LEUKEMIA - Trumped by umbilical cord blood

greenspun.com : LUSENET : Current News : One Thread

Umbilical cord blood trumps leukemia By JIM SHAMP : The Herald-Sun js2@herald-sun.com Jun 13, 2001 : 11:03 pm ET

DURHAM -- Tiny samples of blood from umbilical cords, once discarded as medical waste, have become the literal lifeblood of some adults facing death from leukemia.

A report in today’s New England Journal of Medicine says experimental transplants of newborns’ placental blood has saved the lives of more than one-fourth of the adults who got them.

It comes as no surprise to Duke University employee Gayle Serls, a "poster girl" for the procedure. The 51-year-old single mother of two just celebrated her fifth "rebirthday," meaning she officially qualifies in cancer circles as the longest-term survivor of the adult transplants.

Doctors have used newborns’ cord blood for years to treat other children with blood disorders such as leukemia. In fact, Duke University Medical Center is renowned for its expertise, led by pediatric oncologist Joanne Kurtzberg.

Mary Laughlin, who worked with Kurtzberg at Duke for several years, agreed to try Serls on the unusual form of stem-cell transplant on May 1, 1996, after Serls was left with no other options.

Today Serls is cured -- swept from the clutches of death by two ounces of blood shipped to Durham by FedEx from a New York collection center. The miraculous "medicine" was mere flotsam in the delivery room to a New York family after their little boy’s birth.

But it was a rough road getting to her cure, Serls recalled in an interview Wednesday.

A native of Warrenton, Serls had been divorced and living in Durham with her son and daughter for more than a decade when she was diagnosed with acute lymphocytic leukemia. She also had another strike against her -- Philadelphia chromosome, a genetic hiccup that would complicate her treatment.

"It was determined that I’d need a bone-marrow transplant," she said, "and at the time Duke wasn’t doing transplants on adults with leukemia. At the time I was in remission. My insurance company said I’d have to go to Johns Hopkins in Baltimore. I hated the idea, because my son Matt was a freshman at N.C. State and daughter Corbin was a freshman at Jordan High. But I have wonderful friends who’ve supported us through all this."

Hopkins offered Serls a risky autologous transplant, which means some of her own marrow would be removed and cleansed while her remaining marrow tissue would be killed. Then the cleansed marrow would be re-introduced in an attempt to "seed" new cell growth.

The procedure never happened. The day it was to take place, Serls had a relapse. She was sent home and told to put her affairs in order. The doctors were throwing in the towel.

"It was the lowest of the low," Serls said Wednesday, through tears.

When she returned to Durham from Baltimore, Serls was readmitted to Duke immediately. Her lymph nodes were inflamed. "I got really sick. I was in a lot of pain, and I didn’t know if I’d ever be a candidate for anything again," she said.

A few nights later, Serls said her mother was watching Peter Jennings’ TV news broadcast in which a doctor was being interviewed about treating adult leukemia patients with cord blood.

"She called me at the hospital," chuckled Serls. "I called a friend right away because I knew I’d forget it, and my friend called the Red Cross to find out where this was going on."

When the answer came back, Serls was shocked. The doctor on national TV was down the hall -- Mary Laughlin of Duke.

"I bypassed all protocol," Serls said and laughed. "I called Dr. Laughlin directly from my hospital room, and she came to see me, and together we got a fast OK from my insurance company and Boom! Suddenly I was a 45-year-old pediatric patient!"

After the transplant, Serls, exhausted from the radiation and chemotherapy, was confined to a tiny sterile room with a roaring air purifier for company. Day by day her blood was checked for signs of new cells telling doctors that her immune system was renewing. Soon they came. At first, just a couple of cells. Then more. Then 100. Then it leveled off discouragingly for a few days. Then it started building again.

Serls had entered the hospital the last week of April, grabbing at straws. By the third week of June she was back home in her apartment, slowly regaining strength and renewed in her belief that the therapy was working.

Laughlin left Duke about four years ago to lead her own transplant program at Ohio’s Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University. She served as lead author of the New England Journal of Medicine study, which also included Kurtzberg as a co-author.

