Duke Cancer Institute multiple myeloma specialist Cristina Gasparetto, MD, and her patient Thomas Goode, have a candid conversation, in four parts, about the physician-patient journey — from Thomas’ multiple myeloma diagnosis 16 years ago to the present. The journey includes building a strong relationship to support struggles and successes and a path to the future.
This "Mye Journey" series is presented by Duke Cancer Institute and is funded by Multiple Myeloma Research Fund donations.
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.”
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.