Here in the Northwest, where we take pride in being actively engaged with our beautiful natural surroundings, there’s a growing health issue no one can afford to ignore: Smoking, you say? The lack of Vitamin D? Cancer, perhaps?

The obesity epidemic that is gripping America is now the top public health concern among the majority of Puget Sound adults polled in a recent survey by Seattle Cancer Care Alliance, the treatment arm of the Hutchinson Center.

With obesity linked to diabetes, heart disease and other conditions, and two-thirds of American adults now classified as obese or overweight by the Centers for Disease Control and Prevention, it is no exaggeration to call obesity a public health crisis.

A growing body of research also is showing us that obesity is strongly associated with cancer risk, which has given health experts pause that science could lose momentum in its fight against cancer.

This is one of the reasons why several of our researchers are studying these obesity-cancer links. Last year, Dr. Anne McTiernan, director of our Center’s Cancer Prevention Program, put the obesity epidemic within a cancer-related context: “Obesity is almost like the new smoking,” McTiernan told the Los Angeles Times. “The effect isn’t as big for most cancers, but it’s so prevalent that it will have a huge impact.”

In recent years, Hutchinson Center researchers have linked, or are studying the relationship between, obesity and a host of cancers:

• Abdominal obesity is a strong risk factor for Barrett’s esophagus, a precancerous condition, according to research by Dr. Thomas Vaughan.
• The Center is the coordinating hub for the Transdisciplinary Research on Energetics and Cancer, or TREC study, which is studying the link between obesity and colorectal cancer.
• Obesity, smoking and alcohol consumption all significantly increase the risk of second breast cancers among survivors, according to research by Dr. Christopher Li.
• Researchers have discovered that obesity is associated with an 80 percent increase in the risk of high-grade, aggressive prostate cancer.
• The National Cancer Institute considers obesity so important that it recently extended the Hutchinson Center’s role by five years as the coordinating hub of a nationwide consortium studying obesity’s link to cancer.

“This investment reflects the urgency of the problem and the need to accelerate scientific progress to inform cancer-control strategies,” said Dr. Robert Croyle, director of the NCI’s division of Cancer Control and Population Sciences.

The Hutchinson Center’s Statistical Center for HIV/AIDS Research & Prevention played a major behind-the-scenes role in the HIV prevention study that Science magazine recently chose as its scientific breakthrough of the year for 2011.

Last May, the HIV Prevention Trials Network study, known as HPTN 052, showed that the early use of antiretroviral drugs reduced heterosexual HIV transmission to uninfected sexual partners by 96 percent. More than 1,700 couples in which one partner is HIV positive and the other is HIV negative from nine countries on four continents participated in the study.

The Center’s Dr. Ying Chen was the lead statistician for the study and the second author of the paper, both led by Dr. Myron Cohen of the University of North Carolina at Chapel Hill. Drs. Thomas Fleming and Lei Wang also contributed.

Our HPTN 052 team helped design the study and develop its blueprint with the principal investigators. They worked with an independent data and safety monitoring board as it reviewed the study’s safety and efficacy data twice yearly. Since the study began participant enrollment in 2005, the team processed almost 518,000 forms containing the study volunteers’ medical data, conducted the interim analysis and provided all of the statistical support for the paper.

This data crunching, attention-to-detail role gets little fanfare but is crucial to forming accurate conclusions and study results. And when time is precious and the stakes are as high as preventing AIDS, their commitment is critical.

“In combination with other promising clinical trials, the results have galvanized efforts to end the world’s AIDS epidemic in a way that would have been inconceivable even a year ago,” wrote Dr. Bruce Alberts, editor-in-chief of Science, in his Dec. 23 editorial about the breakthrough.

“This is not to say that we can abandon the search for an AIDS vaccine. Nor will profound change come overnight from the promise of using treatment as prevention. But for its role in making success conceivable, we have chosen the results of this trial as our breakthrough of the year.”

Dr. Siddhartha Mukherjee’s homage to the bravery of cancer patients in his Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer, struck a chord with me. It made me think of my sister-in-law, Jenny, and her battle with aggressive multiple myeloma.

“The story of cancer isn’t the story of doctors who struggle and survive, moving from one institution to another,” Mukherjee wrote. “It is the story of patients who struggle and survive, moving from one embankment of illness to another. Resilience, inventiveness and survivorship—qualities often ascribed to great physicians—are reflected qualities, emanating first from those who struggle with illness and only then mirrored by those who treat them. If the history of medicine is told through the stories of doctors, it is because their contributions stand in place of the more substantive heroism of their patients.”

