Bone marrow transplant patients celebrate survival
BY MATTHEW EARLY WRIGHT
Lucky Nagra was 26 years old, hale and hearty, in November of 1998. He used to preach good health to his friends and co-workers, advocating a good diet and regular exercise. On the same day he was to receive the keys to his new home, his doctor shocked him with a dreadful announcement: Nagra had acute myeloid leukemia.
He immediately began chemotherapy at a San Jose hospital. His doctors hoped the treatment would kill off the defective white blood cells that are the hallmark of AML. But it soon became clear that chemotherapy alone wouldn't suffice. He was faced with a tough decision.
A bone marrow transplant could save Nagra's life, but it would be excruciatingly painful. It would also require even more powerful chemotherapy drugs. "One doctor explained it to me like this: 'If chemotherapy is like jogging, then a bone marrow transplant is like running a marathon,'" Nagra said while attending the 17th annual Blood and Marrow Transplant reunion at Stanford on July 30.
At the time Nagra underwent the operation—in April 1999—there was no guarantee that it would work. In fact, if his body had rejected the transplant, which happens in a significant number of cases, it could have killed him. But he and hundreds others decided it was worth taking the risk.
Nagra was one of about 300 transplant patients gathered outside the James H. Clark Center, celebrating the new leases on life the procedure has afforded them. Every summer, the event gives patients an opportunity to catch up with their doctors and nurses and to share stories with other patients and their families.
The big turnout at this year's reunion is quiet testament to the growing effects of Stanford's BMT program. "This is my favorite day of the year," said BMT program director Robert Negrin, MD, in his opening remarks. "It's very therapeutic for all of us—patients, doctors and staff." Advances in bone marrow transplantation are likely to keep attendance rising at future reunions, he added later. For example, doctors have become more proficient at using stem cells from the bloodstream instead of actual bone marrow, improving patients' odds against rejection.
At the reunion, patients who have gone 10 or more years since the transplant receive leis of fresh orchids to commemorate the milestone. In the past 17 years, this group of patients has grown quite a bit. "Our friends in Hawaii have been very busy this year," Negrin said.
Gil Mitchell has been wearing a lei at the last four reunions. In 1991 he was diagnosed with non-Hodgkins lymphoma, a condition in which white blood cells called lymphocytes reproduce uncontrollably, clogging up the patient's lymph nodes.
Mitchell's doctors determined that only two bones were affected, one each in his left leg and arm. Mitchell therefore qualified for an autologous transplant, in which his own healthy marrow was removed prior to chemotherapy and then re-infused during his recovery. This is preferable to a standard donor transplant, known as an allogeneic transplant, because the patient's immune system is not as likely to reject marrow that is a genetic match.
But all the same, the radiation and chemotherapy left Mitchell's immune system compromised. About five months after his transplant he contracted shingles—a condition he said was even more painful than the transplant. Before the infection subsided, it robbed Mitchell of his left optic nerve.
Yet Mitchell is grateful for the years of life his transplant continues to give him. "I've lived to see my kids grow up," he said. "I've ridden my bicycle across 14 states and two countries. Overall, I feel great."
High doses of chemotherapy and radiation can take their toll in other ways: the process can also render a transplant patient sterile. In order to have children, most patients bank their sperm or eggs before treatments begin. But every now and then, a patient's body prevails despite the onslaught of these harsh treatments.
Such was the case for Tom Kelly, who received his transplant in July of 1997. Just a month prior, he was diagnosed with aplastic anemia, a disorder in which the bone marrow simply shuts down, producing far too few blood cells. Although he banked sperm, he didn't need to use them. He and his wife Kim were able to naturally conceive their sons David and Michael, 3 and 2 years old.
Kelly's story is one of extreme good luck, even among the many success stories told every year at the BMT reunion. His allogeneic transplant was a complete cure. "I was a very close match with one of my sisters," he explained. "I feel 100 percent normal, with no residual effects."
Nagra, who also had an allogeneic transplant, had a much rougher time. Though his transplant was also a close match, subtle differences in tissue type wreaked havoc with his immune system. Just four months after his procedure, he was diagnosed with graft-versus-host disease. The condition is essentially immune rejection in reverse: the marrow donated by his oldest sister had begun to attack the rest of his body.
But when things seemed most dire, Stacy Campbell walked into the transplant room and introduced herself as his nurse. They immediately formed a powerful bond, and three years later, they were married. The nurse, now known as Stacy Nagra, brushed off the wedding as a mere formality. "We like to say that our meeting was a marriage in itself," she said.
Stacy inspired Lucky to perform everyday tasks, such as taking a walk around the hospital ward to get some exercise. "My family could coerce me, but if Stacy asked, I just did it," he said.
Nagra will probably struggle with his transplant for the rest of his life. But the experience has given him new perspective, and he and Stacy have two new reasons to celebrate. In February of this year, the Nagras celebrated the birth of their twin girls, Simranjeet and Kulraj.