City of Hope performed the institution’s 10,000th hematopoietic cell transplant on Jan. 13, marking a major milestone for a program that was one of the pioneers in development of the treatment.
|Hundreds of survivors now return to City of Hope for the annual transplant reunions. (Photo by AmyCantrell.com)|
“These occasions provide an opportunity to pause and reflect,” said Stephen J. Forman, M.D., Francis and Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation and chair of the Department of Hematology & Hematopoietic Cell Transplantation.
“Day to day, our work is all about a single life at stake that we’re trying to save. Reaching 10,000, you think about the many people, children and adults, who have benefited from City of Hope’s nursing care and research — the many wonderful people who have come here, trusting us to care for them.”
Hematopoietic cell transplantation, or HCT, is a therapy used to treat patients with life-threatening cancers and other disorders of the blood and immune system. In the procedure, physicians seek to establish a new, disease-free blood and immune system by transplanting healthy blood stem cells.
The journey toward the 10,000th such transplant was only possible through the bold first steps of pioneers in the field — men and women who believed the investigational treatment could save the lives of patients once told they could not be cured.
The City of Hope HCT story began more than 34 years ago in a three-bed unit led by two physicians — Karl Blume, M.D., who is now with Stanford University, and the late Ernest Beutler, M.D. — along with a few dedicated nurses. Guided by scientific diligence and persistence, they were one of the first teams anywhere to perform a successful transplant, proving that the therapy was lifesaving.
Now more than 30 physicians care for patients in an advanced 60-bed unit dedicated solely to the treatment of hematologic cancer in City of Hope Helford Clinical Research Hospital. Performing more transplants than any other center in the state, the program also is one of the world’s largest and most successful.
|Karl Blume was one of the original physicians to introduce bone marrow transplantation at City of Hope. (City of Hope Archives)|
“In the early days, this was a therapy of uncertain efficacy, done at a very small number of places. Our results helped validate that this could work to cure patients. Now it is a standard of care for the treatment of many diseases,” said Forman, who joined City of Hope in 1978.
“Drs. Blume and Beutler were the real pioneers in this effort,” he continued. “It is upon their shoulders that we now all stand.”
As HCT advanced from investigational therapy to gold standard for several diseases, City of Hope’s treatment program has saved more than 36,000 years of life.
That success of the City of Hope transplant program also has given hope to patients who lack a matching donor within their families.
These patients must rely on stem cells from unrelated donors sometimes a world away. The procedure carries potential for dangerous complications, especially among the sickest patients. But the National Marrow Donor Program recently reported that City of Hope’s Matched Unrelated Donor Program is the only one nationwide to achieve above-expected survival outcomes for five consecutive years.
“Caring for patients, we work as a team of physicians, nurses, scientists and other support staff, including those in transfusion medicine,” said Auayporn P. Nademanee, M.D., director of the Matched Unrelated Donor Program. “It allows us to anticipate — to say, ‘Ah, something’s going to happen tomorrow. Let’s take care of the problem now.’”
The influence of HCT
City of Hope research continues to lead to advances. New approaches to the transplant regimen improved cure rates, extended the procedure to older patients and expanded HCT to diseases beyond leukemia, lymphoma and multiple myeloma.
Through studies led by John A. Zaia, M.D., Aaron D. and Edith Miller Chair in Gene Therapy, and the late Gerhard Schmidt, M.D., City of Hope was among the first to develop a treatment to prevent cytomegalovirus, a potentially deadly infection to HCT patients.
|In a photograph from the program’s early days, physicians remove cells from a donor’s bone marrow. (City of Hope Archives)|
Andrew A. Raubitschek, M.D., chair of the Department of Cancer Immunotherapeutics and Tumor Immunology, investigates a strategy called radioimmunotherapy, in which engineered immune molecules deliver targeted radiation directly to cancer cells. This approach has shown promise for lymphoma and is now being extended to leukemia.
Following on City of Hope’s remarkable transplant results for treatment of patients with HIV-related lymphoma, scientists also have adapted HCT to tackle HIV/AIDS. Zaia worked with John J. Rossi, Ph.D., Lidow Family Research Chair in the Department of Molecular and Cellular Biology, Amrita Krishnan, M.D., director of the Multiple Myeloma Program, and David DiGiusto, Ph.D., research professor in the Department of Virology, to develop a technique that couples HIV-fighting gene therapy with HCT in a bid to cure patients of HIV-related lymphoma while also blocking the virus that causes AIDS. A recent study from the City of Hope transplant program showed the anti-HIV genes persisted in patients up to two years after infusion.
Although HCT has come a long way, challenges remain. City of Hope laboratory and clinical scientists are driven to make HCT safer and more effective, and help extend the length and quality of life of patients who come to City of Hope for care.
Said Forman: “At the end of the day, all of our efforts are about our commitment to patients and their families — recognizing each of them as a dignified human being with a story to tell and a life to live. They also are our partners in developing new therapies for those who will come to us tomorrow for care. There’s an enormous number of people who are alive today because they were and are a part of something we did at City of Hope that was both bold and new. And that number continues to grow.”
Transplants at a glance — more than three decades of lives renewed
- City of Hope performs more than 500 transplants a year (about 45 per month).
- One patient attended the first Bone Marrow Transplant Reunion in 1977. Now, hundreds of patients and their families return to City of Hope each year for the Celebration of Life picnic.
- City of Hope’s Bone Marrow Transplant (BMT) program is the largest in California.
- The youngest patient to undergo transplant was 4 months old. The oldest patient was 79 years old at the time of transplant.
In 1976 …
View a timeline of discovery >>
- … transplants could only be performed between matched sibling donors. Now, unrelated donor transplants are more common.
- … six patients underwent transplantation. The longest-surviving patient is now 35 years out from transplant.
- … there were three BMT staff physicians in the program. In 2011, more than 30 physicians and more than 100 scientists work in the program.
- … City of Hope had fewer than 10 transplant nurses; now there are more than 400.
- … there were only three beds for patients undergoing transplant on the Machris third floor. Today, City of Hope Helford Clinical Research Hospital has 60 beds dedicated to the care of transplant patients.
- … it was rare to transplant a patient over the age of 30. Now, patients can undergo transplant well into their 60s and even 70s.