June 13, 2001 -- "This isn't the way it should be; I'm mad, and I'm going to do something about it!" Chris DeVine, age 30, recalls how he felt in May 1998 when he was diagnosed with leukemia, a cancer affecting blood cells.
But DeVine's treatment options were limited. Bone marrow transplantation for his type of leukemia often succeeds in restoring the primitive stem cells that can grow into normal, mature blood cells, but unless those cells are a close genetic match to the patient's, the body's defense system will usually mount an attack against the unrecognized "invaders." In DeVine's case, his doctors couldn't find a suitable donor.
Using blood from the umbilical cord is a relatively new approach. Normally discarded along with the placenta after birth, cord blood can be collected without risk to mother or baby, shipped frozen, and stored while awaiting transplant. Because stem cells in the cord blood are immature, they are less likely to be rejected than bone marrow.
There's only one catch -- at the time DeVine had to face this decision, virtually all cord blood transplants had been done in children. Researchers were concerned that the tiny amount of blood in each umbilical cord -- only two ounces -- might not be enough to replenish the blood-forming system in an adult, and that more sophisticated immune defenses might increase the risk of rejection.
"It was really scary," DeVine tells WebMD. "Once they obliterate your bone marrow, it's the point of no return. If the cord blood transplant doesn't take, it's game over."
But one conversation with Mary J. Laughlin, MD, helped put DeVine's mind at ease. She is director of the Allogeneic Transplant Program at Case Western Reserve University and University Hospitals Ireland Cancer Center in Cleveland, and DeVine says he was "really impressed with her confidence."
"Transplantation of cord blood following high-dose chemotherapy and radiation can save the lives of about one-third of our adult patients with life-threatening blood diseases for whom other treatments are likely to fail," Laughlin tells WebMD.
Thankfully, DeVine was in that fortunate one-third. Laughlin saw the first signs of cell recovery in him about 10 days after transplant, earlier than in most patients. His energy level remained low for almost two years after transplant, but after one year, he returned to a full work week.
"I feel great," says DeVine, who now works fulltime as a technical recruiter for Synova Inc., in Detroit, and often travels back to his native Vail to enjoy skiing and snowboarding. "I think cord blood is the direction transplants are going."
Laughlin agrees. For every 10 patients needing transplantation for a blood disease like leukemia, only two have a sibling who is a suitable bone marrow donor. Of the remaining eight, only four find a matched unrelated donor from the National Marrow Donor Program, while the others eventually die of their disease. For minorities, the likelihood of finding a match is less than 15%.
"The conclusion that these cells are a good alternative for patients without a suitable donor is premature but real," Morris Kletzel, MD, tells WebMD after reviewing Laughlin's research report in the June 14 issue of the New England Journal of Medicine. He is director of the stem cell transplant program at Northwestern University Medical School in Chicago.
Although only 19 of the 68 patients in Laughlin's study who received cord blood survived, they all had been suffering from life-threatening blood cancers. Kletzel is encouraged that 90% of recipients had growth of new, healthy blood cells after cord blood transplantation. Of those, 18 were still completely disease-free more than three years later.
"I think that an unrelated cord blood transplant should be offered in adults when the patient is affected by a life-threatening bone marrow disease when there is no alternative treatment," Eliane Gluckman, MD, a hematologist at Hopital Saint-Louis in Paris, tells WebMD. "At this stage, only patients who do not have a [genetically matched] bone marrow donor are candidates."
Laughlin's team is now trying to grow cord blood stem cells in the laboratory, hoping that transplanting a larger dose of stem cells will allow faster recovery of blood counts and lower risk of infections.
"Cord blood banks have been established worldwide, and they offer a potential for new approaches at cell and gene therapy," says Gluckman, who wrote an editorial accompanying Laughlin's study.
What advice does DeVine have for cancer patients?
"Ask a lot of questions, and don't be afraid to find out all you can. You have to be the one in charge of your own body and your own treatment. The fighters are the ones who survive."