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About the success of twenty years ago, which changed the fate of many patients with blood cancers, and the fact that each of us can continue this success, contributing to the improvement of the results of treatment of this disease – says Prof. Jerzy Hołowiecki, who in 1997 performed the first Polish bone marrow transplant from an unrelated donor.
Halina Pilionis, Medonet: 20 years ago, for the first time in Poland, you performed a successful bone marrow transplant from an unrelated donor. Can we try to imagine what the situation of blood cancer patients would look like today if transplantology had not developed?
Prof. Jerzy Hołowiecki: Cure rates of hematopoietic diseases such as leukemias and malignant lymphomas would be approximately four times lower. For some of them, there would be no other therapeutic method. Many of the conditions we are currently managing would be a death sentence. The discovery of this method of treatment was a milestone in medicine, awarded with the Nobel Prize. The main causes of these diseases are tumors of the bone marrow and the lymphatic system as well as disturbances in their anti-tumor activity. Therefore, transplantation of hematopoietic cells in many cases allows for a complete cure.
What are the chances of curing these diseases today?
Today, the cure rate for all diseases of the hematopoietic system is within 60%. There are diseases, such as bone marrow aplasia, where it reaches up to 90%. In the case of leukemia, it is around 70 percent.
Of course, treatment is not only about transplants. As a young doctor, working in Austria and Switzerland, I dreamed of creating a network of centers in Poland that would cooperate with each other and work out the best treatment standards. After returning to Poland, I wrote letters to all institutions in the country with an appeal that we should unite in the fight against these diseases. And thanks to this, we established the Polish Leukemia Group – PALG. As a result of this cooperation, we have developed, among others, a unique Polish method of treating acute myeloid leukemias, which has been recognized as a new standard by the National Comprehensive Cancer Network – an American organization associating the most outstanding oncology experts. The method increased by several percent. the percentage of cured patients, and in the high-risk group – people aged 50-60 years – even by several dozen. Today it is one of the three methods of treatment used in the world.
What were the chances of the success of the first pioneering bone marrow transplant in Poland from an unrelated donor?
In 1991, we performed the first autologous transplant, which means that the marrow was collected from the patient himself and then “donated” to him. This method of treatment may not be used in all cases. My patient lived 16 years after this procedure. This success convinced me that it is worth trying to implement this method. A few months later I had a bone marrow transplant from a related donor. The next level of difficulty was bone marrow transplantation from an unrelated donor. It was extremely difficult. The chances of success of this pioneering procedure were estimated in 1997 at around 20%. Donor compatibility was not predicted as accurately as it is today by molecular testing. The methods of checking the donor’s compatibility with the recipient used at that time were not very accurate, which resulted in unexpected complications. So I did not want to practice Polish Cossack and that is why we prepared very diligently for this treatment with the entire team.
How is this treatment likely to be successful today?
Transplantation from unrelated donors is still at risk, but the mortality rate after such surgery is much lower than 20 years ago. It varies between 12-13%, and in the case of transplants, where the donor is the patient himself, it is only 2%. The therapy itself today is less debilitating for patients – for example, sometimes it is possible to preserve their fertility. In our clinic in Gliwice, we use a unique method of irradiating patients before transplantation, which selectively hits only the skeleton, avoiding other organs. We are the only company in Poland, and only a few centers in the world perform this procedure. Drugs administered after transplantation, which suppress the patient’s immunity and prevent rejection of the transplant, were previously dosed according to the patient’s weight. Today, we constantly monitor their level in the blood and thus carefully select the dose. We can usually start stopping these drugs after six months after the transplant.
A patient who was the first in Poland to have a bone marrow transplanted from an unrelated donor, Urszula Jaworska, lives to this day and helps other patients herself. Do you remember that first transplant twenty years ago?
Urszula Jaworska, 35 at the time, was treated at the Institute of Hematology in Warsaw. She came to see me and said I had to get her a bone marrow transplant from an unrelated donor. I replied that it is not being done in Poland yet. She replied that she had a little daughter and she knew that this was her only chance to save her life. We began searching the world’s registries to find a donor. Polish at that time practically did not exist. The donor turned out to be a 47-year-old Dutch woman, mother of five children. The marrow was collected from her on February 17, 1997 in Amsterdam. Our doctor was supposed to transport him on scheduled planes from Amsterdam via Warsaw to Krakow and by car to Katowice, about 60 kilometers away. The departure from Amsterdam was delayed. We managed to arrange for a scheduled flight from Warsaw to Krakow to wait for the arrival of the one from the Netherlands. However, due to a blizzard, the plane from Amsterdam finally landed in Krakow. And so on February 18, 1997 at 1.30 am we started the transplant. We finished it at five in the morning. I remember meeting a journalist with a photojournalist in the corridor before the surgery. Meanwhile, we did not inform anyone about the procedure. I asked what you were doing here and she replied with a question and you were hiding something. It gave me wings. I figured it must work.
