First Ever Beijing Stem Cell Donor for Taiwanese Recipient

Despite any political maneuvering between China and Taiwan, it is articles like these (1, 2) that bring our minds back to the basics- which is that geopolitics aside, our genetic heritage links us and binds us eventually to a common fate.

Additionally, stem cell resources will always reside with the size and diversity of the population, hence China with more than 1.3 billion is a stem cell treasure trove for chinese people all over the world if we are able to thoroughly profile and screen the stem cells.


The article which I noted a while ago (sorry, it's a late comment, but I thought it worthwhile) reports the first time that stem cells were matched from a patients in Taiwan to donors in Beijing*. The two profiled donors were Ms. Hang from Jiangsu province and Ms. Xiaoyan from Hunan province. (click here if you'd like to know where the provinces are in relation to Beijing)

They were brought to Beijing and their stem cells were mobilized from their bone marrow to the bloodstream (you can read more on mobilization and collection here) and their stem cells collected via apheresis. Their stem cells were subsequently transported to Taiwan for the transplantation.

The second article provides a little more detail on the donors and their perceptions of stem cell harvesting and donation.

Ms. Hang who is a youthful 36 year-old is a registered blood donor who has donated blood several times in her life. Apparently, a marrow bank was established in her home province in 2003 but few people registered as donors. Ms. Hang signed up as a donor in the registry not only because her employer, Amway urged all employees to do so, but also because she saw it as "an opportunity to help others... why not do it?"

Amway's staff registration yielded 1,500 new potential donors and they report that 4 of them have already been called on as donors.

Ms. Hang's father is a doctor and said that the process of mobilizing and collecting stem cells was harmless and supported her decision to donate. The recipient was a 16 year-old girl and I hope that they collected as many stem cells as they could and that the patient has recovered.



*Taiwan has exported stem cells obtained from donor's cord blood, bone marrow and peripheral blood to patients all over the world. Cord blood stem cells obtained from a private company that facilitates the storage facility for databasing and sale, Stemcyte incur a charge of between RM 100,000 to RM 150,000 per unit (they have released in excess of 250 cord blood stem cell units). Some patients have also withdrawn 2 cord blood stem cell units to use in a double transplant when one unit is insufficient.

Malaysian patients have accessed this facility many times and have been able to find successful matches which has allowed life-changing stem cell transplantation to proceed.

Credit also goes to the Tzu Chi Taiwan Marrow Donor Registry, the third largest of its kind in the world, which has made over a hundred matches for mainland patients and patients in South East Asia.

11 Year-Old Malaysian Girl Provides Stem Cell Match for Brother With Acute Myeloid Leukemia

Its not often that we get news on Stem Cells in Malaysia but I do think that ever since we've started highlighting the applications, many more doctors are beginning to speak out about the important work that they do.

I read yesterday in the Star about a little girl by the name of Siti who has undergone a peripheral blood stem cell harvest to help her 17 year old brother Muhammad, who was diagnosed 5 months ago with Acute Myeloid Leukemia (see Angel's story).

You can read Siti's story here but I thought that it would be good to pick up on a few key points in the article which supports our preemptive peripheral blood and cord blood stem cell banking service. Its all about providing options for yourself in the future.

The treating haematologist Dr. Ng Soo Chin describes the chances of finding a match within the family:


STEM CELL MATCH

"A blood test, called HLA typing, is done to test whether a potential donor is a match. “There is a 25% chance of a sibling being a match to the patient,” Dr Ng notes. However, parents and half-siblings are usually not such good matches. "

I thought that it was a very well written article and Dr. Ng points out clearly that bone marrow harvesting- which is painful and very unpopular- is on a decline and that now peripheral blood stem cell harvesting is the way to go.


NO MORE PAINFUL BONE MARROW

"Not too long ago, the idea of donating stem cells frightened many people, not least because it required general anaesthesia and painful extraction of the stem cells directly from the bone marrow. Now, 90% of stem cell transplants use peripheral harvesting, instead of bone marrow,” Dr Ng assures. Peripheral harvesting means that the stem cells are collected from the blood stream in a procedure called apheresis. "

Peripheral blood stem cell collection is much preferred over bone marrow because doctors can be assured of a decent harvest. Very often bone marrow extractions require a lot of manipulation and may not obtain a reliable amount of cells for a transplant. Clotting of the blood is often one of the problems, a long with trauma bleeding, anaesthetic risk and patient discomfort.


PERIPHERAL BLOOD STEM CELLS - A VERY SAFE PROCEDURE

Dr. Ng says: “It’s like blood donation, except that it takes longer. However, the actual volume of blood that you donate is only about 50-100ml,” he explains, insisting that this is a very safe procedure.

