The new therapy could increase the survival
rate of leukaemia patients who undergo
bone marrow transplants.
Image: iStockphoto

In February 2003, Lane Martino was a fit, dedicated, surf-loving 16 year old in his final year of high school – who was suddenly diagnosed with acute lymphoblastic leukaemia.

Such a diagnosis would leave many reeling, but Lane opted to face it head on and sought to find out what could be done to combat the illness.

“I remember being told that leukaemia cells had been found in my blood”, he said.

“I looked across to my mother and after a moment asked ‘What do we need to do from here?’ I was pretty fit and keen to get started on the treatment. I never felt any fear and was positive about everything”.

The first three and a half years of treatment went exceptionally well. Lane suffered only minor bouts of sickness and actively pursued his love of surfing. He even managed to travel overseas, self medicating with oral chemotherapy when required.

2006 found Lane studying business at Notre Dame University before transferring to the University of Western Australia and opting for a degree in commerce. Not long after, he finished his leukaemia treatment program in May 2006.

A few months later, however, Lane appeared pale and one eye was half closed.  A visit to his haematologist revealed he had suffered a relapse and required a bone marrow transplant.

Unfortunately, his siblings were not a match, but a donor was found in Victoria and a stem cell transplant was completed in March 2007.

Prior to the transplant, Lane presented with a fungal infection of the lung and several weeks after the transplant he suffered respiratory failure and allergic reactions to medications.

As a result of the severity of these complications, he was transferred to the intensive care unit and placed on life support.  He wasn’t expected to survive more than 24 hours.

For the next 31 days, his parents and family witnessed his fight for survival on life support, before being transferred back to the bone marrow transplant unit where he then battled graft versus host disease (GVHD).

GVHD is a life threatening complication that occurs after around 50 per cent of bone marrow transplants, due to the complex interaction between donor cells and recipient tissues.

The disease has a mortality rate of around 85 per cent.

The standard treatment for GVHD is corticosteroid therapy, which suppresses the immune system. However, an increasing number of patients find that it is unable to stop the complications, which can range from a skin rash, abdominal pain and diarrhoea to liver dysfunction.

In September 2007, when things were looking bleak, Professor Richard Herrmann, a leading haematologist and researcher from the Royal Perth Hospital, became Lane’s treating consultant.

Professor Hermann was completing pioneering research on a new type of cellular therapy, where mesenchymal stromal cells (MSCs) are infused into a patient via IV drip.

Although the MSC therapy was quite new, Professor Herrmann realised quickly that Lane was an ideal candidate.

“Lane was extremely sick with infection after his transplant. We were sure he was going to die. At this stage we had already done stage three trials with MSC therapy and knew the procedure was quite safe,” says Professor Herrmann, who is Director of Cell and Tissue Therapy WA, clinical manufacturing facility at Royal Perth Hospital.

Lane was the first patient in Western Australia to receive the ground breaking therapy that ended up saving his life.

Unlike blood and organ transplants, MSCs can be harvested from any willing donor, as they lack antigen.

Professor Hermann was able to harvest MSCs from Lane’s mother, brother and sister, before growing them in the lab for several weeks. The cells were then frozen and thawed out when needed by Lane.

“When the cells are infused into the patient, the signs and symptoms of GVHD are reduced. The MSCs are able to tune down the recipient’s immune response,” said Professor Herrmann.

“Their other remarkable property is they have the ability to differentiate or change into multiple tissue types.  That is, they can convert to cells of cartilage, bone, muscle, heart muscle and neural origin and this may assist with healing,” he explained. 

In December 2007, Lane finally left the unit after a big party in his honour as the patient who had stayed the longest – an accolade that quite rightly does not sit so well with the ambitious young man!

It’s clear that Lane’s journey has created not only a bond with his consultant but an understanding and great appreciation of the treatment.

“Richard is not only my doctor but a good friend. I trust him with my life. This research and development has saved my life. Also, it is so passive I don’t have to rely on higher doses of medication, namely steroids that have a debilitating effect on your body after prolonged use,” said Lane.

Although it is still ‘early days’ for the therapy, according to Professor Herrmann, Phase I trials on a group of nine patients with GVHD have shown that all have responded to the MSCs.

The therapy was originally quite expensive, but thanks to funding from Research Infrastructure Support Services the cost has now been halved to around $5000 a patient. Professor Herrmann hopes that one day the therapy could be used widely around Australia to treat GVHD.

Further research is also being done into whether MSC therapy could help to stop complications following other types of transplants, and to tackle other autoimmune conditions such as Crohn’s disease.

Lane has in the past regularly received MSCs to help control the GVHD complications together with medication for his recent diagnosis of Shapiro’s Syndrome – a rare illness that affects body temperature and blood pressure together with mild memory loss.

However, he has not needed the therapy for some months and has stopped taking immunosuppressants.

Currently, he still has occasional ongoing problems with GVHD and the soles of his feet, but life is looking up.

Lane has his drivers licence back and is attending translational education a couple of times a week and hopes to be back at university in the future.

He is also working out at the gym with the determination to get back on the board and following the surf once more.