New process allows more leukemia patients to get life-saving stem-cell transplants

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August 25, 2016- Dr. Salil Goorha, medical director of Baptist Cancer Center Malignant Hematology and Transplant Program, meets with patient Bernita Glass. Doctors at Baptist Memorial Hospital-Memphis are using a newly developed procedure to help leukemia patients and others get needed stem-cell transplants even when they have no sibling or other available donor who matches their tissue type. (Nikki Boertman/The Commercial Appeal)

Diagnosed with a rare and aggressive form of leukemia, Bernita Glass faced daunting options.

“Do nothing,” Glass was told, “and she’d live no more than six months.” Or, she could get a stem-cell transplant to bolster her immune system and fight off the disease.

The problem was she had no family members or other prospective donors who were 100% matches in terms of tissue types. Without such a match, Glass would be at risk of developing potentially deadly graft-versus-host disease, in which the cells from the donor would attack her body.

But a recently developed procedure offered new options and hope for Glass, a former Head Start program director living in West Helena, Arkansas. In February of last year, at Baptist Memorial Hospital-Memphis, she became perhaps the first adult in Memphis to undergo what is known as a haploidentical, or half-matched, transplant, receiving stem cells harvested from the bone marrow of her son, even though he was just a 50% match.

Now 52, Glass has been in remission ever since.

“I was blessed,” she said, “I just believe I was led here for a purpose.”

Glass had contracted prolymphocytic leukemia, a disease in which large, immature cells called prolymphocytes proliferate rapidly and fill the bloodstream. Chemotherapy generally is not effective in arresting the disease.

A transplant of blood stem cells — undifferentiated cells that will develop to form new blood — is needed “to give your body a new immune system to fight and kill the cancer” according to Dr. Salil Goorha, medical director of Baptist Cancer Center’s Malignant Hematology and Transplant Program.

“We perform transplants to save people’s lives, but it has not always been available. The reason the option often isn’t available is that up to 40% of all patients have no fully-matching donor available. Family ties often don’t help either because the chance of a someone’s sibling being a full match with him or her is only 25%”, Goorha said.

But heredity and ethnicity does play a role in determining who is a match. And because most donors are Caucasian, African-Americans, such as Glass, have an especially difficult time finding a match.

That’s where the new process fits in. Developed at Johns Hopkins University, it incorporates a chemotherapy drug called cyclophosphamide. The drug, administered in high doses three and four days after the transplant, kills the cells that cause graft-versus-host disease while preserving the stem cells and the cells that destroy the cancer.

Patients also receive a different chemotherapy drug before the transplant.

Although he wasn’t a full match, Glass’s then-29-year-old son was suitable for the haploidentical transplant because he is closely related, offering a better chance for success.

“It’s important to understand that haplo doesn’t just mean 50% match. It also means there’s a genetic similarity between the donor and recipient,” Goorha said.

One drawback involves the sometimes painful side effects of cyclophosphamide, which include bladder inflammation and bleeding.

In addition to Baptist, the Blood and Marrow Transplant Program, run by Methodist Healthcare and West Cancer Center, has been performing haploidentical transplants for about a year. Methodist spokeswoman Mary Alice Taylor said. St. Jude Children’s Research Hospital also has been using a variation of the process on child cancer patients.

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