The research study reviews the cases of 68 adult leukemia patients who couldn’t find suitable donors for bone marrow -- the standard transplant tissue used after the patient’s own damaged marrow is "killed" with high doses of chemicals and/or radiation. Killing the patient’s marrow can halt the uncontrolled cell production called cancer. But it also kills the source of disease-fighting blood cells, exposing the patient to all forms of invaders.

Of the 68 patients in the review, 22 came to Laughlin at Duke and 18 saw her more recently at the Cleveland complex. The others were treated at hospitals in Buffalo, Washington, D.C., and the University of Minnesota at Minneapolis. They ranged in age from 18 to 58. All had received the marrow-killing therapy before their transplant of cord blood.

Cord blood is rich in stem cells -- cellular building blocks that can "morph" into many types of body structures. It isn’t prone to rejection the way fully formed adult marrow cells might be when transplanted from one person to another, so it doesn’t have to be an exact match to be effective, even in rejection-prone adults, said Laughlin.

Fully 90 percent of the 68 patients in the study experienced growth of new, healthy blood cells after transplant, said Laughlin. Rejection complications struck 18 percent of the group. But that compares with an expected incidence of 55 percent among adults getting marrow from well-matched donors.

"Some of the patients we originally treated with this new modality were very sick," said Laughlin. "Eight died in the first four weeks, largely because they were so weakened by so much treatment before transplant. So patient selection is always an issue."

It’s an especially big issue in states like Ohio, she said, where survival statistics must be published. "Sometimes we’re pressured not to transplant some of these high-risk patients because of the expected poor outcomes," said the physician.

Several additional research studies are planned for the next few months to look at ways to expand cord blood transplant successes, said Laughlin.

Meanwhile, Serls said she’s happy to be part of today’s research report.

"I always knew I was going to be rich and famous somehow," she laughed. "But I’ve learned you’ve got to be really specific in what you want. I’m rich in ways I didn’t figure. I’m famous in some circles. I even remember waking up in the hospital and thinking, ‘I always wanted a sabbatical, but not this way.’Ê"

"Turns out I’m just an ordinary person trying to live through an extraordinary time," she said. "But now when I say I’m really happy to be here, it has a new connotation to it."

Umbilical cord blood trumps leukemia By JIM SHAMP : The Herald-Sun js2@herald-sun.com Jun 13, 2001 : 11:03 pm ET

DURHAM -- Tiny samples of blood from umbilical cords, once discarded as medical waste, have become the literal lifeblood of some adults facing death from leukemia.

A report in today’s New England Journal of Medicine says experimental transplants of newborns’ placental blood has saved the lives of more than one-fourth of the adults who got them.

It comes as no surprise to Duke University employee Gayle Serls, a "poster girl" for the procedure. The 51-year-old single mother of two just celebrated her fifth "rebirthday," meaning she officially qualifies in cancer circles as the longest-term survivor of the adult transplants.

Doctors have used newborns’ cord blood for years to treat other children with blood disorders such as leukemia. In fact, Duke University Medical Center is renowned for its expertise, led by pediatric oncologist Joanne Kurtzberg.

Mary Laughlin, who worked with Kurtzberg at Duke for several years, agreed to try Serls on the unusual form of stem-cell transplant on May 1, 1996, after Serls was left with no other options.

Today Serls is cured -- swept from the clutches of death by two ounces of blood shipped to Durham by FedEx from a New York collection center. The miraculous "medicine" was mere flotsam in the delivery room to a New York family after their little boy’s birth.

But it was a rough road getting to her cure, Serls recalled in an interview Wednesday.

A native of Warrenton, Serls had been divorced and living in Durham with her son and daughter for more than a decade when she was diagnosed with acute lymphocytic leukemia. She also had another strike against her -- Philadelphia chromosome, a genetic hiccup that would complicate her treatment.

"It was determined that I’d need a bone-marrow transplant," she said, "and at the time Duke wasn’t doing transplants on adults with leukemia. At the time I was in remission. My insurance company said I’d have to go to Johns Hopkins in Baltimore. I hated the idea, because my son Matt was a freshman at N.C. State and daughter Corbin was a freshman at Jordan High. But I have wonderful friends who’ve supported us through all this."

