Mini-transplant is an alternate cancer tactic

MEDICAL MATTERS

September 16, 2005|By JUDY FOREMAN | JUDY FOREMAN,SPECIAL TO THE SUN

If you have cancer, is there any way to get some of the benefits of a bone marrow transplant without all the risks?

Yes, it's called a mini-transplant.

In a normal transplant, blood stem cells and immune cells are taken from the bone marrow or blood of the patient or from a well-matched donor.

After the patient has high-dose chemotherapy and radiation to destroy his own marrow (and with luck, his cancer cells as well), the marrow or blood cells are re-infused into the patient to grow a new immune system and blood.

Both the high doses of therapy and, in the case of donor transplants, the new immune system play important roles in fighting the cancer.

But high-dose chemotherapy and radiation are very toxic. So doctors are experimenting with lower and lower doses of chemotherapy in blood-cancer patients who have not had a previous transplant and who have a donor available. (Mini-transplants do not work if the patient is his own donor, in part because it's the foreign immune cells that seem to be crucial for killing cancer cells.)

So far, mini-transplants are used primarily for people with leukemia, lymphoma or myeloma, said Dr. Robert Soiffer, director of hematologic malignancies at Dana-Farber Cancer Institute. Success varies, depending on the type of cancer, but emerging data suggest mini-transplants are "at least as good as standard transplants" at putting patients into remission, he said.

At Johns Hopkins Hospital, Dr. Rick Jones, director of the bone marrow transplant program, added that mini-transplants "are not a panacea, but they do lessen the toxicity from high dose chemotherapy." The chances of putting cancer into remission are highest in people with slower-growing lymphomas.

In people with blood cancers who have had a previous transplant from a donor but have relapsed, another technique is also showing promise. Called "donor lymphocyte infusion," it gives the patient another dose of the donor's immune cells (often without any chemotherapy).

These cells must come from the original donor because, as a result of the previous transplant, the patient's immune system is now partly like that of the donor.

Because these donor immune cells recognize the patient's cells (normal cells and those with cancer) as "foreign," this booster infusion appears to energetically attack lingering cancer cells in the patient's body.

How many eggs is it safe to eat in one week?

Recommendations vary, but three to seven eggs per week is fine for healthy people.

People who have heart disease or diabetes "need to be more careful," said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health.

But even for them, eggs are relatively benign compared with other cardiac risk factors such as consuming saturated fat or trans fat, smoking, not eating enough fruits and vegetables and not getting enough exercise.

The average large egg contains 215 milligrams of cholesterol, all of it in the yolk, said Dr. Lawrence Cheskin, director of the Weight Management Center at the Johns Hopkins Bloomberg School of Public Health.

The American Heart Association recommends eating no more than 300 milligrams of cholesterol a day, so eating one egg means you shouldn't consume much more cholesterol - from red meat, cheese or milk - that day, he said.

Since most of the cholesterol in an egg is in the yolk, one solution, if you're worried, is to eat just egg whites, or use egg products with few or no yolks.

The other issue to consider is what you would eat instead if you skipped your morning egg. Switching to a bagel with jam, for instance, has little nutritional value and raises blood sugar, said Willett.

Do hold the bacon, though.

Send your questions to foreman@baltsun.com.

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