February 2009 is now in the rearview and so is an important milestone for Cook Children’s – the 700th bone marrow transplant. On Feb. 16, an 18-year-old girl was not only the patient to receive this landmark transplant but her unique situation also tells the story of how much Cook Children’s transplant program has evolved since it began.
Despite appearing to be in remission for Acute Lymphoblastic Leukemia (ALL), a new, more sophisticated test on her bone marrow samples detected very minute amounts of the leukemia clone, called Minimal Residual Disease (MRD). With MRD testing, her doctors were armed with a clearer picture of her condition.
“Ten years ago, we probably would not have recommended a bone marrow transplant for her because the testing available would not have shown this presence of residual leukemia cells,” said Medical Director of Cook Children’s Hematology and Oncology Center Gretchen Eames, M.D., M.P.H. “We now get a better handle on the patient’s disease state and are able to tailor their treatment options, whether transplant or additional therapy, based upon the MRD testing.”
Based on these test results and the experience of the physicians at Cook Children’s, Dr. Eames felt that transplant was in the teenager’s best interest. “It was better to do it now when she only has a tiny, minuscule amount of leukemia present, then at the time of possible relapse,” Dr. Eames said.”
This preemptive approach is part of a new era for the Cook Children’s transplant program. “Where a transplant 20 years ago would have been a treatment of last resort, this is absolutely not the case today,” Dr. Eames said. “It is now a very intense treatment we are offering patients early on in their therapy with the hope that we can save more children.”
In 1986, the transplant program started at Cook Children’s under the direction of Paul Bowman, M.D., with a goal of keeping patients in need of transplant close to home instead of sending them across the country to other transplant sites far away.
Over the last 23 years, thanks to burgeoning technology, participation in clinical trials and being a National Marrow Donor Program center for transplant, collection and donation, Cook Children’s has become the third largest transplant program in Texas.
It has grown from only a handful of matched sibling transplants into approximately 40 transplants annually with half of the procedures being for complicated unrelated donor transplants, 25 percent for matched sibling transplants and the remaining 25 percent for autologous transplants, which involves the removal of the patients’ cells to be used later for them after receiving intensive therapy. Based upon the high percentage of unrelated transplants performed, Dr. Eames pinpoints an equally important milestone.
“Seventy percent of patients in need of a bone marrow transplant don’t have a match in their family,” Dr Eames said. “If they don’t have a match within their family, the only recourse is to look through national and international donor registries to find a match. So in 1993, when we did our first unrelated donor transplant, that was a big step in the right direction to treat more kids, similar to the way we can use MRD testing today to act early.”
At Cook Children’s, the primary patient diagnosis is ALL with 60 percent of the patients having a malignancy of some type and 40 percent being nonmalignant disorders, such as bone marrow failure syndrome, immune deficiencies, red blood disorders, and metabolic disorders.
“I was here for the 600th and remember it as being something special. We know that the last hundred have been great and now look forward to continuing with the program for the next hundred and beyond,” Dr. Eames said.