Transplant lite

John Seymour of Arlington has a new lease on life. In February 1999, when doctors diagnosed him with non-Hodgkin's lymphoma, cancer of the lymphatic system, he was in dire condition. After three recurrences of the cancer over the next few years, doctors realized the conventional chemotherapy being used was not effective.

In 2002, he received a bone marrow transplant to save his life. However, because Mr. Seymour was 64 years old, physicians were unsure his body could withstand the intense chemotherapy and radiation treatment that accompany most bone marrow transplants, which are used to treat various types of cancer, including blood cancers and some solid tumors. Therefore, doctors decided to use a non-myeloablative bone marrow transplant, which offers the benefits of the regular transplant with less toxicity. Because lower doses of therapy are used, the patient's healthy bone marrow is not destroyed. This method is also called a "mini bone marrow transplant" or "transplant lite."

"I was really concerned when I realized I had active cancer," Mr. Seymour says. "After the transplant, we got rid of it. ... We snuffed out the last active tumor. I've had no sign of active cancer since then."

Mini bone marrow transplants are becoming a popular option for patients who aren't able to achieve long-term remission by receiving an infusion of their own marrow. Unlike a transplant in which the patient receives an infusion of his own stem cells after several days of chemotherapy or radiation, the minitransplant uses cells from a sibling or unrelated donor. Mr. Seymour received marrow from his sister, Gail Wing of Nappanee, Ind., whose bone marrow was compatible. In some instances, patients still receive high doses of chemotherapy and radiation when receiving marrow from a donor, which is called a myeloablative bone marrow transplant. However, the approach of the non-myeloablative bone marrow transplant requires lower doses of therapy, which is safest for patients who are 55 or older or have other serious health problems, such as heart disease.

The bone marrow for the procedure is collected by a needle usually inserted into the pelvic bone of the donor. The process gathers stem cells, which can produce the cells made by bone marrow when transferred to a patient. After the patient receives chemotherapy or radiation, which hopefully destroys large amounts of cancer cells and defective bone marrow, the transplant is delivered through an IV. The procedure is similar to a blood transfusion.

The chemotherapy and radiation also are supposed to destroy the patient's immune system so that when the transplant is given, the patient's body doesn't reject the new immune system, which will be provided by the donor marrow. When the marrow is introduced into the patient's body, the individual usually experiences graft-versus-host disease, in which the donated cells attack the patient's organs and tissues. This condition causes a range of symptoms from a skin rash, intestinal discomfort, blistering and peeling skin to life-threatening liver, stomach and intestinal problems. Doctors use blood transfusions, antibiotics and other drugs to sustain the patient until new bone marrow grows, which usually takes two to five weeks.

Although graft-versus-host disease is unpleasant, the battle between the donor's cells and the patient's body usually triggers an anti-cancer phenomenon called the graft-versus-tumor effect, in which the donated cells also attack the cancer. The donor's white blood cells can play a crucial part in killing the cancer cells that remain in the patient after chemotherapy and radiation. Sometimes, the patient needs additional donor cells for the transplant to be effective.
Various patients, such as Mr. Seymour, have achieved long-term remission because of this process, says Dr. Saul Yanovich, medical director of the blood and marrow transplant program at Georgetown University Hospital in Northwest. Ideally, this treatment is used on a patient who doesn't have large amounts of cancer spreading in the body.

"Since the immune system from the donor recognizes the tumor in the host, the new immune system kills the tumor," Dr. Yanovich says. "This mechanism is more important than high-dose chemotherapy. ... When technology improves, it will become more effective."

In the future, researchers would like to identify the cells responsible for the graft-versus-tumor effect and tailor the therapy so patients won't experience the overall graft-versus-host disease, which can be fatal in certain individuals. Right now, researchers know which cells to remove from the donor's immune system to eliminate graft-versus-host disease, but they have not pinpointed the cells that must remain to allow the graft to attack the tumor, says Dr. Richard Jones, professor of oncology and director of the bone marrow transplant program at Johns Hopkins Sidney Kimmel Cancer Center in Baltimore.

"It is to be seen if it will work," Dr. Jones says. "You need to create a new immune system without graft-versus-host disease that isn't tolerant against the tumor."
Despite the negative side effects of the mini bone marrow transplant, Giovanni Ramirez of Silver Spring considers the procedure a miracle. In 2002, Mr. Ramirez underwent the transplant for multiple myeloma, cancer of the bone marrow. His brother, Saul Ramirez of Silver Spring, donated the marrow for the procedure.
"I cannot believe I survived it and that I'm alive," Giovanni Ramirez says. "I consider myself very blessed to be in this part of the country. We have very good care in this area. I still can't believe that science and medicine can do so much."

Even though Mr. Ramirez is 35 years old, he opted for this treatment because it is effective as well as easier on the body. He has been in remission since June 2002 and has returned to work.

"I want to live a normal life," he says. "I don't want to have to worry about having this come back on me. I have two young children I have to raise. ... I'm not the same person I used to be, but that's a matter of perception."