What My Sister's Keeper Can Teach Us About Leukemia

A diagnosis chosen for a reason

Jodi Picoult's novel gives Kate Fitzgerald a specific illness. Kirkus Reviews, summarizing the book, says Kate was diagnosed at age 2 with acute promyelocytic leukemia. Her younger sister Anna was conceived to be a genetic match. Anna gives platelets, bone marrow, and cord blood stem cells over the years, then sues to stop.

The legal fight is the story. The blood disease behind it is real, well understood, and worth knowing about on its own.

What the words actually mean

Leukemia is cancer of the blood-forming tissue, mostly the bone marrow. Acute means it moves fast. Myeloid points to the family of blood cells it starts in.

Acute promyelocytic leukemia, or APL, is a subtype of acute myeloid leukemia. NCI explains it clearly. Genes on chromosome 15 swap places with genes on chromosome 17. That swap builds an abnormal gene called PML-RARA. The faulty gene stops promyelocytes, a young type of white blood cell, from growing up.

Those stalled cells pile up in the marrow and blood. They crowd out healthy white cells, red cells, and platelets. NCI notes that severe bleeding and blood clots can both happen in APL, and calls it a serious problem that needs treatment as soon as possible. That bleeding risk is the reason APL is an emergency the day it is suspected.

How it is found

The first clue is often a routine blood count that comes back wrong. Too few red cells, too few platelets, or a strange white cell count sends the sample onward.

Confirming it takes a look at the marrow itself. A doctor draws a small sample from the hip bone with a needle. Lab tests then hunt for the specific gene change. In APL that means testing for PML-RARA. Finding it does two things at once. It names the disease, and it points to the treatment. Our overview of leukemia walks through the wider family of blood cancers.

Why APL is treated its own way

Most acute leukemias start with intensive chemotherapy. APL does not have to.

NCI lists tretinoin, also called all-trans retinoic acid or ATRA, and arsenic trioxide as the drugs used in APL. They are not standard chemotherapy. They push the stalled promyelocytes to finish maturing, or they kill them directly. For newly diagnosed childhood APL, NCI lists tretinoin with arsenic trioxide, or tretinoin plus chemotherapy with or without arsenic trioxide.

NCI's health-professional summary adds that APL has a specific sensitivity to ATRA, and that high remission rates and long disease-free survival can follow either ATRA with chemotherapy or an arsenic-based regimen without chemotherapy. This is the part of the story medicine got right in the decades since the novel was written.

Where a sibling donor really fits

The book turns on Anna being a match. That idea is grounded in something real.

An allogeneic stem cell transplant uses blood-forming stem cells from another person. NCI explains that donors are matched on HLAs, which are protein markers found on most cells in the body. The more HLA markers two people share, the better the odds the body accepts the graft. A brother or sister is often the closest match. The cells can come from the bloodstream, the bone marrow, or blood collected from an umbilical cord at birth.

A transplant is not a simple gift. NCI describes months of treatment, long stays at a specialized center, and a risk of graft-versus-host disease, in which donor immune cells attack the recipient's skin, liver, gut, or other organs. Our page on stem cell transplant covers what the weeks around day zero involve.

Worth saying plainly: most people with APL today are treated with drugs, not transplants.

Signs worth an appointment

NCI lists these signs of childhood acute myeloid leukemia and related conditions:

• fever, with or without an infection
• drenching night sweats
• shortness of breath
• weakness, tiredness, or looking pale
• easy bruising or bleeding
• petechiae, which are flat pinpoint spots under the skin caused by bleeding
• bone or joint pain
• pain or fullness below the ribs
• painless lumps in the neck, underarm, stomach, or groin

Any one of these has ordinary causes far more often than cancer. The combination that should move fast is bruising or bleeding that makes no sense together with tiredness and fever. A blood count is a cheap, fast test, and it is the right first step.

What this story cannot tell you

• The novel is fiction. Kate's course was written for a plot, not drawn from a case.
• Treatment for APL changed a great deal after the book appeared in 2004. Today's approach leans on tretinoin and arsenic trioxide.
• SEER records five-year relative survival for acute myeloid leukemia as a whole at 33.4 percent for people diagnosed from 2016 to 2022. APL sits inside that figure and behaves differently, so the number does not describe APL, and it describes no individual at all.
• Being a tissue match does not decide anything by itself. Donation is a choice, and living donors in the United States give consent for each procedure.

Sources

• Kirkus Reviews: My Sister's Keeper
• NCI: Childhood Acute Myeloid Leukemia Treatment (PDQ) — Patient Version
• NCI: Adult Acute Myeloid Leukemia Treatment (PDQ) — Health Professional Version
• NCI: Stem Cell Transplant
• SEER Cancer Stat Facts: Acute Myeloid Leukemia

How this page was made

An AI-assisted editorial system helped prepare this page. This article has not been reviewed by a healthcare professional unless a named reviewer is specifically shown. Cancer Explained is published by the National Cancer Information Foundation as a nonprofit-oriented public-interest education project. It is not a diagnostic service, does not recommend treatments, and is not for emergencies.

Found an error, a broken source link, outdated information, or wording that feels insensitive? Report it here — we log and act on material corrections.