Reproductive endocrinology and infertility specialist Kelly Archarya, MD, and Erin White, MS, IVF lab manager/program manager at the Duke Fertility Center.
Onco-Fertility Services Make Patients' Family-Dreams Come True
Sasha Zarzour, Development Director at Caring House, a Durham-based extended stay facility for outpatients being treated at Duke Cancer Center, is a two-time survivor of Hodgkin’s Lymphoma. Sasha went through successful egg cryopreservation and IVF at the Duke Fertility Center in 2019. Son Bobby (top right) was born at Duke Regional Hospital in May 2020. After thinking she would be unable to have more children, Henry – her “surprise child” – was born in October 2021.
“I had a great experience and am so grateful for the team at the Duke Fertility Center,” says Zarzour. “They knew how much my husband Billy and I wanted to have children, and they were willing to do whatever they could to make that a reality. The best thing is that they were thinking about my entire life – not just my cancer."
A cancer diagnosis brings with it a flood of emotions — sometimes one at a time, often all at once. A patient’s initial questions relate to their type of cancer, course of treatment and most importantly, the likelihood of survival.
What may not immediately come to mind is the possible effect the cancer and its treatment could have on the patient’s future ability to have children. Just 20 years ago, this was rarely considered. Then cancer survival rates were lower, and the technology to preserve future fertility was not readily available.
Today, a novel collaboration between the Duke Cancer Institute’s (DCI) Supportive Care & Survivorship Center and the Duke Fertility Center is helping cancer patients' family-dreams come true.
For decades, bone marrow transplantation has saved the lives of patients with blood cancers or other inherited or acquired bone marrow diseases. But today, it’s helping more people than ever because medical advances have made the procedure feasible for more patients.
Bone marrow is spongy tissue in our bones that houses the blood stem cells that give rise to red blood cells, platelets, and the workhorses of the immune system, white blood cells. In a bone marrow transplant, stem cells from healthy bone marrow or blood are infused into a patient to do the work of producing blood cells. Patients with certain blood cancers like lymphoma may need a transplant if the chemo or radiation necessary to kill their cancer also kills their bone marrow. In other cases, the recipient’s bone marrow stem cells may be producing blood cells, but those cells aren’t up to the task of recognizing and killing cancer and need to be replaced with stem cells from a healthy donor.
The transplanted cells can come from the patient (collected ahead of time) or from a donor. In the past, patients in need of a transplant had to have a matched donor, meaning that recipient and donor had the same immunologic proteins, called HLA. Otherwise, the donor cells would launch an immune attack on the recipient’s body.
Over the last few decades, researchers have made significant progress in discovering how to perform transplants using donated cells that aren’t a perfect match. Furthermore, stem cells can now be harvested not just from bone marrow but from blood and umbilical cord.
“More patients can benefit from transplantation now because there are more donor options,” said Edwin Alyea, MD, the chief medical officer of the Duke Cancer Institute. “And we can now offer reduced intensity transplants, with lower-dose chemotherapy, to patients who were previously not eligible because of age or other medical problems.”
Former patient Kameron Kooshesh speaking at his 2022 Harvard-MIT Health Sciences and Technology graduation.
In 2006, 12-year-old Kameron Kooshesh temporarily moved from California to Durham with his parents so that he could get a bone marrow transplant with Duke’s Joanne Kurtzberg, MD. He had just undergone three years of chemo for acute lymphocytic leukemia, and his cancer had returned. His mom researched pediatric bone marrow transplant programs nationwide and chose Duke for her son.
Kooshesh quickly bonded with Kurtzberg and others on his team, from physicians to nurses to case managers. “They knew me and my family so well,” he said. “We trusted them as we would a family member. Duke felt like my home.”
Kooshesh’s bone marrow transplant initially went well, but he developed severe graft versus host disease (GVHD) that didn’t respond to standard treatment. Kooshesh knew of some other kids who had died from GVHD and wondered if the end had come for him.
>Kurtzberg was aware of a drug that might help, but it was still in clinical trials. She won a compassionate-use authorization from the Food and Drug Administration. “Just a couple of infusions of this drug, and I was cured,” he said, “truly cured.” Kooshesh believes he wouldn’t have gotten that drug if he’d been treated at another institution. “Dr. K. is absolutely unbelievable,” he said. “She has a mastery of basic science and clinical and translational medicine that few others have.”
Kooshesh graduated from Harvard Medical School in 2022 and is now a resident in internal medicine at Massachusetts General Hospital. He plans to devote his career to improving stem cell transplants and reducing GVHD.
“I now do the exact kind of research that served as the basis for the drug that saved my life,” he said.
