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Stanford Report, May 10, 2000

Former bone marrow transplant patient enjoys Mother's Day with new baby  

BY KRISTA CONGER

Jennifer Wire and her husband Christopher have two good reasons to celebrate this Mother's Day. This week marks the five-year anniversary of her return home after undergoing a bone marrow transplant at Stanford Hospital for treatment of advanced Hodgkin's disease. But perhaps even more important, it will also be her first Mother's Day with her two-month-old son Nathaniel. Nate's existence is somewhat of a miracle, say Stanford doctors, because the high doses of chemotherapy that precede a bone marrow transplant leave most patients infertile.

"We are delighted, but we wouldn't have predicted this," said Karl Blume, MD, professor of medicine and chief of the division of bone marrow transplantation at Stanford. "Jennifer beat the odds."

Wire had been working for the marketing department of Stanford University Hospital when she was diagnosed in June 1994. After suffering from a lingering cough and persistent itching that she attributed to allergies, the 27-year-old writer received a call from her doctor's assistant at Palo Alto Medical Clinic. An X-ray had revealed a mass in her chest.

"She asked if I could come in that afternoon," Wire remembered, "but she wouldn't say anything else. I just knew something was very wrong."

Wire had Stage IV Hodgkin's disease, a cancer that arises when the cells in the lymphoid tissue begin dividing uncontrollably. Because the cancer doesn't cause many troublesome symptoms in the early stages, the first clue of the disease is often the presence of enlarged lymph nodes either in the neck or, like in Wire's case, in the chest.

Approximately 7,500 cases of Hodgkin's are diagnosed in the United States per year. Unlike many cancers, Hodgkin's often strikes people when they are young -- between the ages of 15 and 35. News that they have Hodgkin's disease can be especially devastating for young adults, whose plans for the years ahead hadn't included battling a life-threatening illness.

"I was completely shocked," said Wire. "My vision of my future had been shattered." Wire credits her ability to get through the months following her diagnosis to the steadfast support of her husband, their families and friends and the health care professionals she met at Stanford.

In particular, Sandra Horning, MD, professor of oncology at Stanford, offered encouraging words when Wire came to her for treatment.

"Dr. Horning gave us hope," Wire said. "She told me 'We expect you to do well.'"

At Stanford, Hodgkin's patients are treated with a special regimen of chemotherapy and radiation. This regimen, known as the Stanford V protocol because it is the fifth generation of Hodgkin's protocols to arise at Stanford, is designed to kill the tumor cells while minimizing long-term side effects of treatment, which can include secondary cancers, infertility and damage to the patient's heart and lungs. The key lies in delivering low but frequent doses of both chemotherapy and radiation over a short time period. According to Sheila Breslin, RN/MS, an oncology research nurse at Stanford, the success rate for the Stanford V protocol approaches 90 percent.

Things looked promising at first for Wire. The protocol began to work immediately, shrinking her tumor and relieving her shortness of breath and loss of appetite. By November she was feeling good again. But in March she found a lump under her collarbone. The cancer had returned.

"The threat of relapse was always looming, but as each month passed, my confidence in a durable remission grew," Wire said. "I was devastated when the cancer returned, but at the same time, I was incredibly fortunate to have a second chance at a cure." Her quick relapse -- within one year of her initial treatment -- meant that her best chance for survival now lay in a bone marrow transplant. She learned that a transplant's success rate for patients like her is between 40 and 60 percent.

Wire began the bone marrow transplant procedure in March 1995. Physicians first collected some of her own stem cells -- non-cancerous progenitors of normal immune system cells. The collection and storage of the cells was necessary because the high dose of chemotherapy drugs necessary to eradicate the cancer cells would also wipe out Wire's existing immune system, leaving her without protection against even the most common infection. Then they began the chemotherapy.

On May 1, after the chemotherapy, the physicians added back Wire's stem cells. The cells began reconstituting her devastated immune system, and she left the hospital the day before Mother's Day, 1995, happy to be alive.

Although she has remained disease-free for five years, which indicates that the chemotherapy successfully eradicated the cancer, Wire didn't expect to have children after her treatment. According to Blume, the ovaries and testes are particularly sensitive to the high doses of chemotherapy needed to complete a successful bone marrow transplant.

But once again Wire beat the odds, this time with a little help from Stanford's division of reproductive endocrinology and infertility. She became pregnant last July, and "Nate the Great" arrived five weeks early on March 5 -- perhaps eager to get on with defying convention? Whatever the reason, his parents are glad to have him.

"He's a huge blessing in our lives, and we're just enjoying every second with him," said Wire. Although -- like most new moms -- she has her hands full dealing with a new baby, Wire hopes that her story of survival will inspire other cancer patients.

"I think it's incredibly valuable for patients to speak out about their experiences," said Blume. "I often ask former patients to return to the clinic to speak with patients who are currently undergoing treatment."

To promote this idea, Blume has organized an annual meeting of current and past bone marrow transplant recipients that has been celebrated since 1989. This year's gathering will be held on July 8 on the medical school lawn. And Jennifer, Christopher, and Nathaniel will be there to share their success story with everyone who will listen. SR