THE ESSENCE OF A NEWBORN IS HOPE. Today, that hope extends even further to leukemia patients as Seattle researchers experiment with umbilical-cord blood as a new source of donor cell material. One man they're watching is Rob Gomez, who was given such a transplant two months ago. -----------------------------------------------------------------
Nearly two years ago, leukemia stole a part of Rob Gomez that gave him some of the happiest times of his life: the strength to run miles every day, to lift weights, to play pickup basketball, to revel in his athleticism.
Now what would seem the most fragile of sources may help restore that strength and save his life: the umbilical-cord blood of a newborn.
"Right now, I'm feeling good," says Gomez, 25, from his Veterans Affairs Medical Center bed. "If it's working like this, I think there's a really good future in it."
Gomez is hopeful that the rare transplant of the umbilical-cord blood he received two months ago will defeat the leukemia that has threatened his life for 21 months.
The former Navy submarine petty officer is one of about 115 people worldwide - only 15 adults and about 100 children - to undergo an umbilical-cord blood transplant - an experimental procedure that may boost the chances of those who can't find matching bone-marrow donors.
Two children and one young adult also have received the transplants at the Fred Hutchinson Cancer Research Center in Seattle. Two died, but one has survived for six months after additional treatment.
Cord blood may offer new hope to those with blood diseases and certain inherited disorders because it may be easier to match than bone marrow. That is, there may be fewer problems with the transplant rejecting its host body than with marrow.
Many of the nearly 8,900 Americans who die each year waiting for a bone-marrow match are of a minority race or ethnicity, important factors for a match. More than 80 percent of those on the National Marrow Donor Registry are Caucasians.
"We don't know how well this will work in the long term. We're just trying to ask the question, `Can we offer something to patients who have nothing'? " says Dr. Eric Sievers, the Fred Hutchinson Center scientist who is lead researcher on the cord-blood program used by the VA Medical Center. "It's an attempt to address the disparity in how we serve different ethnic populations." Like bone marrow, blood from umbilical cords is rich in stem cells - the mother cells that make all other blood cells. Cord blood used in transplants is collected from the placentas of newborns whose mothers consent. It is then frozen and stored until a match is found. The transplant is similar to a bone-marrow transplant:
A patient first receives high-dose chemotherapy and radiation to kill the diseased cells and suppress the immune system to prevent rejection. But that also kills the body's natural stem cells. The cord blood is then given intravenously, like a transfusion. If all goes well, the stem cells reproduce red cells to carry oxygen, white cells to fight disease and platelets to repair injuries.
The first umbilical-cord blood transplant was performed in August 1993 in France, and scientists have been greatly encouraged by the results of the procedure in children.
In nine out of 10 patients, the stem cells survive and reproduce. And about 60 percent of those patients have been alive and well for anywhere from three months to 2 1/2 years. The results are much better than the early days of bone-marrow transplants, a treatment now quite successful for many blood diseases.
"I think it's very, very exciting. This offers the possibility of finding many donors," says Dr. Joanne Kurtzberg, director of the cord-blood program at Duke University in Durham, N.C., where most of the procedures in this country have been performed. The technique also may have implications for treating other diseases, such as advanced breast cancer, she says.
Gomez's cord-blood transplant is the climax to a battle with acute lymphocytic leukemia that began in July 1994. For two weeks, Gomez had been fighting flulike symptoms while trying to keep up with his rigorous duties as machinist's mate aboard the USS Providence, a Connecticut-based nuclear submarine. Finally, he passed out while carrying a fire hose during a drill at sea. Within 24 hours, he had been sent to the naval hospital in Bethesda, Md., tested extensively and told by a group of doctors that he had the life-threatening leukemia.
"All of a sudden, I went from perfect health to a hospital," said Gomez. "I told them, `I understand, what do we do about it now?' Only later did the emotional part hit me."
Gomez had 10 weeks of intensive chemotherapy, followed by what was to have been maintenance doses for three years. But last April, the telltale symptoms returned: extreme fatigue, sleeplessness, no appetite, easy bruising.
The leukemia had returned, and this time Navy doctors said he needed a bone-marrow transplant. If a match could be found, the procedure would be performed at Seattle's VA Medical Center, which specializes in transplants using unrelated donors.
The donor search began with two big hurdles: Gomez had been adopted and didn't know the whereabouts of his biological family. Second, he is of Hispanic origin, and only 7 percent of those on the National Bone Marrow Registry are Hispanic. Records showed 12 people on the registry of 2 million names might qualify as matches. But refined testing eliminated each.
Because of the medical emergency, a California court opened Gomez's adoption record, and a private investigator hired by his adoptive father found his biological mother and five siblings. Three siblings and his mother were tested, but none matched enough for a transplant.
Finally, another possible donor turned up on the registry. Extensive tests showed the young Hispanic man was a nearly perfect match. Gomez was elated. So was Dr. Tom Chauncey, director of the VA Medical Center marrow-transplant program. He told Gomez to come to Seattle; the procedure was set up for October.
Then the worst happened. Three weeks before the scheduled procedure, the potential donor disappeared and no one could find him. Facing the extraction of bone marrow through a needle in his hip, he had backed out. Gomez was devastated.
"So here I am, already in Seattle, and I have no donor," Gomez recalled. "I was mad. I was heated. I was very upset."
Gomez continued on chemotherapy, which by now had put his leukemia in remission. But Chauncey knew the disease would return soon, and he talked with Eric Sievers and other Hutchinson Center doctors about the possibility of a cord-blood transplant. On Jan. 2, a research committee approved the experimental procedure; Gomez received the cord blood of an unidentified infant on Jan. 29.
Last week, Gomez returned to his outpatient apartment near the VA Medical Center. Doctors will monitor his progress for another month before he returns to Connecticut.
For now, he is enjoying visiting with his best friends, Jeremy and Melissa Davis, who drove from Connecticut to be with him. And he's making plans that for too long didn't seem worth considering - running long distances again, weight lifting and, down the road, maybe starting his own business.
"His attitude is determined and positive," says Chauncey.
The anonymous mother who consented to donating her baby's cord blood to Gomez was a patient at the Mount Sinai Medical Center maternity clinic in New York City. The clinic patients' racial and ethnic diversity "is close to ideal to match the general population of the United States," says Dr. Pablo Rubenstein, director of the New York Blood Center, which furnishes almost all of the cord blood for transplants in the United States.
The average 3 ounces of blood collected from each umbilical cord proved early in the transplant experiments to provide enough stem cells to thrive in most children. But scientists wondered if it would be sufficient for adults. Now the adults with transplants are faring about as well overall as the children. ----------------------------------------------------------------- Chances for a bone-marrow match
Unbilical-cord blood transplants may ffoer new hope for those who can't find matching donors for a bone-marrow transplant. It is easier to find a compatible donor with cord blood. Here are the chances of finding a matching bone-marrow donor, by race or ethnic origin:
Caucasian 71 percent . Hispanic 62 percent . Asian-Pacific Islander 45 percent . African-American 24 percent .
SOURCE: National Marrow Donor Program. ----------------------------------------------------------------- SEATTLE TIMES