News and Events

A South Miami Hospital doctor crusades for a leukemia lifeline

Date: 09. 2007

Source: by Fred Tasker, Sept 11, 07; Published by MiamiHerald.com

In January, when Dr. Harry Aldrich sought a bone-marrow transplant to save the life of his 9-year-old son, who had acute myelogenous leukemia, he got discouraging news. No perfectly matched donor could be found. Not in his family. Not in the whole country. But Aldrich, of Pinecrest, is a cardiologist at South Miami Hospital, up on medical news. He had heard of a newer way of attacking leukemia -- with stem cells found in umbilical cords. In March, his son underwent a three-month set of procedures at the University of Minnesota that involved high doses of chemotherapy, followed by an injection of the cord stem cells into a vein leading to his heart. He has been in remission ever since. The boy, whose parents asked that his name not appear in this story, is brave about it: ''A nurse coordinator explained it like it would be awful,'' he says. ``It didn't turn out to be that awful.'' And the Minnesota physician, Dr. John Wagner, has published a paper in the June issue of The Lancet, the prestigious British medical journal, concluding for the first time that cord blood is as good as or better than bone marrow for fighting leukemia. And a lot easier to get. ''It's amazing,'' says Aldrich. ``And it comes from the umbilical cord -- something we just throw away most of the time.'' Aldrich now is working with South Miami Hospital to set up the first public cord-blood collection center south of Sarasota. He's responding to a Congressional study that says there are only 68,362 units of cord blood on hand for such transplants, while it would take at least 150,000 units to provide a potential match for every patient who needs one. A unit is the blood from one umbilical cord. Leukemia is a cancer of the blood, which starts in the bone marrow. It is the most common cancer in children, and 3,800 are expected to develop it in 2007, according to the Leukemia & Lymphoma Society. About 80 percent can be successfully treated by chemotherapy and other means. The rest must undergo an arduous regimen using not only chemotherapy, but a bone marrow or cord blood transplant. In a bone marrow transplant, a needle burrows through the donor's hip bone or other bone, a painful process, to extract the adult stem cells needed to rebuild the marrow. (Adult stem cells, which can be used only for blood diseases, do not involve embryos and thus avoid the controversy of destroying embryos to harvest primitive stem cells.) About 45,000 such transplants are performed yearly around the world, treating not only leukemia but other blood diseases such as lymphoma, multiple myeloma, aplastic anemia and sickle cell. More and more doctors say the fight against blood diseases may be approaching a watershed. Today, transplants of stem cells from bone marrow are still the ''gold standard'' for fighting leukemia -- in use for decades. Yet cord-blood transplants have potential to change that, doctors say. For one, umbilical cord blood is taken from the cord after it is clipped from the baby, without pain or risk. It also doesn't require bone marrow extraction. Perhaps the biggest advantage: A bone marrow transplant requires a perfect match between donor and recipient on several fronts while cord blood does not. ''Cord blood is somehow more forgiving,'' Wagner says. ``This is crucial because until now, at least half of our patients -- especially those of non-European descent -- can't find a matching bone marrow donor. But even partially matched cord blood gives them outcomes equal to the best-matched bone marrow.'' ''This is major news in long-term survival,'' says Dr. Gary Kleiner, a pediatric immunologist at the University of Miami Miller School of Medicine, who wasn't involved with Wagner's study. ``It gives the doctor stem cells for people -- especially minorities -- who can't find a bone-marrow donor.'' Only about 20 percent of the volunteer donors on the National Marrow Donor Program registry are blacks, Hispanics, Native Americans and Asians/Pacific Islanders while more than 40 percent of those awaiting transplants fall into these groups, according to a report by the National Institutes of Health. Other physicians are more cautious. ''I'm sure we will see more use of cord blood cells, but it's not entirely proven yet,'' says Dr. Morton Cowan, director of the pediatric bone marrow transplantation program at University of California at San Francisco, who wasn't involved with Wagner's study. It's been a tough couple of years for Aldrich's son, who was diagnosed with acute myelogenous leukemia in January 2006 when he was 8. Five intense rounds of chemotherapy over five months put him in remission, and he entered third grade at