Doctor praises improvements in stem cell transplantsTweet
By Helen Adams
Hematology/Oncology’s Dr. Robert K. Stuart reviews a patient’s case prior to a stem cell transplant procedure. Story taken from MUSC News Center, visit http://academicdepartments.musc.edu/pr/newscenter/. photo by Brennan Wesley, Business Development & Marketing Services
It’s a claim to fame Archie Suber probably would rather not have.
On June 26 he became the 1,500th person to receive a bone marrow or stem cell transplant at MUSC to treat his mantle cell lymphoma, which accounts for about one in 20 Non–Hodgkin lymphoma diagnoses in the nation.
Archie Suber was MUSC’s 1,500th person to receive a bone marrow or stem cell transplant on June 26. photo Sarah Pack, Public Relations
The day before his stem cell transplant, Suber had something else on his mind as well – his favorite church buffet in Columbia, where he lives. He laughed, trying to make it sound nutritious.
“It’s not unhealthy food. They fix baked chicken. They have your basic vegetables, your carrots, green beans and salads. And the little strawberry shortcakes.”
The father and computer programmer hopes to eat at that buffet again in a few months, once he recovers from his transplant.
Appropriately, Robert Stuart, M.D., supervised Suber’s transplant. The MUSC doctor knows a lot about such procedures. He performed the first stem cell transplant in South Carolina more than 27 years ago at MUSC.
Today, Stuart is a professor of medicine in MUSC's division of hematology/oncology. If he could go back in time and talk to his younger self in the 1980s, when he was new at bone marrow and stem cell transplants, he would tell himself that he was wrong about what he thought then.
Stuart told his mentor at the time that bone marrow transplants wouldn’t last long. “The future is obsolescence. I said, 'if at the end of my career I’m still doing this brutal, barely defensible procedure, I will consider my career a failure.' I was joking a little bit, but not completely," he said. “We’re still doing it, but now we’re doing it a lot better.”
Studies show survival rates have increased significantly among patients who receive blood stem cell transplants from both related and unrelated donors for many reasons, including advances in human leukocyte antigen tissue typing, better supportive care and earlier referral for transplantation.
Stuart said in the early days of bone marrow transplants, the methods for determining whether two unrelated people really were matched well enough for a transplant were very crude. He has watched the procedures evolve.
“In the 2000s, we started doing basically DNA typing – like the TV show “CSI.” So now we identify the genes for each of the immune system identification signals called HLA antigens. Everybody has four critical HLA genes. You have two copies of each. So we say a perfect match is an eight out of eight match. Now, we actually sequence those four genes for the donor and the recipient. When the DNA is exactly the same, that’s a real match.”
That dramatically improved the matching procedure at a time when the demand for bone marrow and stem cell transplants was on the rise. When Stuart started doing bone marrow and stem cell transplants in the 1980s, patients had to be under 40 to qualify. Doctors believed it was too toxic for anyone older.
“Then what happened was the doctors started getting to be over 40,” Stuart said, joking.
Doctors started raising the age limit as they got better at the transplants and refined their techniques. They increased the number of people receiving autologous transplants, which involve the patient’s own stem cells, and the number of people receiving allogeneic transplants, which involve cells or marrow from donors. MUSC doctors now perform about 120 such procedures per year, compared to 40 per year in the 1990s.
Stuart’s hair has gone from brown to gray during his three decades of performing bone marrow and stem cell transplants. Both he and MUSC’s 1500th transplant patient are looking forward to the future; Stuart, because he’s still fascinated by the intellectual challenges of his field, and Suber, because he is looking forward to more than just a church buffet. His daughter is about to start her freshman year in college, possibly majoring in education. Suber plans to be around to see where life takes them both.
July 18, 2014