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On the surface, Owen Ho looked fine. But on the inside, it was a different story.
Ho, 42, was exhausted. He couldn’t muster up the strength to exercise even though months earlier, six-hour bike rides were his norm. His platelets were low, his white blood cell count plummeting. He started to notice that he bruised easily. Then his gums began bleeding and he experienced headaches, which led to a brain bleed the size of his palm that landed him in the hospital intensive care unit in September 2022 for five days.
No one seemed to know what was wrong with him. “I had my will ready,” said Ho, a senior business strategy manager at Microsoft.
Ho made an appointment with Maria Cristina Ghiuzeli, MD, a hematologist-oncologist at Fred Hutch Cancer Center, who diagnosed him with severe aplastic anemia, a disease caused by failure of the bone marrow to produce blood cells. People with aplastic anemia have low platelets, hemoglobin and white blood cells. Some hereditary syndromes such as Fanconi anemia can be associated with aplastic anemia, but Ho didn’t have any of those syndromes.
“It was just bad luck,” said Ghiuzeli.
With a diagnosis in hand, the next decision was how to treat his condition. Doctors agree that patients under 40 should receive bone marrow transplants to replace the diseased marrow with healthy marrow. But transplants are hard on a patient’s body; they can trigger graft-versus-host disease, which causes the transplanted cells to attack a transplant recipient’s tissues.
As a result, transplants are not typically recommended for patients older than 40, who are often treated instead with immunosuppressive therapy — a cocktail of drugs combined with platelet-stimulating medication and steroids. Ho was 41.
“Owen was on the border,” said Ghiuzeli. “In general, due to the toxicity associated with transplant, we want younger patients.”
Yet a transplant can be curative as opposed to immunosuppressive therapy, which treats the condition but doesn’t eradicate it. Since Ho was close to the age recommendation, Ghiuzeli decided to proceed with transplant, which is the gold standard for blood cancers and other blood-related disorders.
“This is not cancer,” Ghiuzeli said. “It’s an autoimmune bone marrow failure.”