When was the transplant successful?
The fight for life was yet to begin. If the action of the new bone marrow is too strong, it can start destroying the patient’s body. This is called graft-versus-host reaction, which in turn is life-threatening. I went to the congress in France then and I remember running out every now and then to call and check on the patient. Unfortunately, there was such a reaction. Ursula’s temperature was above forty degrees for several weeks. She was suffering from vomiting, diarrhea, and a rash. We had to administer anti-recoil drugs that completely suppress human natural immunity. However, after two months, we were able to celebrate success. The treatment was successful. Urszula Jaworska has not needed any medications for many years and is cured of leukemia. He is active in the Foundation helping the sick that he founded.
Did you save many patients’ lives? How old was the youngest and oldest?
So far, I have actively participated in about 3 bone marrow transplants, initially in a clinic in Katowice, then in a new clinic in Gliwice. As people live longer and the risk of developing leukemia or lymphoma increases with age, there has been an urgent need to overcome the next age barriers in bone marrow transplantation in recent years. When we started to perform this procedure, we qualified patients up to 35 years of age for the procedure. Then, with time, this border was shifting. Today we are basically interested in the so-called biological age, not calendar age. We check the efficiency of the heart, lungs, liver and kidneys. The oldest patients to whom we have transplanted the bone marrow are over 70 years old. The youngest are teenagers.
Is finding a donor difficult?
Statistically speaking, out of approximately 20 potential donors, only one will be appropriate. Siblings are the most likely to find the right bone marrow. The laws of inheritance show that only one in four siblings can be a donor; in practice, only 9 percent. patients have a brother or sister compatible with HLA antigens, and this is the best option. However, families are becoming smaller and smaller. If there are no HLA-compliant siblings, a search of the world’s unrelated honorary donor registers begins. The trait compatibility must be at least 10 out of XNUMX. Unfortunately, the search takes a long time and is not always successful.
What does this success depend on?
From the number of potential donors. In Poland, 600 patients need bone marrow transplantation every year.
How do Poles compare with other nations in terms of bone marrow donation?
When we started to perform bone marrow transplants in Poland, there were about 100 donors in our registers, which placed us in one of the last places in Europe in this respect. Today there are over one million 165 thousand people. It is an incredible success. In Europe, only Germany is ahead of us. UK registers may have slightly more donors, but they are much older compared to ours, which means that some reported donors may not be available for various reasons. Our registry mainly includes young people. The average age is 30. In addition, due to the fact that they reported quite recently, we can assume that they are in over 90 percent. available.
Does this success translate into the effectiveness of treatment in Poland?
Before the Polish registry of potential donors became so large, we had to pay other centers for bone marrow collection. For Americans, twenty-several thousand dollars. Considering that our budget for treatment is quite limited, you have to be aware that it reduced this amount quite significantly. Moreover, the collected marrow had to be brought back. Sometimes from as far away as Australia. The Polish doctor on the cruise plane traveled this path, taking care of the cooling of the transported material, undergoing all the necessary procedures at the borders. Today, when 60 percent. transplants in Poland are performed from Polish donors, the collected bone marrow is transported by ambulance, and the cost of its collection and transport is many times lower, not to mention the fact that the money remains in Polish hospitals.
So each of us, by becoming a bone marrow donor, can continue your success in the first bone marrow transplant and improve the results of blood cancer treatment in Poland?
In Poland, every hour someone learns that he has leukemia and similar diseases. Such a diagnosis is heard by parents of young children, adolescents and adults. Regardless of age – anyone can get sick. Fortunately, anyone can help too. For many patients, the only chance for life is bone marrow transplantation. Only 20 percent. of patients find a “genetic twin” in the family, others rely on unrelated donors. The probability of finding a suitable donor is 1 in 20, and sometimes even 000 to several million. That is why the search is so difficult. The more potential donors registered, the greater the chance of finding a genetic twin. Fortunately, many young Poles report to Polish registers. They are wonderful and respectable people. After donating hematopoietic cells, they are honored with the badge of Honorary Donor of Transplantation.
And when a donor cannot be found, there is no more hope?
Currently, when it is difficult to find a compatible donor in the HLA pattern, we perform a transplant from a “half” compatible family donor, ie in one haplotype – the so-called haploident transplant. Until recently, it was practically impossible, but the current technology means that we can transplant in a parent-child system and among relatives sharing one haplotype. This creates great opportunities in bone marrow transplants, because almost everyone has a dose. The number of such transplants in our clinic is growing, the first patients have been living for over 2 years.
Prof. Jerzy Hołowiecki is a Polish doctor, specialist in internal medicine and hematologist. He was the first in Poland to carry out an innovative bone marrow transplant that had been unrelated for a long time. For his outstanding contribution to the development of Polish medicine, he received, among others Knight’s Cross of the Order of Polonia Restituta and the Officer’s Cross of the Order of Polonia Restituta.