Marrow transplant for Waterloo woman

Finding a match for Cathy Holder in the Italian-Canadian community key to survival

Family, friends and neighbours of Cathy Holder, a Waterloo resident of Italian descent, have launched a public appeal in search of a suitable bone marrow donor who could save Cathy's life. The outcome of this campaign - and the fate of Cathy Holder - could lie in the hands of the Italian-Canadian community.
In 2001, Cathy was diagnosed with breast cancer, and after surgery, radiation and chemotherapy treatment, she seemed to have made a full recovery. But in December of 2003 Cathy came down with an infection she couldn't shake. She was admitted to hospital and underwent tests, when it was revealed that she was suffering from a rare side effect of chemotherapy - leukemia.
"The possibility that this could happen to someone as a result of chemotherapy was presented to us," says her husband, Chris. "But it's presented in such a way - it's so very unlikely, the odds are so low that this would ever happen - that nobody has turned down chemotherapy because this might happen some day."
That remote possibility has now become a reality for the Holders, both 46, and their two daughters, Courtney, 20, and Caitlin, 17. Shortly after being diagnosed with AML (acute myelogenous leukemia) in December, Cathy began a round of chemotherapy, which entailed three periods of hospitalization over four months. She was in remission from January until early September, when she was diagnosed with a return of leukemia and began another round of chemotherapy.
Even if this round of chemotherapy is successful - which the Holders will find out in the coming weeks - it's highly unlikely to cure the leukemia permanently. "There is a very slim chance she'll be cured by the chemotherapy, but it's rare. Once [the leukemia] comes back the first time, the chances of it never coming back again are less and less. The bone marrow transplant is the only treatment that doctors stand behind and say represents an opportunity for a cure," says Chris.
The Holders have known this since Cathy was first diagnosed with leukemia. Their problem has been finding a suitable donor, someone whose bone marrow has a sufficiently close genetic makeup to that of Cathy. The genetic markers used to match donors and recipients are called Human Leukocyte Antigens (HLA's). Because HLA's are inherited from our biological parents - 50 percent from each - the most common place to find a match lies within the immediate family. In approximately 30 percent of cases a sibling possesses a suitable match. But in the majority of cases - like Cathy's, whose brother is not a good match - a donor must be sought outside the family. This is a much more complicated procedure than finding matching blood types, and the two procedures are unrelated.
Beverly Campbell, director of the Unrelated Bone Marrow Donor Registry, says that ethnicity plays a role in defining a person's HLA, which is why people of mixed racial backgrounds or people of unique genetic makeup, like aboriginal Canadians, can have a difficult time finding a donor. But Italians are considered Caucasians, and Caucasians are the best-0represented ethnicity amongst the worldwide network of registered potential donors - 220,000 in Canada, and over 9,000,000 worldwide.
The problem in Cathy's case is not ethnicity but the presence of a rare genetic marker in her HLA. Since the international network of potential donors has failed to come up with a match, Chris and Cathy are appealing to people who come from the same region as Cathy's parents, in the hopes that someone, perhaps an unknown distant relative, has a compatible HLA profile.
"Cathy's parents come from a small community, and if there are people there who have lived there for years and years, there might be a chance that someone else has the same genetic marker," says Beverly Campbell. Cathy's parents, Francesco and Maria, are from the small town of Ruvo del Monte, in the province of Potenza, approximately 200 km east of Naples. Cathy's maiden name is Crecca, and her mother's maiden name is Muccioli.
Campbell says that targeting people who live in the region, or whose ancestors came from there, makes more sense than randomly canvassing neighbours of diverse backgrounds here in Canada. But she cautions that it will still be difficult to find a perfect match. Chris Holder is also wary of focusing solely on people from this small area of southern Italy. He has been told of near-perfect matches that have been used in cases like Cathy's and feels that there's still hope that a match could come from just about anywhere.
The motivation behind Chris and Cathy's public awareness campaign goes beyond self-interest. Both feel that the general public should learn more about the need for bone marrow transplant donators. "It's not just me," says Cathy, "there's hundreds of us waiting for a donor."
Bone marrow is the spongy tissue inside bones that produces stem cells, which in turn spawn the three necessary types of blood cells: platelets, which control bleeding; red blood cells, which carry oxygen through the body; and white blood cells, which ward off infection. In people suffering from acute leukemia, stem cells produce an excessive amount of irregular blood cells that crowd the bone marrow, impeding its ability to produce healthy cells.
A bone marrow transplant is a two-stage process: first the recipient's diseased marrow is destroyed through radiation or chemotherapy; then the donated healthy marrow is given intravenously. It is a non-surgical procedure, but during the period of engraftment - as the donor's cells migrate toward the major bone cavities and begin producing cells - the patient's condition is extremely vulnerable. In most cases a period of four to eight weeks of hospitalization is necessary.
Becoming a potential donor, on the other hand, is a fairly simple procedure, akin to donating blood. In the event that the genetic profile of a person in need matches that of a potential donor, the latter is contacted; provided the donor is still willing, the process is initiated. The side effects of donating bone marrow are relatively minor and the risks are very low. The donator leaves hospital the same day, and typically misses a few days of work to recuperate his or her strength. Some soreness in the pelvic area where the marrow is extracted may also occur.
It was back in August of this year that the Holders realized that the UBMDR was having difficulty finding a suitable donor. Since then, family, friends and neighbours have embraced their cause and helped spread the word. Chris says that the media attention that he and Cathy have attracted recently is the direct result of other people's efforts. Recently, for example, a neighbour of the Holders sent an email to the Waterloo newspaper The Record. When the paper's editor heard the story he made it a front-page story.
"We really appreciate the way friends and family have come together with one common goal," says Cathy, somewhat overcome with emotion. "Everyone is working hard and I just can't tell you how much my whole family appreciates what everyone has done."
Both Cathy and Chris grew up in London, Ontario, where they attended high school together. Cathy completed a degree in Business and Economics at the University of Western Ontario, while Chris completed his studies in Flint, Michigan. The couple lived in Scarborough and Oshawa before moving to Kitchener-Waterloo in the late 1980's. In the early 1990's the Holders started their own business - a lubrication and conveyer company - which they've run ever since.
The experiences of the past year have reminded Cathy that even in the age of science we still need the goodwill of community members to survive. "There's things people can do, even in this day and age, with all the medical marvels we have, we still need people to go in and give blood and do the bone marrow testing."
For more information on Cathy Holder, including information on how to become a potential donor, please visit www.bmt4cathy.com/journal. The Unrelated Bone Marrow Donor Registry is run by Canadian Blood Services - call 1.888.2DONATE (1.888.236.6283) or visit www.bloodservices.ca.

Publication Date: 2004-10-17
Story Location: http://www.tandemnews.com/viewstory.php?storyid=4518