I’ve written about Jenny before as she hoped back-to-back stem-cell transplants would buy her a long reprieve from the relentless march of her myeloma. They didn’t.

A battle against the ‘incurable’

When Jenny’s blood work started to show a rise in her incurable cancer last December, she returned to Seattle Cancer Care Alliance, the treatment arm of the Hutchinson Center, and started on a late-stage clinical trial with an immunomodulator called Rivlimid.

Many cycles of that drug knocked her myeloma down again, but blood tests in September confirmed an upward trend in her M protein levels (a measure of myeloma’s presence in the blood), necessitating a new game plan. This is common with a tricky foe like myeloma: advance, retreat, adjust.

She’s been on other clinical trials since then, all with the realization that the various chemotherapies have dampened, but not defeated, her myeloma. This disease—like many our patients face—is a tough customer.

In the months when a drug is working, Jenny and her husband, Bob, are confident of the path. “The sudden turns—the transitions when it’s not clear what’s working or not, or even what the next option presents—are the hardest emotionally,” they admit.

This is the world of clinical trials, ripe with promise and pitfalls. With a disease that has yet to be defeated, such trials offer patients access to promising new interventions that are generally not available outside of a clinical trial.

If the treatment proves more effective than standard therapy, trial participants may be the first to benefit. And for Jenny, who yearns for someone, someday, to benefit from her struggle, the trial results may help other people who need cancer treatment in the future.

Jenny faces a new clinical trial

With some trepidation, Jenny signed a 19-page consent form this month to join a new phase 1 clinical trial involving three proven drugs not given in combination before. She is one of the first patients in the world to receive this treatment and SCCA’s only patient on the regimen.

Getting a spot was a little like winning the lottery but being unsure you want the prize. As Jenny said, “I’m more comfortable being in the third wagon train over the pass, but I’ve tightened my bonnet strings and ventured forth as a real pioneer.”

Unlike later-stage studies, a phase 1 trial is primarily conducted to learn how safe a treatment is and to determine the medication amount that can be given safely. Jenny’s doctors, of course, also want to learn how well her cancer responds to this treatment.

New interventions are often studied in a stepwise fashion, with each step representing a different phase in the clinical research process. Ideally, patients would like to enroll in a phase 4 study, which builds upon earlier, successful studies to further evaluate the effectiveness and long-term safety of drugs or other interventions.

They usually take place after a drug or intervention has been approved by the Food & Drug Administration for standard use. Jenny’s new treatment may reach that phase someday, but for now, the building blocks are being laid.

The heroism of cancer patients

In my eyes, that she could read that lengthy consent form warning of rare side effects like multi-organ failure, leukemia, cerebral hemorrhage, and more, and forge ahead, is the “substantive heroism” of cancer patients of which Mukherjee writes.

“There are days when I think of Jenny’s treatment as though we are riding a series of waves, each moving her life forward,” Bob said. “As one wave’s power wanes, another comes along and picks her up.

“After awhile, I realize that it’s not about any particular wave, but more about the ocean itself: The accumulated knowledge of patients and doctors, caregivers, nurses and researchers contributing to the treatment of this disease,” he said.

“That’s the force that carries us forward. And Jenny isn’t just a passenger or beneficiary of this; she’s one of the reasons it moves forward. Doctors and patients together making a difference. And every new day we live that wonderful consequence.”

How’s this for an easy, diet-related New Year’s resolution: If you can’t give up snacking between meals, just make sure nothing hits your belly between breakfast and lunch.

A new study by the Hutchinson Center’s Anne McTiernan, a cancer prevention researcher, shows that the little bites you have after breakfast and before lunch—the pastry at the coffee stand or the sweet hidden in your desk drawer—is taking a big bite out of your diet plan.

McTiernan led a yearlong study that found dieters who had a snack between breakfast and lunch lost an average of 7 percent of their body weight, while those who didn’t lost 11 percent.

Dr. Anne McTiernan

“We think this finding may not relate necessarily to the time of day one snacks, but rather to the short interval between breakfast and lunch. Mid-morning snacking therefore might be a reflection of recreational or mindless eating habits rather than eating to satisfy true hunger,” McTiernan said.

But snacks aren’t all bad, according to McTiernan.

