My Sister's Keeper (2009)

Anna Fitzgerald was conceived as a genetic match for her older sister Kate, who has acute promyelocytic leukemia. Since birth she has provided blood, marrow and tissue.

At thirteen she hires a lawyer and sues her parents for medical emancipation, rather than donate a kidney. Her mother, a former attorney, takes the other side of the case. The household has organized itself around Kate for years, and the trial forces every unspoken arrangement into the open.

Spoilers throughout. This page says how My Sister's Keeper ends.

Whether a minor can meaningfully consent to a procedure that mainly benefits someone else is a real ethical question, not just a screenwriter's invention.

The film is also good on the well sibling. Anna is simultaneously essential and invisible, and their brother Jesse drifts almost entirely out of the family's attention. Well siblings can feel overlooked when a child is seriously ill.

The film names Kate's disease. That naming is what breaks it.

Acute promyelocytic leukemia is a distinct subtype of acute myeloid leukemia, making up about 7% of childhood AML. Its defining feature is not resistance to treatment. It is sensitivity to two drugs: tretinoin, a differentiating agent, and arsenic trioxide. This figure comes from the National Cancer Institute’s “Childhood Acute Promyelocytic Leukemia Treatment.”

The results are among the best in oncology. In the Children's Oncology Group AAML1331 trial, 154 children aged 1 to 21 were treated with tretinoin and arsenic trioxide. Standard-risk children had a 2-year event-free survival rate of 98% and an overall survival rate of 99%. High-risk children did better than in the previous trial, with 2-year event-free survival of 96.4% against 82.9%, and overall survival of 100% against 85.7%. One standard-risk child died, and 3 children relapsed after finishing therapy.

Every standard-risk and high-risk child who completed induction reached remission before day 70.

The film's entire premise is a sibling donating tissue to keep Kate alive. Two facts dismantle it.

First, NCI states directly that because of the favorable outcomes with tretinoin and arsenic trioxide, hematopoietic stem cell transplant is not recommended for APL in first complete remission. The transplant Anna exists to supply is not what this leukemia calls for.

Second, leukemia is a disease of the blood-forming marrow. A kidney does not make blood cells, so a kidney is not a leukemia treatment. (This point is our own plain reasoning, not a quote from NCI.)

None of that makes the ethical question fictional. The film simply attached a real dilemma to a leukemia that does not generate it.

There is a genuine crisis in APL, and it happens in the first days rather than years later.

APL blasts trigger disseminated intravascular coagulation, a state in which blood clots and bleeds at the same time. NCI says this severe coagulopathy is often present at diagnosis. The consequence is early death from bleeding. In a multicooperative group analysis of children with APL, coagulopathic deaths during induction occurred in 25 of 683 children, or 3.7%. Twenty-three deaths were from hemorrhage, 19 of those in the central nervous system.

This is why tretinoin is started as soon as APL is suspected, on clinical and morphological grounds, before confirmation. A retrospective analysis found more early deaths from hemorrhage when tretinoin was delayed. It is also why a lumbar puncture is not performed until the coagulopathy has resolved.

That first week is the real drama in this disease. The film spends its tension on a courtroom instead.

Leukemia can announce itself vaguely. NCI lists these signs in children: fever with or without infection, drenching night sweats, shortness of breath, weakness, tiredness or looking pale, easy bruising or bleeding, tiny flat red spots under the skin (petechiae), and bone or joint pain. NCI also lists painless lumps, headache, trouble seeing or confusion.

Many other conditions cause these signs, so they do not mean leukemia on their own. Any of them that persists, or several together, is a reason to see a doctor.

Bleeding that seems out of proportion, such as a nosebleed that will not stop or bruising with no injury, needs care right away. If bleeding will not stop, call 911 or go to the nearest emergency room.

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My Sister's Keeper is worth watching for the family it draws and the question it asks. It is not a guide to leukemia, and the specific leukemia it names is now one of the most curable there is.

A change that persists is worth a conversation, whatever a story led anyone to expect. My Sister's Keeper cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses My Sister's Keeper for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.

• NCI PDQ — Childhood Acute Promyelocytic Leukemia Treatment (Health Professional Version)
• NCI — Childhood Acute Myeloid Leukemia Treatment (patient version), signs and symptoms

Checked on 2026-10-02.