ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Tuesday, February 11, 1997 TAG: 9702110039
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: Personal Health
SOURCE: JANE BRODY
Eighteen years ago, Doreen LeMoult of Darien, Conn., discovered that she had chronic myelogenous leukemia that could be rapidly fatal. The doctors at Memorial Sloan-Kettering Cancer Center in New York told her that with available treatment she had at most two years to live.
That did not seem quite long enough to a mother of two young children. So she chose a 50-50 chance that she would survive potentially lethal doses of chemotherapy and radiation followed by a bone marrow transplant.
LeMoult was very lucky. She had a sister, who turned out to be a near-perfect match. At the time, July 1978, bone marrow transplants for cancer were highly experimental and the risks were great.
But LeMoult made it despite a few hurdles, including a bout of interstitial pneumonia that temporarily plunged her survival chances to less than 1 percent. She also developed cataracts and a damaged ear tube, ``which seems very little to have to deal with in light of what I got in return - the chance to raise my sons, who are now 21 and 25,'' said the part-time writer and homemaker.
Peter Smith was a 21-year-old college senior and athlete from Rye, N.Y., when in 1988 he was found to have aplastic anemia, a failure of the blood-forming cells, that did not respond to treatment. A bone marrow transplant was his only hope, but none of his three siblings was even close to a match.
So his doctors at Memorial Sloan-Kettering turned to the national registry of bone marrow donors in hope of finding someone whose tissue type matched this young man of Irish and Czech parentage. Five months later, a woman was found who matched perfectly and became his lifeline.
Now a 30-year-old meeting planner who recently married, Smith recalls that he was determined to ``come out 100 percent.'' He came close; the high doses of steroids he had to take to prevent rejection damaged his hip, requiring a replacement. So instead of gymnastics, basketball or skiing, he plays golf and racquetball and lifts weights to stay in shape.
LeMoult and Smith are among many hundreds of long-term survivors of bone marrow transplants both here and abroad. According to Dr. Thomas Duell of the University of Munich in Germany, about half of all patients who undergo bone marrow transplants survive, even though the vast majority of the procedures are now being done in cancer patients, who start out with the poorest survival chances.
Recent improvements in transplant treatments have made it possible to do successful transplants in older and much sicker people than in the past, Duell said.
Bone marrow transplants using donor marrow have become standard treatment for several otherwise fatal conditions, especially leukemias in adults and in some children, aplastic anemia and certain congenital blood disorders.
And whereas in 1980 only a few hundred bone marrow transplants were performed in United States, about 4,500 are now being done each year. The procedure is difficult and costly, averaging $90,000 to $250,000 a transplant just for the hospital stay.
But many more transplants might be done if more people volunteered to be bone marrow donors. Only about 30 percent of patients in need of a transplant have a family member who is suitably matched and able to donate marrow. The remaining 70 percent must depend on the generosity of unrelated volunteers.
On average, within a racial or ethnic group, one unrelated person in 20,000 will turn out to be a suitable match for a given patient. According to Susan Stewart, herself an eight-year survivor of a bone marrow transplant for acute myelogenous leukemia, about two-thirds of those needing a transplant are unable to have one because a suitable donor cannot be found. Stewart, who gave birth to her first child three years ago, publishes the quarterly Blood and Marrow Transplant Newsletter that is used internationally by transplant centers for patient education.
Currently, 97 transplants are done each month using donors who have signed up with the National Marrow Donor Program Registry. More than 2.5 million people have already joined the registry by giving a small amount of blood to a donor center, but there remains a great need for more donors, especially minority donors, because the chances of finding a match are much greater within a racial or ethnic group. To learn more about becoming a donor, call the registry at (800) 654-1247.
The big question has long been this: once patients are past the initial crises of acute rejection or recurrence of cancer or deadly infections, how well do bone marrow recipients fare? Duell, who is currently at Lawrence Berkeley National Laboratory in Berkeley, Calif., and other participants from 43 European transplant centers examined the fates of 798 bone marrow recipients who had survived five or more years after their transplants. It is by far the largest such study of long-term bone marrow transplant survivors.
Recurrent cancer ultimately claimed the lives of 21 of the long-term survivors who died. Eleven succumbed to the effects of chronic graft-vs.-host disease, and eight died of a second cancer, most likely resulting from the immune suppression needed to prevent rejection. And five died of AIDS acquired from contaminated transfusions that took place before it was possible to test donor blood for HIV antibodies.
Of the remaining patients who were alive and able to be evaluated, the study showed that the news on the whole was very good. ``Our principle finding is that most patients who survived more than five years after bone marrow transplantation are in good health and are socially reintegrated,'' the researchers wrote in the current issue of Annals of Internal Medicine. The health of more than 93 percent was found to be compatible with normal activity, and more than 89 percent had returned to full-time work or school.
Of course, some long-term survivors in the study did have disturbing health problems as a result of their treatment. The most frequent problems involved chronic graft-vs.-host disease, cataracts, bone changes, neuropsychological disturbances, new cancers and lung and liver dysfunction.
``This is a very invasive type of treatment,'' Duell noted. ``Patients really have to undergo an ordeal, and not everyone can deal with these situations. Each patient has to be fully informed of the process and the risks and decide for himself. But our study shows that for those who choose a bone marrow transplant, the outcome is well worth it.''
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