Boy Got Gift of Life From Sister’s Bone Marrow
By all odds, David Camp should be dead.
Instead, Camp is a strapping 18-year-old with a fresh high school diploma, a mechanical flair and a love of dirt bikes and Motocross.
Camp owes his life to medical research and the resulting clinical procedures that gave him the immunological system that he was born without.
Camp is considered the world’s longest-living survivor of severe combined immunological deficiency disease corrected by a bone-marrow transplant. He was the first to receive marrow from a donor other than an identical twin--a highly experimental procedure for its time.
Thus, David Camp’s lifetime at 18 just about fits the time span of the pioneering medical technology that not only saved his life but led to continuing dramatic progress in dealing with immunological deficiencies, according to Dr. Richard Gatti of UCLA, who was one of 3-month-old David’s doctors at the University of Minnesota in 1968.
Ann and Francis Camp of Wallingford, Conn., parents of four daughters, were apprehensive when they learned their newest baby, born March 17, 1968, was a boy. There was an alarming history of male infant mortality in Ann Camp’s family.
She discussed it on a recent visit here with David and her daughter, Doreen, 26, donor of the bone marrow that saved her brother’s life. David and Doreen appeared with Gatti on a March of Dimes fund-raising telecast.
“My mother lost four boys,” she said. “I had four brothers and none made it. All died before they were a year old. My mother thought it was pneumonia.
“She had six girls. Of those, I have two sisters who lost sons, one who lost two and one who lost one. I was 6 1/2 months pregnant when I had a miscarriage and lost my first boy; the doctors called it toxemia, but they didn’t know.
“Having lost so many boy babies in the family, we were on the lookout,” she said.
By the time Ann Camp had David, progress had been made with bone-marrow transplants from one identical twin to another. Transplants using bone marrow from other siblings had been unsuccessful.
The Camp family’s pediatrician had heard of the work and wrote to Dr. Robert Alan Good, who was pioneering bone-marrow transplantation at the University of Minnesota and who since has become a noted clinical immunologist and cancer biologist. It fell to Good’s young assistant, Dr. Richard Gatti, to respond.
He did so with hope in his heart: “We realized that, with four sisters, David just might be the case we were looking for.”
Gatti explained why “four” was the magic number.
“We have four chromosomes: two from the mother--call these A and B--and two from the father--say, C and D. The possibilities are four for the children: AC, AD, BC, BD,” Gatti said. “That is why the Camp family was a perfect sample: They had four other children,” which meant that David had a strong chance of matching at least one of them.
It turned out to be his 8-year-old sister, Doreen. Now Doreen Enoch and living with her husband, Jeffery, in Cincinnati, she spoke on her visit to Los Angeles about being David’s bone-marrow donor twice in 1968.
“I was a little bit frightened,” she said. “On the other hand . . . I was ecstatic because David was going to get a chance.”
Gatti explained that the transplant procedures used for David are essentially the same now. The key difference is that the Camp case was the first successful use of a sibling donor who was not an identical twin. (Recipients of marrow transplants from identical-twin donors in the early ‘60s survive, according to Dr. Donnall Thomas, a pioneer in the field who now is associate director of clinical research at the Fred Hutchinson Cancer Center in Seattle.)
“We use an operating room because we have to have a sterile environment,” he said. “We give a light anesthesia because it hurts. We take a long sturdy needle with a wide bore and a stylet down the center so it doesn’t get plugged up.
A Sturdy Bone
“A small or narrow bone would break under such a needle so we use the back of the hipbone, which is a sturdy bone.
“We took Doreen to the operating room on a Saturday morning--the only time we could use it--and we took marrow from Doreen’s hip. We did a theoretical calculation--we had no way of knowing for sure--as to how many cells we would need based on David’s size. . . . We knew we didn’t need much; we took an ounce and a half.
“We kept it from clotting--bone marrow is like blood, red and clotting--by adding heparin, an anticoagulant. Then, at that time, we were worried that there would be little, little pieces of bone and fat in the marrow, so we didn’t want to give it intravenously and we didn’t want to filter it for fear we would lose too much of the marrow in the process.
“So we injected it into David’s belly through a catheter. We knew from mouse work (experiments on mice) that it would find the right place, would home to the marrow.”
Gatti and his University of Minnesota colleagues, Drs. Hilaire Meuwissen and Richard Hong, who assisted him, were uncertain about the outcome of their unprecedented surgery.
“We had no idea what was going to happen, really,” said Gatti, now a professor of pathology and research scientist at UCLA.
“I had just lost a child named Sharon. Yes, I remember her first name and her last name, too. . . .”
Richard Gatti came to Southern California to establish and direct the pediatric cancer program at Cedars-Sinai Medical Center. After five years he found he wanted to do research. Affiliated with UCLA as a professor in residence, he moved from the pediatrics department (although he remains board certified in pediatrics) to the department of pathology.
“I prefer working with children by being in a lab,” he said. “If someone doesn’t go into the lab, next year we have the same questions we had this year. Or the same question at a different level.”
Gatti is working on “probably the last of the major disorders of severe combined immunological deficiency with no cure” and a name, ataxia-telangiectasia, so boggling it is abbreviated to “AT.”
“It is a childhood disease that begins at 1 year and is a progressive neurological and immunological disease,” Gatti said. “These children develop a lot of cancer.”
One of the newest frontiers in this kind of medicine is gene therapy in which the patient’s own cells are changed by inserting a new gene. The hope and expectation is that the altered cells will provide a natural immune system to develop in the patient. AT is one of the prime targets.
For his research, Gatti, who also is president of the Leukemia Society’s Los Angeles chapter, is receiving funding from the National Cancer Institute, the AT Medical Research Foundation, Concern II Foundation of Los Angeles and Children’s World in the San Fernando Valley.
Ann Camp hesitated when asked if David’s illness had disrupted the family’s life. Doreen Camp Enoch answered at once.
“Very much so,” she said.
Ann Camp stayed with David in Minneapolis, keeping the girls with her until they had to return to school. Expenses mounted, and Francis Camp, who works for a steel firm in Wallingford, received financial help from the March of Dimes, Red Cross and Salvation Army.
Doreen Enoch recalled that “David was like the boy in the plastic bubble. We had a brother but we couldn’t touch him or hold him or kiss him. . . . After the first transplant they took him out for a couple of days but they put him right back.”
Gatti acknowledged that “there were problems along the way.”
“We almost lost him,” Gatti said. “The first transplant corrected the immune deficiency but destroyed the bone marrow, and he developed aplastic anemia.” (Aplastic anemia is the result of a virus or a radiation accident and is one of the problems confronting physicians treating victims of the Chernobyl nuclear disaster.)
“So we did a second transplant. We were not sure what to do. We were afraid any mild reaction he had had with the first transplant might be that much more severe with a second.”
Doreen’s Inoculations
Doctors, apprehensive about exposing David to a live virus, ruled out the usual childhood inoculations. As it turned out he didn’t need any. He had gotten all of Doreen’s in the transplants.
David now is 5 feet, 11 inches tall and weighs 180 pounds. “And,” Doreen said, “growing.” He works in a grocery store and plans to go to a technical school this fall.
Doreen plans to have a family. Does she worry about having a boy?
“Yep,” she said firmly.
“It worries me, but it does not discourage me about having children.”
