When the first bone marrow transplant took place at Stanford 30 years ago, patients had to nearly face death to survive. The process required patients to undergo a grueling regimen of radiation and chemotherapy to destroy their existing bone marrow cells, lengthy hospitalizations and a high risk of infection and rejection. The Stanford Blood and Marrow Transplant (BMT) program has made huge strides in the last three decades. Today, more sources of stem cells and less toxic treatment regimens allow more patients to be treated with blood and marrow transplantation.
To commemorate the 30-year anniversary of blood and marrow transplantation at Stanford, the BMT program held a celebration for its more than 300 faculty, nurses and staff on Nov. 2, 2017. Each team member received a commemorative pin designed by BMT nurse Colleen Avery and a water bottle. Speakers included School of Medicine Dean Lloyd Minor, MD; Vice President, Cancer Services Sri Seshadri, PhD; Stanford Health Care President & CEO David Entwistle; BMT Clinical Director and Clinic Chief Laura Johnston, MD; and Robert Negrin, MD, Chief of the Division of Blood and Marrow Transplantation, who was at Stanford when the first patient was transplanted in 1987.
Since that first procedure, Stanford’s BMT program has performed over 7,000 transplants, and is growing rapidly. “In fiscal year 2017, we performed a record-breaking 445 transplants,” said its Administrative Director Julie Porter.
“Thirty years ago, all we had as donors were the patients themselves or a sibling,” said Negrin. “That meant we couldn’t offer the treatment to a lot of people because we couldn’t find a donor.” Today, there are worldwide registries of over 25 million individuals who could serve as possible donors, the use of umbilical cord blood, and the ability to use half-match family donors, he said.
Another advancement has been the ability to do a transplant with less aggressive preparation, said Negrin. “What we’ve learned is that the major benefit of a bone marrow transplant is that the transplant of a normal immune system from a donor helps fight off the cancer,” he said. “It was really that recognition that helped us develop less intensive, less invasive ways to transfer the immune system more safely.” These more patient-friendly regimens greatly reduce the side effects, which allows some patients to be treated and monitored as outpatients. It also makes it possible to use BMT as a treatment modality in older patients, those in their 60s and 70s, when the diseases that are more likely to benefit from a transplant are more prevalent.
Today, patients spend much less time in the hospital than in years past. Drugs to control nausea and diarrhea make the experience more tolerable, and antiviral and antifungal medications greatly reduce the risk of infections. Immune protocols developed at Stanford help reduce graft versus host disease, the major complication of transplantation where the donor immune cells recognize the patient as foreign and attack. And the use of growth factors helps newly transplanted immune cells replicate faster, which reduces the length of treatment, and likewise, the chance of infection.
“In the 1980s and 1990s, BMT was a last ditch effort for patients who had failed multiple therapies,” said Negrin. “These days, BMT is much more part of the normal treatment algorithm for patients with hematological malignancies. Blood and marrow transplantation is much better tolerated by our patients now, with fewer side effects, less risk and a better quality of life.”