University of Florida Physicians Perform First "Mini" Bone Marrow Transplant

GAINESVILLE, Fla.---For what is thought to be the first time in Florida, University of Florida physicians have performed a "mini" bone marrow transplant using much less intensive chemotherapy and no radiation.

The experimental procedure, performed at Shands at UF and reported at only four other centers worldwide, could be an alternative for thousands of cancer patients too old or too ill to withstand conventional transplantation.

Larry Tucker, a 43-year-old Jacksonville resident fighting an aggressive form of lymphoma, was the recipient. Previous chemotherapy failed to keep the disease in check.

Doctors used potent drugs at half the usual doses to suppress his beleagured immune system, replacing it May 23 with powerful disease-fighting cells known as lymphocytes donated by his sister, said John Wingard, director of the bone marrow transplant program at Shands at UF. Tucker, who was discharged from the hospital June 20, will return as needed for repeated infusions of those cells. Physicians hope they will be the foundation for a new, more robust immune system.

"In the past, we have relied mostly on the "atom bomb" approach to treating cancer -- blasting the tumor with drugs and radiation treatment," Wingard said. "We are calling this a "kinder and gentler" transplant. With this new procedure, we are trying to exploit the new immune system of the donor to fight against the cancer.

"There are a number of patients who could potentially benefit from a bone marrow transplantation, but either because of their age or other illnesses they are excluded -- physicians fear aggressive regimens will be too tough and too toxic for them to endure," he added.

In Florida, the situation is complicated by an aging population. Up to now, older adults who contract cancer unresponsive to first-strike treatments have discovered they have few options. Meanwhile, diseases like leukemia primarily strike the elderly -- the average age at diagnosis is 64, Wingard said.

"Most patients who benefit from the current, most aggressive forms of treatment are very young," said Fred Weeks, a clinical fellow in medical oncology at UF's College of Medicine. "This is something we can offer the older patient with leukemia, particularly elderly patients with liver, heart or kidney disease who otherwise couldn't withstand high-dose chemotherapy. It's a very different way of thinking."

In Tucker's case, physicians feared he would not tolerate a traditional transplant because he also has hepatitis, a lung infection and impaired lung function from previous chemotherapy treatments. Early tests show the transplant successfully took. Time will tell whether it is effective against the cancer.

In recent years, physicians' understanding of the immune system has evolved.

"We used to think of cancer to be like an infectious disease entity where we had to kill off every last cell up front," Weeks said. "But what we've seen with this approach is that even if people have relapsed we might be able to bolster their immune system with donor cells and eventually get them into remission.

"The only way that could work, especially given the small number of lymphocytes from the donor -- about the amount in a pint of blood -- is that the immune system is a lot more powerful than we ever gave it credit."

The novel treatment also is offered at the M.D. Anderson Cancer Center in Houston, and medical centers in Singapore, Israel and Italy.

"We don't know ultimately if this is going to work; that's what we aim to find out," Wingard said. "But our study may show this to be very suitable for the large elderly population we have here in Florida."

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