Bone marrow transplantation is a successful therapy for a variety of malignant and non-malignant diseases, cancer-related illnesses, and some autoimmune diseases.
(PRUnderground) April 29th, 2024
According to the American Cancer Society, an estimated 62,770 people will be diagnosed with leukemia in the US this year, and about 8% of these cases will be Chronic Myeloid Leukemia (CML). An estimated 23,670 people will die from leukemia in the US in 2024.
CML, or chronic myeloid leukemia, is a type of blood cancer that affects the white blood cells. It occurs when a genetic mutation causes some of the bone marrow cells to grow out of control and crowd out the normal blood cells. CML can cause symptoms such as fatigue, weight loss, night sweats, fever, and bleeding or bruising easily.
The standard treatment for CML is a class of drugs called tyrosine kinase inhibitors (TKIs), which target the abnormal protein that drives the cancer cells. TKIs can keep CML under control for many years, but they do not cure the disease.
Some patients may develop resistance or intolerance to TKIs or have advanced stages of CML that do not respond well to them. In these cases, a bone marrow transplant may be an option.
A bone marrow transplant, also known as a stem cell transplant, replaces the patient’s diseased bone marrow with healthy donor cells. The donor cells can come from a sibling, a relative, or an unrelated person who has a compatible tissue type. The donor cells can help fight the cancer and restore normal blood production.
However, a bone marrow transplant is not a simple procedure. It involves high doses of chemotherapy and radiation to destroy the patient’s existing bone marrow, which can cause serious side effects and complications. The patient also needs to take drugs to prevent the donor cells from attacking their own body, a condition called graft-versus-host disease (GVHD). The risk of infection and bleeding is also high after a transplant.
Dr. Julie Asch, a hematologist and medical director of the Blood and Marrow Transplantation Program at Intermountain LDS Hospital, said that a bone marrow transplant is a “lifesaving but high-risk” treatment for CML patients who have no other options.
“We only consider a transplant for CML patients who have failed two or more TKIs, or who have very aggressive disease that does not respond to TKIs at all,” she said. “A transplant is a major undertaking that requires a lot of preparation, coordination, and support from the patient, the donor, and the medical team.”
Dr. Asch added that finding a suitable donor can be challenging, especially for patients from diverse ethnic backgrounds. “The best chance of finding a match is among siblings, but only about 25% of patients have a sibling who is a match. The next best option is to search the national registry of volunteer donors, but the chances of finding a match vary depending on the patient’s ancestry. For some groups, such as African Americans, Native Americans, Asians, and Pacific Islanders, the odds are much lower than for others,” she said.
Dr. Asch said that sometimes, a mismatched transplant can be performed, if the donor is close enough of a match and the patient is in urgent need of a transplant.
“A mismatched transplant has higher risks of GVHD and rejection, but it can also have a stronger anti-leukemia effect. We weigh the benefits and risks carefully for each patient and donor pair, and we use special techniques to reduce the chances of complications,” Dr. Asch said.
One of the patients who received a mismatched transplant at Intermountain LDS Hospital is Marc Dunbabin, 38, from Highland, Utah.
Dunbabin was diagnosed with CML in May 2021, after a routine eye exam revealed some blood in his retina. A specialist ordered blood tests, and the day after Mother’s Day, he found out he had leukemia.
He saw an oncologist, who started him on a TKI. The TKI was initially effective, but started to lose its efficacy a year into treatment which prompted the oncologist to change to a different TKI. While on this new TKI, Marc started to experience migraines. After a few months, he developed intense migraines, exhaustion, and balance problems. He went to the emergency room several times after collapsing and experiencing an inability to speak. A spinal tap revealed that his leukemia had spread to his central nervous system, which is very rare and dangerous.
He was admitted to Intermountain LDS Hospital. Because of his resistance to TKIs and the aggressiveness of the cancer, his doctors determined that he needed a bone marrow transplant. In order to prepare his body for a bone marrow transplant, he received chemotherapy injections into his spine and into his peripheral blood. He stayed in the hospital for 20 days until the cancerous blasts were cleared from his CNS.
His brother was tested as a potential donor, but he was not a match. His sister was a perfect match, but she was pregnant and could not donate. The next option was to find an unrelated donor through the registry.
Fortunately, they found one who was a close enough match, even though not a perfect one. The donor was a woman who lived in the U.S., but Dunbabin did not know anything else about her.
“Some amazing person decided to be a donor,” he said. “Being a donor does not require a huge sacrifice, but it has a huge impact, it is amazing. If I didn’t have a donor, I would not be here right now. So, I’m very grateful she decided to be a donor.”
He received his transplant in March 2023, and spent another three weeks in the hospital. He said the recovery process was hard, but he felt supported by his family, friends, and medical team.
He also felt a connection with his donor, whom he hopes to meet someday.
“I feel like my old self again,” he said. “I have energy, I can do things with my family, I can work. I feel very blessed, and I have grown closer to God and to my loved ones. Life is full of surprises. I see this as an opportunity. There are a lot of silver linings.”
Dunbabin is married and has three children, ages 11, 9, and 6. As a family they love to hike, play board games, and go on walks. He still gets a biopsy every three months and monthly blood tests to monitor his condition, but he is optimistic about his future.
He also wants to raise awareness and encourage more people to join the donor registry.
Anyone who is healthy and between 18 and 44 years old can sign up online at bethematch.org, and receive a cheek swab kit in the mail. The kit is then sent back to the registry, where the tissue type is analyzed and stored. If a match is found, the donor is contacted and asked to donate either bone marrow or peripheral blood stem cells, depending on the patient’s needs.
“It’s a simple process to join the registry, but it can make a huge difference for someone who needs a transplant,” Dunbabin said. “You can save a life, just like my donor saved mine.”
“It’s a great reminder, during this Donate Life Month,” said Dr. Asch.
Each April, the United States recognizes National Donate Life Month, bringing attention to organ, eye, bone marrow and tissue donation and transplantation.
Donate Life month honors and recognizes those who have saved lives. It is only through the generosity of donor families and donors that makes saving lives through organ and bone marrow transplantation possible.
About Intermountain Health
Headquartered in Utah with locations in seven states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 33 hospitals, 385 clinics, medical groups with some 3,900 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information or updates, see https://intermountainhealthcare.org/news.
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