.net/goto/Freireich.