====================== JeffNEWS, July 1, 1995 ====================== New Bone Marrow Transplant Program Benefits Patients With Cancer, Hematologic Disorders ---------------------------------------------------- Sometimes physicians must treat patients with extremely high doses of chemotherapy and radiation to destroy their cancers; however, this damages or destroys normal blood formation in the bone marrow, too. Bone marrow transplants provide a way to restore patients' blood-forming systems afterwards. Jefferson's new bone marrow transplant program offers two types of bone marrow transplants: the allogeneic (a-lo-gen-nay-ic), where the patient receives marrow from a donor and which will be the main focus of our program, and the autologous, where the patient's own marrow is used. (See program specifics below.) The key personnel for program are now on campus, said program director, Neal Flomenberg, MD, professor of medicine/neoplastic diseases, Jefferson Medical College. They include Fred Garbrecht, MD, who is responsible for the marrow processing laboratory; Janet Brunner, PA-C, physician's assistant, the program's senior coordinator; Fran Walker, RN, who will be the nursing care coordinator for the unit, and Shelley Burcat, RN, the unit's clinical nurse specialist. There will also be a pharmacist, social workers and additional nursing staff. The unit, which was made possible in part by a $500,000 pledge from the hospital Women's Board, is on the 14th floor of the Foerderer Pavilion and will consist initially of six beds, which will be expanded to 13. There are rooms for physicians to discuss cases and rounds, places for them to meet with family, a family lounge and a small kitchen. The unit's air quality, which is comparable to that of an operating room, ensures that patients, whose immune systems have been compromised by the intensive treatment, are as protected from germs as possible. "The rooms are designed so that if patients need intensive-care support, it can all be provided within the unit's protected environment," Dr. Flomenberg said. For further information, call Ms. Brunner at 1962. About Bone Marrow Transplants and Jefferson's Unique Program ------------------------------------------------------------ "Allogeneic transplants are cases where bone marrow comes from a donor, related or unrelated to the patient, whose human leukocyte antigens (HLA), or tissue type, closely matches the patient's," explains program director, Neal Flomenberg, MD, professor of medicine/neoplastic diseases, Jefferson Medical College. "Using a syringe and needle, the bone marrow transplant team draws out the donor marrow, which is infused into the patient once chemotherapy is completed and within hours following the final radiation treatment." Allogeneic bone marrow transplants may benefit patients with leukemias and lymphomas, as well as aplastic anemia and sickle cell anemia These patients may require prolonged follow-up to prevent or treat many side effects of the transplant, such as opportunistic infections. Autologous transplants use the patient's own marrow, which has been removed and frozen before chemotherapy to protect it from the treatment. The marrow is thawed and reinfused into the patient after the potency of the chemotherapeutic drugs has been exhausted. Autologous bone marrow transplants are helpful in breast cancer, in lymphoma and in certain types of leukemia. Unique Approaches ----------------- "Jefferson is one of only a small number of centers nationwide and the only one in the region with the expertise to decrease the problem of graft- versus-host (GVH) disease in highly mismatched allogeneic transplants. We do this by processing the donor marrow to deplete, or remove, all but one small subset of T-cells. These are the immune cells that cause GVH," he said. "Marrow contains many immune cells and when those cells are introduced into another person's body, they recognize that body as being different and react as though the body is being infected," Dr. Flomenberg explained. "The marrow is actually trying to reject the body into which it has been placed. "Our approach substantially increases the number of possible donors because we can dramatically reduce from 100 to 50 percent the degree of HLA-matching required of a donor." The initial responses to this therapy have been encouraging; but because few patients have so far received such treatment, Dr. Flomenberg suggests it at this point only for those who have failed standard therapy and who have no other good options for a transplant or other treatment. He also notes that a limited amount of graft-versus-host disease may be tolerated and that it may even fight the patient's leukemia. This "graft versus leukemia" effect may be as important as high-dose chemotherapy and radiation in curing some diseases, such as chronic myelogenous leukemia, which respond well to bone marrow transplant. The Jefferson team also has at its disposal a highly successful new technique to counter relapses in patients with CML who have received transplants of T-cell-depleted marrow. In those cases, Dr. Flomenberg and his colleagues will infuse into the patient white blood cells from the original marrow donor. At the Medical College of Wisconsin, he and his team achieved a favorable response in all 13 patients treated this way. ------------------------------------------------------------------------------ Information provided by: Editor, JeffNEWS (215) 955-6204 ------------------------------------------------------------------------------