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Akron hospital hopes to get approval to offer area patients transplants from unrelated donors
By Cheryl Powell
Beacon Journal medical writer
Published on Sunday, May 11, 2008
Akron-area children battling cancer or other serious conditions soon might not need to leave town to get new bone marrow from a stranger anywhere in the world.
In recent years, Akron Children's Hospital has grown its cancer program by adding new treatment options that allow patients from the region to stay there for advanced, life-saving procedures.
But every year, about six to nine of the most critically ill patients still are sent to other hospitals because they need a bone marrow or blood stem cell transplant from a donor who isn't related to them.
If all goes as planned, that could change by early next year.
The hospital is in the process of expanding its blood and marrow transplant program to provide transplants from unrelated donors.
''Over and over, we've heard from families that if it were up to them they would prefer to stay here, where it's near their community and their other children and their spouses,'' said Dr. Jeffrey Hord, director of the hospital's Showers Family Center for Childhood Cancer and Blood Disorders. ''We're excited
to be providing additional services in the region.''
Within the next few weeks, he said, Children's plans to submit an application to become part of the National Marrow Donor Program.
The nonprofit program facilitates blood and marrow transplants and maintains a database of nearly 7 million Americans — and millions of others worldwide — who have been tested to become donors.
''We have to be approved to utilize the database and search for the donors,'' Hord said.
Bone marrow contains immature, blood-forming stem cells. These stem cells either turn into other blood-forming cells or become one of the three types of blood cells: platelets or white or red blood cells.
Blood-forming stem cells also can found in cord blood, as well as in smaller amounts in the bloodstream.
Current procedures
Since 2000, Children's has provided autologous transplants, in which the medical team harvests the child's own stem cells and then later puts them back in the patient.
This procedure sometimes is used to ''rescue'' the stem cells before a patient undergoes high-dose chemotherapy treatment that knocks out their malignancies but also destroys their bone marrow, Hord said.
Autologous transplant is not a good option for conditions such as leukemia, in which the bone marrow itself is taken over by cancer, Hord said. ''You really don't want to give back a diseased bone marrow.''
In 2004, Children's started offering transplants from sibling donors.
However, each sibling only has about a 20 percent chance of matching enough of the patient's tissue markers, known as antigens, Hord said.
Of the 62 patients at Children's who needed transplants since 2000, 38 were referred to facilities in Cleveland, Columbus, Cincinnati or other cities nationwide, Hord said.
The National Marrow Donor Programs is ''looking for centers that have experience in sibling transplant'' when they seek approval to expand to unrelated transplants, said Pam Robinett, manager of members services for the program.
Programs also must meet staffing, quality and facility requirements to get access to the donor registry, she said.
Closer to home
The planned program expansion at Children's is reassuring news to Abby Hexamer and her family.
Hexamer, an 18-year-old Perry High School senior, was diagnosed three months ago with aplastic anemia, a rare blood disorder that causes the bone marrow to stop making new blood cells.
Though transfusions and other treatments have been effective, Hexamer, an active teen, knows that she still might need a transplant in the future.
None of her family members are a potential match.
If she eventually needs a transplant, she said she would like to stay at Children's, where the staff has become ''a second family.''
''I know the people here and I trust their abilities,'' she said. ''You really get to know the staff.''
Centralizing care
But not everyone thinks more transplant programs are needed in Northeast Ohio.
Rainbow Babies and Children's Hospital in Cleveland is trying to strengthen regional collaborations that allow patients to get their transplant at Rainbow and then return to hospitals closer to home for much of their follow-up care.
''I don't think it's optimal to have multiple transplant centers in a small region,'' said Dr. Ken Cooke, director of the pediatric blood and marrow transplant program at Rainbow. ''I think it would be much more optimal to centralize super-subspecialty care like this at an institution that has a long track record.''
Rainbow has been offering transplants from unrelated donors for at least 15 years and averages five to 10 such procedures annually, Cooke said.
With that experience, he said, the team has gained expertise not only in the procedure but also in handling the serious complications that often follow.
Transplants from unrelated donors are more challenging, largely because of the risk that the new immune cells will view the patient's body as foreign and attack it — a life-threatening complication known as graft-versus-host disease.
''It just takes time,'' he said. ''It takes volume. It takes years of experience, not just on the physician level.''
Rainbow and the Cleveland Clinic currently are the only hospitals in Northeast Ohio approved by the National Marrow Donor Program for pediatric transplants from unrelated donors.
Receiving accreditation
In addition, Rainbow and its partner adult program at University Hospitals Case Medical Center comprise the only pediatric blood and marrow transplant program in Northeast Ohio accredited by the Foundation for the Accreditation of Cellular Therapy (FACT).
The voluntary accreditation increasingly is used by private or government insurance plans to determine where patients can go for their care to be covered.
Hord said Children's wants to pursue FACT accreditation, but he acknowledged the hospital likely won't meet the requirements that pediatric programs perform at least 10 related or unrelated transplants annually.
Pediatric programs that partner with an adult program are required to perform four transplants per year for FACT accreditation — a point that Akron Children's Hospital plans to protest.
But Cooke said pediatric programs such as Rainbow's benefit from being affiliated with adult programs, which treat more patients and offer access to more resources.
''There's no question that a partnership with an adult program is a huge advantage,'' he said.
Planning ahead
Children's is investing more than $1 million in technology, staffing and renovations needed to expand the transplant program, Hord said.
Dr. Xiaxin Lin, a fellow at Rainbow who ran a pediatric bone marrow transplant program in China before coming to the United States, is joining the program at Children's in July.
The hospital also has hired a research nurse to conduct the donor searches.
In addition, Children's is adding more floor nurses and advanced-practice nurses or physician assistants to care for transplant patients, who often require hospital stays of 100 days or longer, Hord said.
''We did not want to jump into doing everything at once and risk any kind of problems in such a steep learning curve so quickly,'' he said. ''We wanted to take things gradually so we'd be able to do things well and do them confidently.''
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
Akron-area children battling cancer or other serious conditions soon might not need to leave town to get new bone marrow from a stranger anywhere in the world.
Get the full article here.
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