GEORGETOWN PHYSICIAN UPDATE NEWSLETTER
May/June – Volume 1, Issue
3
Mini-Transplants Provide Options for Cancer Care
It's given me a second
chance," is what 62-year-old Jeanette McGowan had to say about the
mini-transplant program at Georgetown University Hospital. Diagnosed with Acute
Myeloblastic Leukemia (AML) in September 2000, McGowan underwent normal
chemotherapy treatment, pushing the disease into remission. The AML came back,
and while her doctor was able to put her back into remission a second time, he
feared that it wouldn't be long before she would be battling leukemia for a
third time. She was, her doctor thought, a good candidate for a mini-transplant.
Mini
transplant is the term used to describe a less-toxic form of bone marrow
transplantation that Georgetown doctors are currently using and studying for the
treatment of several types of cancer, including leukemia, lymphoma, multiple
myeloma, Hodgkin's disease, and metastatic renal cell carcinoma.
Using
lower dosages of chemotherapy and/or radiation than given during a normal
stem-cell transplant, mini transplants are more easily tolerated by older people
and by those whose bodies may be less able to withstand the rigors of a standard
transplant, either because of additional medical concerns or because of previous
cancer therapies.
They
"offer an option to patients who had few, if any, alternatives five years ago,"
said Saul Yanovich, MD, director of Bone Marrow Transplantation (BMT). A method
used to collect and transplant blood-forming cells, or stem cells, BMT allows
physicians to treat cancer by allowing the administration of higher doses of
chemotherapy and/or radiation therapy than would otherwise be possible.
Unfortunately, high-dose therapy not only destroys the cancer cell, it can also
destroy the bone marrow and its ability to produce disease-fighting white blood
cells, or stem cells. By gathering stem cells from the patient (autologous
transplant) or from a donor (allogeneic transplant) prior to high-dose treatment
for transplantation following the therapy, physicians can avoid this
life-threatening effect.
Two Methods
Of the two transplantation methods,
autologous is considered the safest and is the most widely used, even for older
patients. Allogeneic transplant, however, can have harmful effects on both
cancer and other cells, and is typically reserved for younger and stronger
patients.
According
to Dr. Yanovich, the mini transplant takes an immunologic approach to care.
Using the proven disease-fighting ability of white blood cells, the premise is
to rely almost exclusively on allowing donor cells to eliminate the malignant
cells, in what is
known as a "graft vs. tumor" effect.
Rather than using chemotherapy or radiation to kill the cancer cells,
doctors administer just enough of the toxins to kill the patient's immune system
to avoid rejection of the donor cells.
"The program has far fewer immediate
side effects than conventional allogeneic transplant," said Dr. Yanovich. In the
past five years, hundreds of patients have been treated with a similar program,
including patients in their late to mid-60s, and while the clinical trials are
ongoing, the data so far appear to be encouraging for a variety of malignancies
and blood disorders, he pointed out.
Jeanette McGowan would agree. She underwent a mini-transplant last August
and has been clear of AML ever since. "It's given me a quality of life that I
didn't have before," she said.
-T. Regan
For more information, call
(202) 342-3300. For a brochure on the Bone Marrow Transplant
Program, call (202) 784-4388.
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May/Jun 2002
