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Originally posted July 19, 1999

ANN ARBOR, MI - New hope is available for older people in need of a bone marrow transplant, a procedure typically reserved for patients under age 55 because of its complications.

A clinical trial under way at the University of Michigan Comprehensive Cancer Center is expanding the boundaries of treatment for older people battling life-threatening blood cancers such as leukemia and lymphoma.

The new treatment being performed in the clinical trial uses less radiation and chemotherapy, instead allowing the immune system of the transplanted marrow to help fight the disease. The new, less-toxic approach offers an alternative.

"We think this trial is going to enable patients who need a transplant but who wouldn't be able to get one," says James Ferrara, M.D., director of the U-M Bone Marrow Transplant Program. "So someone who's 60 or 65, for example, is now going to be able to receive a bone marrow transplant, which is curative therapy for their malignancy or their condition."

Bone marrow is found inside the body's large bones. It manufactures all of the body's blood cells: red cells that carry oxygen, white cells that fight infection and platelets that allow blood to clot. When bone marrow is threatened by blood diseases such as leukemia and Hodgkin's disease, the body cannot protect itself from infection.

Bone marrow must be genetically matched to that of the patient's to be transplanted.

People over the age of 50 typically have not been candidates for bone marrow transplants because of complications that come with the procedure. In particular, disease is a threat as the new marrow works to establish itself; the new marrow's cells may attack the patient's tissues.

To prepare for a transplant, a patient undergoes a week of extensive chemotherapy and radiation; doses are intentionally high to destroy all bone marrow. Donated marrow is then transplanted, but needs several weeks to engraft and fully produce blood cells.

The side effects during this period are serious and life-threatening, says Ferrara.

"The patients are very fragile. They're very susceptible to infection; they need daily infusions of blood products and antibiotics. They are very sick," he says.

Given how toxic a transplant can be, it is performed only if a patient's life is in danger.

"What's new is we're not trying to destroy all of the patient's bone marrow. We're allowing the new immune system from the donor marrow to do some of the work. All we want to do is eliminate enough of the patient's own bone marrow so that the new bone marrow can take hold," he says.

Five patients have undergone the new procedure; four have survived and are "doing very well," Ferrara says.

The standard procedure has a 70-percent survival.

"This really represents a change in the way we think about transplants. For a long time in the 1980s, we thought that it was really the chemotherapy and the radiation that eliminated the malignancy or the problem. Now we understand that it's really the immune system in the donor marrow that is a major component to the therapy and that's why we think that we can use less radiation, less chemotherapy and rely more on the power of the donor immune system to help eliminate the malignancy," Ferrara says.

Facts about bone marrow transplants:

  • Bone marrow transplants may be used to treat leukemia, lymphoma and other serious blood diseases.
  • The National Marrow Donor Program has nearly 3 million volunteer donors.
  • It is becoming more common for bone marrow donors to not be related to patients receiving transplants.

For more information: Contact U-M TeleCare at 1-800-742-2300, category 1010.


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