[Homestead] Stem cell cure for bone marrow myelofibrosis, leukemia etc.
Tvoivozhd
tvoivozd at infionline.net
Sun Aug 29 18:11:51 EDT 2004
Bone marrow cancers are not all that common and previously incurable.
Things are changing with the attention given stem cell treatment. by
everyone except idiot Bush.
If I were a few years younger, I'd be laying in a hospital bed right
now, undergoing stem cell therapy for myelofibrosis.
BY MERRY SUE BAUM
------------------------------------------------------------------------
"For some people, a stem cell transplant is an alternative where there
is no other, " says Roger K. Strair, MD, associate professor of medicine
at UMDNJ-Robert Wood Johnson Medical School (RWJMS).
One such person was Olga Rabke. While on a trip to her native Italy,
Rabke suddenly experienced what felt like a pulled muscle in her groin.
When she returned home to Scotch Plains in March, she went to her
physician. Except for being slightly anemic, she was given a clean bill
of health. He did recommend, however, that she see an orthopedist. She
did, and he discovered she was suffering from multiple myeloma, or
cancer of the bone marrow that causes tumors to form inside the bones.
An x-ray showed that her femur looked like "Swiss cheese."
She started her search for an oncologist. Her neighbor, Rohit Sharma,
MD, a student at RWJMS at the time, recommended Strair. She liked him
immediately. "He said a few words to me in Italian," she says, "and he
took the time to explain everything to me. I felt like I was in very
good hands." He recommended an autologous stem cell transplant for his
new patient.
According to Strair, who is also director of stem cell transplantation
at The Cancer Institute of New Jersey, the procedure, which has been in
use for about a decade, has often proven effective in the treatment of
multiple myeloma, lymphomas, leukemias, Hodgkin's disease, aplastic
anemia, testicular cancer and some congenital immunodeficiency diseases.
Bone marrow transplants were at one time the ultimate treatment for
these disorders. And depending on an individual's history and the
disease, it is still the preferred therapy.The procedure begins by
either taking some of the patient's own marrow and freezing it, or
finding a suitable donor.
Next, high doses of chemotherapy and radiation are given to the patient
to destroy the cancer-causing cells. While this is perhaps the most
grueling part of the treatment, the physician says often it is not
nearly as horrific as it's portrayed. "Some people don't get very sick,"
he says. "And we have drugs that are very effective for controlling
nausea."
After the chemotherapy and radiation have been completely metabolized by
the body, the preserved or donated marrow is given to the patient via a
transfusion. If all goes well, the stem cells in the transplanted bone
marrow will give birth to a generation of tumor-free blood cells in
about 15 to 25 days.
A stem cell transplant is, in essence, a bone marrow transplant with
several distinct differences. Andrew L. Pecora, MD, a UMDNJ-New Jersey
Medical School (NJMS) alumnus and director of the Marrow and Stem Cell
Transplant Program at Hackensack University Medical Center, explains.
"In a bone marrow transplant, the stem cells are in the marrow," he
says. "In a stem cell transplant, they are harvested from the
circulating bloodstream." Stem cells taken from the bloodstream multiply
much faster, so new cells form within only five to 15 days. Since the
white cells - the body's defense system - are produced much faster than
in a bone marrow transplant, the patient is far less likely to contract
a life-threatening infection. Hospital stays, if needed at all, are
shorter, and costs are significantly reduced. To stimulate stem cells to
move into the bloodstream, a patient is given chemotherapy and a growth
hormone for 10 to 14 days, or a growth hormone alone for five days. He
or she then goes through an almost painless harvesting procedure known
as leukophoresis. It is done on an outpatient basis, in a special stem
cell laboratory, and is much like getting a blood transfusion. A needle
is inserted into a vein and blood is slowly removed and run through a
leukophoresis machine. The stem cells are filtered out, counted, and the
remaining blood is pumped back into the patient. The patient next gets
high doses of chemotherapy and/or radiation, the stem cells are infused
again through a vein and they "home" to the bone marrow and begin making
new cells.
