Posted on 12/08/2008 2:26:59 PM PST by Coleus
Stephen Sprague was supposed to die 11 years ago.
The leukemia patient was preparing for the end when he signed up for a medical experiment. He became one of the first adults in the U.S. to receive a transplant of stem cells from a newborn’s umbilical cord. He was cured. Wendy Favorito received a second chance at life when she had a transplant of her sister’s stem cells. Cynthia Dorsey is alive — and has a baby boy — also thanks to a stem cell transplant. "Miracles do happen," said Sprague, who was treated at Hackensack University Medical Center, one of the busiest stem cell transplant centers in the nation. "Sometimes they aren’t just miracles of medicine. They’re miracles of faith and determination and attitude and support." Hackensack's program is one of very few worldwide to have done so many transplants. It's also the first in the U.S. to receive disease-specific certification from the Joint Commission, an accreditation agency for hospitals. Each year, more than 300 patients at Hackensack and 10,000 around the country have stem cell transplants. Worldwide, more than 45,000 such transplants are performed each year. New Jersey has several programs, of which Hackensack’s is the biggest.
It’s a harrowing treatment that — when it works — cures. Stem cell transplants are now standard treatment for certain life-threatening blood-borne cancers and diseases. They could one day be used to treat melanoma, renal-cell cancer and other diseases — if doctors can find a way to prevent a common side effect in which the stem cells attack the patient they’re meant to cure, said Dr. Andrew Pecora, founder of Hackensack’s stem cell transplant program. Researchers around the world, including some at Hackensack, have been working on the problem and recent progress is "very promising," said Pecora, head of the hospital’s John Theurer Cancer Center. He called the solution to graft-versus-host disease "the holy grail of transplantation medicine." More than 450 of the 3,300 patients who have received stem cell transplants at Hackensack gathered recently to talk about their journeys. "They wouldn’t be here — they wouldn’t be alive — without this treatment," Pecora said.
They knew they were the lucky ones. Half of the program’s patients over the last 18 years have died, some soon after transplant from infection or in the war between the cells, others after enjoying life for years before succumbing to other causes. Sprague said it took a whole year for him to "understand what happened to me." "The more you learn, the more you wonder, ‘Why me?’ and ‘How did I end up at the right place at the right time?’ Then I asked, ‘What should I do with my good fortune?’ " Michael Steinberg has had two stem cell transplants at Hackensack. How has it changed him? "The colors are brighter," he said. "The sun shines every day."
Two decades ago, stem cell transplantation was a small, experimental branch of medicine. Complications were common. A quarter of all patients died without leaving the hospital. Some promising stem cell treatments proved futile. Hackensack performed 100 transplants a year for women with advanced breast cancer in the late 1990s before studies showed that they died at the same rate as they did with standard chemotherapy. Over the years, doctors became better at preventing infections. The donation process improved: Most stem cells now are harvested by filtering blood as it circulates through a machine, rather than suctioning them from bone marrow in the hips. Stem cell transplants are now a first-line treatment for multiple myeloma, and a fallback for leukemias and lymphomas that don’t get better with chemotherapy. Five-year survival can reach 70 percent.
Before a transplant, patients receive heavy doses of chemotherapy or radiation, which destroys their immune systems. Then intravenous bags of stem cells are attached with tubing, their contents flowing into the patient’s bloodstream. The stem cells enable the body to rebuild a new, healthy immune system, as the cells "engraft" in bone marrow and begin producing red and white blood cells and platelets. For some diseases, it’s the chemotherapy that destroys the disease — along with the healthy blood cells; the stem cells help rebuild healthy blood cells. In other cases, the stem cells produce blood cells that cure the patient. "When it works," Pecora said, "you see the magic of it."
It worked for Stephen Sprague. Diagnosed at age 47 with chronic myelogenous leukemia, Sprague had no siblings to turn to when chemotherapy failed and doctors recommended a transplant. The national bone-marrow registry listed a million potential donors. Not one matched. "They sent me home," the Holmdel father said. "They told me to start getting my affairs in order." At the time, Hackensack was preparing for a clinical trial to learn if the tiny amount of stem cells in a single newborn’s umbilical cord could be "grown" to provide an adequate supply for an adult. Sprague didn’t think he was likely to be chosen for the research. He had diabetes. He’d already survived a heart attack and open-heart surgery. He was big — 239 pounds.
Yet somehow, sitting on the shelf at the New York Blood Center, the only public repository for such donations at the time, was a perfect match. An anonymous woman had donated her newborn daughter’s umbilical cord. "Some mother did what mothers weren’t doing," he said, "and that turned out to be my one and only opportunity." Sprague is now what he calls a "cord blood crusader." He testified before Congress for public funding of cord-blood banks. He encourages patients to join clinical trials and speaks to expectant parents. "I’ve often said this was in the hands of God, but I don’t know why he chose me," he said.
| BY THE NUMBERS
Stem cell transplants at Hackensack University Medical Center. * Autologous (self-donated) transplants: 2,194 |
Cynthia Dorsey arrived at the reunion pushing a stroller. Hospital staff ooh-ed and aah-ed and asked to kiss 9-month-old Caleb. It’s not often that a transplant recipient comes back with a baby. On a Friday afternoon in 2004, Dorsey went to the ER at Hackensack, a few blocks from her home, to have a rash checked out. Scans led to a biopsy. Lesions were found on many internal organs. She had aggressive B-cell lymphoma. She didn’t leave the hospital for two months. Doctors operated to remove several tumors. When chemotherapy didn’t stop the lymphoma, a stem cell transplant was recommended. She was told the heavy dose of chemo would leave her infertile, but there wasn’t time to save the eggs from her ovaries.
