Half-match Stem-cell Transplant Program Leads to Lifesaving Option

As director of the Haploidentical Transplant Program at Washington University School of Medicine, Rizwan Romee, MD, is pioneering new approaches to treat cancers of the blood through half-match transplants. The option is a game-changer for minority patien

Author: Lucy Schultze

For many physicians, determining the focus of one’s career is a process that unfolds over time, informed by a series of rotations and a growing awareness of what suits one best.

Not so for Rizwan Romee, MD. A leading researcher in the field of stem-cell transplantation, Romee has been on the same track since his teenage years — when he watched his cousin die from leukemia and resolved to unlock the secrets that could have saved him.

Today, he is clinical director of the Haploidentical Transplant Program at Washington University School of Medicine, where a novel “half-matched” stem-cell transplant procedure allows parents and children to donate healthy cells to blood cancer patients.

“It used to be fairly common that a patient would wait and wait for a bone-marrow transplant, only to die before an HLA matching donor could be found,” Romee said. “But this new approach changes everything for patients who cannot find an HLA identical matched donor for a transplant.”

The procedure was adapted from one pioneered at Johns Hopkins University, which published promising results in 2008. At Washington University, researchers modified the approach, using stem cells from peripheral blood rather than bone marrow.

“We did the first 10 or 12 patients and saw very encouraging results,” Romee said. “We then decided to offer it routinely, and for the last two years we’ve been offering this option to anyone that does not have a fully matched brother or sister or a match through the international registries.”

That option has been particularly valuable to members of the African-American population in St. Louis, Romee said, since minorities are poorly represented in the National Marrow Donor Program (NMDP) registry.

The NMDP aims to connect patients in need of a bone-marrow transplant with unrelated donors around the world who may share most of the 12 human leukocyte antigens (HLAs) that determine tissue compatibility. The half-matched approach is providing similar results — but with far better odds of finding a match. Patients can be automatically matched to either a parent or a child, with a 50-percent chance of also matching with a sibling.

In a typical recent case, Romee said, a half-matched transplant was provided to a young African-American woman who works at Barnes-Jewish Hospital.

“She had been diagnosed with Hodgkins lymphoma a couple of years back, and was treated with chemotherapy,” he said. “But unfortunately, the disease came back, and when that happens you look at transplant options.”

No donor was readily available for the patient through the NMDP, he said.

“A couple of years prior, she would have had to wait and wait, and we would have lost critical time,” Romee said. “But last year, we were comfortable with our option, so she was quickly taken to transplant using her mother as the donor. Now, she is almost a year out and doing great. She’s getting married. Every time I see her, I get a nice hug from her.”

Being able to effectively restore a blood-cancer patient’s life is the culmination of a long-held ambition for Romee. Raised in India in a small town near New Delhi, he was interested in biology from a young age. His focus on medicine and oncology was sharpened after his cousin was diagnosed with leukemia.

“I watched him getting sicker and sicker, waiting for a transplant that would never happen — literally dying in front of my eyes,” Romee said. “That broke my heart, but also triggered my desire to find a solution.”

That course led him from medical school at India’s GMC Srinagar to a residency at the University of Minnesota, where researchers were pioneering stem-cell transplantation from umbilical cord blood. He stayed on for a fellowship in hematology, oncology and transplantation.

“During my training in Minnesota, I was able to learn some potential disadvantages of using cord blood,” he said. “I learned that it takes a longer time for patients to recover, and also that the rate of infection is higher in those patients. I saw that using cord blood is an option but not ideal for transplantation.”

Romee completed a postdoctoral research fellowship at the University of Minnesota under Jeffrey Miller, MD, a leading expert in understanding natural killer (NK) cells and their potential in cancer treatment. Romee honed in on the relationship between NK cells and half-match donors, and was already interested in pursuing a half-match transplant program when he arrived at Washington University in 2011. He completed an advanced bone marrow transplantation fellowship and stayed on as a faculty member in the Bone Marrow Transplantation & Leukemia Section, Oncology Division.

Today, Romee’s research in the Haploidentical Transplant Program continues to move forward, with results in hand from some 150 half-match transplants over the last three years.

“Our patients have a success rate comparable to those with traditional full-match transplants, but still 20 to 30 percent end up having the disease come back,” he said. “We are now focused on trying to cut down on rates of relapse.”

Toward that end, Romee finds promise in the discovery during his postdoc fellowship of a new subset of NK cells, Cytokine-Induced Memory-Like (CIML) cells. He was the lead author of a study describing the anti-leukemic properties of CIML cells, and has begun a collaborative new trial that applies those cells from half-match donors for patients who have failed remission. His work is being funded by a Scholar Award from the American Society of Hematology (ASH) and a Conquer Cancer Foundation Career Development Award from the American Society of Clinical Oncology (ASCO).

Romee is also collaborating on efforts to reduce the rate of graft-versus-host disease (GvHD) among transplant patients, specifically using the half-match approach.

Off hours, Romee enjoys traveling, photography and spending time with his family. His wife, Saba Beg, MD, is a member of the rheumatology faculty at Wash U. They have two children, Myra and Arsh.

 

RELATED LINKS:

Cytokine-induced Memory-like NK Cells in Patients with AML or MDS

Siteman Cancer Center

Washington University School of Medicine: Rizwan Romee, MD

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