High-Risk Procedure Pays Off for Leukemia Patient
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.
Before receiving the cord blood, DeVine had to undergo massive doses of radiation and chemotherapy to wipe out his own remaining bone marrow.
"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%.