“Snacking could be part of a dieter’s toolkit if they’re eating in response to true hunger. Individuals should determine if they experience long intervals—such as more than five hours—between meals. Adding a snack might help people deal better with hunger and ultimately help them to make more sound choices at their next meal,” she said.

But what if your stomach starts growling at 10:30 in the morning?

“Many people think that a weight-loss program has to mean always feeling hungry,” McTiernan said. “Our study suggests that snacking may actually help with weight loss if not done too close to another meal, particularly if the snacks are healthy foods that can help you feel full without adding too many calories.”

So, reach for a non-fat yogurt, string cheese or fruit—items with protein that pack a nutritional punch and are low in calories.

The snack findings are part of a larger trial to test the effects of nutrition and exercise on breast cancer risk.

Here’s something else to chew on:

• Nationwide surveys indicate that 97 percent of U.S. adults report snacking.

• One study found that the most commonly preferred snacks were salty and crunchy items such as potato chips, pretzels and nuts; baked goods such as cookies and cakes; fruits; and ice cream.

A few years ago, Joanne Wilkie might have thought you were crazy if you told her she’d spend this Thanksgiving traveling from her native Scotland to a small city in the Eastern Washington desert. She would have found it even stranger to hear that her bone marrow cells got there six years before she did.

In 2005, Wilkie had some of her bone marrow extracted in a London hospital to help Ryan Kilbury—a man she’d never met who was being treated by Hutchinson Center doctors—in his fight against myelodysplastic syndrome. Wilkie’s cells were flown here to Seattle, where they were transplanted into Kilbury as part of a therapy that cured his disease. Now, Kilbury lives in Pasco, Wash., the father of three children who came far too close to losing their dad.

This year, the Kilbury family invited Wilkie to join them for Thanksgiving, giving them the chance to finally express their gratitude in person. As part of the visit, they toured the Hutchinson Center and met the doctors and researchers who delivered Kilbury’s lifesaving treatment.

To Wilkie, donating her cells was a no-brainer. She’s a firefighter who makes helping other people her personal mission.

“In my line of work, I save lives—it’s what I love to do—and this was just something else I could do to help someone,” she told a British newspaper.

Wilkie’s words—and her willingness to translate them into action—are a reminder of how progress against cancer relies on something more fundamental than research. It relies on the part of the human spirit that drives us to help others in need.

This Thanksgiving, we’re grateful to everyone who has harnessed this spirit to help push our mission forward. The research that enabled therapies like the one that saved Ryan Kilbury would not have been possible without the participation of clinical trial participants, bone marrow donors, financial supporters and all the other people who make up our community. The Hutchinson Center thanks you all.

1. Know your holiday stress points. Do certain family members put you on edge? Do you take on too much and then find you don’t have time for it all? Start by asking yourself what makes you feel most pressured or irritable, and then what choices do you have to make this stress more manageable. If you have to see a difficult relative, can you arrange something fun afterward? This way you can remind yourself that in a few hours you’ll be doing something that you enjoy. It will help you get through a potentially difficult time.

2. Are there holiday events or traditions you could live without? Can you gracefully bow out of gatherings or obligations you no longer enjoy? Do you really need to bake all those cookies? Can this be the year you send a Christmas email or a link to your Facebook page instead of all those cards?

3. Are there non-holiday events you could postpone for a week or two? If your holiday to-do list is longer than Santa’s, perhaps schedule your next routine CT scan or mammogram after the holidays.

4. Remember your precious people. Schedule “together time” with those who may need you the most this holiday season, or those you most want to see. By scheduling ahead you can make sure you make time for what matters most to you. Our bodies and brains respond positively in lots of ways to time spent connecting with those we are close to; consider this important for your health during the holidays.

5. Keep moving. Physical activity is the clearest step you can take to benefit your health during the holidays and any time of year. It is certain to make you feel good and help your body and brain to function better. It can even reduce your cancer-related risks. Make opportunities to walk or take stairs for at least 10 minutes at a time. If exercising alone is hard, check with your local Y to see if they have a program for cancer survivors.

6.  Practice healthy nutrition. Know what foods help you feel and do your best, then focus more on giving your body what it needs (such as fruits and vegetables) and less on trying not to eat certain foods. Eat sweets in moderation and make sure you also get protein, fiber and healthful fats. Eat your healthy food before going to a party so that it is easier to indulge in moderation. Make an appointment with a nutritionist if you are unsure what is healthy for you or if you have digestion problems.

