Burkitt Lymphoma, an extremely rare form of cancer, accounts for only two percent of lymphomas — and is considered a medical emergecy due to its rapid-fire growth. When a Greenfield, Wisc., mother of three was diagnose with it, she felt blessed to find herself at one of few medical centers in the sate with a team of lymphoma specialists. "The miracles just kept happening," says Sue Waldoch, 38, of the treatment leading to her recovery.
Lymphoma is a large family of cancers of the lymphocytes, blood cells that live in the lymph nodes and bone marrow and make up the immune system. Operating properly, cells of the lymphoid system protect us from infection by producing antibodies, or by directly attacking disease-producing organisms. "In lymphoma, malignant lymphocytes grow in an uncontrolled fashion in lymph nodes, marrow and other sites outside the lymphatic system," explains Christopher Chitambar, MD, a Medical College of Wisconsin medical oncologist who specializes in lymphoma.
There are many different kinds of lymphoma, generally categorized as Hodgkin's or non- Hodgkin's, and treatment depends on the type. Treatment usually involves radiation and chemotherapy. Among Sue's "miracles" was having a bone marrow transplant (BMT) at one of the country's leading BMT authorities.
"The Froedtert & Medical College of Wisconsin Cancer Center is a nationally-recognized BMT powerhouse," says Dr. Chitambar, noting it is a coordinating center for a research consortium of the 16 largest transplant centers in the country.
After a grueling regimen of chemotherapy, requiring a hospital stay every third week for six months, Sue was in "clinical remission:" chemotherapy had done its job, but risk of a fatal recurrence was high. She was ready to prepare for a bone marrow transplant.
Creating a New Immune System
Since a suitable donor had not been located, Sue was her own donor. While in clinical remission, healthy blood-cell-forming stem cells were harvested from her bone marrow. She then received massive doses of chemotherapy to destroy remaining cancer cells — and also her normal blood-forming marrow cells. Stem cells from her healthy bone marrow were re-infused to rebuild healthy marrow.
Sue was lucky. Because huge doses of chemotherapy kill infection-fighting white blood cells, the risk of infection during BMT is high. Today, a new type of transplant being studied at Froedtert & Medical of Wisconsin eliminates the need for high doses and greatly reduces the risk of infection.
With the so-called "mini-transplant," patients receive a much smaller dose of chemotherapy — not to kill all cancer cells, but to suppress the immune system without destroying it. Then, donated blood or marrow (given through an IV infusion) can go to work. The mini-transplant uses to its advantage a potentially dangerous side effect of BMT called graft vs. host disease. In GVHD, the "donated" immune system sees everything as foreign and begins attacking the entire body. But it also attacks cancer cells. With anti-rejection drugs and careful monitoring, doctors can harness GVHD to work to the patient's advantage.
Mini-transplants have proven effective against leukemia and multiple myeloma, along with lymphoma, according to Dr. Wade, a member of the team that performed the world's first mini-transplant in 1997. Cancer Center researchers are also looking at using mini-transplants for kidney cancer.
Among other treatments available at Froedtert & Medical College of Wisconsin are monoclonal antibodies, a type of "immunotherapy." Antibodies that target lymphoma cells are developed in the laboratory and injected into the bloodstream. The antibodies recognize, seek out and kill cancer cells. With radio-immunotherapy, a sort of hybrid of radiation and immunotherapy, radioisotopes are hooked up to the antibodies. "They 'zoom' radiation directly to the lymphoma cells," Dr. Chitambar explains.
Medical College of Wisconsin researchers are also investigating drugs for use in brain lymphoma and agents to induce cancer cells to "commit suicide" by blocking pathways through which they receive the message to multiply. Dr. Chitambar has demonstrated gallium nitrate, a drug traditionally used for diagnostic purposes, can arrest certain types of lymphoma.
Sue was hungry for information about her condition, and she says staff fed her curiosity by recommending books, articles and websites. The Cancer Center social worker helped her work through telling her children about her situation. And the nurses knew what was most important: "Every day, they asked, 'How are your kids?'" Sue remembers.
What would she tell someone newly diagnosed with cancer? "I'll pray for you — and be sure you go to Froedtert."