Surviving the cure

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Science  14 Jul 2017:
Vol. 357, Issue 6347, pp. 122-125
DOI: 10.1126/science.357.6347.122

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Transplants of bone marrow or just blood stem cells have become a cornerstone of leukemia treatment, and they have steadily increased over the past decade. Part of the reason they work is because the donor’s immune system sees the host’s remaining cancer cells as foreign and attacks them. But about half the time, the new immune system attacks tissues and organs, causing a life-threatening condition called graft-versus-host disease (GVHD), which is also on the rise. Lukas Wartman, a leukemia doctor and researcher at Washington University School of Medicine in St. Louis in Missouri, developed leukemia himself in 2003, and although aggressive chemotherapy repeatedly has helped him beat back the disease, he has required two transplants, bone marrow from his brother, and stem cells another from an unrelated donor. After the second transplant 5 years ago, he developed a serious case of chronic GVHD that he has been battling ever since. New insights into the causes of GVHD, a better organized research field, and more carefully done clinical trials have raised the prospects that preventive strategies and treatments for GVHD will soon convincingly prove their worth. Wartman—who has suffered from GVHD-induced muscle wasting, skin rashes, and vision problems—remains hopeful that something new will surface to help calm his haywire immune system, allowing him to survive his cure.