life Recycling cancer patients find hope from a formerly discarded tissue BY NOELLE SHOUGH

Transcription

1 Recycling life cancer patients find hope from a formerly discarded tissue BY NOELLE SHOUGH Deborah Liney, Cord Blood Donation Program administrative director, extracts the stem cell rich resource that can save the life of a patient with blood disease. 12 bwh spring 2011

2 Larry Maglott The fifth floor of the Center for Women and Newborns at Brigham and Women s Hospital (BWH) is relatively quiet for a Friday morning. Suddenly, from one of the patient s rooms, shouts of joy burst forth. Immediately on their heels come the cries of a newborn. The family is awestruck, elated, and no doubt exhausted by the miracle of human birth. But there s more than one miracle connected to that birth BWH, in partnership with the Dana-Farber Cancer Institute (DFCI), is now able to spread the gift of life beyond that single infant, and save people who once succumbed to fatal blood cancers. The BWH and DFCI public Cord Blood Donation Program the only one in New England collects this valuable substance for future transplantation use. Once simply discarded after birth, cord blood today saves lives at the Dana-Farber/ Brigham and Women s Cancer Center (DF/BWCC) and elsewhere. This stem cell rich resource, taken from the umbilical cord that is cut after a baby s birth, gives new hope to those suffering from leukemia, lymphoma, and other genetic diseases of the blood. Cord blood banking offers us a wonderful way to recycle something that would otherwise be disposed of as medical Cord blood banking offers us a wonderful way to recycle something that would otherwise be disposed of as medical waste. And for these cancer patients, who have no other option, they would die of their disease if it weren t for cord blood. Deborah Liney, administrative director of the BWH and DFCI Cord Blood Donation Program waste, says Deborah Liney, administrative director of the BWH and DFCI Cord Blood Donation Program. And for these cancer patients, who have no other option, they would die of their disease if it weren t for cord blood. Babies would save my life Susan Mitchell wears a mask and gloves whenever she steps outside her house. It s how she keeps the bacteria at bay bacteria that wouldn t harm most people. But for Mitchell, exposure to that bacteria in the first 12 months after her cord blood transplantation could have serious consequences. Her immune system is currently rebuilding itself from the ground up. When she was first diagnosed in August 2009 with myelodysplasia a serious blood disorder in which the bone marrow does not produce sufficient blood cells Mitchell and her physicians searched for a suitable adult for a blood donor match, but to no avail. The National Marrow Donor Program s registry came up empty-handed. A transplantation using the cord blood from two newborns (most adults require blood from two cords) was Mitchell s best option. My children were disappointed that there was no adult donor match. But I was a nurse and a lactation consultant, so it made sense to me that babies would help me, considering bwh spring

3 Larry Maglott Cord blood collection specialists Joceneia Timas (left) and Laura Hitchcock package and record donated cord blood to ship to the Carolinas Cord Blood Bank at Duke University Medical Center in Durham, N.C. I had helped so many babies, Mitchell muses. In the end, babies would save my life. In February 2010, DF/BWCC s Joseph Antin, MD, performed her cord blood transplantation. Then it was time to wait to see whether the transplantation was a success. Banking on cord blood In 2008, BWH began the first public cord blood bank in Boston, partnering with the Carolinas Cord Blood Bank at Duke University Medical Center in Durham, N.C. We are the only hospital in New England that is actively pursuing public cord blood banking, explains Robert Barbieri, MD, chair of Obstetrics and Gynecology and Reproductive Biology at BWH. Most hospitals don t offer new moms the opportunity to bank their blood stem cells in a public cord blood bank because it s expensive to harvest, ship, and pay another entity to store it. Currently, this venture is supported solely by BWH and DFCI. The program supports cord blood collection on Monday through Friday from 8 am to 6 pm. Liney has visions of running the collection service 24/7 and expanding the program to all Partners HealthCare institutions if financial support becomes available. What makes cord blood so precious? In fetal Cord blood versus adult blood transplantation There are tremendous advantages to using cord blood for a transplantation, rather than blood from an adult donor. They include the following: 1 Cord blood allows for flexibility in matching the donor and recipient bone marrow or HLA types. Every year, approximately 35,000 patients need blood stem cell transplantations, but 70 percent of them don t have a family member with whom they have an exact match and many of those won t find an adult donor to match with at all, meaning, without cord blood, they would eventually succumb to their cancer, according to BWH s Robert Barbieri, MD. Further, the cord blood is more adaptable. Cord blood allows for a greater mismatch because the cells are naïve and less recognizable as foreign to the recipient s body, says Liney. 2 This potential for a less exact match is especially important in minorities, for whom it is harder to find a human leukocyte antigen (HLA) match. Your HLA type is inherited, just like your skin and eye color. Because the majority of adult stem cell donors are Caucasian, it is difficult to find matches for minorities and people of mixed race with blood cancers. Recently we had a young man of mixed race, with a father of African- American heritage and an Asian mom, recounts Liney. It was highly unlikely he would find an adult donor match, but with a cord blood transplantation at DF/BWCC, he survived and thrived. He s doing great now; he s back in college. It s a remarkable story, she says. 3Cord blood is immediately available. If a patient is matched with an adult donor, that donor must be found, pass a medical exam, consent to donation, and undergo stem cell collection. After all that, the blood stem cells are ready to ship to the recipient. The National Marrow Donor Program states that the average time from work-up to transplantation is two months. With cord blood, the process is much faster, as the cord blood is removed from storage and shipped to the hospital overnight in a specially designed carrier to keep it frozen, says Barbieri. 14 bwh spring 2011

