Fred Hutchinson transplant program pioneers treatment options for minority patients struggling to find a donor match.


Patients from ethnic minority and mixed-racial backgrounds are less likely to receive a lifesaving bone marrow transplant than Caucasian patients with the same disease due to lack of matching donors, according to the National Marrow Donor Program (NMDP).

The likelihood of a patient finding a bone marrow donor match is highly dependent on genetic similarities between the patient and donor. Seventy percent of patients in need of a transplant do not have a matching donor in their family, according to Be The Match, operated by the NMDP. These patients must instead turn to a donor registry or alternative methods for treatment. Unfortunately, few minority patients have either a matched family member or an identified matched unrelated donor. This is due to complex genetic factors and low donor-registration numbers.

Seattle Cancer Care Alliance (SCCA) is working with Fred Hutchinson Cancer Research Center to pioneer new lifesaving transplant procedures to reduce the need for matching bone marrow donors by providing bone marrow or blood stem cell transplants to patients who would not typically be candidates due to lack of a matching donor.

“The striking difference in donation levels echoes the need to raise awareness of the bone marrow and umbilical cord blood donation registries, while continuing the development of transplant programs that expand the availability of these life-saving treatment to more people,” said SCCA’s Colleen Delaney, M.D., MSc, director of the Cord Blood Transplant Program and associate member of the Clinical Research Division at Fred Hutch. “Thanks to innovative treatments developed at Fred Hutch and available today through the SCCA Transplant Program, nearly all patients in need of a bone marrow or blood stem cell transplant will be able to identify a donor. Our goal is to make sure every patient who needs a blood stem cell transplant will get one with survival rates that are equivalent to conventional unrelated donors.”

Delaney is a renowned expert in the development of novel methods to grow cord blood stem cells in the laboratory and has pioneered steps toward reducing the risk of life-threatening infections in patients who receive a cord blood transplant.

Cord blood is unique from other sources of stem cells for bone marrow transplants. This leftover blood in the umbilical cord, which is collected immediately after birth without harm to the infant or mother, contains immune cells that are protected from foreign invaders such as bacteria and viruses. Due to this protection, these “naive” immune cells do not perceive a patient’s unmatched stem cells as a threat. This means cord blood transplants do not require a near identical genetic match between donor and patient for successful treatment. Most cord blood transplants involve a genetically mismatched donor and patient.

While cord blood transplant recipients have been at high risk for early post-transplant complications due to the low number of cells available in a single cord blood unit, Delaney’s innovative methods for expanding the number of cord blood cells per unit prior to transplant have been able to reduce such risks.

Jessie Quinn, a patient of half-Caucasian and half-African American ancestry, knows first-hand the lifesaving promise of expanded cord blood cells method. A survivor of acute myelogenous leukemia (AML), Quinn was the first patient to participate in an SCCA clinical study led by Delaney using her novel approach with expanded cord blood cells. Quinn credits her survival to the Fred Hutchinson Transplant Program at SCCA and her doctors’ dedication to developing innovative options for patients unable to find a donor match.

The Fred Hutchinson Transplant Program at SCCA also provides successful haploidentical transplants for patients unable to find a relative who is a perfect match. Led by Paul O’Donnell, M.D., Ph.D., medical director of SCCA’s Adult Transplant Service and researcher in the Clinical Research Division at Fred Hutch, haploidentical transplants are performed when a patient’s relative offers a partial donor match. Through advances in drug therapies, physicians are able to control the adverse immune system responses that previously prevented these partially matched relatives from serving as donors. Haploidentical transplants are especially beneficial for pediatric patients using their parents or siblings as donors.

“Patients should not give up hope if they run into difficulties finding a donor,” O’Donnell said. “At SCCA, we are committed to turning cancer patients into cancer survivors. Sometimes that means exploring alternative options and looking into clinical trials to help our patients conquer cancer. The Fred Hutchinson Transplant Program at SCCA offers patients additional treatment plans when they often believe they are out of options.”

O’Donnell is currently leading a multi-center, randomized clinical trial to determine the effectiveness of double unrelated umbilical cord blood transplants versus haploidentical related bone marrow transplants in people with leukemia or lymphoma. He is actively recruiting patients. A multi-center randomized Phase II study led by Delaney is also currently recruiting patients to evaluate the clinical efficacy of giving study participants umbilical cord blood cells that have been expanded in the laboratory to increase the number of cells available for the transplant.

SCCA has been at the forefront of revolutionizing transplant treatment options since the clinical use of bone marrow and stem cell transplantation was first developed at the Fred Hutch more than 40 years ago. One of its founders, E. Donnall Thomas, M.D., won the 1990 Nobel Prize in physiology or medicine for this groundbreaking work. As a result of Thomas’ innovation, the world’s millionth blood stem cell transplant procedure took place in January of this year. To date, SCCA’s doctors have performed more than 14,000 bone marrow transplants and the clinic consistently ranks among the country’s top transplant centers in one-year patient survival rates.

