EDITOR’S NOTE: This story was reported in collaboration with the Global Health Reporting Center with support from the Pulitzer Center.
As a budding specialist in bloodborne cancers like leukemia, Dr. Marcel van den Brink learned how to perform one of the most delicate high-wire acts in medicine: Starting in the early 1990s, many of his seriously ill patients had sophisticated procedures to rebuild, or reinstall, a new immune system.
In this procedure – called an allogenic hematopoietic cell transplant – the patient’s immune system is virtually wiped out with potent chemotherapy, clearing the way for cells transplanted from a donor to replace it. Until that replacement takes root, the patient is exquisitely vulnerable.
Transplant patients were kept in figurative and sometimes literal bubbles, spending months at a time in suites with carefully controlled airflow to guard against microorganisms. “Nurses and family would deal with patients through gloves that stuck through the plastic,” van den Brink recalled.
To maintain a germ-free state until the new immune system took over, patients were also blasted with high doses of broad-spectrum antibiotics. But despite all precautions, in the 1990s, about a quarter of all patients died from infections and other complications, including graft-versus-host disease, in which transplanted immune cells attack the body’s own tissue.
