More than 30 years after University physicians pioneered the world’s first successful bone marrow transplant, campus researchers have found a new use for the procedure.
The process, called autologous stem cell transplantation, evolved from bone marrow transplantation and is currently being used in a clinical trial by University physicians to treat persons with severe autoimmune diseases, such as rheumatoid arthritis and lupus, at Fairview Medical Center.
Rheumatoid arthritis, the most common of autoimmune diseases, affects 1 percent of the world’s population and can be deadly. While some people suffer from the joint aches of rheumatoid arthritis throughout a long life, others, especially young adults affected by the disease, face the possibility of paralyzation or death within 10 years of diagnosis.
Like rheumatoid arthritis, other severe autoimmune diseases involve the destruction of a person’s body by their own immune system. But none of these diseases are curable with current therapies — something the University team of physicians, led by Dr. Arne Slungaard, is hoping to take a step toward changing with the procedure.
Although physicians have not been able to decipher the exact cause of the autoimmune diseases, the treatment has proven to be initially affective.
Blue Shield of California, an insurance company, reports that in the last two years, more than 100 similar procedures were attempted in Europe where two out of three people had a 50 percent reduction of symptoms.
The University team, though, is taking the treatment one step further.
“We saw the European attempt as a first approach,” Slungaard said. “We are doing additional, more aggressive treatment after the transplant to prevent recurrence of the disease. What we’re aiming for is several years more remission from the disease, or a cure.”
While some of the results are encouraging, this procedure also involves a risk for the patient.
“The downside is that the chance of dying in the process of the excessive chemotherapy and radiation is roughly 5 percent, which is the same mortality rate as treatments for lymphoma or leukemia,” Slungaard said.
Many patients, though, are willing to take this risk and go on with the treatment. Since the call for patients began in November, there have been several referrals, and the only transplant patient for autoimmune disease to date traveled from Ohio and is currently under the care of the team of University physicians.
“One of the problems,” says Slungaard, “has been that insurance views this as experimental and is reluctant to pay for something that is this clearly unproven.”
Slungaard recognizes that cost is a large issue at hand, and making patients and their insurance companies see that their money is well spent is one of the objectives of these clinical tests.
“What we’re trying to do is raise the bar and take a risk that is much more aggressive therapy, which might actually produce cures,” he said.
The Process
The transplantation, Slungaard said, begins by extracting some of the patient’s stem cells, which produce all of the body’s blood cells. This includes the white cells and T-lymphocytes, which make up the body’s immune system.
Once the stem cells are extracted, the T-lymphocytes, which are believed to be responsible for the autoimmune diseases, are discarded. The harvested cells are frozen in liquid nitrogen. The patient is then treated with lethal doses of chemotherapy and radiation.
Slungaard said the doses are lethal because, “if you didn’t rescue (the patient) afterwards, (the doses) would kill all their stem cells, and their bone marrow would be empty.”
The patient is rescued by infusing the harvested cells back into the body.
The patient must wait two weeks for the stem cells to produce enough white cells to fight off infection. These new stem cells also produce naive T-lymphocytes, which drive the immune system and are less likely to cause disease.
But the medical community is not quite sure what causes T-lymphocytes to attack the body. “It could be that all of us, if we tangle with the wrong virus, might be provoked into attacking, by mistake, our joints,” Slungaard said. “The transplant might interrupt that process, and as long as you didn’t tangle with the same virus again, you might not be affected again.”