Thanks to a $1 million National Cancer Institute grant, a Wilmot Cancer institute hematologist and oncologist is launching a clinical trial using hyperbaric oxygen therapy to improve the recovery of people with multiple myeloma who are treated with a stem cell transplant using their own blood.
Hyperbaric oxygen therapy is well-established as a treatment for decompression sickness and wound healing, but is not often used in cancer care. It involves a person going into a pressurized chamber and breathing 100 percent oxygen.
Omar Aljitawi, M.D., associate professor of Hematology/Oncology at the Wilmot, received the NCI funding for a three-year project based on earlier pilot studies showing that oxygen therapy was safe and effective at stimulating healthy blood production following stem cell transplantation.
Multiple myeloma is a cancer that accumulates in the bone marrow and interferes with blood cell production; a blood stem cell transplant helps to control the disease and improves quality of life. Aljitawi believes that patients who undergo a transplant for multiple myeloma may benefit from the addition of hyperbaric oxygen therapy.
In the upcoming study at Wilmot, which is expected to begin next month, Aljitawi and his team will also investigate whether hyperbaric oxygen improves the recovery of a type of white cell called “natural killer cells” or NK cells, which are key components of the body’s immune system. If hyperbaric oxygen therapy boosts NK cells, he said, it has the potential to control the myeloma after the transplant.
Patients will receive their own blood stem cells, which will be removed from the body and then re-infused after high-dose chemotherapy to kill the cancer. Some patients will be randomly assigned to the additional oxygen therapy. Aljitawi is collaborating with hyperbaric oxygen therapy experts at the University of Rochester Medical Center and Wilmot experts in the blood and marrow transplant program—which is among the largest BMT centers in New York—as well as the University of Kansas Cancer Center, where he was on faculty before joining the URMC in 2016.
His earlier research explored the cellular signaling involved in a process known as stem cell homing. It pinpointed a problem for some patients who receive stem cell transplants for blood cancers: During a critical time—when newly infused, healthy stem cells are migrating to the bone marrow to set up production or engraftment—high levels of a hormone known as erythropoietin (EPO) can cause poor engraftment by interrupting the homing process.
But when EPO signaling is blocked and the hormone levels are reduced, he discovered, transplants are more effective. Hyperbaric oxygen is one safe and relatively inexpensive way to reduce EPO, he said, because it does not require manipulation of the stem cells. In two pilot studies, almost all patients who received umbilical cord blood transplants and autologous blood stem cell transplants tolerated the hyperbaric oxygen therapy well, and those who received the hyperbaric oxygen recovered faster than their counterparts who did not receive hyperbaric oxygen.