September 1, 2010

Mandi Schwartz Update: Remission Achieved; Transplant up Next

 Yale Women's Hockey Center to Receive Stem Cell Transplant

NEW HAVEN, Conn. – Mandi Schwartz and her family received the good news they have been waiting for on Tuesday: based on her biopsy results, she is back in remission. This is the third time she has gone into remission since she was initially diagnosed with cancer in December of 2008. This time, the plan is for Mandi to receive a stem cell transplant designed to help her win her battle with acute myeloid leukemia once and for all. The transplant, which involves a breakthrough procedure developed by one of her doctors at the Seattle Cancer Care Alliance's Fred Hutchinson Cancer Research Center, will be scheduled as soon as possible.

"We are relieved to hear that Mandi is back in remission," said Rick Schwartz, Mandi's father. "The support we have received during this difficult time has been inspiring. We thank everyone who has kept Mandi in their thoughts and prayers, and encourage everyone to continue raising awareness of the need for bone marrow donors and umbilical cord blood donors to save the lives of all patients who need transplants like the one Mandi will receive."

On Aug. 11 -- just 16 days before her originally scheduled transplant date – a biopsy indicated that Mandi's cancer had returned. The transplant had to be postponed as she underwent another round of chemotherapy.  After being discharged from the hospital when that round finished on Aug. 19, Mandi returned to the Seattle Cancer Care Alliance's University of Washington Medical Center on Aug. 25 with a high fever. She is currently being treated and monitored there, and that is where her transplant will take place.

Mandi, a center from Wilcox, Sask., needs a stem cell transplant -- essentially, a new blood and immune system -- to survive. Stem cells have the ability to change into any of the body's cell types. In Mandi's case, they will be used to give her new blood cells and new immune cells. Her current immune system, along with the cancerous cells, will be wiped out by chemotherapy and radiation.

Mandi's transplant will utilize stem cells from two units of umbilical cord blood, including one that has had its number of stem cells increased using a procedure pioneered by Dr. Colleen Delaney of the Fred Hutchinson Cancer Research Center. With the increased amount of stem cells involved in the transplant, engraftment -- the generation of infection-fighting white blood cells of Mandi's new immune system following transplantation --  is likely to happen more quickly, thus limiting the risk of infections.

 

Here is a look at some of the key elements to Mandi's battle:

 

About Acute Myeloid Leukemia

Acute myeloid leukemia is a type of cancer that starts inside the bone marrow and grows from cells that would normally turn into white blood cells -- cells of the immune system.

 

Treatment Back Home in Saskatchewan

Mandi was initially diagnosed with acute myeloid leukemia in December of 2008, the first semester of her junior year at Yale. She returned home to Saskatchewan for treatment at the Allan Blair Cancer Centre in Pasqua Hospital in Regina. After multiple rounds of chemotherapy she was first declared to be in remission in the spring of 2009. She returned to Yale in January of 2010 and resumed practicing with the women's hockey team, but she was re-diagnosed this past April and had to return home for more chemotherapy. At that point it became clear that she would need a stem cell transplant to survive, and her family chose to have the transplant through the Seattle Cancer Care Alliance. Her chemotherapy in Saskatchewan put her in remission, which is necessary in order for her to be able to receive the stem cell transplant, for a second time. She was found to be in remission on June 9, and was discharged from Pasqua Hospital on July 11. That enabled her and her family to make the trip to Seattle and begin preparing for the transplant.

 

Attempts to Find a Genetic Match for Mandi

The stem cells for transplants like the one Mandi needs can come from the bone marrow or peripheral blood of an adult donor or the blood left over in the umbilical cord after a baby is born. In order to limit the risk of complications, the stem cells must come from a donor who is a close genetic match to the patient.

For transplant purposes, genetic matches are judged by comparing proteins -- or markers -- found on most cells in the human body. The immune system uses these markers, known as human leukocyte antigens (HLA), to recognize which cells belong to that body and which do not. A close match between HLA markers can reduce the risk that the recipient's immune cells attack the donor's cells or that the donor's immune cells attack the recipient's body after the transplant. There are many different HLA markers, but transplant donors and patients are primarily compared for matches of eight to 10 markers that are most important in transplant outcomes.

Mandi has been unable to find a bone marrow donor that is a genetic match -- 16,000 leukemia patients diagnosed each year cannot. None of her family members are matches. Inspired by Mandi, bone marrow donor drives have been held throughout her native Canada and the United States. The Yale Athletics Department has held drives each of the past two springs, adding more than 1,600 people to the National Marrow Donor Program's "Be The Match" registry. A series of drives in Canada added more than 2,600 people to Canadian Blood Services' "OneMatch" registry. The people that registered at these drives may be called upon someday to help save the life of a patient, like Mandi, with a life-threatening illness.

 

The Umbilical Cord Blood Option

With no matching stem cell donor available, the best option is to get the stem cells for the transplant from umbilical cord blood. Cord blood has advantages as a stem cell source: fewer viral infections are transmitted with it, and -- because umbilical cord blood lacks well-developed immune cells -- there is less chance that the transplanted cells will attack the recipient's body (graft-versus-host disease). Using cord blood thus does not require the extremely close genetic matching of bone marrow transplants.