And he also describes why using one's own stem cells are preferred, although this option is not always available:

When the patient is both the donor and the recipient of the stem cells, there are fewer risks involved – namely, no graft-versus-host disease, no immunosuppression needed and fewer infections.


TRANSPLANT ALREADY PERFORMED

Siti's stem cells had already been transplanted into her brother at the time of the publication and I do hope that he recovers and tells his story so that others may also know how a matching set of stem cells was critical in making the procedure possible.


StemLife provides stem cell collection and banking from the peripheral blood for healthy individuals and families. We also provide services for patients seeking treatment in collaboration with qualified medical specialists.

Please feel free to call us for a no obligation consultation at +603 2163 8800 or at 012 2050 165. We'd be happy to help.

If you have a twin brother, he can donate his adult stem cells to you

I was reading some of the news that's published on the web (my usual after-dark activity) and came across this very interesting account of a journalist whose brother was diagnosed with multiple myeloma and was called upon to donate his stem cells. It really is rather well documented and very emotional description of what his feelings for his brother, the process that he went through for stem cell harvesting and also the potential huge amounts that would have been spent had he not been able to donate.

Having read his story, I think that the doctors should have banked some of his own for him -whilst he is healthy- just in case he also develops the cancer and requires his own stem cells for a transplant. I've copied the story here in full text, just in case the link goes off-line, and I've also added in my own thoughts in italics just to share with you the experiences we've had at StemLife.

THE STORY:

My brother, Gene Berthelsen, was born at 5:13 p.m. on Oct. 4, 1937. I was born 20 minutes later at 5:33, although it could have been the other way round. We're not sure.

That's because when our mother brought us home from what was then Siskiyou County Hospital in Yreka, and bathed us for the first time, she took the hospital-supplied identification bracelets off both of us. Once finished, she told us decades later, she discovered we were so identical that she couldn't figure out which was which. One of us arbitrarily became Gene and the other John, which was disconcerting. Even though we were separated only by minutes, over the years, as we grew up in the remote mountain town of Etna, near the Oregon border, we developed an older brother-younger brother relationship -- he steadier and more responsible, I more rebellious and immature; he has lived his life in California, I have spent much of mine in Asia. He is also one of Northern California's most prominent traditional jazz musicians. I play CDs on the stereo.

We are monozygotic, or mirror twins. I am left-handed, he is right-handed, a sign that we originated from the same ovum. Because we have suffered almost exactly the same diseases at nearly identical times, when he was stricken with bone marrow cancer last year I was filled with dread. The multiple myeloma he contracted became a foe we both would fight. Our remarkable similarity, we hope, appears to be a key to prolonging my brother's life. This is a story of our unique advantage in battling cancer and the very real danger that what happens to one could happen to the other. Since I live on one side of the planet, he on the other, the fact that we share the same DNA has brought us into more intimate contact with each other than we have known for decades.

In the face of vastly differing diets, climates and lifestyles, our body weight has usually been within a pound of each other. Despite the fact that our careers have separated us by a third of the globe, we remained largely identical for many years -- enough so that once, rounding a corner and unexpectedly encountering a full-length mirror, he asked it what I was doing there. Even after we broke our noses in separate childhood accidents, his curved slightly to the right, mine slightly to the left, maintaining the mirror image. On meeting us together for the first time, his oncologist, Dr. Ginna G. Laport, did a double-take and asked which of us was which, despite the fact that at that point he had lost most of his hair and I am bearded.

In February, I flew from Hong Kong, where I live, to the United States to donate adult stem cells to be injected into him in an attempt to restart his bone marrow production and re-create my immune system in his body. Interestingly, it is also expected to give him any allergies I might have acquired over the years. Thus, whatever physical divergences we have undergone over almost seven decades and wide geographic separation are about to end. We are about to become one again.

The story began on May 27, 2005 when, after complaining for several weeks of what he thought was a severe charley horse, my brother received a chilling diagnosis, multiple myeloma, or cancer of the plasma cells. As the cancer grows, it tends to clump up within the marrow and eat away the bone. He required the immediate insertion of a titanium rod in his left femur within hours. If the operation hadn't taken place, his doctors said, the bone could have disintegrated in an instant simply from walking. Later, cancer also would be discovered in the marrow of his pelvis and rib.

Until fairly recently, a diagnosis of multiple myeloma was almost a death sentence. Even today the survival rate is only three to four years, according to the American Society of Hematology. That was enough to send my own blood racing, not only out of concern for my lifelong doppelganger, but because our medical histories are so similar. In 2002, for instance, when I entered the hospital for a triple bypass operation to clear blocked arteries, he was operated on just three weeks later for the same problem. Could cancer be an inevitable part of my future?