4 development, stem cells are produced in the placenta, among other places, explains Antin, who is chief of the Medical Oncology Stem Cell Transplantation Program at DF/BWCC. Blood in the umbilical cord is particularly rich in hematopoietic, or blood cell producing, stem cells. These stem cells busily work to form the three different types of blood cells: red cells, white cells, or platelets. In addition to cord blood banking, the DF/BWCC is also by far the leading institution for hematopoietic stem cell transplantation in New England and third in the world, performing more than 490 transplantations each year. About of those are done with cord blood, according to Dianne Cerce, the executive director of oncology services. A world of good Because BWH is the birthplace of babies of all ethnicities, the program collects a variety of types of cord blood. Public cord blood banking serves Deborah Liney confers with Kathleen Looney, RN, and Batya Goldwaser, medical student, about imminent new moms in BWH s Center for Women and Newborns who wish to donate their cord blood. In fetal development, stem cells are produced in the placenta, among other places. Blood in the umbilical cord is particularly rich in hematopoietic, or blood cell-producing, stem cells. joseph antin, md chief, medical oncology stem cell transplantation program, dana-farber/brigham and women s cancer center as a rich resource for ethnic minorities in need of transplantation, because the match doesn t have to be exact. With cord blood, minority patients get a lot better shot at a successful transplantation. There was an unmet need for cord blood from minorities, and we had an obligation to help the transplantation community, explains Antin. Even though the cord blood program is expensive to run, he and others in the Brigham community feel it is the hospital s responsibility to support the local community, as well as to support patients needing transplantation around the country. And when it comes to public versus private cord blood banking, the former is considered by most to be the better bet for both banking families and patients. In the case of private banks, the family pays a fee to have cord blood harvested and stored though the costs are high and the chances they would ever need such blood stem cells are extremely minute, and the blood is restricted to that family s use only. Public cord blood banking is free, and the cord blood is available to whoever needs it. Plus, the quality control measures the bank takes to keep the cord blood safe are stringent, ensuring the stem cells will be robust when a patient needs them. The only drawback that comes to mind is that cord blood transplantations are more complicated and require longer hospital stays than standard transplantations, says Cerce. Larry Maglott A long road With Susan Mitchell, it was indeed complicated. She, her nurses, and her physicians waited to see whether the transplanted cord blood engrafted, which means to grow new white blood cells, red blood cells, and platelets in the body. In Mitchell s case, they were disappointed tests showed that the new cord blood did not engraft. I was really deflated, she says. I had to get a second cord blood transplantation. But no one was ready to give up. Mitchell credits the bwh spring

5 encouragement and support of the nurses from the BWH Tower s sixth floor while awaiting her second cord blood transplantation. They told me that the second transplantation would work, and that they would get me through it. It was from their strength that I feel it was successful. Mitchell spent 89 days living as an inpatient before she was cleared to go home. Even then, she says, her whole life was turned upside down. I have to wear the mask and gloves, I can t go out, I have to be very careful of what I eat; there are The program comes full circle as cell processing technologists Heather Hansen (left) and Peter Gelinas remove cord blood that has been shipped up from the Carolinas Cord Blood Bank to ready it for transplantation into a patient who needs it. a lot of restrictions, she says. Now, eleven months later, she s about ready to give up her sterile barriers, her year of restrictions nearly complete. Mitchell admits that it may be hard for her to live mask-and-glove-free after all, hundreds of thousands of bacteria routinely hang out in places like the kitchen sink, the bathroom, and even in the foods that we eat but she is ready to try. A rich research resource Some cord blood cells don t make it to the bank usually, because there are too few of them to be viable for a transplantation, even for a small child. In those cases, researchers can use these cells, which were once discarded as medical waste, to further the science of transplantation, cell regeneration, and more. The government has strict rules on how the cells can be used, and the cells are de-identified units, meaning that no one can obtain information about the mother or the baby. As long as we have a copy of the lab s research protocol, these cells are available to the entire Boston research community, says Liney. Now, researchers are focusing on growing these stem cells, using them to regenerate tissue, and unlocking their mysteries to cure blood cancers. They are looking at switching cells on and off to activate or deactivate certain genes, says Cerce. Our future is to see how we can manipulate stem cells to further the study of disease and treatment. As for Mitchell, she hopes expectant mothers will consider donating their cord blood without hesitation, whether it is eventually used for transplantation or research. It s like I ve come full circle. I worked with mothers and babies for years as a lactation consultant, and now they gave me new life, she marvels. I really want the moms to think about donation because those cords saved me. u help US save lives The Cord Blood Donation Program makes available a precious substance that saves the lives of blood cancer patients. To read more and watch the video Giving Birth to Hope, go to and type cord blood donation program in the search box. If you d like to learn about making a philanthropic donation to this vital program, please contact Susan Andrews in the Development Office at or sjandrews@partners.org. 16 bwh spring 2011