7. Know how alcohol affects your health. Alcohol use has been associated with an increased risk of certain cancers. If you drink, do so in moderation (one drink a day for women and two for men).  Before a social event, plan ahead what and how much you’ll drink. Alternate between alcoholic and non-alcoholic drinks, such as sparkling water with lime, to help pace yourself and stay hydrated. If it’s hard to say no once you’ve started drinking, then plan to stick with non-alcoholic drinks.

8. Relax your body and mind. When you are more relaxed you sometimes get more done—and feel better doing it. When you feel wound up or overwhelmed, take five minutes to breathe deeply and scan your body from head to toe. Close your eyes and breathe in through your nose to a count of four, hold your breath for a count of two, breathe out through your mouth for a count of four, and repeat. Check your forehead, jaw and tongue for tightness, relax; then check your neck and shoulders, stretch and move them to find a comfortable position, then continue with your arms, chest, abdomen and legs. You can even breathe and relax your body while driving – just don’t close your eyes!

9. Tend to your body’s needs. Notice if there are parts of your body that aren’t working well. Make a list and an appointment with your doctor for after the holidays. Talk with your doctor if you have fatigue that hasn’t improved with time; mental fog that makes it hard to work or remember things; neuropathy (numbness or pain in your feet, hands or elsewhere), incontinence or other problems that affect your quality of life. Knowing you have a plan for attending to these problems can ease your mind during the holidays and let you focus on other things.

10. Have a long-term plan for your survivorship care. Schedule an appointment to go over your survivorship needs if you aren’t sure about your risks for long-term problems or you aren’t sure what symptoms to watch for to maintain your health. Tap into a survivorship program to help you detail a follow-up care plan to share with your primary care provider. Make appointments now so you can forget about them during the holidays.

In the Northwest region, visit the website of the Fred Hutchinson Cancer Research Center Survivorship Program at www.fhcrc.org/survivorship. For information on other LIVESTRONG Survivorship Programs of Excellence visit www.livestrong.org/What-We-Do.

On a pleasant fall evening recently, dozens of children and their families rambled through the Hutchinson Center—a place typically reserved for serious cancer research—eating, laughing and dancing.

The children are brain tumor patients, some newly diagnosed. Others are young survivors with parents who continue to count their blessings. They all share an unbreakable bond with the host, Dr. Jim Olson, a member of the Center’s Clinical Research Division, and his staff.

Dr. Jim Olson

For more than two decades, Olson, a brain cancer researcher, has placed a high value on bridging the gap between research and patient care. It was this deep commitment to his patients that led to his lab’s annual patient appreciation night.

For Olson and his staff, the night of fun is more than an opportunity for researchers to exchange their white coats for chef’s aprons and decorate the Center’s courtyard. It’s a welcome home for patients and families, past and present, who come together and celebrate their individual stories and collective support of brain cancer research.

“It evolved naturally. I always wanted to have integrated research and practice,” Olson said. “We come together as a family in a purely social setting to increase the already strong ties between our lab and our patient families.”

For Olson, who loves to have fun, it is a party with a purpose. The people who work in his lab are motivated by the direct connection with thankful patients, and families are inspired to become advocates, donors and ambassadors for brain cancer research.

And this is an opportunity for parents to meet, sometimes for the first time, other parents of children living with a cancer diagnosis.

“It gives the new families the chance to see kids who had the same kind of cancer, and that they are healthy and doing great,” Olson said.

The Hutchinson Center has hosted many public events over the years so people can see first-hand the kind of work conducted here. And like Olson, other researchers open the Center’s doors to visitors.

Olson's lab members prepare the food for the 'Big Night.'

But Olson has certainly taken the visits to a new level—bringing researchers, patients and their families together in an inspiring night of fun for everyone. And it’s certainly something that other researchers everywhere can easily replicate to break down the boundaries between research and the people who benefit directly from it.

“Based on what my lab and the patient get out of it, it’s a great model for the future,” he said.

Age was once considered a defining factor to determine whether an older patient with blood cancer was a candidate for stem cell transplantation.

Many older and medically sicker patients could not tolerate the standard, more toxic, high-dose regimens used to prepare patients for transplantation. For many years after the Hutchinson Center pioneered bone marrow and stem cell transplantation, people over 40 were generally not eligible for either procedure, but thanks to work by Hutchinson Center researchers, that age limit started moving up.

Dr. Rainer Storb

The most dramatic shift came after Center researchers, led by Dr. Rainer Storb, developed what came to be known as the mini-transplant, a “kinder, gentler” form of allogeneic (donor cell) stem cell transplantation.