"The doctor talked about taking me ‘down to zero’ " — no disease and no immunity, she recalled. "I walked out of there thinking, ‘No, I’m not going to do this.’ " A talk with her pastor changed her mind. "He told me that we have certain things in life, certain tests, where we have to trust God and have faith," she said. Dorsey donated her own stem cells, as is typical in lymphoma, to be transplanted after the chemotherapy. She doesn’t remember the aftermath of the transplant. "I was living, but not really here," she said. Gradually, she recovered. Five months later, she traveled to Atlanta to visit relatives. Six weeks after that, she started working again. When Dorsey discovered last year she was pregnant, she was shocked — and nervous. Would the baby be healthy? Would she? Caleb arrived last Dec. 22, perfect in every way. "He is truly a miracle baby," Dorsey said.
‘Re-birthday’
Wendy Favorito was a working mom on the fast track when she was diagnosed with an aggressive form of leukemia. During a family vacation in Disney World in 2004, she noticed bruises. When she got home, all it took was a finger stick of blood at her doctor’s office. "My whole life changed," she said. She endured five rounds of chemotherapy — with no improvement. Her doctor suggested that her four siblings be tested as possible stem cell donors. Susan Abbondanzo, her older sister, was the closest match. They laugh about it now, because it seemed so unlikely. Wendy and Susan had never been best buddies. When they were teens working at McDonald’s, Susan told the other employees that Wendy was adopted, they looked so different.
Susan injected herself with Neupogen to boost the production of stem cells. Wendy had intense chemotherapy and full-body radiation for a week, a brutal lead-in. "They kill as much as possible without flat-lining you, and then do the transplant," she said. She’d fantasized about becoming an online trader in the hospital, but found herself watching the hands on the clock move instead. Then the donated cells attacked her own cells. She grew so sick and weak that she lost the ability to walk and use her hands. She spent six weeks in the hospital. She had to relearn how to walk, write and tie shoes. At home, she needed physical and occupational therapists and an aide. Her 9-year-old son was taught how to help his mom up the stairs.
"When you have a transplant, they say it’s your ‘re-birthday,’ " she said. "It is almost like you’re babylike." Life now is a "new good," not a fast track. She coaches her daughter’s cheerleading squad, and volunteers as a class mother for her son. She walked in a half-marathon in San Francisco to raise money for leukemia. "Team Wendy" pulled in $30,000. She took tennis lessons — an item on her "bucket list" — and plays every Wednesday with friends. They aren’t great, but they laugh a lot. "I was lucky I had my two children," she said. "Nothing makes you want to get better more than your family."
Michael Steinberg, a Summit orthodontist, is "Mr. Three-Thousand" to the hospital staff — the 3,000th stem cell transplant patient. Technically, he’s also "Mr. Two-Thousand-Five-Hundred-or-So," because he had an earlier transplant that failed. Steinberg had an incurable disease of the bone marrow. While his first go-round was a "mini transplant," with a lower dose of chemotherapy, the second — last December — was the full Monty. He is doing well. The only visible effect of the transplant is his baldness; his hair has been slow to grow back. "This gave me another chance at life," Steinberg told those at the reunion of stem cell transplant survivors. "Another chance to be with my wife, my children, and my six grandchildren, another chance to practice my profession. Another chance to experience all that life has to offer."
bump
And yet Zero and the democrats want to divert funding away from the successful adult stem cell and umbilical cord blood stem cell research to throw it at embryonic stem cell research instead.
Stem cell transplants at Hackensack University Medical Center.
* Total, from 1992 to Sept. 30, 2008: 3,334
Of those:
* Autologous (self-donated) transplants: 2,194
* Allogeneic, from a family member, transplants: 534
* Allogeneic, from an unrelated donor, transplants: 484
* Cord blood transplant: 112
* Second transplants: 318
* Patients still living: 1,581
* Attended reunion: 450
ALL from Stem cell research accomplished without creating and destroying embryos.
By way of comparison, the number of promising treatments developed from embryonic stem cell research: 0, nada, zip.
bump & a ping
B ump for later.
The awful thing is that so much is wasted.
A family member recently had twins. It was too expensive for them to have the cord blood stored themselves. But no medical person (or anybody else) in their area (Portland, OR) knew where it could be donated (or even sounded interested).
Potential life-saving treatment lost.
The programs are changing faster than any of us can keep up with. Hopefully, there will be fewer and fewer places and times when families can’t donate to public cord blood banks.
All the donations do have to be arranged in advance, and not all hospitals are set up for the collection and processing. (Yet.)
For future reference:
The South Texas Cord Blood Bank has programs for collecting cord blood over Texas, and they may have more information for planned donation in other areas of the country.
http://www.bloodntissue.org/texascordbloodbank.asp
People may also want to check with their local blood bank, the American Red Cross (http://www.redcross.org/index.html )
and/or with MD Anderson in Houston.
http://www.mdanderson.org/care_centers/celltherapy/dIndex.cfm?pn=5A263CED-C57B-4F2D-9BD1943C5A209658
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