BONE MARROW TRANSPLANT GENETIC BASIS OF CANCER
The University of Chicago Medicine’s innovative approach makes transplants possible for patients who do not have a standard match and for high-risk patients.
Gleevec is used in the treatment of several cancers, including leukemia, lymphoma and gastrointestinal stromal tumor (GIST).
TODAY
TODAY
Late 1940s
1972
Leon Jacobson, MD, performs the first bone marrow transplant on a mouse. Twenty years ago, the University of Chicago Medicine started the first pediatric bone marrow transplant program.
Janet Rowley, MD, discovers the first recurring chromosomal abnormality associated with cancer, demonstrating that cancer is a genetic disease. Her research led, decades later, to the development of Gleevec (imatinib), the first, and most successful, targeted cancer therapy.
PRESENT Although she is a physician, Anjuli Nayak, MD, had never been on an oncology unit. She realized that was going to change the moment she learned the results of a routine blood test. Her white blood cell count measured 22,000 — more than twice the upper limit of normal. “I wasn’t sick, and I didn’t have any symptoms, but I knew I had leukemia,” said Nayak, an allergist-immunologist with a practice in Bloomington-Normal, Ill. By that evening, Nayak and her family huddled together to discuss the options. After researching the top leukemia programs in the country, she decided to see Wendy Stock, MD, a hematologist-oncologist at the University of Chicago Medicine and a nationally known authority on leukemia. | B E L OW | Leukemia patient Anjuli Nayak, MD,
right, and her physician, Wendy Stock, MD
Nayak was diagnosed with acute lymphoblastic leukemia (ALL), an aggressive type of cancer of the blood and bone marrow. Genetic analysis showed the leukemia tested positive for the Philadelphia chromosome, a mutation that results when breaks occur in each of two chromosomes and genetic material switches places to create a “fusion” gene. This new gene codes for a protein that causes leukemia. Forty years ago, the University of Chicago’s Janet Rowley, MD, was the first to show that these chromosomal translocations were a trigger for development of leukemia and other cancers. This pivotal discovery laid the groundwork for the development of imatinib (Gleevec) and other targeted therapies. Nayak’s initial treatment combined traditional chemotherapy with dasatinib (Sprycel) — a second generation of imatinib. The medical team felt her best chance for cure was to proceed with a stem cell transplant once the leukemia went into remission. Because Nayak did not have a matched donor, she was offered an opportunity to enroll in a unique clinical trial: a National Cancer Institute-sponsored research study involving transplantation of stem cells from both a half-match donor and from donated
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umbilical cord stem cells. Nayak received her half-match cells from her middle son, Zachary, then in medical school. “This approach allows us to make transplant available to patients who do not have complete immunological matches,” Stock said. Almost two years after her diagnosis, Nayak has no measurable evidence of lingering leukemia. She continues to take dasatinib daily. Using highly sensitive and sophisticated diagnostics, the medical team checks her blood monthly to be sure no cancer cells are detected. “I am so grateful to the leukemia transplant team for the care, compassion and courage received from the doctors and nurses,” Nayak said. “They have given me a rebirth, for which I am eternally grateful.”
FUTURE University of Chicago Medicine researchers are discovering radical new ways to fight cancer, one cell at a time, by applying the principles of evolutionary biology and population genetics. Lay people may think of tumors as homogeneous masses of cells. But some cancer researchers, including University of Chicago Medicine scientists