Procedure Will Take Place Sept. 22
NEW HAVEN, Conn. – Following the results of a recent biopsy, doctors at the Seattle Cancer Care Alliance have determined a schedule for the stem cell transplant Yale women's hockey center Mandi Schwartz needs to help win her battle with cancer. The transplant, which will utilize stem cells from two umbilical cord blood units donated anonymously to public cord blood banks, is now scheduled for Sept. 22 at the Seattle Cancer Care Alliance's inpatient transplant unit at the University of Washington Medical Center.
Mandi, a native of Wilcox, Sask., has been battling acute myeloid leukemia for nearly two years. She 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 in the next few days.
"The scheduling of the transplant gives us reason for optimism," said Rick Schwartz, Mandi's father. "Mandi has kept up a positive attitude throughout this whole process, and we are looking forward to the day when she can be declared cancer-free. We continue to be thankful for all the support that we have received, and for the efforts of the doctors at the Seattle Cancer Care Alliance. Please 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."
The recent biopsy indicated 2.5 to seven percent blast cells in Mandi's bone marrow. Blast cells are immature cells in bone marrow that mature into white blood cells or red blood cells. They normally account for up to five percent of the cells in bone marrow, so a higher ratio than that can indicate a problem.
Mandi will undergo two one-hour sessions of radiation each day from Sept. 15 through 17. She will then have two days of chemotherapy, Sept. 19 and 20. This is designed 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 final words from her SCCA team nurse were for her to prepare herself mentally and to think of this as the toughest hockey game she has ever yet played," Mandi's mother, Carol, wrote on her CaringBridge website. "She is to focus on never giving up during this game and on emerging the winner!!! I warned the nurse that her medical team ought to look out for the odd body check if this is how she is to prepare because she can be one very aggressive girl.......she will win!!!!"
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 that the next big milestone is "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 should happen within a month of the transplant.
Complete recovery of Mandi's new immune system takes approximately a year, but could take longer if she develops any complications as a result of the transplant. 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.
The original plan was to have Mandi receive cord blood that had its number of stem cells "expanded", or increased, in order to speed up the time to engraftment. Because of the results of the recent biopsy, she will now receive a transplant from units that have not had their number of stem cells expanded.
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, near the end of 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 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.
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. They are working with Dr. Colleen Delaney, an oncologist and researcher in Dr. Irwin Bernstein's Clinical Research Division lab. Mandi and her family have met with Dr. Delaney and the transplant team to prepare for the transplant. Mandi's attending physician is Dr. Paul Martin, a medical oncologist.
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.
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, tests indicated that she was 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 nearly $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. She brought in nearly $3,000.
Report by Sam Rubin '95 (firstname.lastname@example.org), Yale Sports Publicity
1. Send Mandi a card or letter showing your
Wilcox, SK S0G 5E0
2. Send donations (checks made out to "Yale University", with "Mandi Schwartz" in the memo line) to:
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