Maxine Kates and Robin Walden
Cells and kindness multiplied
Nineteen-year-old Timothy Blomquist of Chicago was just driving around listening to the radio, as teenagers often do, when he heard an ad for bone marrow/stem cell donors, and decided to sign up. Twelve years later and 1,000 miles away in Boston, his action saved the life of 58-year-old Maxine Kates, setting in motion a circle of love and science that continues today.
Blomquist's cells are keeping Kates's cancer at bay, while her daughter, Robin Walden, 34, stands ready to donate her own stem cells to a 62-year-old man awaiting a transplant. "I was blown away that a stranger did this for my mom," says Walden. "But I believe that my giving is part of a chain that connects people around the world. It makes sense."
Today, Kates accepts her transplant's long-term effects - known as chronic graft versus host disease (GVHD) - as a fair trade for the joy of being alive. "My donor's cells own my body," she says. "But each day that I have with my family is a celebration. I know that life is precious and fragile."
Kates came to Dana-Farber in 2001 to receive care for acute myelogenous leukemia (AML). Aggressive chemotherapy drove her cancer into remission, allowing her to dance with her son at his wedding in May 2002. But the cancer came back that November, and this time a stem cell transplant was her only chance for a cure.
Edwin Alyea, MD, associate director of Dana-Farber's Stem Cell Transplant Program, leveled with her. "I tell patients they are trading one set of problems for another, only the new problems will be more manageable," he explains. About 40-70 percent of patients who receive stem cell transplants from an unrelated donor - a process known as allogeneic - end up developing GVHD, which can cause dry eyes, tightening or thickening of the skin, and puffiness in the face from medications.
Some patients receive an autologous transplant, which involves harvesting their own cells, then putting them back later to become healthy new bone marrow. Others, like Kates, need stem cells from a donor. No one in her family was a match, so the search team at Dana-Farber began to comb worldwide registries, including the National Marrow Donor Program (NMDP).
Enter Blomquist, by then a businessman and father of two. Keeping the promise he had made as a teen, he donated his stem cells in Chicago. They were delivered the same day to Kates in Boston, who received her transplant in March 2003. "When I was lying in bed, I thought about how the cells of a young man were going into my body," she recalls. "I was amazed by his selfless gift."
A year later, when her body had adjusted to the new cells, Kates took advantage of the NMDP's option for stem cell recipients to request a meeting with their donors. In September 2004, Blomquist traveled to Connecticut and participated with Kates in the Fifth Annual Light the Night Walk in Hartford, an event coordinated by the Leukemia and Lymphoma Society. They and their families remain close friends today.
Even with more than10 million stem cell donors in the world, the odds for a match vary greatly. "It's hard to quantify," explains Deborah Liney, technical director, unrelated donor/transplant services. "When we compare HLA types, some patients have no matches, others have thousands. HLA markers on the surface of each cell identify you as you, and your HLA type is like your own personal lottery number. There are millions of combinations."
The good side to GVHD
Over the last five years or so, Dana-Farber doctors have learned that an allogeneic stem cell transplant isn't over when a patient leaves the hospital. It is a lifelong, dynamic experience in which the donor cells keep fighting any tiny cancer cells that might emerge. "If the transplanted cells are fighting your body, it means they are probably fighting any residual leukemia cells, as well," explains Alyea.
Scientists at Dana-Farber are working hard to understand the interactions between transplanted cells and a recipient's own tissue. One promising remedy is an antibody called rituximab, which in a recent study reduced the severity of chronic GVHD in 70 percent of the study participants who completed at least one course of treatment.
