The field has gone from being viewed as something of a last resort in its early days to now being a viable option where likelihood of recovery is often strong.
San Diego, CA (Vocus) May 19, 2010
The outlook for patients with leukemia and other life-threatening blood cancers has improved dramatically since Scripps Health founded San Diego County’s first blood and marrow transplantation (BMT) program, which celebrates its 30th anniversary in 2010.
Dr. James Mason, the medical director of Scripps’ BMT program at Scripps Green Hospital, says the survival rate of Scripps’ BMT patients has more than doubled since 1980, and the number of transplants performed annually by Scripps has increased tenfold.
“The field has gone from being viewed as something of a last resort in its early days to now being a viable option where likelihood of recovery is often strong,” Dr. Mason says. “We’ve become much more adept at matching appropriate donors with patients, developing medications to fight previously lethal infections and creating new techniques to make transplants tolerable for older patients. We’re also seeing many patients return to productive lives in a matter of weeks or months after transplant, instead of years or not at all.”
Russ Zinser of Encinitas is a case in point. Diagnosed with chronic leukemia in 1984, Zinser is now healthy, active and completely free of the disease. Zinser found a blood marrow donor among his 12 siblings and underwent a successful transplant at Scripps Green in June of 1986. He was back at work by Halloween of the same year and has been cancer-free ever since. “The experience made me realize how fragile life is and that there are lots of things I want to do,” says the retired engineer, who today keeps busy as a musician, woodcarver, author, mentor and golfer, among other activities.
Still, blood and marrow transplants do not always lead to a cure, and the most common forms of blood disease – leukemia, lymphoma and myeloma – continue to pose major public health concerns. These three diseases collectively caused approximately 53,000 deaths in the United States last year and accounted for nearly 10 percent of all cancer-related deaths in the country.
Despite persistent challenges in the quest to eradicate blood cancers, a number of significant advances been achieved in the past 30 years to help doctors improve clinical outcomes for patients. These include:
Improved Means of Locating Donors. Thirty years ago, those needing a bone marrow transplant usually had to rely on a sibling to be their donor – a difficult proposition, since about 70 percent of patients don’t have a matching donor in their family. But today, the prospect of finding a donor has evolved from a hope to an expectation, thanks to the creation of the National Marrow Donor Program (NMDP), a computer database of more than 8 million volunteer donors worldwide. Scripps’ BMT program is the NMDP’s only collection center in San Diego and Imperial counties, and also serves much of Orange and Riverside counties. Scripps collects stem cell products from donors every week and either uses them for patients in San Diego, or ships them off to NMDP network hospitals around the world for their patients. Likewise, Scripps taps into the NMDP’s extensive database to find bone marrow donors for its patients in San Diego.
Less-Invasive Donation Process. In the 1980s, the process of donating bone marrow for transplantation was highly invasive. Donors were put under general anesthesia while a large needle was inserted into the middle of a large bone (typically the pelvis) to extract bone marrow for transplant into the patient. Now, doctors rarely use bone marrow for transplantation, instead opting for peripheral blood stem cells, which are removed from the donor via a relatively painless blood donation technique called apheresis. The donor’s blood is withdrawn through a sterile needle in one arm and passed through a machine that removes the white blood cells (red blood cells are returned to the donor). Peripheral blood cells are usually better for recipients too, helping them recover faster from the transplant.
Ability to Transplant Older Patients. Transplants are most commonly performed for patients with acute leukemia, a disease that usually occurs in people age 50 and older. This created a catch-22 in the early days of transplantation, since most people over 50 couldn’t tolerate transplantation due to the harsh chemicals involved. Today, the development of a newer technique – a non-ablative transplant, or “mini-transplant” – involves a gentler regimen that allows people up to age 70 to successfully endure transplantation, with lower risk of serious infection and transplant-related mortality.
Greater Power to Fight Dangerous Infections. In years past, many blood disease patients who developed post-transplant complications such as cytomegalovirus (CMV) infections simply died due to lack of medications. In recent decades, significant improvements have been made in managing post-transplant infections. Highly effective antibiotics such as gancyclovir and voriconazole are now available to fight infections and aid in patients’ recovery.
Better Typing Techniques for Donor Compatibility. A major shift has taken place in the last five years that has improved doctors’ ability to accurately determine donors’ compatibility with patients. Thirty years ago, screening for donor compatibility was a relatively crude process in which donor and patient cells were mixed together into a culture to see if they’d fight each other. Today, typing has become computerized, using advanced DNA technology to sequence and match up parts of the donor and patient genomes. This shift has expanded the number of potential donors, while helping to winnow out who should and shouldn’t be donating cells.
Using Patient’s Own Cells for Transplant. When Scripps’ BMT program first began, patients were limited to allogenic transplantation – that is, the use of cells from one person (the donor) for another (the patient). Subsequently, doctors have developed techniques for autologous transplantation, in which the patient’s own stem cells are harvested, frozen and returned to the body following chemotherapy and other possible treatment. Autologous transplants have the advantage of lower risk of infection during the immune-compromised portion of treatment. Autologous transplants have become standard for diseases such as lymphoma, but in other cases such as acute myeloid leukemia, allogenic transplantation may still be preferred to combat the likelihood of cancer recurrence.
Housed on a dedicated 31-bed unit at Scripps Green Hospital in La Jolla, Scripps’ BMT program is available to all cancer patients across the Scripps Health system of five hospital campuses and 19 outpatient centers. Scripps offers the region’s only comprehensive BMT program, with all services operated under a single medical director to provide greater continuity of care, flexibility and convenience to patients.
Contact: Steve Carpowich
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