THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, February 27, 1996 TAG: 9602270292
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 154 lines
Some days, 1-year-old Zachary Edmonds probably seems more of a pain than a help to his big sister, Morgan.
Like one snowy evening, when he sat on the floor in the front hallway of their Portsmouth home, smack in the path of Morgan's child-sized plastic car. Then, she fussed at him.
But someday, Morgan, age 2, will appreciate what Zachary has done for her. His birth may have given her a second chance at life.
Morgan, who needs a bone marrow transplant to combat a serious blood disease, will be treated with stem cells taken from the blood of the placenta and umbilical cord immediately after Zachary's birth.
Those adaptable cells probably have a better chance of taking hold in her body than cells from Zachary himself.
Cord blood used to be thrown out. But now it's recognized as a rich supply of stem cells, the same type found in bone marrow. And that's made cord blood a hot commodity in the medical and scientific world. Doctors see in it a potential cure for many diseases, including leukemia, some types of cancers and AIDS.
Dr. R. Nathan Slotnick is one of those scientists.
Slotnick, an assistant professor in the obstetrics and gynecology department at Norfolk's Eastern Virginia Medical School, sees the day when collecting blood from the cord will be as routine as cutting it in the delivery rooms at Sentara Norfolk General Hospital.
Each newborn's stem cells would be stored for years. Like money in a savings account, the cells might be a hedge against future trouble. If the baby ever needed a bone marrow transplant, the cells would be there, 100 percent compatible. They might also be used for a sibling, possibly even a parent.
It is ``kind of an insurance policy for a child being born,'' said Slotnick. In later years, he said, if that child develops leukemia or breast cancer, ``we might be able to give that child the ability to be cured.''
It is especially useful for minority families, who have a particularly difficult time finding matching donors for bone marrow transplants, Slotnick said.
The practice still poses a lot of unanswered questions, ethical and scientific. Some say key questions haven't been answered about how useful the cord blood's cells really are. And it's not cheap.
The technique is not new, at least not by the standards of medical technology. It was first used in 1988. Cord blood stem cells were first collected in Hampton Roads for a transplant 5 1/2 years ago, when a baby born at Virginia Beach General donated cord blood for an older brother with leukemia. By the end of 1994, 62 transplants with cord blood stem cells had been performed worldwide.
Thousands more samples have been collected and stored.
So far, only about half a dozen families have taken advantage of Slotnick's program at Sentara Norfolk General Hospital. In every case, the family needed the cells for a family member.
Chris and Leslie Edmonds never thought about these things during the births of their first two children - Morgan and Shane, 7. ``The other two (placentas), I assume, they just threw away,'' said Leslie.
Leslie was seven months pregnant in December 1994 when the family learned that Morgan was seriously ill.
Bruises appeared all over Morgan's body. Just putting on socks could raise bruises on her legs.
She had thrombocytopenia, the Edmondses learned, a disease that causes a severe drop in the number of platelets, small blood cells needed for clotting. Treatment at Children's Hospital of The King's Daughters made her well enough to go home, but she had problems with some of the treatments. And facing the possibility that any minor injury could cause serious bleeding, doctors decided she would need a bone marrow transplant.
No one in the family was a good match, so Morgan's doctor suggested they turn to Slotnick to collect Zachary's cord blood stem cells.
Stem cells give rise to all other types of blood cells.
The process poses no risk to the mother or newborn - an advantage over bone marrow collection, which requires the donor to be anesthetized before a needle is inserted deep in the hip.
Immediately after birth, the blood from the placenta was poured into a solution to keep it from clotting. It was taken on ice to a laboratory and put into a centrifuge. Then the extracted cells were frozen. By this time, the blood had been distilled to just a few cubic centimeters, stored in several test tubes in a laboratory at Sentara Norfolk General Hospital.
Zachary, it turns out, isn't a perfect match for his sister. But stem cells seem to be more tolerant of slight mismatches than cells taken from bone marrow. That reduces the risk that the new cells will attack Morgan's own - a potentially fatal complication. Morgan will have the transplant at Duke University's medical center, probably in the next few weeks.
Zachary won't lose all his stem cells by giving some to his sister. The 140 cubic centimeters or so of blood probably contains enough for several transplants in children.
But supply is still a question for adult recipients. While doctors are certain that the blood contains enough cells for children and small teenagers, they are not sure there's enough for an adult. A bone marrow donor can give more if the transplant requires a boost; cord blood is a finite supply from each donor. But cord blood is also more concentrated than marrow.
Also, doctors haven't proven that cord blood transplants work as well as marrow transplants in adults.
There are other unanswered questions.
Because the practice is relatively new, scientists don't know for sure how long the cells last in storage. The only data available says the cells can stay viable for 10 to 15 years.
A larger question will require more study: Suppose a person was born with a genetic predisposition for, say, breast cancer? If that woman develops breast cancer, would she really benefit from a transplant with her own cells, containing the same genetic material?
Slotnick thinks there's not much danger. The transplant would be giving her additional bone marrow cells, not breast cells, he said.
Some critics have pointed out that the odds are low that a baby will develop a disease treatable by cord blood cells.
Ethicists have raised other considerations: Suppose a couple conceived a child simply to provide cord blood for an ailing sibling? How should a doctor advise a couple facing that decision?
Slotnick said he hasn't had to confront that. The handful of patients who have used the technique, like the Edmondses, were already expecting when they learned about an older child's illness, or have said they already planned to have another baby.
The Edmondses' insurance company paid for the procedure because it had an immediate use. But most companies don't pay for it if it's being done just in case. The people who could most benefit from it - minorities - are among those least able to afford it, Slotnick notes.
Some for-profit national companies have sprung up recently to offer the service, for quite a bit more than Slotnick charges.
Slotnick has bigger plans. He'd like to find grant money that would make the procedure available to every baby born at Norfolk General, regardless of the family's financial situation. The federal government is already financing similar, experimental programs in New York.
Some cells would be reserved for the baby, Slotnick said. The rest, he said, might someday be tapped to benefit the community at large.
``If we do 5,000 deliveries at Norfolk General a year, if we could do cord blood isolation for every one, we'd be developing a bone marrow bank that would be second to none in the world,'' he said.
In the meantime, Chris and Leslie Edmonds believe, every parent who can afford it should pay to have the procedure.
``This is something everyone should do,'' said Leslie, ``because you never know.'' ILLUSTRATION: Color photos by VICKI CRONIS, The Virginian-Pilot
Transplanted cells from the umbilical cord of Zachary Edmonds, 1,
will help his sister, Morgan, 2, fight a serious blood disease.
Dr. R. Nathan Slotnick, of EVMS, sees the day when collecting blood
from the umbilical cord will be as routine as cutting it. The
preserved cells would benefit minorities in particular, who often
have a hard time finding matching donors.
Photo by VICKI CRONIS, The Virginian-Pilot
Blood cells saved from the umbilical cord of Chris and Leslie
Edmonds' son, Zachary, provided a critical transplant for sister
Morgan, 2. A serious disease cut the number of platelets she had for
blood clotting.
by CNB