Pioneering Pediatric Bone Marrow Transplants

December 29, 2017 | by Travis Marshall

When pediatric patients are referred to City of Hope for bone marrow transplants, it’s often because they present with a case that other facilities would not treat.

“We’re structured differently from other facilities because so many of our patients are referred from outside,” said Anna Pawlowska, M.D., director of the Pediatric Hematopoietic Stem Cell Transplantation Program at City of Hope. “That gives us a lot of expertise in the most challenging cases.”

A Pediatrics Pioneer

That expertise has made City of Hope a leader in treating aggressive forms of leukemia and lymphoma, solid tumors, as well as non-malignant conditions like sickle cell disease and thalassemia.
 

Rosenthal-Joseph Joseph Rosenthal, M.D.
“We work collaboratively with City of Hope scientists and national research groups, including the Pediatric Blood & Marrow Transplant Consortium, which coordinates clinical trials in the U.S. and Canada; and the Children’s Oncology Group (a global research team dedicated to childhood cancers). This allows us to offer innovative clinical trials to our very high-risk patients,” Pawlowska said. “Additionally, we are the designated Southern California center for Kaiser Permanente’s transplants.”

City of Hope has also been ranked as the only “overperforming” transplant center in the U.S. for 13 years in a row by the Center for International Blood and Marrow Transplant Research.

 

Better Outcomes for More Patients
 

“We perform transplants that others will not,” said Joseph Rosenthal, M.D., director of Pediatrics Hematology/Oncology at City of Hope. “Just recently, I got a card from patient we transplanted 18 years ago. This patient had a fungal infection, and nobody would touch her. We did the transplant, and she’s now 28 years old, doing her master’s degree.”

Among the different types of transplants offered at City of Hope are half-matched transplants that expand the potential donor pool for patients who don’t have a fully matched sibling or unrelated donor.

City of Hope was also the first facility to successfully perform total marrow irradiation using intensity-modulated radiation therapy (IMRT), a directed radiation approach that targets the marrow and can spare critical organs.
 

Pawlowska-Anna Anna Pawlowska, M.D.
“We are investigating ways to induce mixed chimerism, which is a condition where elements of the immune systems from both a donor and the patient coexist, conferring immune tolerance to each other,” Rosenthal explained. “This approach may provide a safe venue in several conditions, including solid organ transplants, by decreasing the risks for toxicity on one hand and rejection on the other.”

City of Hope has also helped pioneer new ways to use stem cells from umbilical cord blood in transplants for certain patients. Cord blood transplants can be a viable alternative for patients for whom there is no appropriate donor. City of Hope has participated in trials to help improve the outcomes of these transplants, making them available to a growing number of patients who wouldn’t be candidates for bone marrow transplants otherwise.

Caring for Patients – and Their Families

 

City of Hope’s bone marrow transplant program is among the largest in the country. “We do more transplants than anyone else in California,” Rosenthal said. “Last year, we did about 660 transplants total, and about 50 total for pediatrics. Because we have such a well-established program, we have tremendous benefits from infrastructure.”

Rosenthal is referring to the multi-disciplinary team of specialists, researchers, nurses, social workers and counselors who rally around every patient.

That multi-disciplinary approach is especially important when treating this younger population of patients. Children and young adults battling these devastating diseases have unique psychological, social, familial and logistical needs that must be considered along with their medical care.

“At City of Hope, the patient is truly the center of care,” Rosenthal said. “We are coordinated and nimble, and we surround him or her with every possible kind of specialist.”

 

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