A preschool child with leukemia underwent the Charlotte area's first pediatric bone marrow transplant Thursday at Levine Children's Hospital.
“The patient is doing well and is in good spirits,” said Dr. Andrew Gilman, who was recruited to Levine from UNC Chapel Hill this year.
Gilman performed the transplant late Thursday using marrow from an unrelated donor found through the National Marrow Donor Program.
The patient's name was not released at the parents' request.
Until this year, Charlotte was the largest city in the country without a pediatric bone marrow transplant program, Gilman said. He hopes to do 20 transplants a year at Levine, using marrow from related and unrelated donors.
This is the first major new service offered by Levine, which opened in September 2007 at Carolinas Medical Center. Previously, parents have had to relocate to other cities when children received bone marrow transplants.
Levine's is the third pediatric bone marrow transplant program in North Carolina. Others are at UNC and Duke University.
Transplanting healthy cells
Bone marrow, a jelly-like substance in the cavities of the bones, contains stem cells that produce white blood cells that fight disease, red blood cells that carry oxygen and platelets that enable blood to clot. With a transplant, a patient's diseased stem cells are replaced by healthy donor cells.
Doctors can transplant bone marrow or retrieve stem cells from the marrow and transplant the stem cells only.
Healthy stem cells can come from related or unrelated donors. A patient's own stem cells can also be removed, cleansed and re-implanted.
Carolinas Medical Center has for 10 years performed bone marrow transplants for adults who can donate their own marrow and stem cells. In August, Gilman performed Charlotte's first pediatric stem cell transplant, using a child's own stem cells.
Long recovery process
Before Thursday's transplant, the patient first received chemotherapy to kill the leukemia cells in the bone marrow. The donor marrow was collected in the morning – even Gilman didn't know the name or location of the donor – and transported to Charlotte. The local child then received the infusion of donor marrow – about six ounces over two hours – through an intravenous line.
Gilman said it will take three to six months for the patient to grow enough red blood cells to fight infection. Until then, the child will remain in the hospital. After discharge, the child must remain at home for six to 12 months to give the immune system time to recover.
The success of pediatric bone marrow transplants from unrelated donors varies depending on the patient's disease and the degree of match with the donor. But overall, the chance that a child with acute leukemia will be alive two years after transplant is 60 to 75 percent, according to the national marrow program.
Finding a donor
The best donors for children are siblings with matching blood types, said Gilman, 46, who directed the transplant program at Children's Mercy Hospital in Kansas City before working at UNC.
Because today's families are small, the chance of finding a sibling match is about 15 percent, he said. For that reason, Gilman has worked since 1994 on using parents, who are a “half match” for their children, as donors. The success rate for such transplants has improved in the last 10 years because of new techniques.
In his years at UNC, Gilman often treated children from Charlotte. Families had to move to Chapel Hill for months.
Sometimes, one parent stayed behind to work.
“It's one of the most stressful times, and it removes the family from their support system,” Gilman said. “I thought there was a need for families and children in Charlotte. It's a large enough city to justify a program on its own.”
Dr. Joanne Kurtzberg, director of Duke's pediatric blood and marrow program, has been skeptical about the need for a third program in the state. Duke has nine transplant doctors who perform 100 transplants a year.
UNC's transplant director, Dr. Thomas Shea, said having a program in Charlotte, the state's largest population center, “may prove appropriate if the volumes are sufficient.”
Instead of traveling to a large out-of-town center, Gilman said many patients prefer to stay closer to home with a program that is “smaller and more individualized, where everybody knows your name.”