Rays & Bone Marrow

Dramatic progress was reported last week in efforts to cure victims of massive overdoses of radiation, and to turn this new-won skill to advantage in treating victims of acute leukemia. Nub of the problem is the fact that the human blood system responds automatically to the presence of foreign protein by developing antibodies to destroy it. This is why skin grafts and organ transplants do not "take'' permanently, except between identical twins.

Radiation in doses exceeding about 400 r. (for roentgen) is usually fatal because it destroys the bone marrow's blood-forming mechanism, and it incidentally suppresses the antibody reaction. Theoretically, it should be possible to cure many cases of radiation injury by injecting bone-marrow cells from donors while the patient's antibody production is knocked out. And in acute leukemia, when the bone marrow is secreting abnormal cells, it might be possible to destroy the marrow deliberately with massive radiation, then replace it with healthy marrow. It has worked in mice and dogs, but the human system, far more, choosy, usually gets its antibody factory working again, and thus defeats treatment with injected "foreign" bone-marrow cells.

Twenty Punctures. Most striking success in getting around the antibody reaction--at least for the time being--was reported by France's Dr. Henri Jammet to the United Nations in Manhattan. His subjects were six atomic scientists (five men and a woman) who had been exposed to normally fatal radiation in a reactor accident at Vinca, Yugoslavia's equivalent of Oak Ridge. The patients were flown to Paris, lodged in the Hopital Curie. The mildest case, estimated to have absorbed 400 r., got better with conventional treatment--blood transfusions, special diet, rigorous protection against infection. The other five, nauseated and vomiting, soon showed a dangerous drop in blood-cell counts, and Radiologist Jammet decided to try heroic measures.

From volunteers under total anesthesia his colleagues extracted 200 to 300 cc. of bone marrow each, through as many as 20 punctures into the breastbone and hip bones. Dr. Jammet promptly injected this fluid into the veins of the five Yugoslavs. One, who had soaked up 1,000 r., died. In the other four, the donors' marrow cells made blood for them until their own marrow began working again. They are now convalescing at home.

Why had marrow transplants worked in these cases after so many failures? Dr. Jammet had taken care to match the donors' blood by ten factors (most transfusion matching covers only two), had even picked men of the same eye and hair color and body build. Beyond that, he could only guess. Perhaps it was because his patients had been healthy before the accident, then had suddenly received such a whopping jolt of radiation that it could not fail to knock out their marrow function--including antibody formation. Frozen marrow keeps for at least six months; if it can be kept longer, general bone-marrow banks may become practical. In any case, Dr. Jammet suggested, people working around reactors might have some of their own marrow removed and stored as a precaution.

From Twin or Fetus. This "autograft" principle was the basis of U.S. efforts to arrest leukemia. A four-year-old girl in Mary Imogene Bassett Hospital, in Cooperstown, N.Y., was near death, and anti-leukemia drugs would no longer give any relief. Dr. E. Donnall Thomas told an American Cancer Society seminar at Excelsior Springs, Mo. how he then placed the child between two cobalt "bombs" (equivalent to 2,000,000-volt X-ray machines) and subjected her to 800 r.--more than had ever before been given intentionally to a human being. Then he injected marrow cells taken from her identical twin sister. She is still alive and seemingly well. Though her hair fell out, it is growing back.

Because only one in about 200 people has an identical twin to serve as donor, Dr. Thomas has tried injecting another child leukemia victim with marrow cells taken from a fetus in a therapeutic abortion. (Fetal cells rarely trigger the antibody reaction.) It is too early, he said, to judge results in this case.

Relying on the fact that drugs can usually restore even children with severe leukemia to a normal-appearing blood pattern for a while, a Harvard University research team at Boston's Massachusetts General Hospital tried yet another approach. They took bone marrow from the patients during such remissions, deep-froze it until all drugs had ceased to work, then gave the children 600 r. of X rays and a prompt reinjection of their own marrow. In the New England Journal of Medicine the doctors report that one case was a clear failure; the second child died, but with no signs of leukemia, while a third (a two-year-old girl) went home and lived for months, though she later died of other complications.

No matter what method they use, the doctors cannot estimate how long these remissions may last. Even with a patient's own marrow, they cannot be sure that it was as healthy as it looked. But the Boston team and Dr. Thomas agree that if the principle can be shown to work in leukemia, it may be possible to extend it to other forms of widespread cancer.

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