Elihu (“Eli”) Estey collapsed and died at his home in Seattle, Washington, on October 8, 2021. Eli was a consummate academician whose many contributions to research changed practice in acute myeloid leukemia (AML). He was known worldwide for his piercing intellect, generous mentorship, and iconoclastic nature.
Eli was raised in Brooklyn, New York, received his undergraduate degree in mathematics from Yale University in 1968, and initially planned to pursue a career as a mathematician. He graduated with an MD from Johns Hopkins University in 1972 before completing a residency in internal medicine and chief residency in neurology at New York University. There he met his future wife Dr. Cynthia (“Cindy”) David, then a radiology resident. He spent most of the next three decades at MD Anderson Cancer Center under the helm of his mentor Dr. Emil Freireich and alongside colleagues such as Dr. Hagop Kantarjian, with a brief tenure at the National Cancer Institute to work with Dr. Richard Simon (renowned for developing Simon's two-stage design). In 2008, Eli relocated to Seattle with his family. He directed and nurtured the AML clinical research program, which quickly gained national and international prominence, as a Professor in the Division of Hematology at the University of Washington and in the Clinical Research Division of the Fred Hutchinson Cancer Research Center.
As a clinical researcher, Eli was never satisfied with the status quo. His career began before the rapid expansion of oncologic drug development by pharmaceutical companies, and this allowed him considerable freedom in testing novel hypotheses and chemotherapy combinations. Eli notably and boldly administered all-trans retinoic acid and arsenic trioxide as an alternative to chemotherapy in newly diagnosed acute promyelocytic leukemia (APL), now the standard of care for this leukemia. He was the first to report treatment with FLAG (fludarabine, cytarabine, and granulocyte colony-stimulating factor), now routinely used as intensive induction chemotherapy for patients with AML. Eli often pointed out that “blood counts do not come from the sky,” leading to analyses questioning the value of complete remission with incomplete count recovery. He questioned the strict eligibility criteria used by many pharmaceutical studies, reminding colleagues: “Don't let the protocol interfere with your frontal lobe.” Most recently, Eli vigorously questioned the value of the 20 percent blast threshold to separate AML from high-grade myelodysplastic syndrome. He was an active member of the European LeukemiaNet guidelines for AML and APL. Eli's CV contains 675 peer-reviewed publications and more in press.
As a clinician, Eli cared deeply for his patients. He matter-of-factly acknowledged that he had probably seen more AML patients than anyone else in the world given his years of experience and busy clinical service in Houston and Seattle. He gleefully recollected the Louisiana-style dirty rice that his 85-year-old patient brought to clinic every three months after she was cured of APL using his chemotherapy-free regimen. Eli's dedication to patients led directly to his drive to improve clinical care through research, calling out the value of clinical versus statistical significance, particularly with the plethora of “promising” drugs in recent years. He frequently referred to the Social Security Index actuarial tables to emphasize the devastating loss of life-years associated with an AML diagnosis, recommending intensive treatment for fit individuals of any age. He reminded patients of his motto “prepared for success,” but he simultaneously acknowledged that he was “a doctor, not a prophet.”
Eli excelled as a mentor and teacher, willing to work with trainees at all stages and recognizing the potential of those from all backgrounds. Despite growing up in a different time and working his way through the academic hierarchy in different circumstances, he was particularly supportive of female junior faculty. He kept a running list of potential projects that used his AML database and worked closely with mentees to conduct and write up projects. His mentorship extended far beyond Seattle even before the ubiquity of Zoom. He was always open, responsive, and available to all, from those who knew him well to those who were meeting him for the first time. Eli was the first to the microphone at every AML session at the ASH annual meeting, asking insightful questions often preceded by the phrase “I’m just a simple country doctor.” He used common sense to guide his research, and he expected his mentees to do the same. His many pithy, yet always appropriate, comments (affectionately known as “Eli-isms”) will forever reverberate in the minds of mentees and colleagues. These include: “The plural of anecdote is not data”; “the definition of insanity is doing the same thing over and over and expecting a different result”; and “no drug is too stupid to test.”
Outside of medicine and hematology, Eli loved sports (particularly football and the Astros) and sports trivia; he discussed sports with anyone and everyone, from fellow fanatics to more casual observers (with whom he had endless patience). He loved potato chips and sparkling water. He loved New Orleans and gumbo. He loved exercise, particularly walking in the light drizzle so common in Seattle. He loved his family, and he leaves his wife Cindy, children Andy and Emily, and dog Hutch. Though nothing can do justice to Eli's vitality and legacy, this remembrance may be a start. As Eli would have said, “Don't let the perfect be the enemy of the good.”