Hopkins offered Serls a risky autologous transplant, which means some of her own marrow would be removed and cleansed while her remaining marrow tissue would be killed. Then the cleansed marrow would be re-introduced in an attempt to "seed" new cell growth.

The procedure never happened. The day it was to take place, Serls had a relapse. She was sent home and told to put her affairs in order. The doctors were throwing in the towel.

"It was the lowest of the low," Serls said Wednesday, through tears.

When she returned to Durham from Baltimore, Serls was readmitted to Duke immediately. Her lymph nodes were inflamed. "I got really sick. I was in a lot of pain, and I didn’t know if I’d ever be a candidate for anything again," she said.

A few nights later, Serls said her mother was watching Peter Jennings’ TV news broadcast in which a doctor was being interviewed about treating adult leukemia patients with cord blood.

"She called me at the hospital," chuckled Serls. "I called a friend right away because I knew I’d forget it, and my friend called the Red Cross to find out where this was going on."

When the answer came back, Serls was shocked. The doctor on national TV was down the hall -- Mary Laughlin of Duke.

"I bypassed all protocol," Serls said and laughed. "I called Dr. Laughlin directly from my hospital room, and she came to see me, and together we got a fast OK from my insurance company and Boom! Suddenly I was a 45-year-old pediatric patient!"

After the transplant, Serls, exhausted from the radiation and chemotherapy, was confined to a tiny sterile room with a roaring air purifier for company. Day by day her blood was checked for signs of new cells telling doctors that her immune system was renewing. Soon they came. At first, just a couple of cells. Then more. Then 100. Then it leveled off discouragingly for a few days. Then it started building again.

Serls had entered the hospital the last week of April, grabbing at straws. By the third week of June she was back home in her apartment, slowly regaining strength and renewed in her belief that the therapy was working.

Laughlin left Duke about four years ago to lead her own transplant program at Ohio’s Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University. She served as lead author of the New England Journal of Medicine study, which also included Kurtzberg as a co-author.

The research study reviews the cases of 68 adult leukemia patients who couldn’t find suitable donors for bone marrow -- the standard transplant tissue used after the patient’s own damaged marrow is "killed" with high doses of chemicals and/or radiation. Killing the patient’s marrow can halt the uncontrolled cell production called cancer. But it also kills the source of disease-fighting blood cells, exposing the patient to all forms of invaders.

Of the 68 patients in the review, 22 came to Laughlin at Duke and 18 saw her more recently at the Cleveland complex. The others were treated at hospitals in Buffalo, Washington, D.C., and the University of Minnesota at Minneapolis. They ranged in age from 18 to 58. All had received the marrow-killing therapy before their transplant of cord blood.

Cord blood is rich in stem cells -- cellular building blocks that can "morph" into many types of body structures. It isn’t prone to rejection the way fully formed adult marrow cells might be when transplanted from one person to another, so it doesn’t have to be an exact match to be effective, even in rejection-prone adults, said Laughlin.

Fully 90 percent of the 68 patients in the study experienced growth of new, healthy blood cells after transplant, said Laughlin. Rejection complications struck 18 percent of the group. But that compares with an expected incidence of 55 percent among adults getting marrow from well-matched donors.

"Some of the patients we originally treated with this new modality were very sick," said Laughlin. "Eight died in the first four weeks, largely because they were so weakened by so much treatment before transplant. So patient selection is always an issue."

It’s an especially big issue in states like Ohio, she said, where survival statistics must be published. "Sometimes we’re pressured not to transplant some of these high-risk patients because of the expected poor outcomes," said the physician.

Several additional research studies are planned for the next few months to look at ways to expand cord blood transplant successes, said Laughlin.

Meanwhile, Serls said she’s happy to be part of today’s research report.

"I always knew I was going to be rich and famous somehow," she laughed. "But I’ve learned you’ve got to be really specific in what you want. I’m rich in ways I didn’t figure. I’m famous in some circles. I even remember waking up in the hospital and thinking, ‘I always wanted a sabbatical, but not this way.’Ê"

"Turns out I’m just an ordinary person trying to live through an extraordinary time," she said. "But now when I say I’m really happy to be here, it has a new connotation to it."

-- Anonymous, June 14, 2001


Moderation questions? read the FAQ