There are three types of marrow and stem cell transplants: autologous,
in which the patient's own marrow or stem cells are transplanted;
syngeneic, in which marrow or stem cells from an identical twin are
used; and allogeneic, in which marrow or stem cells from another person
with similar blood and tissue types are used.
"Allogeneic is much more complicated," Pecora says. "Patients undergo
prolonged therapy with immunosuppressant drugs to avoid rejection of the
new bone marrow. The drugs lower the white cell count making the patient
very susceptible to infections. They must take antibiotics and be
monitored very closely."
But the upside, he says, is that the new marrow or stem cells are highly
unlikely to be contaminated with tumor cells, so the chances of
recurrence are lowered. Also, the patient now has a different immune
system that may see the tumor cells as foreign and kill them.
An autologous transplant is much safer. "Everyone survives," he says,
"but there is always the chance that a few tumor cells got into the
harvested marrow or stem cells, and the disease will return. Syngeneic
is probably ideal: there is next to no chance of rejection and no chance
of contamination. However, most people don't have an identical twin."
In Rabke's case, she first received chemotherapy to mobilize the stem
cells into the bloodstream. Throughout the chemotherapy, she continued
teaching Italian, as she had for years, at area book stores and adult
high schools. "I'm very strong," she says. "Sometimes students would
come to my house if I was too tired, but I was never really sick."
After having a chest catheter inserted as an outpatient at Robert Wood
Johnson University Hospital in New Brunswick, Rabke underwent three
sessions, about six hours each, of leukophoresis. Next came two days of
high doses of chemotherapy. She and her husband stayed in a hotel nearby
while she received the treatments. One day later, November 1, her own
stem cells were infused back into her body through the chest catheter.
"It was a big day for me," she says. "I finally made it to the end of
the road."
Rabke says she lost her hair, which was probably the most traumatic part
of the treatment. And it took about three months for her appetite to
return, but once it did, she was her old self. "Dr. Strair said I didn't
need vitamins, I should just eat well. I'm Italian. I love to cook. So I
ate well."
*BENEFITS OF UMBILICAL CORD BLOOD*
Patients with certain blood or bone marrow diseases (such as leukemia or
congenital immunodeficiency diseases) can be cured by replacing their
diseased blood-forming cells with normal blood stem cells from healthy
donors. This procedure is called stem cell transplantation. After
chemotherapy and/or radiation to reduce or eliminate their diseased
blood cells, patients receive transfusions of the donors' blood or
marrow stem cells, which begin producing new blood cells within a few
weeks.
The immune cells transplanted among the donor cells can benefit the
patient by fighting against the patients' diseased cells. In some cases,
however, the patient's body can be attacked by the donor's transplanted
immune cells because the patient's and donor's immune systems recognize
each other as 'foreign.' Such an attack, called graft vs. host disease
or GVHD, can lead to serious disability or death, even after the
original disease has been eradicated. In order to reduce the risk of
severe GVHD, the donors' cells must be closely matched to the patients'
immune system markers (termed HLA typing). If the patient has healthy
siblings, the chance of a complete match is approximately 1 in 4 for
each sibling. Cells from incompletely HLA-matched siblings are likely to
cause clinically significant GVHD. Cells from unrelated donors, even if
matched, are more likely to cause clinically significant GVHD due to
immune system mismatches that are not identified in HLA typing.
Unfortunately, it is often difficult to find even unrelated matches for
individuals of ethnic minorities (i.e., non-Caucasians in the United
States) among the traditional bone marrow (stem cell) registries.
It has long been recognized that blood from umbilical cords of newborn
babies contains higher numbers of stem cells than adult blood. Cord
blood is collected after delivery of the placenta, without any risk or
discomfort to mother or baby. Since the late 1980s, several hundred stem
cell transplants for both children and adults with either malignant or
non-malignant diseases have been performed using unrelated cord blood
when no matched siblings were available. In general, the results have
been better in children with non-malignant diseases; however, many
adults with malignant blood diseases have had very long disease-free
survivals.
