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Image: Allan Jones and Paul Allen
Paul Allen, at right, looks over a slice of brain tissue with Allan Jones, CEO of the Allen Institute for Brain Science, in 2016. Allen died Monday after his second bout with non-Hodgkin’s lymphoma. (Vulcan Photo)

“I felt as bulletproof as most people under thirty. I took my health for granted.”

That’s how Paul Allen, the co-founder of Microsoft and a leader in science, technology and the arts, described being diagnosed with cancer at just 29 years old in his 2011 memoir Idea Man.

Allen went on to beat the disease, called Hodgkin’s lymphoma, and even overcame a second bout with cancer in 2009, this time the more deadly non-Hodgkin’s lymphoma. He died Monday at the age of 65 after his non-Hodgkin’s lymphoma returned.

Allen’s battles with cancer fundamentally changed the course of his life. It was after his first bout that he left Microsoft and threw himself into his many other ventures, from real estate to popular culture to space exploration.

“With my Hodgkin’s in remission, I didn’t know what to do next; I just knew that I wanted to enjoy life,” Allen wrote. “I would literally stop in my tracks to look at a flower or the sky, or consciously savor a moment with family or friends.”

A microscopic image of Hodgkin’s lymphoma. Large cells called Reed-Sternberg cells differentiate the cancer from non-Hodgkin’s lymphoma. (Fred Hutchinson Cancer Research Center Photo)

What is lymphoma?

Lymphoma is the name for cancers that grow in the system of lymph nodes that run across our bodies, most notably in the neck, armpits and groin. These nodes remove excess fluid from the body and also produce immune cells.

There are two kinds of lymphoma: The more common, and more deadly, non-Hodgkin’s lymphoma and the rarer Hodgkin’s lymphoma, also called Hodgkin’s disease.

The main difference between the two is the kind of cancer cells that they grow: Hodgkin’s cancer contains a kind of cell called a Reed-Sternberg cell, a huge, overgrown version of immune B cells. Hodgkin’s lymphoma also spreads much more slowly and normally affects younger people.

Only about half a percent of people diagnosed with lymphoma today have Hodgkin’s. Thanks to radiation therapy and bone marrow transplants, a procedure pioneered at Seattle’s Fred Hutchinson Cancer Research Center, Hodgkin’s lymphoma is curable and relatively easy to treat.

“I’d drawn a scary card, but hardly the worst,” Allen wrote of his first diagnosis. At the time, the survival rate for Hodgkin’s was in the 90 percent range, so Allen had a good outlook. The survival rate of non-Hodgkin’s was somewhere about 50 percent.

Hear Allen talk about his experience fighting cancer, his relationship with Bill Gates and more in the player below.

How did lymphoma alter Allen’s life?

Allen recovered from his first fight with cancer relatively quickly. He was diagnosed in September of 1982, and for the next few months continued working at Microsoft.

“I spent time with my parents and sister, but I needed more to distract me. So instead of doing the sane thing and taking a leave, I went into the office a few afternoons a week, just to keep my hand in,” he wrote. “That was the no-excuses Microsoft culture: relentless commitment to work.”

Cancer may not have kept Allen from the office, but it did provide a wake-up call for him. Fissures between Allen and his co-founder Bill Gates had existed before his diagnosis, but as he was going through treatment Allen had another falling-out with Gates over his ability to contribute to the company.

In Idea Man, Allen wrote that cancer and the falling-out were something of a wake-up call.

“Once I was diagnosed with Hodgkin’s, my decision became simpler,” he wrote. “If I were to relapse, it would be pointless — if not hazardous — to return to the stresses at Microsoft. If I continued to recover, I now understood that life was too short to spend it unhappily.”

By February of 1983, Allen had resigned his executive position at Microsoft. He was also cancer-free.

Non-Hodgkin’s Lymphoma

After leaving Microsoft in 1983, Allen went on to fund, found and support a huge variety of cultural and scientific organizations. But in 2009, he was once again diagnosed with cancer, this time the more aggressive non-Hodgkin’s lymphoma.

Things had changed in the 25 years since Allen’s first bout with cancer. A variety of new treatments for non-Hodgkin’s lymphoma has increased survival rates across the board: Today about 70 percent of those diagnosed with non-Hodgkin’s lymphoma survive five years.

The most notable of these treatments are immunotherapies, treatments that leverage the immune system to fight cancer. One of the breakthrough drugs in this area is Rituximab, a drug that uses immune cells called antibodies to attack B cells int he body. Work behind the drug was conducted at Fred Hutch by Seattle immunotherapy expert Dr. David Maloney.

A newcomer to the scene, even since Allen’s diagnosis in 2009, is CAR T immunotherapies. These treatments genetically engineer a patient’s T-cells, the immune cells that fight bugs like the common cold, to find and destroy cancer cells. There are two CAR T immunotherapies on the market to treat lymphoma.

Allen was successfully treated for non-Hodgkin’s lymphoma in 2009 and went into remission for eleven years. He announced earlier this month that the cancer had returned.

Paul Allen at the University of Washington in 2017. (GeekWire Photo / Kevin Lisota)

“A lot has happened in medicine since I overcame this disease in 2009. My doctors are optimistic that I will see good results from the latest therapies, as am I,” Allen wrote at the time.

Allen died less than two weeks after that announcement, from complications related to his lymphoma.

Beyond his personal experience with the disease, Allen has also been a strong supporter of medical and biological research, including his Allen Institute for Brain Science. He has specifically funded cancer research projects, like research into early detection of cancer through blood tests.

“Some people are motivated by a need for recognition, some by money, and some by a broad social goal. I start from a different place, from the love of ideas and the urge to put them into motion and see where they might lead,” Allen wrote.

He reflected that, at the time of writing his book, he had spent more than half of his life post-Microsoft: In other words, more than half of his life came after that life-changing cancer diagnosis. “Over the last twenty-seven years, I’ve been able to do things I once only imagined,” he wrote.

Allen reflected on his bouts with cancer in a 2011 interview with GeekWire after the release of his book.

“Whenever you go through one of these treatment regimens there are many things that are completely out of your control,” he said. “You just have to be patient and hope things work out for the best, and be optimistic. Take a positive attitude. On the other hand, realize that if there isn’t a positive outcome, your time may be limited so it makes you that much more focused on realizing your dreams and hopes, because all of our times on this planet are limited.”

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