Bone marrow transplant patients have come a long way
David Occhipinti (left) with Robert Negrin, MD, at the 19th anniversary of Stanford's Blood and Marrow Transplant program. In 1987, Occhipinti became the first Stanford patient to get a bone marrow transplant
David Occhipinti was 33 in June 1987 when his family doctor delivered the news that Occhipinti had an aggressive form of leukemia and without treatment, he would be dead within three weeks. Occhipinti replied, 'Doc, I'm going to beat this thing.'
Blume offered Occhipinti the chance to receive the program's first transplant, a risky and grueling procedure. Occhipinti recalled doctors telling him, 'We have to practically kill you in order to save you.'
Occhipinti chose to roll the dice. That October, he entered the hospital for a 59-day ordeal that tested his will to survive. Radiation and chemotherapy treatments destroyed his bone marrow cells. For almost two months, the self-described workaholic who once thought nothing of working 12-hour days lay flat on his back hardly able to move, battling intense nausea and pain.
On Nov. 2, 1987, Occhipinti received a bone marrow transplant from his brother. Nurses hung a bag of cloudy reddish liquid on his I.V. stand; the donated marrow flowed into his system through the catheter in his chest. Over the next weeks, his white blood cell count crept up, but the danger wasn't over. He fought through pneumonia and a viral infection. 'I almost died three different times,' Occhipinti said.
Perhaps it was Occhipinti's sense of humor that saw him through. He liked to nickname the drugs he was given: 'The Red Death,' 'Da Pig' (for the drug DHPG). 'I did a lot of kidding with the nurses,' he said. Or perhaps he was just too stubborn to die.
Two decades later, Occhipinti will return to Stanford as the BMT program celebrates its 20th anniversary on Nov. 2. Occhipinti, who now lives in San Jose, will attend a breakfast where he will be reunited with some of the same nurses who cared for him 20 years ago.
The BMT program has made huge strides in the last two decades, transforming the experience of cancer patients like Occhipinti so they no longer need to face death to survive. The program's emphasis on taking cutting-edge research directly from the lab into the clinic has helped to revolutionize treatment for cancers of the blood.
The program, housed in the Stanford Cancer Center and Stanford Hospital, has performed more than 3,400 transplants and does about 250 transplants per year. The integrated team includes researchers, clinicians, administrative staff and a lab for processing blood products. 'Teamwork is a core value of ours and a big part of our success,' said professor Robert Negrin, MD, director of the BMT program. A great asset of the program is its team of experienced nurses, some of whom have been with the program from the beginning and who work closely with the doctors.
It is one of the few BMT programs currently funded by the National Cancer Institute, and is now in its 19th year of continuous funding. It is one of 16 core centers in the Clinical Trials Network. The program has tested almost 200 new treatments, some of which have become standard regimens.
About 10 percent of the program's patients now receive an innovative treatment protocol developed by Samuel Strober, MD, professor of immunology and rheumatology. The treatment dramatically decreases graft-versus-host disease, a debilitating side effect in which the donor's immune cells attack the patient's body, and has reduced patient mortality. Other cancer centers, such as City of Hope in Los Angeles, are planning to adopt this protocol.
In the early '90s, Negrin helped pioneer research on growth factors, and Stanford was one of the first centers to use them clinically. Today growth factors are standard treatment. 'Growth factors transformed the practice,' said BMT nurse manager Donna Healy, RN, MS.
Assistant nurse manager Torey Benoit, RN, said she describes the process to patients this way: 'You get chemotherapy, which kills everything. Then you get the transplant, which is like planting a seed. You fertilize it with the growth factors and wait for it to grow.'
The use of growth factors has dramatically shortened treatment time. It used to take one month for patients' blood counts to recover after a transplant, said Negrin; now it takes 10 days. This means less vulnerability to infection, shorter hospitalizations, less cost and more outpatient care. Patients stay mobile and keep up their muscle strength.
If Occhipinti were receiving treatment for his cancer today, he would not have to perform the same feats of endurance. Instead of 59 days in the hospital, he might only spend two weeks. Drugs would control his nausea, and faster diagnosis and antiviral drugs would stop his infections before they became serious. He would enjoy fewer side effects, less risk and a better quality of life.
Occhipinti, who has attended 19 patient reunions, is just happy for the chance that brought him to the BMT program 20 years ago. Thinking about what might have happened without the program, he said, 'There was an angel on my shoulder.'
Madolyn Bowman Rogers is a science-writing intern in the medical school's Office of Communication & Public Affairs.
Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.