Fighting Disease with Song

THE BALTIMORE SUN

When two of the great singers of our time, Jose Carreras and Marilyn Horne, sing together tonight at Wolf Trap for the benefit of leukemia-related foundations, the extraordinary concert will have personal significance for me. Twenty-five years ago I was one of the first leukemia marrow-transplant donors.

Both singers have volunteered for personal reasons. Miss Horne's father died of leukemia. A marrow transplant in 1987 enabled Mr. Carreras to survive acute lymphoblastic leukemia. A quarter-century ago when my sister contracted this same leukemia, it was a quick death sentence.

My sister, Patricia McCloskey Worthington, was in her early 30s, newly married. By the time doctors diagnosed the acute leukemia they could give her only about three weeks to live. After numerous tests, a research team at Johns Hopkins Medical Schools held out a straw.

Marrow transplant was a new field of medical research. The theory, proved in the laboratory but yet without long-term success on patients, was this: Leukemia kills by destroying the body's bone marrow, which is responsible for the immune system. If a patient's infected marrow could be destroyed and then replaced, the uninfected marrow might generate new, healthy cells to override the cancer. A French team had performed marrow transplants, but the donor marrow had in the end proved incompatible, resulting in patient rejection (and death) in what the researchers termed "graft-versus-host reaction." A Johns Hopkins team under Dr. George Santos was using cytoxin, a potent drug that had the potential of preparing a transplant recipient to accept the graft.

After extensive testing on laboratory animals, the Hopkins team was poised for the definitive step. They needed a patient with acute leukemia for whom they could find a compatible marrow, a match as rare then as now, but far more difficult to determine. They found the match in me.

My sister bravely consented to the untried procedure. Her husband Fred concurred. The procedure took place in a special unit at City Hospitals. Pat entered a strict isolation environment. No outside infection could be risked as doses of cytoxin gradually destroyed her immune system. Fred was the only authorized visitor. The rest of us communicated by phone, praying together and talking often to keep up her spirits and ours.

The family worked closely with the doctors. One of the four-man team, Dr. Philip Burke, became our go-between and sympathetic counselor. The others, with Dr. Santos, were Drs. Albert Owens and Lyle Sensenbrenner.

The treatment required a steady infusion of platelets from whole blood to maintain the patient's blood-clotting ability. The call went out, and numerous Baltimoreans, including many of my colleagues at the Johns Hopkins Applied Physics Laboratory, responded. It became a gravely cheerful social round. While the donors lay supine, a closed system centrifuged their blood to remove some platelets (soon regenerated) while returning the rest of the blood to their systems.

As I moved around the leukemia enclave, I visited non-isolated patients being treated conventionally. I remember a frightened teen-ager and a quiet man in his 20s attended by his wife and infant son. With each, I passed a cheerful word one evening, and next morning found their rooms empty. The nurses did not want to speak of it. This form of leukemia killed that quickly.

After the removal of my marrow under general anesthesia, I felt weak and sore for a while and needed to take anemia pills for several weeks afterward, but I walked from the hospital two days later. I still run a basketball court routinely at age 65, so there were no long-term effects. Today a donor's marrow is extracted in a quicker procedure (only 2 to 5 percent of it at that), and the donor can leave the hospital next day. In some cases doctors need use only a spinal anesthetic. Marrow donation has become safe and relatively uncomplicated.

My sister received the marrow, and recovered enough to return home. We were all jubilant over her gradual improvement. A month later the symptoms and others returned. It was the dreaded graft-versus-host reaction. Her body had initially accepted my marrow, but then a rejection started. She died the day after Christmas.

The knowledge gained from Pat's marrow transplant and subsequent reaction, however, enabled teams around the world to advance their work. She had lived longer in remission by more than a month than any previous marrow recipient with a quickly- fatal disease. The Hopkins team's experience formed the basis for an international symposium held in Paris the following year. Drs. Santos and Burke presented proof that a patient's leukemia xTC could be annihilated chemically and a graft implanted, but urgently advised strong, early preventive treatment against a graft reaction.

My sister's case provided a basis for subsequent advances in the field. Marrow transplants now treat leukemia and also aplastic anemia and some 60 congenital disorders. Long-term survival rates have become 30 to 40 percent for diseases that would be fatal without transplants, much higher for others.

The beneficiaries of the Carreras-Horne concert are the Jose Carreras International Leukemia Foundation, the Marrow Foundation and the Wolf Trap Foundation.

The Marrow Foundation, based in Arlington, Virginia, primarily supports the National Marrow Donor Program. A major problem in treating patients who need a marrow transplant is finding suitable donors. Only about one in four victims can find a genetic match within the family; the odds within the general public can run one in a million.

Since its inception in 1987, the Donor Program has enlisted more than 1.1 million volunteer donors worldwide, and has provided marrow for more than 2,300 transplants. At any given time its registry is being searched for some 2,000 active cases, and it has averaged 55 successful matches a month. A larger registry would increase the number of matches. In conjunction with the Carreras-Horne concert, the Marrow Foundation in Arlington is conducting a local drive for minority donors, a major concern, since a patient will likely find a genetic match within only his own racial group. For information call 703-351-7411, or the national donor program at 1-800-MARROW-2.

Jose Carreras can now continue to sing, and others have likewise returned to fully functional lives from a one-time death sentence. My sister helped.

Baltimore writer William McCloskey's books are principally about seafaring.

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