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Combining Bone Marrow and Organ Transplants Shows Promise

NEW YORK (Sep 1, 2013)

Researchers at NewYork-Presbyterian are helping to pioneer combined bone marrow and solid organ transplantation, an approach that increases the likelihood of organ acceptance without the use of immunosuppressive drugs. The promising new therapy is only being undertaken at a few leading centers in the United States. It may be especially beneficial for patients with multiple myeloma and renal failure.

By performing a kidney transplant at the same time as a bone marrow transplant doctors at NewYork-Presbyterian are able to solve two problems at once.

Markus Y. Mapara, M.D., Ph.D.
Markus Y. Mapara, M.D.,
Ph.D.
"The combined approach induces tolerance and kills the underlying cancer," said Markus Y. Mapara, M.D., Ph.D., Director of the Blood and Marrow Transplantation Program at NewYork-Presbyterian/Columbia University Medical Center. "The major problem with solid organ transplantation is that the recipient will reject the graft and require lifelong drugs to suppress their immune response," explained Dr. Mapara. "A potential way to prevent rejection is to combine solid organ and bone marrow from the same donor so the patient will no longer need immunosuppressive drugs and be tolerant to the organ transplant."

Working with Dr. Mapara is Megan Sykes, M.D., who is spearheading the combined approach at the Columbia Center for Translational Immunology (CCTI).

Megan Sykes, M.D.
Megan Sykes, M.D.

Dr. Sykes led research at Massachusetts General Hospital that resulted in the first worldwide combined bone marrow and kidney transplants; first in patients with multiple myeloma and renal failure and later in patients who had renal failure from non-malignant diseases. At CCTI, she is currently conducting large animal studies to fine-tune and develop protocols for combined bone marrow and solid organ transplants. "We anticipate being able to write protocols for clinical trials for the kidney in humans at end of year," she said.

Studies show that the kidney plays an important role in the combined approach (not just the bone marrow). However, researchers may not be able to achieve tolerance in other organs as easily. Next, Dr. Sykes has her sights set on the liver. "We think the liver may work as well and maybe even better than the kidney. We are working with the liver transplant team at NYP/Columba to develop a large animal model of liver transplant combined with bone marrow and then we can explore clinical trials. I think the future is going to be tolerance," she said.

Drs. Sykes and Mapara also are studying the role of regulatory T-cells in inducing tolerance. "We are interested in whether regulatory T-cells will improve the combined approach for other organs. We have exciting preliminary data in large animal models," said Dr. Sykes. She noted that this requires special facilities, including space for growing the regulatory T-cells and a bone marrow transplant unit. NYP/Columbia is currently building the bone marrow transplant program from scratch by recruiting and hiring new talent and constructing a special unit set to open in December 2013. "I think NYP/Columbia will really become a world leader here," said Dr. Mapara. With one of the biggest solid organ transplants centers in the country, the CCTI, and a budding bone marrow transplant program, we have a really unique environment to pursue these studies. It will be just spectacular," said Dr. Mapara.

Besides focusing on patients with multiple myeloma who need kidney and bone marrow transplants, future research endeavors include using bone marrow transplant to induce tolerance in nonmalignant disease as well as giving bone marrow to patients with previously transplanted organs in order to try to achieve tolerance.

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