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Stem cells offer glimmer of hope

Transplant will be costly for cancer patient

Marlynn Schmidt is a Type A sort who says she likes to confront a challenge. When doctors told her the breast cancer they'd banished seven years ago was back, but this time in her back, abdomen and liver, she had her obituary picture taken so she wouldn't have to worry about it. She made a few plans. And then, with those details out of the way, she focused on figuring out how to survive it.

But some challenges are hard to confront and harder still to fix. She'd gone in for a scan in preparation for surgery for a herniated disk. The news was a complete shock. Doctors told the 45-year-old mother of three she would most likely succumb to this adversary, possibly quite soon.

She started chemotherapy right away. And it may help. But there's no chance it will cure her. The only treatment that offers her any chance of that is a stem-cell minitransplant.

So far, Utah doctors have performed the procedure about 20 times but not for breast cancer. With kidney cancer, it's "extraordinarily promising" said Dr. Finn B. Petersen, and that's where most of the incentive has come to investigate the possibility.

"We consider her incurable with the standard therapy available," said Petersen, professor of medicine at the University of Utah Medical School and medical director of LDS Hospital's Blood and Marrow Transplant Program, where the transplant would take place.

"This new procedure, if it didn't cure her, would, we believe, at least exert a profound and meaningful anti-cancer effect."

Her insurance company is unlikely to pay for the transplant, which has been used with great success with other types of cancers. Its use with this type of cancer is considered promising, to be sure, but still experimental.

Her younger brother Grant is a suitable donor for the stem cells and immune cells she'll need. Before he can donate, he'll be on a blood-building drug for a few days, then blood will be drained through a needle in his arm and run through a machine to isolate the desired immune cell and stem cells. The remainder of the blood will be piped back into him.

It is, the doctor believes, the future of stem-cell transplantation. It opens the possibility of treating a variety of cancers, he said. And it's certainly Marlynn Schmidt's only hope.

The stem cells are the foundation of the transplant. But immune cells are the warriors. If all goes well, they will overpower the cancer cells. The problem is, they might also overpower her normal cells, in a condition known as graft vs. host.

Doctors know that she'll experience some graft vs. host disease, likely with some ugly side effects such as rashes, nausea, fevers and even infections. To an extent, that's OK. But if it could not be controlled, she would be in real trouble, because that's where most of the procedure's risk occurs.

Ask her about that and she smiles, adjusting the hat she's worn since her hair fell out from chemotherapy.

"I'm already in real trouble."

The transplant is an outpatient procedure for donor and recipient, but it still costs more than $100,000. Her husband and daughter, Jonalynn, are scrambling to find that money, planning fund-raising dinners and other events. Her daughter Heather is on a mission and her youngest daughter, Keriann, who is intellectually challenged, is 13.

It will take six months to tell if the minitransplant is working.

Marlynn Schmidt will continue to have chemotherapy prior to the procedure, slated for spring. Afterward, they won't dare use chemo, because they can't risk the slightest harm to the healthy immune cells.

In the meantime, she's back at her job, working for a food broker, as often as she can. Sometimes she's too tired. The chemotherapy has been much more exhausting this time around, she says.

She was used to giving. Now she's trying to learn how to receive gracefully. Her family wouldn't have made it this far without help, she says.

What does she want, besides life?

"They don't even really know the side effects to this treatment yet. There's so much to learn. Perhaps eventually they'll develop a smart drug and when someone needs it they'll be able to inject it and save a life."