John GoldmanBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1467 (Published 10 March 2014) Cite this as: BMJ 2014;348:g1467
- Anne Gulland, London
John Goldman became interested in chronic myeloid leukaemia (CML) at a key moment in the understanding of the disease. At the beginning of his career CML was fatal, with average life expectancy after diagnosis being around five years. The only treatment available was chemotherapy—which controlled the symptoms but did not prolong life. Goldman joined the haematology department at Hammersmith Hospital just as the genetic basis for the disease was being discovered.
Edward Donnall Thomas, a physician in the United States who eventually won a Nobel prize for his work, had started to publish papers showing the promising results of bone marrow transplantation on patients with leukaemia. Goldman became interested in this, and in the late 1970s he became the first UK doctor to perform a transplant from a matched sibling donor. This patient recently celebrated the 35th anniversary of that procedure.
Because 70% of patients did not have a matched relative donor, Goldman, amid much professional scepticism, began to consider casting the net wider and using bone marrow from unrelated donors. The increased risk of transplant related complications when using cells from unrelated donors prompted Goldman and colleagues at the Hammersmith to pursue the use of monoclonal antibodies to remove “dangerous” immunologically active cells from the donated stem cells before the procedure. They soon realised, however, that these cells performed an important role in the ongoing eradication of the disease and that without them the primary disease was more likely to recur.
Jane Apperley, who went on to succeed Goldman at the Hammersmith, was a junior doctor in the department at the time. She says of Goldman, “What was very impressive to me was his incredible honesty. We had done something in good faith which unfortunately had a detrimental effect. He published it and talked about it at conferences.” This honesty paved the way for a solution and was an important step in improving the outcome of transplantation, she adds.
Realising that leukaemia cells remained in patients’ bodies even after high dose chemoradiotherapy and that the imminent relapse needed to be detected quickly, Goldman encouraged investigators in his laboratory to develop a polymerase chain reaction assay to detect minute levels of residual leukaemia. This was a real breakthrough and led to much improved management of patients after transplantation.
His work with unrelated donors led to his lifelong association with the Anthony Nolan Trust, which had been set up in the 1970s by Shirley Nolan, who was looking for a bone marrow donor for her son. Goldman was appointed medical director of the trust in 1988—a post he held until 2010 when he joined the board of trustees—and he was pivotal in turning the trust from a small operation to the major organisation that it is today. He was also instrumental in setting up the World Marrow Donor Association in 1990, an international network of registries that now comprises more than 20 million donors around the world.
Goldman was born in London in 1938, the son of German Jews who had fled Berlin when the Nazis came to power. His parents became complete Anglophiles, and his father served in the British army during the second world war. He also ran a successful private practice, treating stars including Elizabeth Taylor, and hoped his son would eventually join him. Goldman junior intended to study Classics at Magdalen College, Oxford, but was poached by the medical fraternity and went on to read physiology and psychology. He completed his training at St Bartholomew’s Hospital in London and, after stints in Massachusetts and at the University of Miami, returned to the UK to take up a post at Hammersmith Hospital.
After retirement he still worked at the Hammersmith and the Anthony Nolan Trust. He also travelled widely, advising doctors in developing countries about CML. He was a cultured and cerebral man, with a huge knowledge of literature and art, peppering his conversation with quotes from Shakespeare.
He was also a great campaigner—nowhere more so than in his drive to persuade the drug company Novartis to manufacture imatinib (also known as Glivec/Gleevec). US scientist Brian Druker presented a paper at a conference in 1996, showing the drug’s early promise in treating CML. In 1997 Goldman confirmed its preclinical efficacy and was determined to see it brought into clinical practice. Goldman and Druker persuaded an initially sceptical Novartis to manufacture the drug, which accounted for nearly $4.7bn of sales in the United States alone in 2013. Goldman also helped persuade the National Institute for Health and Clinical Excellence to recommend its use for patients.
Goldman’s career is remarkable in that he was pivotal in seeing a disease go from being fatal within a few years to one where the majority of patients could, with the aid of a single daily pill, go on to enjoy a normal life expectancy.
Goldman leaves two daughters and a son.
Cite this as: BMJ 2014;348:g1467
John Michael Goldman, professor of haematology (b 1938; q Oxford University 1963), died from cancer of the bile duct on 24 December 2013.
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