Fred Hutch continues to lead transplant research and has pioneered the use of transplants to treat autoimmune disorders and other, non-cancerous diseases. By developing “mini-transplants” that use minimal doses of radiation resulting in reduce side effects, older patients who were not previously eligible for transplants now have an additional treatment option.

For more information about the Fred Hutchinson Transplant Program at SCCA, please visit:http://www.seattlecca.org/diseases/bone-marrow-transplant-overview.cfm.

Source: Fred Hutchinson Cancer Research Center

 

 

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Transplant doc, Nobel winner Murray dies in Boston.


Dr. Joseph E. Murray, who performed the world’s first successful kidney transplant and won a Nobel Prize for his pioneering work, has died at age 93.

Murray suffered a stroke at his suburban Boston home on Thanksgiving and died at Brigham and Women’s Hospital on Monday, hospital spokesman Tom Langford said.

Since the first kidney transplants on identical twins, hundreds of thousands of transplants on a variety of organs have been performed worldwide. Murray shared the Nobel Prize in Physiology or Medicine in 1990 with Dr. E. Donnall Thomas, who won for his work in bone marrow transplants.

“Kidney transplants seem so routine now,” Murray told The New York Times after he won the Nobel. “But the first one was like Lindbergh’s flight across the ocean.”

Murray’s breakthroughs did not come without criticism, from ethicists and religious leaders. Some people “felt that we were playing God and that we shouldn’t be doing all of these, quote, experiments on human beings,” he told The Associated Press in a 2004 interview in which he also spoke out in favor of stem cell research.

In the early 1950s, there had never been a successful human organ transplant. Murray and his associates at Boston’s Peter Bent Brigham Hospital, now Brigham and Women’s Hospital, developed new surgical techniques, gaining knowledge by successfully transplanting kidneys in dogs. In December 1954, they found the right human patients, 23-year-old Richard Herrick, who had end-stage kidney failure, and his identical twin, Ronald Herrick.

Because of their identical genetic background, they did not face the biggest problem with transplant patients, the immune system’s rejection of foreign tissue.

After the operation, Richard had a functioning kidney transplanted from Ronald. Richard lived another eight years, marrying a nurse he met at the hospital and having two children.

Murray performed more transplants on identical twins over the next few years and tried kidney transplants on other relatives, including fraternal twins, learning more about how to suppress the immune system’s rejection of foreign tissue. One patient who received a kidney transplant from a fraternal twin in 1959, plus radiation and a bone marrow transplant to suppress his immune response, lived for 29 more years.

But it was the development of drugs to suppress the body’s immune response, a less radical approach than radiation, that made real breakthroughs in transplants possible. In 1962, Murray and his team successfully completed the first organ transplant from an unrelated donor. The 23-year-old patient, Mel Doucette, received a kidney from a man who had died.

Murray continued a long career in plastic surgery, his original specialty, and transplants. He was guided by his own deep religious convictions.

“Work is a prayer,” he told the Harvard University Gazette in 2001. “And I start off every morning dedicating it to our Creator.”

Murray told the Journal of the American Medical Association in 2004 that he continued to get letters from patients he helped years earlier and from relatives of those who died during the early efforts.

“They often say … that they are happy to have played some small part in the eventual success of organ transplants,” he said, praising the courage of his patients and their families.

Murray was honored at the 2004 Transplant Games, for athletes who have received organ transplants, along with Ronald Herrick, the man who had donated a kidney to his twin brother a half-century earlier.

Murray continued to support and mentor others at Brigham and Women’s Hospital after his retirement, hospital president Dr. Elizabeth Nabel said. An exhibit in the hospital’s library housing his Nobel Prize, she said, is framed by his own words: “Service to society is the rent we pay for living on this planet.”

Murray’s interest in transplants developed during his time in the Army during World War II when he was assigned to Valley Forge General Hospital in Pennsylvania while awaiting overseas duty. The hospital performed reconstructive surgery on troops who had been injured in battle.

The burn patients, who often were treated with skin grafts from other people, intrigued Murray.

“The slow rejection of the foreign skin grafts fascinated me,” Murray wrote in autobiography for the Nobel Prize ceremony. “How could the host distinguish another person’s skin from his own?”

The hospital’s chief of plastic surgery had performed skin grafts on civilians and noticed that the closer the donor and recipient were related, the slower the tissue was rejected. A skin graft between identical twins had taken permanently.

Murray said that was “the impetus” of his study of organ transplantation.

Murray was ever the optimist and kept on his desk a quotation, “Difficulties are opportunities,” his son Rick Murray said.

“It reflects the unwavering optimism of a great man who was generous, curious, and always humble,” Rick Murray said in a statement released by the hospital.

Source: Yahoo News