A year after Cancer Care Northwest began offering stem-cell therapy to cancer patients to determine the size of the market here for the treatment, the Spokane oncology practice has decided to offer the procedure on a permanent basis.


In the last year, Cancer Care has treated 10 patients with the therapy, which involves reinfusing patients own stem cells back into their bodies, says Dr. Bruce Cutter, president of the practice. It appears that 10 to 20 patients a year from the local area will need the treatment annually, Cutter says.


Thats enough to have a quality program, he says. It looks like its a real, functioning entity.


The eventual goal is to make Spokane a regional center for the treatment, he says.


The Inland Northwest Blood Center here gathers stem cells from Cancer Cares patients for the transplants, says Dr. Bob Ranlett, the blood banks medical director.


We provide a team, and the equipment, that collects them, which is done in a hospital setting, Ranlett says. The cells are sent to the Fred Hutchinson Cancer Research Center, in Seattle, where theyre processed and stored until its time for them to be sent back to Spokane for the procedure. The blood bank has obtained equipment to process and store the cells, but must modify its building before it can use the equipment, and that wont be completed until after Jan. 1, Ranlett says.


The blood bank also collects stem cells from patients of Dr. Judy Felgenhauer, of the Sacred Heart Childrens Hospital Pediatric Oncology Center, although Felgenhauer says transplants done with those cells are conducted in Seattle. While the center reinfuses some patients own stem cells back into their bodies here in supportive therapy, those procedures arent true transplants, she says.


The blood bank also collects stem cells for the North Idaho Cancer Center, in Coeur dAlene, which is part of Kootenai Medical Center. Susan Herbst, an advanced practice oncology nurse there, says the hospital has operated an autologous transplant program for probably eight to 10 years. Autologous refers to a transfusion or transplant using the patients own blood, bone marrow, or tissue.


Cancer Cares program also is an autologous transplant program, but such therapies shouldnt be mistaken with allogeneic stem-cell transplants, which are done at the Fred Hutchinson center and other major cancer centers, Cutter says. In those procedures, cells harvested from volunteer donors are infused into patients, but sometimes attack the recipient, and mortality rates can be upwards of 20 percent higher, he says.


The procedure used here has a lower mortality rate of 2 percent, but can result in dangerous side effects, says Cutter. Weve not had anybody yet have a serious complication or death, but its just a matter of time, he says.


Dr. Hakan Kaya, who performs the therapy for Cancer Care Northwest, says patients are hospitalized for at least 2 1/2 weeks after the procedures.


The procedure gives patients with Hodgkins disease, non-Hodgkins lymphoma, multiple myeloma, acute myelogenous leukemia, and certain germ-cell tumors a chance at long-term survival after conventional treatment has failed and they face likely death within a year, Kaya says. It gives Hodgkins disease patients a better than 50 percent chance of living for five years or more, which is seen as a cure, and it gives non-Hodgkins lymphoma patients a 35 percent chance of living for that long, he says.


While the therapy wont cure multiple myeloma patients, it can give them a few extra years, which is extremely important right now, because we have new myeloma medications coming onto the market every month, Kaya says.


For germ-cell tumor patients, specifically testicular cancer patients, the therapy can result in long-term survival 60 percent of the time, Kaya says. Studies vary on the results for acute myelogenous leukemia patients, Kaya says, although he uses the therapy for them.


Herbst says the North Idaho Cancer Center also uses the therapy for patients with Hodgkins disease, non-Hodgkins lymphoma, and multiple myeloma, serving up to a handful of patients a year.


The autologous transplants are used when a patients cancer has become resistant to conventional therapy, and heavy doses of chemotherapy needed to combat it would irreversibly damage bone marrow, she says. Its more often not curative, but you have extended good-quality survival, she says. Weve got some wonderful people whove been walking around for a long time after having the therapy.


Cutter also says that patients enjoy good quality of life, but the immediate aftermath of the procedure can be rough.


Before collection of stem cells begins, the patient gets a big dose of chemotherapy, which dramatically reduces their white blood cell count, Cutter says. Ten to 14 days later, as the patients blood-cell count recovers, stem cells are collected from the patient over a two- to four-day period.


After the patient recovers from the initial chemotherapy, a much higher dosage is given to attack the cancer, Cutter says. That dosage would kill the bone marrow and cause (the patient) to die without reinfusion of the stem cells.


He calls the reinfusion a rescue procedure. It allows us to give much higher doses of chemotherapy than we could normally give. Yet, he adds, the aggressive chemotherapy can affect other organs.


Cancer Care Northwest hospitalizes its patients after the procedure. The North Idaho Cancer Center doesnt do so unless its patients are experiencing constant nausea or vomiting or cant eat, Herbst says. Still, it sees them absolutely every day until their bone marrow recovers and they have normal (blood) counts, and it wants them to be housed near the hospital because a life-threatening condition can develop quickly, she says.


Cutter says that while patients white blood counts remain low, they likely will suffer infection, usually a bacterial infection from your own body, your skin, your GI tract. Your body teems with bacteria. When you have no white blood cells, bacteria gain access to your body.


Patients need transfusions of both blood and platelets. They can die from bleeding, as well as infection.


They may need several units of red blood cells several times a week, Cutter says. They may need platelets two or three times a week, or even every day. Before the procedure you cant donate enough of your own blood to handle this, he says.


Cutter adds, Patients often are in bed or confined to their room. Sometimes they can walk the halls, with a mask on. Most people can eat, although intravenous feeding is not unusual. You can have mucusitis, and have terrible sores in your mouth, and cant eat. Kidney and liver failure are dangers.


The bone marrow usually recovers after eight to 10 days, although the longer a patients blood count remains low, the higher the risk from complications, Cutter says. The risk is not how low does your white blood cell count go, but how long does it stay down.


Consultations with an infectious disease-control doctor can be important, and so can complex antibiotic therapy, Cutter says. Patients can become depressed by the extended hospital stays, Cutter says. Youre not having surgery and going home in two or three days. Youre camping.


Preparing patients is a key, and the oncology practices financial counselors get involved in that process, Cutter says. They want to make sure patients wont be left bankrupt. This may cost $100,000. You may be on the hook for $20,000. Thats a lot of money. Not every insurer will cover the procedure.


To have the stem-cell therapy, patients must be in good health, or their bodies cant withstand the heavy doses of chemotherapy, Cutter says.


Contact Richard Ripley at (509) 344-1261 or via e-mail at editor@spokanejournal.com.