Eye on the Future felt the tandem transplant still was the best option for him. With temporary remission achieved, cicon’s own peripheral stem cells were reinfused in January 2011. He spent a little more than two weeks in the hospital. To achieve the best results with a tandem transplant, the procedures must be performed within six months of each other. The search continued for a donor. MD, has been with Rutgers Cancer in- T hrough residency, fellowship and faculty as a hematologist/ oncologist, Mecide Gharibo, stitute of New Jersey for 20 years helping those like Mark Cicon (see adjacent feature story) with rare blood cancers. Mark Cicon’s medical oncologist Mecide Gharibo, MD, believes given the limited patient population, the best way to enhance current data on plasma cell leukemia will be through multicenter collaboration and through research efforts like precision medicine taking place at Rutgers Cancer Institute. “Genomic sequencing may offer new therapy options now,” says the doctor. Needle in a Haystack Cicon’s presentation of de novo plasma cell leukemia in 2010 was Dr. gharibo’s first experience with this rare form of multiple myeloma. to put it in perspective, the center sees about one of these cases every two to three years. “the challenge with this disease,” gharibo explains, “is that few people are diagnosed, so there aren’t many appropriate candidates to undergo a clinical trial to establish new treatments for such a rare disease. For right now, we apply knowledge of similar diseases to “W ith an allogeneic transplant, it is important to find as many donor qualities as possible that are similar to the recipient in- cluding having the youngest donor candidate and same sex if possible,” says Gharibo. Having the same blood type and matching as many elements as possible for tissue typing is important too. cicon is of eastern european descent, and having similar ancestry is important to optimize finding a matched donor, adds the doctor. Through the national registry, three possible candidates materialized. Only one met enough criteria and was available for the transplant. “The timing was perfect,” recalls cicon. “i’m truly fortunate that a donor was available through the registry – and willing to donate. it is an incredibly special feeling to know that so many people, especially my donor (someone i did not know) had to do so much above and beyond what i could have ever expected for me to have this outcome.” Due to confidentiality policies, donors and recipients are not permitted to know each other’s identity until after a one-year period and consent given, but each case is unique and waiting periods may vary. in this case, cicon was grateful to connect with the Ohio mother who was inspired to put herself on the registry after knowing two people who suffered from a blood cancer. They write and call one another. “i would like to meet her one day,” cicon projects. After receiving a stem cell infusion from the donor (harvested through apheresis — a process involving collection of circulating stem cells from the blood circulation), cicon spent 29 days in the hospital, which is a typical post-transplant stay. He did experience a common complication known as graft-versus-host disease (GVHD), in which cicon’s new immune system from the donor cells began to attack parts of cicon’s organs such as the skin and liver. extreme cases of GVHD result in potential life threatening organ failure and severe skin rashes, but with cicon the slight case of GVHD indicated to Gharibo and team that everything was functioning normally and the marrow was doing its job in boosting his immune system. Outside of a mild skin rash (which is also common post-transplant), cicon says he came through just fine. this research, often resulting in treatments typically used for other types of plasma cell conditions.” but she notes there is positive news. “We have more treatments available now for multiple myeloma patients and often we can use similar treatments for patients with plasma cell leukemia. in addition, transplant still remains an option for patients with plasma cell leukemia either using an autologous stem cell transplant to maintain and prolong remission and/or consider tandem allogeneic stem cell transplant with options of a donor source from a matched or halfmatched sibling or parent and/or from an unrelated matched donor.” gharibo believes given the limited patient population, the best way to enhance current data on plasma cell leukemia will be through multi-center collaboration and through research efforts like precision medicine. Researchers at Rutgers Cancer institute already are learning about mutations that are driving different forms of leukemia. Plasma cell leukemia does have some genetic mutations associated with it, but these mutations also are common in other plasma cell disorders, meaning there are none that are specific to plasma cell leukemia. “genomic sequencing may offer new therapy options now,” says gharibo. I To learn more about precision medicine oncology at Rutgers Cancer Institute, visit: cinj.org/precision-medicine. 12 I Cancer Connection I Autumn 2016 Photo by: steVe hoCKsteiN