TeachableMedicalNews article 12312019

Teachable moment in classrooms:

  1. cellular basis of life chapter – formation of cancer cells
  2. blood chapter – stem cells in the formation of white blood cells in red bone marrow
  3. blood chapter – stem cells in red bone marrow can be moved from one person to another
  4. immune system chapter – role of macrophages and cytokines in starting immune reactions

The news item:  A happy introduction was in the news recently where a bone marrow donor and the bone marrow recipient met in person the first time:

Eruption of joy as Laila Anderson meets her bone marrow donor

TOWN AND COUNTRY, Mo. – An 11-year-old came face-to-face with the man whose bone marrow donation gave her a second chance at life. There were hundreds of people gathered at the Be the Match gala in Town and Country to witness the special moment and to support young Laila Anderson’s unique journey.

The article mentions that Laila Anderson’s life was saved by the bone marrow donation.  Laila was a fan of St Louis Blues NHL hockey team while undergoing chemotherapy, and then, after the bone marrow transplant, she became the symbol of resilience as the team was winning the Stanley Cup.

So, Why Do I Care??  Laila was suffering from a rare cancer, hemophagocytic lymphohistiocytosis (abbreviated HLH), and she was approaching certain death. The survival times after diagnosis is less than two years. However, an unusual medical procedure, a bone marrow transplant gave her hope for beating this cancer, and, eventually, she became cancer free.

Plain English, Please!!!  First, let’s talk about the cancer called HLH.  In HLH macrophages (a kind of white blood cell) are growing in large numbers, and these cells make large amounts of cytokines. The macrophage cytokines force other immune system cells to make cytokines as well.

Second, let’s talk about cytokines.  The cytokines are hormone-like proteins. The white blood cells attack invaders only after they are activated, and continuously stimulated. Imagine a traffic light that controls the action in our immune system; on that traffic light the cytokines would be the green light.  In the HLH the large amounts of cytokines prevent the change of the traffic light, and the green light is always on. Eventually the huge amount of cytokines damage internal organs, and cause death.

Third, let’s talk about bone marrow transplant.  So, how can you even think about curing a cancer like HLH?  The only solution is to get rid of the cancerous macrophages, and replace them with normal ones.  Because macrophages are made continuously in the red bone marrow, the red bone marrow itself needs to be replaced. The clinical process that achieves just that is called bone marrow transplant.  At the start of the process all the cancerous macrophages together with all the red bone marrow are destroyed by chemotherapy and radiation.  That was the stage when Laila became very visible St Louis Blues fan. After the destruction of cancerous macrophages and red bone marrow, the replacement comes from donated red bone marrow from a healthy person. Red bone marrow has quickly dividing stem cells that make all kinds of non-cancerous blood cells, including white blood cells and macrophages.  In the quoted article Laila has met the red bone marrow donor, the person whose donated marrow saved her life.

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