City of hope's bone marrow transplant program reaches two historic milestones

City of Hope’s bone marrow transplant (BMT) program recently performed the procedure on its 15,000th patient, becoming one of the first institutions in the world to reach this milestone.
Additionally, City of Hope was recently rated as having above expected BMT survival rates for the 14th year in a row, as calculated by experts at the Center for International Blood & Marrow Transplant Research. City of Hope is the only institution in the United States to have received this distinction for 14 consecutive years.
Stephen J. Forman, M.D., the renowned leader of City of Hope’s Hematological Malignancies and Stem Transplantation Institute and a pioneer in the field, will deliver the E. Donnall Thomas Lecture on Friday, Feb. 22, in Houston at the Transplantation & Cellular Therapy Meetings of the American Society for Blood and Marrow Transplantation and CIBMTR. Under Forman’s helm for the last 32 years, City of Hope’s Hematological Malignancies and Stem Cell Transplantation Institute has grown exponentially.

A Historic First

City of Hope’s 15,000th transplant is a remarkable milestone considering that the program started with just two physicians, three beds and guarded expectations in 1976. In those days, an acute myeloid leukemia diagnosis was grim — BMT as a cancer treatment was still primitive and not in wide practice. At the time, City of Hope was one of only six medical centers in the United States offering it.
Mushtaque Jivani, a college student from Indiana, was the first patient to undergo a BMT at City of Hope. His doctor was Karl Blume, M.D., who established the BMT program at City of Hope in 1975 with the late Ernest Beutler, M.D. Standard treatment in 1976 meant very high doses of chemotherapy followed by lengthy sessions of full-body radiation and a month in complete isolation posttransplant. This grueling treatment put Jivani’s cancer into remission for the rest of his life, and he lived an additional 35 years.
Since Jivani, City of Hope’s labs and researchers have led the way in making transplants more effective and safer, with fewer side effects. And 42 years after his BMT at City of Hope, one of its own employees, Rodrigo Nuñez, is now the longest-surviving BMT patient. Today, City of Hope has the most prolific BMT program in California, performing more than 700 procedures annually.
City of Hope was one of the first institutions to do BMTs in people over the age of 50 by developing a breakthrough method that relies less on heavy doses of chemotherapy and radiation and more on the anti-tumor effects of the graft itself. This development made it possible for the procedure to be offered to children. Patients as young as 4 months and as old as 79 years have received BMTs at City of Hope.
Other firsts that occurred at City of Hope include performing BMT safely in patients with HIV to treat AIDS-related lymphoma and developing a treatment for prevention of cytomegalovirus (CMV) infection after transplant, which has nearly eliminated the threat of CMV for BMT patients.
With the advent of nonrelated matched donors and, most recently, partially matched donors, BMT is saving more lives than ever before. “The biggest news is the ability to do half-matched transplants,” Forman said. This development has greatly expanded the pool of people who are eligible to receive BMTs, particularly among minority patients, who traditionally have had more difficulty finding matches. From a few hundred thousand, the Be The Match registry has now grown to 15 million people.
Looking forward, the program is focused on minimizing the side effects of the procedure, increasing its effectiveness and expanding its reach. These include clinical trials of a City of Hope-developed vaccine for CMV, a common and potentially deadly infection following transplant, and incorporating CAR T therapy, an immune-boosting treatment used either before transplant to put the disease into remission or after transplant to help prevent recurrence.

A Humanistic Approach

According to Joseph Alvarnas, M.D., associate clinical professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, “What’s really differentiated our program is all this is wedded to a deeply humanistic vision of delivering care to the patient. We have a system in which not only do you have hematologists caring for their patients, but you also have them partnering very carefully with members of supportive care medicine, from palliative care physicians to social workers to psychologists — and all of those things create a much more grounded, human-centered vision.”

In addition, every year City of Hope hosts the “Celebration of Life” BMT reunion, bringing together more than 7,000 attendees each year, a tradition that began 43 years ago and one at which Jivani was a regular guest. In addition, City of Hope established a formal long-term, follow-up program in 1998 to maintain communication between patients, families and physicians and to track outcomes so that the hospital is aware of the kinds of problems, both physical and psychological, that some patients have following transplant.
The next Celebration of Life BMT reunion is scheduled to take place in May 2019.