Cord blood cells are immunologically immature and seem to better
tolerate the patients' tissues, resulting in lower frequency and
severity of GVHD than adults' stem cells. Incompletely matched cord
blood cells are being used more frequently for transplantation in
unrelated patients. GVHD appears to be relatively less problematic with
cord blood transplantation than adult stem cell transplantation.
As a result of the encouraging results with cord blood transplants,
several organizations in the United States, Europe, Japan and other
regions have initiated programs to bank cord blood from large numbers of
newborns. It is hoped that a large inventory of banked cord blood units
from widely diverse ethnic backgrounds and HLA types will provide grafts
for those individuals for whom the traditional bone marrow registries
cannot find donors.
The legislature of the State of New Jersey has provided funding to
develop a public umbilical cord blood bank for the citizens of the
region, called the New Jersey Cord Blood Resource, to be housed at the
Coriell Institute for Medical Research in Camden. At least two
additional medical centers in the northern and southern parts of New
Jersey will be recruited to participate in the program.
Richard D. Huhn, MD
Coriell Institute for Medical Research
So far Rabke is doing fine. She's still teaching and is active in the
theater, one of her loves.A veteran actress - she's performed in Italy
and off-Broadway - she recently did a 10-minute monologue on her life at
the Miranda Theater in New York City. She didn't talk about her illness,
she says, but she did tell the audience, "Whatever pasta and wine won't
cure, there is no cure for."
While stem cell transplants aren't new, what is new is their possible
use as a treatment and perhaps cure in diseases other than cancer.
Currently NJMS, Hackensack University Medical Center and Thomas
Jefferson University in Philadelphia are collaborating on a project to
evaluate the effectiveness of stem cell transplants on multiple
sclerosis - better known as MS - and lupus erythematosus. Stuart D.
Cook, MD, president of UMDNJ, and professor of neurosciences at NJMS, is
one of the neurologists involved in the project.
Pecora explains that in these two diseases, T cells, which are part of
the white cell defense team, go awry. In MS they attack a person's own
nervous system, and in lupus they destroy connective tissue in vital
organs like the kidneys and heart.
By doing an autologous stem cell transplant, Pecora says, the adult,
rogue T cells are destroyed and new immature T cells are born. "It's
like re-booting a computer," he says. "These new T cells haven't been
programmed to attack the nervous system and connective tissue, so it's
possible that the disease can be cured." Stem cell transplants are being
done around the country for the two diseases, and many have been very
successful.
Another disease that may respond to the treatment is breast cancer. The
news media has portrayed it as ineffective, Pecora says, but the jury is
still out. "We need a few more years for the data to mature before we'll
know," he explains. "But there are strong indications that when
appropriately applied, it does help in certain types of breast cancer."
He recently published a paper in the Journal of the American Medical
Association that delineates in which cases stem cell transplantation is
helpful and which ones it's not. He reported that 43 percent of young
women were still alive with no breast cancer after three years if they
were in a group that had metastatic disease, had not previously been
treated with chemotherapy, responded to chemotherapy for the disease,
and the disease was limited in the number of sites.
While stem cell transplants are helping more people than ever before,
some people simply can't be cured. Strair says that the patients
themselves, however, are an inspiration. "In spite of all the
difficulties and the uncertainty these patients face, they all have a
dignity that comes shining through," he says. "It's people like Mrs.
Rabke who keep you going."
Both Pecora and Strair are optimistic about the future of the therapy.
Stem cells are now being grown in the laboratory, and umbilical cord
blood has been discovered as a ready source. In fact, Pecora had two
patients in the final stages of chronic myelogenous leukemia who have
survived now for one year and two years, after a cord blood stem cell
transplant. "The number of stem cells in the cord blood was too low, so
we grew more in our lab," he says.
Strair believes that in the not-too-distant future, cell engineering
will be another method of curing these diseases. "We hope to be able to
take a few cells from a person, manipulate them or add a gene, then give
them back and the body will cure itself."
In the meantime, the physicians continue to research better methods of
marrow and stem cell transplantation. And with any luck at all, someday
they both may be out of business.
------------------------------------------------------------------------
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