Principal Investigator Daniel DeAngelo, MD, PhD, checks Violandi's skin to see if he has reacted to a sample of the vaccine.
Turning cells from bad to good
Because leukemia is a cancer of the blood, Violandi's care often involved removing cells from his blood and returning them, sometimes transformed, through a catheter implanted in his chest to spare him too many needle sticks. Over the course of six months, his stem cells were taken out and preserved; leukemia cells were harvested, sent to the Connell and O'Reilly Families Cell Manipulation Core Facility at DFCI, and then made into a vaccine. He received two five-day sessions of chemotherapy, two months apart.
In the laboratory, Technical Supervisor Heather Daley, and Lead Technologist Michele Wilson prepare tumor cells to be made into vaccines.
Next, the vaccine was injected into Violandi's leg, and his own lymphocytes — disease-fighting cells that formed as a reaction to the vaccine — were removed. He received high-dose chemotherapy, and the stem cells and lymphocytes harvested earlier were infused back into his blood, creating healthy bone marrow and marshalling his immune system to fight any residual cancer. Last, he received several more injections of the vaccine.
"Making the body rid itself of disease has worked throughout history, and vaccines for cancer are built on this principle," notes Dorothy Tully, RN, BSN, a nurse in the Kraft Family Blood Donor Center, which collected Violandi's stem cells and lymphocytes. The idea for this particular vaccine was developed at DFCI in the laboratories of Glenn Dranoff, MD, who discovered that adding a protein to certain tumor cells will make them signal the immune system that a foreign body is present. The tumor cells are irradiated so they can no longer spread the cancer.
Violandi's nurse, Ilene Galinsky, RN, and doctor, Richard Stone, MD, discuss his care.
According to Edwin Alyea, MD, the trial's other collaborating investigator, the vaccine is given in the context of a stem cell transplant because it is thought to work best when there is minimal disease. Violandi's chemotherapy dose at this stage was so high that it destroyed his bone marrow, but when he got back the stem cells taken from his blood earlier on, his bone marrow replenished. In time, his body developed a fresh, new immune system.
This is a lot of science for a layperson to understand, and Violandi credits Richard White, MD, PhD, one of the fellows rotating through Dana-Farber as they train to become oncologists, with being a key figure in his care. When White's assignment switched to another location, doctor and patient missed their interactions. "Michael and his family exemplify the conversation that occurs in oncology between caregivers and patients," says White. "We talked everything over. Michael is sensitive and strong. He is aggressive about his treatment, asks questions, and keeps careful track of his care. For me, this was the ideal doctor/patient relationship."
White explains that both the medical and emotional aspects of leukemia are intense: "We all work with the paradox that we sometimes have to make our patients sicker in order to have a greater chance of curing them."
- Next: The circle of care
- Page: 1 | 2 | 3
