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The Future of Blood and Marrow Transplant

Feb 8, 2008 4:00 PM

Kathy Kupka knew something was wrong when she picked up her 17-pound dog Buddie and heard a “snap,” then felt a sharp pain in her collarbone. The Washington, D.C. resident had been complaining of back and leg pain for a couple of months but her family physician recommended “more stretching” before exercise.

This time, X-rays showed a fractured collarbone and something more serious, a lesion on the bone. A visit to an oncologist confirmed her worst fears, an aggressive form of bone marrow cancer known as multiple myeloma.

The 58-year-old photographer sought out the best treatment for the disease and was referred to Guido Tricot, M.D., who at the time was on faculty at the University of Arkansas for Medical Sciences. Tricot and his colleagues had gained national attention for pioneering a treatment technique that increased the median survival for newly diagnosed myeloma patients from 2.5 years to 10 years, or more.

After aggressive chemotherapy, two stem cell transplants, and three separate month-long stays in Little Rock, Kupka was in remission. Six years later she’s still in remission and sees Tricot every six months for a checkup, now in Salt Lake City.

Tricot, professor of internal medicine, came to University Health Care late last year to head the Utah Blood and Marrow Transplant and Myeloma Program. He says his decision to come to Utah was based on a number of factors, including the quality of basic science research going on in the U’s medical school and the reputation of the Huntsman Cancer Institute.

His patients are following him. Tricot estimates that by the end of the year more than half of his patients will be coming from outside of Utah.

What’s different about Tricot’s treatment? Most transplant protocols in myeloma call for one round of high-dose chemotherapy. Highdose chemotherapy not only kills the cancerous cells, but also the patient’s own healthy bone marrow cells. Because of this, these patients need to be rescued by their own healthy stem cells that were collected prior to chemotherapy through a process called autologous stem cell transplant.

Tricot’s more aggressive strategy prescribes four rounds of chemotherapy, two of which are high-dose and coupled with an autologous stem cell transplant. If the high-dose chemotherapy treatment were given without stem cell support, it would take six to eight weeks before a patient’s blood counts would return to levels that prevent infection and bleeding. This would be too risky, especially for older patients. Giving stem cells back as soon as the high-dose chemotherapy is out of the body reduces the period of vulnerability to approximately one week.

“The problem with multiple myeloma,” Tricot explains, “is that the cancer cells are not easily destroyed, and some myeloma cells survive, even after high-dose chemotherapy and stem cell transplantation.” As a result, most patients will ultimately relapse.

In an effort to delay this relapse, Tricot prescribes two years of maintenance therapy to combat any latent myeloma cells still lingering in the body. Tricot and his colleagues also are studying the genetic make-up of myeloma cells to understand what features make them resistant to even the most aggressive treatments and then to find out what can be done to achieve a cure.

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