What kills you sometimes just kills you

The biggest difference between Western and Eastern Medicine is the expectancy of death; Western doctors are taught to avoid the subject of mortality at all costs. Dr. Atul Gawande, author of Being Mortal, writes “I learned about a lot of things in medical school, but being mortal wasn’t one of them.”

And this hopeful, almost fearful, grasp for cures can be encouraging. Research on Bone Marrow Transplants has been promising, developing convenient semi-bone marrow procedures, ‘silenced’-bone marrow transplants and post-surgery protocols that reduce Graft Versus Host disease….

A Semi bone marrow transplant relies on a half-matched sibling to donate unaffected tissue. In the past, BMTs have been heavily and almost solely dependent on HLA matches. In the States, finding an unrelated match can cost over 50 000 USD and sometimes the chance of finding said donor runs only 30%.

A semi bone marrow transplant sidesteps the restrictive nature of a typical BMT, using partially matched marrow followed by immediate chemotherapy to combat the rejection response. This semi-compatible approach has opened effective treatment for over 95% of children with Sickle Cell Disease related to a half-match (1).  The outcomes have been surprisingly favorable and given the actual limited resources that most people live with, this creative method may be the saving procedure for many with TM, SCD and leukemia (2).

In related findings, researchers have discovered that semi-mature and ‘silenced’ bone marrow cells induce tolerance rather than an undesirable immune response (3). The long foe of BMT, Graft Versus Host Disease (GVHD) can kill patents even after a successful procedure. Using semi-mature cells, with a muted 88 factor allowed rats in the experiment to withstand even fully mismatched grafts.

Another study found that administering donor B-cells immediately following a semi-allegoric transplant prolonged GVHD (4). Usually following a transplant, IV immunoglobulins are readily administered, including T-cells. This study administered only donor B-cells on grafted mice.  T-cell depleted mice injected with only donor B-cells never developed GVHD, whereas mice with T-cells died of organ rejection.

Still in the making and forever perfecting, Bone marrow transplants and Semi-bone marrow transplants need further research and a more developed protocol following and preceding procedure. Graft Versus Host disease risks along with the effects of chemotherapy before transplants are both as formidable as the original disease BMTs aim to cure, be it leukemia, thalassemias or Sickle Cell Disease.

Cancer kills people, everyone knows. But chemo kills people too. Effects range from chemo-brain, dry eyes, hair loss to even inducing other forms of cancer. Emotional side-effects include depression, isolation and anxiety. Having witnessed the effects of chemo first hand, I can say these peripheral problems are real, demoralizing and almost bordering inhumane.

When will all the research we fund make a difference? When will the safest and best procedures and protocols develop such that those with blood cancers are not threatened by the very treatments meant to save their lives? What can you do?

  • Be aware, and ask your doctor these 20 questions, don’t just blindly accept or rely on a prescribed chemotherapy. If someone you love has cancer, advocate for them and ask these questions on their behalf.
  • Donate for chemotherapy research! Adopt a star for someone you love.

The truth is we are mortal. And a cure may make us live longer, but if it kills everything in the process is it worth it? This post ins’t meant to make us question life, just chemotherapy.

References

  1. Luznik, L., Engstrom, L. W., Iannone, R. & Fuchs, E. J. Posttransplantation cyclophosphamide facilitates engraftment of major histocompatibility complex-identical allogeneic marrow in mice conditioned with low-dose total body irradiation. Biol. Blood Marrow Transplant. J. Am. Soc. Blood Marrow Transplant. 8, 131–138 (2002). – See more at: http://www.cure2children.org/content/making-cure-possible-even-more-children-using-mother%E2%80%99s-bone-marrow-save-her-child#sthash.ulQXkdVz.dpuf
  2. Bolaños-Meade, J. et al. HLA-haploidentical bone marrow transplantation with post-transplant cyclophosphamide expands the donor pool for patients with sickle cell disease. Blood (2012). doi:10.1182/blood-2012-07-438408 – See more at: http://www.cure2children.org/content/making-cure-possible-even-more-children-using-mother%E2%80%99s-bone-marrow-save-her-child#sthash.ulQXkdVz.dpuf
  3. Yang, XJ., Meng, S., Zhu CF., Jiang H. &Wu WX. Semi-mature MyD88-silenced bone marrow dendritic cells prolong the allograft survival in a rat model of intestinal transplantation. Chin Med J (Engl). 2011 Jan;124(2):268-72.
  4. Samuel, S., Azar, Y., Corchia, N. & Or R. Improved immune function with donor B-cell infusion after semi-allogeneic bone marrow transplantation in mice. Arch Med Res. 2008 Jan;39(1):61-8.

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