Isle teen tests new transplant


POSTED: Monday, March 23, 2009

Sarah Ruiz, an 18-year-old leukemia patient with no match for a lifesaving bone marrow transplant, might soon be going to movies again and eating spicy ahi sushi with half a match donated by her 20-year-old sister, Jessica.

The half-match transplant was made possible by a unique procedure done for the first time in Hawaii at Kapiolani Medical Center for Women & Children.

“;My sister told me, despite all the dangers coming with the transplant, no matter what happens, 'I'm gonna give this a shot,'”; said Jessica Ruiz, a University of Hawaii-Hilo sophomore.

Sarah Ruiz, a senior at Mililani High School, was diagnosed two years ago with acute myelogenous leukemia. Her mother, Mila, said she took her to the doctor after bruises appeared on her body.

“;I've been coming (to the hospital) ever since,”; said Ruiz, describing bouts of sickness and fever after chemotherapy.

In a recent interview in her positive-pressure isolation room, Ruiz was cheerful and hopeful about the outcome of the new procedure.

“;They take blood tests every day,”; she said, smiling. “;I'm used to it already. I know how to cope with it.”;

Her mother said, “;She's a fighter.”;

Although Jessica Ruiz was an imperfect marrow match for her sister, she said she was the best one for the novel transplant, done March 5.

Dr. Randy Wada, head of Kapiolani's transplant program and the Hawaii Cord Blood Bank, had been following the protocol since it was designed by Johns Hopkins University.

In a regular transplant, he said, heavy chemotherapy is done first to wipe out the patient's residual leukemia. With the new procedure, a smaller dose of chemo is given just to weaken the patient's immune system so the donor system can take over.

He said the new immune system is capable of recognizing residual tumor cells and destroying them, but if the immune system starts attacking the patient's normal cells, it can be fatal.

The way the half-match works, he said, is to anticipate cells in the new immune system will start getting stimulated almost immediately after they hit the recipient's body, then they start to divide and activate themselves.

“;On day three or four, about the time that process is reaching a peak, the patient is treated with fairly large doses of chemotherapy that are going to kill all rapidly dividing cells, and most at that stage of the transplant are cells that have the biggest issues.”;

Wada said the advantage of a half-match bone marrow transplant is that almost everyone has a family member who can provide it.

A clinical trial was organized after an encouraging pilot study at Johns Hopkins, and when the trial was opened to affiliate centers, Wada said he became excited because he thought the procedure would benefit some Hawaii patients who had no match through the National Marrow Donor Center or Cord Blood Bank and could not go to the mainland.

With Sarah Ruiz and other patients in mind, he applied to the Blood and Marrow Transplant Clinical Trials Network to let Kapiolani participate.

He performed Ruiz's transplant with pediatric oncologist Dr. Darryl Glaser, who said Kapiolani's ability to participate in the clinical trial “;is huge,”; adding, “;It's opening an opportunity for patients who had no other options in the past, either because they had no (matched) donor or couldn't go to the mainland to get this special kind of procedure.”;

Glaser said Ruiz is doing well and might be able to leave the hospital sooner than expected because her sister's bone marrow is growing quickly and she has not had any serious consequences. But she will be followed closely as an outpatient because complications could develop, he said.

“;The goal of this treatment is that she will be cured of leukemia and live her normal life,”; Glaser said.

He said one or two other young patients without bone marrow matches might be candidates for a half-match transplant. Hawaii Medical Center-East oncologists also are interested in it for adult patients, he said.

Jessica Ruiz said one of the easiest decisions she ever made was to donate bone marrow to her sister. She lost about 2 percent to 5 percent of her marrow, but it grows back within three to four weeks, she said.

“;It's a moment of time when you're recovering, but you're giving a cancer patient a chance to living life they wouldn't have,”; she said.

Sarah Ruiz had looked forward to eating garlic shrimp after recovering from the transplant. But along with her sister's cells, she acquired her food allergies, including an allergy to shrimp, Wada noted.

Now she has a craving for spicy ahi sushi, she said, explaining she collected her “;first and last paychecks”; working two months at a sushi outlet in Mililani before her diagnosis.