How a ground-breaking transplant procedure continues to provide hope – 21 years on

Transplant veteran Peter George is celebrating 21 years on from a life-saving and ground-breaking allogeneic transplant procedure.

In the 1990s, successful allogeneic transplants were relatively rare in adults aged over 50. An allogeneic transplant is a procedure whereby stem cells are donated by somebody else.

The stem cells repopulate bone marrow irreversibly damaged by chemotherapy and radiotherapy cancer treatments.

Following a Stage 4 Lymphoma diagnosis in 1999, Peter George became one of Wales’ first patients to undergo a new method of transplantation as part of a UK collaborative study conducted by Dr Keith Wilson, Director of the South Wales Blood and Marrow Transplant Programme, and colleagues. Known as ‘reduced intensity conditioning’, this allogeneic transplant system is now routine worldwide and accounts for 75% of all adult donor transplants internationally.

 “The thinking used to be that the transplant allowed us to escalate chemotherapy and radiotherapy dosages to eradicate the disease and reduce the chance of relapse,” says Dr Wilson.

It is now clearer that the main effect of the transplant comes from the donor’s T-cells, the part of the immune system that kills off foreign particles, including residual tumour cells.

“The donor’s T-cells can recognise tumour cells as foreign and will attempt to eliminate them in the same manner as the body fights infection,” says Dr Wilson. “However a potentially serious complication is graft-versus-host-disease (GVHD), where the donor cells also attack the patient’s normal tissue. Removing the donor T-cells reduces the likelihood of GVHD, but will lessen the anti-tumour effect, increasing the likelihood of relapse. This is one of the challenges of performing a successful donor transplant.”

The collaborative study involved seven UK centres exploring the concept that the T-cells in the donor graft meant there was no need to escalate chemotherapy and radiotherapy, which significantly reduced the associated hazards of conventional transplantation. “This theory was borne out in practice,” Dr Wilson says. “Our reduced intensity approach allows us to successfully treat people into their mid-70s.”

Between 2015 and 2019, the programme treated 510 patients at the University Hospital of Wales. Half of these were donor transplants.

“We are benchmarked against the whole of the UK and now Europe as well. Although we have patients with more co-morbidity and a higher percentage of unrelated donors, both of which add complications, our survival rates are above the curve. Peter is our longest surviving patient who had this reduced intensity approach.”

Peter recalls how his life changed almost overnight when he was 60. “I received the diagnosis and days later I was in having the first infusion,” he says.

Peter’s first poetry collection, ‘Ceredigion Cycle and Other Poems’, was published in 1997, followed by a commissioned memorial poem set to music. “That’s how I got the feeling I could write for musicians.”

He says the “closeness of death” sharpened his focus as he carried on writing imaginatively throughout his recovery.

Supported by his wife Ann, Peter began to consider his future. “These ideas played through my mind and I started writing seriously.”

The father of three and grandfather of four is now a novelist, award-winning poet and librettist. His most renowned work to date has been ‘WW1 – A Village Opera’, a libretto commissioned in three separate versions between 2014 and 2018.

Peter’s current project is an operatic collaboration between SW Wales and SE Ireland reflecting on climate change.

The treatment he refers to as his “second chance” has allowed for more than 20 years of creative endeavour. Now in his 80s, he shows no signs of slowing down.

“Peter was one of the first to have this type of transplant,” says Dr Wilson. “His 21st anniversary proves the worth of what was then a novel and unproven technology. This is essentially a survivorship success story.”

If you are interested becoming a donor and giving someone else a second chance, find out more here: https://www.welsh-blood.org.uk/giving-blood/bone-marrow-donor-registry/