Today, according to a new study, age alone no longer should be considered a defining factor for older patients seeking stem cell transplantation.

“Age is no longer a barrier to allogeneic transplant,” said Dr. Mohamed Sorror, a lead author of the study.

This is an important finding, the authors said, because more than 20 percent of the U.S. population will be 65 or older by 2030, with an expected 77 percent increase in the number of blood cancers for this population in the next two decades. However, many eligible patients are not being treated with stem cell transplants to treat their blood cancers.

“These statistics clearly highlight the reluctance of providers in offering allogeneic stem cell transplantation to the elderly,” Sorror said. “Little is known about the reasons behind the low referral rate of older patients to transplant or how mini-transplant outcomes compare to those of conventional therapies. We are initiating a multicenter study designed to follow patients from the time of diagnosis to answer both questions.”

Dr. Mohamed Sorror

Sorror and colleagues found that the five-year rates of overall and disease-progression-free survival among mini-transplant patients were 35 percent and 32 percent, respectively.

Patients in three age groups—60 to 64, 65 to 69 and 70 to 75—had comparable survival rates, which suggested that age played a limited role in how patients tolerate the mini-transplant, researchers said.

The mini-transplant, known in medical circles as nonmyeloablative transplantation, relies on the ability of donor immune cells to target and destroy the cancer—without the need for high-dose chemotherapy and radiation. Instead, low-dose radiation and chemotherapy is used to suppress the immune system rather than destroy it. This helps the body accept the donor stem cells, which then go to work to attack cancer cells—called the graft-vs.-leukemia effect—and rebuild the immune system.

One in five cancer cases is triggered by infectious disease, and Casper knew that Hutchinson Center researchers had already helped develop a vaccine that is 98 percent effective in stopping one of those infections, the human papillomavirus, from sparking cervical cancer. Casper believed we could make similar progress against other infection-related malignancies, which together cause 1.5 million deaths each year. But he needed to find a proving ground.

So Casper took a groundbreaking trip to a country that is home to one of the world’s highest concentrations of infection-related cancers: Uganda. His first stop was the country’s lone cancer clinic, where a grim reality confronted him.

Many of the patients were children and, as Casper accompanied the doctors on their rounds, he witnessed a staggering array of cancers. Most of them had already reached advanced stages, leaving little hope. “It was a tragedy,” Casper said, “but it was one I knew we could fix.”

Cynthia Nyakato, 9, was diagnosed with Burkitt lymphoma four years ago. She has returned to the Uganda Cancer Institute for another cycle of treatment. Burkitt lymphoma, both potentially fatal and disfiguring, is the most common cancer diagnosis among Ugandan children, a statistic reflected in the patient ward at the UCI. The disease is caused by the Epstein-Barr virus. Currently, the five-year survival rate is less than 40 percent, but it is estimated that 85 percent of these children could be cured for less than $600 a case.

A cutting-edge research and treatment facility

The lack of quality health care in developing countries has allowed infectious diseases—and the cancers they cause—to run rampant. In fact, cancer cases in the developing world outnumber cases of HIV, malaria, and tuberculosis combined. Since 2004, Casper and his Hutchinson Center colleagues have been collaborating with the Uganda Cancer Institute to defeat this growing epidemic.

This initiative, the UCI/Hutchinson Center Cancer Alliance, took a major step forward this month with the groundbreaking of a cutting-edge cancer training and treatment facility in Kampala. Once completed, the new Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institutewill help our researchers bring the latest treatment to a community that is in dire need while accelerating our progress against infection-related cancers worldwide.

By including amenities such as adult and pediatric cancer care clinics, the 5,600 square foot building will enable lifesaving advances by:

• Giving thousands of patients access to the latest diagnostic technology.
• Dramatically increasing the number of patients who can be treated.
• Providing a state-of-the-art venue for gathering data and conducting studies.

Envisioning a world without infection-related cancers

By treating and studying patients on cancer’s frontier, Casper believes we can accelerate progress against infection-related cancers worldwide. One key element of this progress is developing cost-effective cancer treatments that are better suited to communities with limited resources.

Chemotherapy, surgery, and other traditional cancer treatments cost thousands of dollars and open the door to complications and long recovery times. Antiviral medications and vaccines—such as those used to halt cervical cancer—can be delivered at a fraction of the cost. By learning how to expand these innovative treatments, we can make cancer care affordable in developing countries and reduce the strain on health care resources in the developed world.