The major disadvantage to using umbilical cord blood for a transplant is that each unit has fewer stem cells than other sources (approximately 1/10th). Because of this low number, engraftment (the generation of infection-fighting white blood cells of the new immune system following transplantation) in adults from a cord blood transplant takes about 26 to 28 days, compared to 15 for a bone marrow transplant. While waiting for engraftment patients run the risk of getting infections that can be fatal. That is where the breakthrough technique that will be part of Mandi's transplant protocol comes in.

 

Seattle Cancer Care Alliance, Mandi's Doctors, and the Breakthrough Procedure

When the Schwartzes were looking for a hospital for the transplant, they were drawn to Seattle Cancer Care Alliance, which is operated by Fred Hutchinson Cancer Care Center, University of Washington Medicine and Seattle Children's. As it turns out, they will now have the benefit of working with a doctor who has pioneered a way to speed up the process of engraftment and thereby limit the risk of infections. Dr. Colleen Delaney, an oncologist and researcher in Dr. Irwin Bernstein's Clinical Research Division lab, has been conducting a unique clinical trial using cord blood for the last four years.

In 2002, researchers in the Bernstein Lab found a way to increase the amount of stem cells in cord blood. They rapidly grow the cells on a protein called Delta, which activates a gene that keeps the cells from maturing into more specific cells. With the increased amount of stem cells involved in the transplant, engraftment is likely to happen more quickly.

Mandi and her family have met with Dr. Delaney and the transplant team to prepare for the transplant. Mandi's attending physician is Dr. Rainer Storb, a longtime Hutchinson Center transplant physician and researcher.

 

The Family in Seattle

Mandi, her parents Carol and Rick, and her fiancée, Kaylem Prefontaine, made the trip to Seattle from their home in Saskatchewan by an RV donated by Traveland RV in Regina. Mandi's younger brothers, Jaden and Rylan, have both spent time visiting her in Seattle as well. They are hockey players at Colorado College, and Jaden was recently selected in the first round of the NHL Draft by the St. Louis Blues.

 

The Cord Blood Selected for Mandi's Transplant

The cord blood units that will be used in Mandi's transplant came from two separate donors who are, and will remain, anonymous. They were donated to public cord blood banks and located by a registry search performed by the Seattle Cancer Care Alliance. The units are each identified as "5-out-of-6" genetic matches for Mandi. Because umbilical cord blood stem cells require less strict matching criteria, transplants can be performed even with "4-out-of-6" matches.

 

The Transplant

Mandi's transplant had been scheduled for Aug. 27, but was postponed once it was learned on Aug. 11 that the cancer had returned for a third time. She underwent more chemotherapy to put her back in remission.

In preparation for her transplant, chemotherapy and total-body radiation will be used to ensure that all of the existing cancerous cells in Mandi's body are eliminated. This will also further suppress Mandi's immune system to prevent her from immediately rejecting the new donor cells.

The transplant itself is similar to a transfusion and takes a few hours. The stem cells are placed in the body through a vein, and find their way to the bone marrow to create new blood cells and immune cells.

 

After the Transplant: Waiting for Engraftment

After the transplant, the next milestone that everyone will be watching for is known as "engraftment": the transplanted stem cells beginning to grow in Mandi's bone marrow and manufacture new blood cells and immune cells. This signifies the birth of Mandi's new immune system, and could happen within a few weeks of the transplant.

Complete recovery of Mandi's new immune system takes approximately a year. Following the transplant, she will be monitored regularly through blood tests to confirm that new blood cells are being produced. She will spend several months in Seattle before she can return home to Saskatchewan.

 

Yale Teammates Take Action

While Mandi's transplant will utilize cord blood, the need for bone marrow donors for patients like her remains great. Mandi and her family continue to encourage all adults to sign up as bone marrow donors, and for expectant mothers to sign up as cord blood donors.

In order to raise awareness of the need for bone marrow donors and umbilical cord blood donors in general, and to help the Schwartz family with expenses, Mandi's Yale teammates have been organizing several events. Rising junior forward Aleca Hughes (Westwood, Mass.) raised more than $6,000 and added approximately 70 people to the bone marrow donor registry at the Chowder Cup Tournament last month. On Aug. 26, rising senior defenseman Samantha MacLean (Mississauga, Ont.) completed a five-day, 500-mile bike ride from Toronto to New Haven, "The Ride for 17" (Mandi's uniform number), to raise awareness and funds.

 

HOW YOU CAN HELP  

1. Send Mandi a card or letter showing your support:

Mandi Schwartz
Box 308
Wilcox, SK S0G 5E0
Canada   

2. Send donations (checks made out to "Yale University", with Mandi Schwartz in the memo line) to:

Yale Athletics
ATTN: Wayne Dean
20 Tower Parkway
New Haven, CT 06520

 

3. Become an umbilical cord blood donor:

4. Join the bone marrow donor registry:

 

 

For more information about Mandi and how you can help, visit http://www.yalebulldogs.com/mandi

 

Report by Sam Rubin '95 (sam.rubin@yale.edu), Yale Sports Publicity