[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.

------------------------------------------------------------------------

Winter Table of Contents 
<http://www.umdnj.edu/umcweb/hstate/wntr00/index.htm>
HealthState Home <http://www.umdnj.edu/umcweb/hstate/index.html>

The magazine of the University of Medicine and Dentistry of New Jersey

<http://www.umdnj.edu/umcweb/hstate/sprsm00/index.htm>

<http://www.umdnj.edu/>

 

 


-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment.html 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: body3.gif
Type: image/gif
Size: 299 bytes
Desc: not available
Url : http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment.gif 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: StemsHd.jpg
Type: image/jpeg
Size: 23772 bytes
Desc: not available
Url : http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment.jpg 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: stempic2.jpg
Type: image/jpeg
Size: 56608 bytes
Desc: not available
Url : http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment-0001.jpg 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: stempic3.jpg
Type: image/jpeg
Size: 18740 bytes
Desc: not available
Url : http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment-0002.jpg 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: lilumdblack.gif
Type: image/gif
Size: 634 bytes
Desc: not available
Url : http://lists.ibiblio.org/pipermail/homestead/attachments/20040829/a027b1e8/attachment-0001.gif 


More information about the Homestead mailing list