Half-matched bone marrow transplant provides patients with a whole lot of hope
In March 2019, 28-year-old Jel Calooy was diagnosed with acute myeloid leukemia (AML), the most common type of acute leukemia in adults. It is a rapidly-developing condition that can cause significant physical and emotional disability.
Patient Jel Calooy with her doctor, hematologist Dr. Alma Calavera
Calooy’s doctor, hematologist Dr. Alma Calavera, recommended bone marrow transplant for its high rate of cure for patients with AML. The medical procedure replaces the unhealthy blood-forming cells (stem cells) with healthy ones.
Calooy received a newer kind of bone marrow transplant – half-matched or haploidentical allogenic transplant − at The Medical City (TMC) in July 2019.
Bone marrow transplant is also called Hematopoietic Stem Cell Transplantation or HSCT. In the past, the stem cells were collected from the bone marrow. Today, stem cells can also be collected from the peripheral blood, instead of the bone marrow, the reason why it is also called HSCT.
There are two types of bone marrow transplant–autologous and allogeneic. Both are being performed at the Institute of Personalized Molecular Medicine (IPMM) of The Medical City. It was back in 2016 when TMC’s first bone marrow transplant was performed successfully. Since then, TMC has performed the procedure a total of 40 times.
For an autologous stem cell transplant, the patient’s own stem cells are removed from his or her bone marrow or peripheral blood before the transplant.
An allogeneic transplant is the most common type of bone marrow transplant for AML and involves transferring stem cells from a healthy person − the donor, usually a sibling with a perfect match− to the patient in order to minimize the chance of graft versus host disease (GVHD), rejection, and other complications. The problem is, not all patients will have a perfectly matched sibling.
TMC-IPMM now offers haploidentical allogeneic transplant to patients with clear indication for this procedure, hoping that each leukemia patient will have a suitable donor.
Advantages of half-matched transplant option
An allogeneic transplant involves matching a patient’s tissue type, specifically their human leukocyte antigen (HLA) tissue type, with that of the donor. A close match between a donor’s and a patient’s HLA markers is essential for a successful transplant outcome.
HLA matching promotes engraftment which refers to the growth and development of new healthy blood cells and reduces the risk of a post-transplant complication called graft versus host disease (GVHD). If the HLA match is not close enough, the donor’s immune system, which accompanies the transplanted stem cells, recognizes the HLA mismatch, and will attack the recipient’s tissues. This is how GVHD got its name.
For patients who need a transplant but do not have a HLA-matched related or unrelated donor, recent medical advances have made possible the use of a partially matched or haploidentical related donor who is usually a 50% match to the recipient. He or she may be the recipient’s parent, sibling, or child. Haploidentical transplant increases the chance of finding a donor as almost everyone has at least one haploidentical relative.
Dr. Calavera, who is the head of the Bone Marrow Transplant of TMC-IPMM, says this half-matched option makes transplant possible for nearly every patient who needs the treatment. There is also no need to delay the procedure while waiting for a patient’s perfect or near perfect donor match.
Transplant saves patient, leads to deeper bond with family
Calooy was hospitalized due to dengue in February this year. She was discharged after a few days but during her follow up lab tests, her platelet count remained low and her white blood cells were noted to be elevated at 30,000 per microliter of blood (mcL). The normal range is usually between 4,000 and 11,000 per mcL.
She called up their family doctor who advised Calooy to seek consult with an Infectious Disease specialist at TMC. Calooy saw Dr. Cybele Lara R. Abad who referred her to Dr. Calavera. After a series of tests, Dr. Calavera said they found blasts (immature white blood cells) in the patient’s blood suggestive of leukemia.
“I asked Dr. Calavera, Is my life shorter than others?” shares Calooy. “But Dr. Calavera said, no, we can cure you.”
Dr. Calavera told Calooy she wanted the best care for her so she is not stopping her from seeking second opinion in another hospital, if she wanted to.
“To be honest, I asked myself, what if The Medical City wasn’t the right hospital for me? So I did seek a second opinion only to find myself going back to Dr. Calavera for my treatment,” says Calooy.
“I believe that my doctor can do it, I trust that she will do the best she can to cure me and that she will take care of me. The connection of patient and doctor is so important that it can actually affect outcomes of any tests and procedures. The Lord will make Dr. Calavera His instrument for my cure,” she adds.
Before the patient gets the stem cell transplant, she will get the actual cancer treatment. In Calooy’s case, to destroy the abnormal stem cells, blood cells, and cancer cells, she was given high doses of chemotherapy.
“Jel had two sessions of high dose chemo before proceeding to the transplant. We harvested stem cells from her brother after giving Jel her conditioning regimen,” explains Dr. Calavera.
A few days after Calooy’s chemotherapy, the actual stem cell transplant was performed on July 25, 2019. The harvested stem cells from the donor, Calooy’s 21-year-old brother, and infused through a central line into a vein.
“I knew that finding a donor is the hardest part of the transplant. I am lucky that my siblings are all willing to be my donor but we’re not fully matched. Even my donor, Jheo is a half-match,” says Calooy.
Calooy had haploidentical transplant, where her donor matches exactly half of her HLA. She stayed in the hospital for a month and a half while her blood counts were not yet back to normal. Calooy also experienced the side effects of the transplant − nausea, fatigue, hair loss, and mouth sores.
“But never in my life will I give up, despite all these. I don’t want my brother’s sacrifice to go to waste,” adds Calooy.
“The success of having such miracle during the transplant was the love of family. Yes, by fact that the medicine will treat you but the love and support of your family cures you in words that I cannot explain, that love was my drive to keep on fighting.”
“I am also lucky to have a very supportive boyfriend who showered me with his love throughout my journey, despite being sick (and bald haha) he never left me. I’m not saying that the love of family isn’t enough, but having that extra love to look forward in the future with him/her adds to your willingness to live.”
On August 23, Calooy was happy to be back home. She knew however that the first year after transplant is like her first year of life as a newborn baby and her recovery will be gradual.
“When I got home, I sat on my bed and prayed. I thanked the Lord that I am home, I thanked Him for not leaving me, I thanked Him so much that I cry every time I pray because He gave me more than I deserve.”
Bone marrow transplant changed Calooy’s life, she admits. She is still the vibrant, charming lady that she is but is now more courageous, faithful, and appreciative of the gift of life and the love and support of family and friends.
“For all those who are struggling, let there be known that there is hope and light for all the pain and sacrifices done,” says Jel.
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