It’s all part of Casper’s vision of eradicating infection-related cancers and improving the lives of millions of people in the United States and around the world.

“A lot of cancer research focuses on fragments of solutions that might not materialize for decades,” Casper said, “but we already know how to prevent some infection-related cancers and we can potentially wipe out the others. It’s an incredible opportunity.”

Part 2: ‘What am I doing wrong and how can I make this better?’

By Justin Matlick, Hutchinson Center science writer

Science might be thought of as a white-collar pursuit, but it requires a blue-collar work ethic and dedication. That’s certainly true of translational research, which takes breakthrough discoveries and turns them into real-world treatments. So when Dr. Colleen Delaney started developing a new therapy for leukemia and other blood cancers, she knew it was going to be a long, complicated journey.

Dr. Colleen Delaney

Her starting point was a discovery by the Hutchinson Center’s Dr. Irwin Bernstein. Bernstein figured out that, by activating a particular pathway within blood stem cells, scientists could instruct them to multiply into more stem cells. After extensive testing, Bernstein’s approach was used to increase the number of stem cells in a unit of human umbilical cord blood—a discovery that Delaney knew could be of enormous benefit to blood cancer patients.

Stem cells from umbilical cord blood can be a good alternative for patients who need a stem cell transplant but can’t find a matching bone marrow donor. The problem is, cord blood contains relatively few stem cells. This means it takes longer for cord blood transplants to engraft, leaving patients vulnerable to infection. Bernstein’s discovery had the potential to solve this problem.

It was up to Delaney to translate that potential into a lifesaving therapy, and her medium-term goal was to push the technique far enough along to where she could apply to the FDA to start clinical trials. That meant refining the technique until she could prove it was safe and potentially effective. To accomplish that, she had to overcome some big scientific hurdles—hurdles that illustrate just how arduous and rewarding research can be.

Thinking like a factory engineer

Think of Delaney’s first challenge as the scientific version of manufacturing a next-generation sports car. Bernstein’s discovery was akin to unveiling the eye-popping new prototype. Delaney’s job was to figure out how to actually manufacture thousands of those cars to extremely precise standards.

In scientific terms, Delaney needed to develop a standardized process that could be used to increase stem cells in units of umbilical cord blood, over and over again. That process would have to yield cells that were safe to be used in humans. Only then would she be able to apply to the FDA and move forward with clinical trials.

The crux of this process involved unraveling exactly how Bernstein’s process triggered the cells to multiply. The process rested on a protein that, when introduced into a culture with the stem cells, activated the pathway that caused the cells to multiply. Delaney’s team needed to better understand this reaction so they could know how to reliably manipulate the cells.

This is where the painstaking part of laboratory work comes in. Delaney and her colleagues spent two years testing and re-testing specific doses of the ligand and other substances, closely measuring how the stem cells reacted and how many new cells were reproduced. Their goal was to generate the data they needed to move forward with an application to the FDA.

“When you think of people in the lab, you think of them pipetting stuff into Petri dishes,” Delaney said. “And that’s what we were doing, over and over and over again.”

The a-ha! moment

It’s easy to get lost in this process, to get overly obsessive about testing and re-testing. When your goal is to develop a therapy that will be used in people, you want everything to be as predictable and safe as possible. This single-minded attention to detail is part of what makes a good scientist. It also makes it hard to know when to be satisfied with your results and move on to the next stage.

“I’m the type of person who’s always asking ‘What am I doing wrong and how can I make this better?’ And I was focused on those questions even though, in our tests, we almost always got the outcome we wanted,” she said.

Sometimes it takes getting out of the lab to realize just how far your work has come. That’s one reason scientists don’t work in a vacuum. Instead, they gather ideas and feedback from colleagues at their home institutions and from organizations around the world.

So it’s fitting that one of Delaney’s a-ha moments came not when she achieved a particular milestone in the lab, but when she went to a lecture by another researcher who was also working on growing cord blood stem cells in the lab.

The guest lecturer “was excited about how her team was producing a four-fold expansion of stem cells,” Delaney said, “and I was sitting there thinking, ‘Wow, we routinely get 150-fold or 250-fold expansion.”

That’s when Delaney knew it was time to stop deliberating and take the final steps toward applying to the FDA to conduct clinical trials.

“Until then, I don’t think I realized how good our results were or how robust our system was,” she said. “At the lecture, I realized, ‘Now is the time.”