Pinecrest Elementary. Then came a relapse, and two more rounds of chemotherapy. Suspecting the coming need for a bone marrow transplant, Aldrich had his son tested against him, his wife and their 5-year-old daughter. No match. They tested him against the international registry of bone marrow donors. ``There wasn't a match in the world. It was discouraging.'' January 2007 brought another relapse, two more rounds of chemotherapy. Down to 80 pounds, he had to drop out of school. From outsiders, there was an outpouring of love. Mike Lowell, the former Florida Marlins third baseman now with the Boston Red Sox, telephoned. The Make-a-Wish Foundation, learning the boy likes animal photography, took him to the Omaha Zoo with a National Geographic magazine photographer. ''He had a camera that was 40 pounds and cost $10,000,'' the boy says. ``I took some pictures of my favorite animal, a cheetah. He said my pictures were better than his.'' In March the family turned to Wagner in Minneapolis to try a transplantation of umbilical cord blood stem cells. The family temporarily moved there for the three-month treatment. Contacting the National Marrow Donor Program, Wagner quickly found two good cord-blood matches he would use for the boy -- one in cold storage in Ohio, the other in Germany. The procedure was arduous. High doses of chemo killed the cancerous cells in his blood marrow, but left him without an immune system and very weak. ''He couldn't swallow, couldn't eat,'' Aldrich says. From there, the doctors inserted a catheter into a large vein near the boy's heart, and fed in stem cells from the umbilical cord blood. Wagner used cells from both cords, believing from experience that using more cells would increase the chance of success. Aldrich was surprised by the simplicity of the procedure: ``It wasn't high drama, like a kidney or heart transplant. It was much more like a blood transfusion. Just local anesthesia.'' The new stem cells became part of the boy's marrow, Wagner says, replacing the cells destroyed by chemotherapy and taking over the job of creating new, healthy blood cells. The donors' immune systems also were contained in the stem cells -- and joined the fight against any remaining cancer. Aldrich's son is at home in Pinecrest now, hoping to return to school in January. ``He's still a little weak. But on the whole, he's better than when we started.'' Meanwhile, Aldrich's work to set up an umbilical cord blood collection center at South Miami Hospital is bearing fruit. ''It's a long tedious process,'' says Denise Woods, an assistant vice president for the hospital. ``But our intention is to become a collection center.'' Already, about 20 percent of the 4,000 mothers who give birth at South Miami each year are sending their umbilical cords to a private company, to preserve their stem cells in case a family member needs it. The price is $1,995 to collect the blood from the cord plus a yearly storage fee of $125, said Justine Koenigsberg, spokeswoman for Boston-based Viacord. When South Miami Hospital's new public cord blood collection program is in operation, expected in 2008, Woods says, new mothers who otherwise would discard their umbilical cord will be able to donate it with no fee for use by others. South Miami will work with an Orlando firm called CORD:USE Cord Blood Bank -- one of 16 companies in the country that collect and transport the blood. The company will courier it to one of 19 storage facilities around the country, said Dr. Edward Guindi, its president. There the blood will be centrifuged to spin out the stem cells, which will be tested, analyzed and stored, cooled by liquid nitrogen to minus 196 degrees Celsius. The blood is then registered with the National Marrow Donor Program, based in Minneapolis, which works to match donor to recipient. When a future patient needs a transplant, his or her blood will be compared with that in storage; if a close enough match is found, the stored stem cells can be delivered to a doctor within two weeks. For a recipient who needs the cord blood from the public bank, the cost is about $25,000. The same charge would apply even if the recipient's own cord had earlier been donated to the public bank. The entire operation costs about $200,000 -- about the same as with blood marrow, Guindi saids. Other doctors say the cost can approach $350,000, depending on complications. Not all insurance companies will pay for the operation. Aldrich is encouraged that his hospital is setting up a collection center for cord blood. And he's proud of his recuperating son. ''We've come over a big hurdle, but we've got a few more to go,'' he says. The boy is looking forward to returning to Pinecrest Elementary, perhaps in January. ``Except I don't like writing, and I heard there's a lot of writing in fourth grade.''