Department of Medicine

Advances in Bone Marrow Transplantation Save Lives 

Twenty-five years after being diagnosed with acute lymphatic leukemia, David Occhipinti is grateful to be alive. On a sunny fall day, at his home in San Jose, he remembered the experience as if happened yesterday. Back in the summer of 1987, Occhipinti
David Occhipinti
David Occhipinti
wasn’t feeling well and went to visit his doctor. An examination and subsequent blood test revealed leukemia so aggressive that without immediate treatment he could be dead within two weeks.

Occhipinti was referred to Stanford Hospital and underwent a protocol of chemotherapy that drove the leukemia into remission.  He also met Karl Blume, MD, a leader in the field of bone marrow transplantation, recently recruited from the City of Hope to establish Stanford’s Blood and Marrow Transplant Program.

As new technology develops transplantation will be applicable to many other fields of medicine.
-Karl Blume, MD, Professor Emeritus of Medicine

“He told me there was a good chance that the leukemia would come back,” said Occhipinti. “There was no guarantee, but a bone marrow transplant might prevent the disease from recurring.”

Fortunately, Occhipinti brother’s was an ideal match. With the odds stacked in his favor, he decided to go ahead with the transplant. First, however, there was chemotherapy and radiation so intense, “I was close to death more than once,” he said grimly. “They have to kill the leukemia without killing the patient and sometimes it’s a very fine line.”

With his body ready, David Occhipinti was infused with his brother’s lifesaving stem cells on November 2, 1987, just months after he was first diagnosed. He spent 59 days in the hospital, much of it in isolation. When the ordeal was over, Occhipinti was 'Numero Uno,' as he is fondly called at the BMT program, or the first adult to undergo a bone marrow transplant at Stanford.

Looking back, 58 year-old Occhipinti recalled the determination, positive attitude, and support from his doctors and nurses that got him through such a difficult time. “I might have died if I waited; there was no way I was going to let the leukemia beat me.”

Therapeutic Breakthroughs

Over the years innovative treatments have brightened the horizon for patients with life-threatening blood and immune disorders. During a recent symposium, 25 Years of Progress in Blood and Marrow Transplantation, speakers from leading centers throughout the country and Stanford gave attendees an historical overview of the tremendous advances made in the field. Breakthroughs such as total lymphoid irradiation (TLI) developed in transplant medicine by Samuel Strober, MD, Professor of Medicine, Division of Immunology and Rheumatology, fundamentally alters the immune system to decrease graft vs. host disease (GVHD) and limit the need for toxic and expensive anti-rejection drugs. The use of mobilized peripheral blood has shortened transplant recovery times from one month to 10-12 days and reduced the risk of infection. If infection occurs, better drugs are available to fight it.

“Modern treatments make the process much safer,” said Robert Negrin, Professor of Medicine, Chief of the Division of Blood and Marrow Transplantation, and BMT Program Director. “Patients spend less time in the hospital, undergo more outpatient care and can be treated in the early stages of their disease, which is very important.”

Robert Negrin MD
Robert Negrin, MD

Developing safer and lower risk strategies to treat older adults is another advance. Until recently, bone marrow transplantation was not an option for people over 50. We can now match treatments with the demographics of the disease to benefit more patients, said Negrin. Annually, the adult and pediatric BMT programs at Stanford provide transplants to more than 300 patients and have performed more than 5,000 transplants since 1987.

The program, however, would not be where it is today without the dedicated staff and nurses, some of whom have been there since the beginning. “Twenty-five years ago, bringing in feedback from the whole staff was not a common place practice,” said Negrin. Today, it’s in the patient’s best interest to have input from nurses, social workers, dieticians, physical therapists and all members of the transplant team. Everyone from the technician that prepares the transplant to the people who work in office have a role in the success of the program.

One Step Further

Being firmly established as a core treatment for high risk hematological diseases has also opened a path into the field of cellular therapy. With research underway to reduce the risk of GVHD, investigatorsJudith Shizuru, PhD, MD, Associate Professor of Medicine, Division of BMT, John Scandling, MD, Professor of Medicine, Division of Nephrology, Samuel Strober, MD, and others are exploring tolerance induction and creating strategies to make organ transplants safer by transferring blood- forming cells along with organ grafts to eventually eliminate the need for lifelong immune suppressants.

Another corollary, said Negrin, is the opportunity to treat autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, or scleroderma by using cells in clinical medicine instead of drugs as cutting edge cellular therapy. “Scientific evidence shows its effective, and yet, there’s a huge space between the laboratory and the clinic. This program is headed in a direction to bridge that gap.”

In the meantime, 'Numero Uno' is busy inspiring others who’ve followed in his footsteps. Every year David Occhipinti attends the annual summer BMT Reunion with staff and former patients who are one year after transplant. Together they celebrate life, amazed by a procedure that has come so far and saved so many lives.

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