"My most desperate hope was for one small space in time where we could have a normal life together again," says Corky Kyle.

Corky spoke those words after learning that her husband, Scott, was diagnosed with an aggressive form of leukemia. Together, the couple would travel a long road to normalcy — a trip only a few can imagine.

It began with a pain in his midsection as Scott flew his single-engine Bellanca Scout over Cook Inlet spotting salmon for fishermen in Homer, Alaska. Even though he hadn't been feeling quite right for some time, he chalked up the aches and pains to turning 49.

Then one July morning in 1998, he woke to so much pain that his wife called the hospital for treatment suggestions, which helped for a while. The severe pain returned later that day and Scott was rushed to the hospital.

The doctor found Scott's spleen so enlarged and his white blood cell count so high, he immediately had him airlifted to Anchorage and from there flown to the University of Washington in Seattle. The diagnosis was acute myeloid leukemia, an aggressive cancer of the marrow and spleen.

"My reaction at the time was much like I reacted to any setback," Scott recalls. "I remember thinking, okay, leukemia, we'll handle this."

He began two back-to-back courses of chemotherapy to try to halt the progression of the cancer and induce remission. After the chemotherapy, however, his immune system didn't recover as expected and he developed aspergillosis, a fungal infection in the lungs.

While the chemotherapy slowed the cancer, it failed to halt the disease. His UW physician, Dr. Virginia Brody, proposed an experimental transplant she knew about through her colleagues at Fred Hutchinson Cancer Research Center.

The procedure, a modified bone-marrow transplant called a non-myeloablative stem-cell transplant, was developed by Dr. Rainer Storb and colleagues at Fred Hutchinson. The technique originally was developed for patients over 65, who tend to fare poorly with the toxic side effects of conventional stem-cell transplants.

In Scott's case, his fungal infection and weakened state — not his age — precluded the conventional regimen.

"My heart, kidneys and lungs had suffered and my doctor said I would not be able to withstand a standard stem-cell transplant," Scott says.

Sometimes referred to as a "mini-stem-cell transplant," the procedure works by using just enough radiation to suppress the patient's immune system without wiping out the bone marrow, and it seemed ideal for Scott.

"What we do is deliberately reduce the total body irradiation from the usual 1,200 to 1,500 centigray, which is equivalent to being close to the epicenter of a nuclear bomb blast, to 200 centigray," Storb says. "Then we do not administer any high-dose chemotherapy."

The low-dose radiation suppresses the patient's immune system, which allows doctors to infuse the donor's stem cells. They then maintain the immune suppression with drugs to allow the donor stem cells to take hold and begin producing a full range of blood and immune system cells. Once that happens, the two immune systems, patient and donor, achieve a mutual tolerance for each other, which sets the stage for a subsequent infusion of fresh donor immune cells to initiate what is called a "graft-versus-leukemia" effect.

In Scott's case, his brother Gary Kyle turned out to be a suitable tissue-type match to donate stem cells. Doctors planned to use Gary's immune system to produce white blood cells that would recognize Scott's cancer cells as foreign and eliminate them. Such an effect has been well documented in standard marrow transplants for certain types of leukemia.

Storb says that achieving a balance of patient and donor blood cells works not only for leukemia, but also holds promise for curing non-cancerous blood diseases such as aplastic anemia, thalassemia and sickle cell disease, as well as autoimmune and many other genetic diseases.

By the time Scott was ready to begin the transplant procedure, his condition had worsened and he was in and out of consciousness. He was delusional and thought he had been taken prisoner of war. When conscious, he plotted to escape with his wife.

"Everyone except Scott thought he was dying," says Corky.

On Sept. 30, 1998, he underwent the low-dose radiation. Later, resting in his hospital bed, he received his brother's stem cells.

"A nurse told me I had to hang in there for two weeks before the stem cells would take and my counts would begin to rise," Scott says. "That gave me hope. I figured I could hang on for two weeks."

One day short of two weeks, however, he was doing so well that he was discharged to Fred Hutchinson's outpatient unit, which today is housed at the Seattle Cancer Care Alliance clinic on Fred Hutchinson's campus in Seattle.

With the mini-transplant, most patients are treated in an outpatient clinic, in sharp contrast to conventional stem-cell transplants which require patients to go to a hospital for intensive medical support for three or four weeks until their immune systems regain function.

Scott, who had been hospitalized for 93 days before beginning the treatment, faced a somewhat more difficult road to recovery. Following his initial discharge to outpatient status, his fungal infection did not subside and he had to be readmitted to the inpatient unit, where doctors treated the stubborn infection for an additional eight days.

After his discharge from Fred Hutchinson, he and his wife did not return to Alaska; they moved to Olympia, where they had family, to continue his recovery. Four years ago, the Kyles moved to Wallowa, Oregon, to start their lives over.

Scott began by going back to work and rebuilding his Bellanca. He recently passed his flying physical and now has his commercial license back. Today, at 53, he frequently travels between Oregon and Alaska.

"I took one day at a time, but now I am starting thinking about the future," Scott says. "I know I'm just lucky to be here."

According to Corky, "these four years have been a gift."

Storb and his colleagues at Fred Hutchinson believe the mini-transplant procedure is both safe and effective, and have expanded access to mini-transplantation through collaborations with two dozen major academic medical centers outside of Seattle.

To find out how to access this procedure and other treatment options, contact the Seattle Cancer Care Alliance patient intake office at (206) 288-1024 or visit www.seattlecca.org.

The Seattle Cancer Care Alliance is a collaboration between Fred Hutchinson Cancer Research Center, the University of Washington Academic Medical Center, and Children's Hospital and Regional Medical Center, bringing together three of the most internationally renowned institutions in a collaborative effort to offer the best cancer care available in the Pacific Northwest.

Read more about Acute Myeloid Leukemia >