Indeed a very valid question and at StemLife, we provide banking services to enable healthy adult donors to bank their own stem cells for a potential future need, alleviating the daunting prospects of having to hunt for a donor.

Dr. Laport, an oncologist at Stanford University Medical Center Bone Marrow Transplantation Program, says nobody really knows today how much of a role genetics plays. Certainly there is an obvious genetic predisposition among siblings, especially among those who share identical DNA. But, Laport said, unidentified environmental factors play an equally vital role -- or played, probably 20 to 30 years ago -- an irony for us, as my brother spent his life in the relatively clean surroundings of Northern California, while I have spent much of the last three decades in several environmentally degraded Asian countries.

DTR a fellow blogger is extremely concerned about HK's continually degrading environment, check out his blog on this here.

Fortunately, my brother is a member of Kaiser Permanente, one of the biggest health maintenance insurance plans in the United States. Despite controversies over limitations of care to some patients in other areas, Kaiser was willing to pour vast and expensive resources into his care.

For several months, Kaiser doctors sought to control his cancer through chemotherapy, with mixed results. Then, in December, they were elated to discover that he had a twin brother whose DNA was identical. Unfortunately, that brother was 7,000 miles away. Exhaustive physical examinations ensued in Hong Kong, including the drawing of 12 vials of blood to test for such afflictions as AIDS, syphilis and others. I emerged clean and ready for California.

Until relatively recently, close siblings and those who shared identical DNA underwent bone marrow transplants rather than stem cell transplants. Fortunately, that is no longer necessary. Bone marrow donations are excruciatingly painful. The donor is anesthetized while holes are drilled in the back of the pelvic saddle for the extraction of marrow. That pain has largely been eliminated through the substitution of transplanted stem cells for bone marrow.

Bone marrow extraction is quite painful (sometime excruciatingly so) and involved a surgical procedure which can be traumatic to a child or an adult. This procedure is now quite unpopular and many donors have turned down donating their stem cells due to the pain and risks involved. Those who donate their marrow once, very rarely will undergo the procedure a second time.

The common misperception is that stem cells are found only in the nuclei of human ova. The stem cells found in the human ovum are embryonic stem cells, which are even more immature and less differentiated than hematopoietic stem cells, which promote the formation of blood cells. Hematopoetic stem cells are found in the bone marrow of all humans. Over the past 15 years, doctors have discovered that they can increase the production of immature hematopoietic cells by the injection of a hormone called granulocyte colony stimulating factor, known commercially as Neupogen.

If no independent donor can be found, cancer patients donate their own stem cells, which can be manipulated and processed to remove cancer cells, and then transplanted back into the patient. But, according to Adele Ullner, a Stanford Blood and Bone Marrow Center nurse, it is difficult to remove all cancer cells from a stricken patient's cells. Having an independent donor with identical -- but cancer-free DNA -- is far preferable and gives the patient a far better chance for longer remission.

They also have a relatively cheap donor. Finding an independent donor with similar DNA costs about $300,000, about triple the cost of that from an identical twin. The cost for the remainder of his oncological care, including the removal and replacement of his femur, probably ran to another $100,000. Our medical situation is certainly unusual, although we are not particularly rare, since about four of each 1,000 live births result in identical twins, a pattern that seems to have held steady across different ethnic groups for ages. Stanford's cancer program, Ullner said, has been doing marrow transplants for 16 years. To her knowledge, this is the first time an identical twin has been found as a donor.

Neupogen injections to stimulate stem cell production are no picnic. Although often they involve little pain, at odd times they involve pain so acute, Ullner said, that some receiving the shots call the hospital in the belief that they are having heart attacks.

These pains strike at odd times. For me, I was lying in bed watching television. I got up momentarily to discover that every single heartbeat was sending what seemed to be a pulsating electric shock through my body. I was reminded of a time when I was a child on our father's dairy farm and on a dare I touched an electrified cow fence. Painkillers such as Vicodin help, but there are times when even Vicodin doesn't slow those electric shocks. Another possible side effect is an enlarged spleen. (Indeed, those injected with Neupogen are warned not to fly for at least three days after the process because one patient who didn't wait suffered a ruptured spleen while in the air. The 14 1/2-hour flight back to Hong Kong was no place to experiment.)

I wonder what dose of Neupogen was administered, StemLife clients who have been stimulated do not always experience any side effects- perhaps it is because we use a lighter dose.

At the end of the five days comes "apheresis,'' the harvesting of those stimulated cells. It is mainly boring -- sitting in what vaguely resembles a dentist's chair, a tube in the left arm draining off blood, which then runs through a centrifuge that separates out blood stem cells before the remainder of the blood is returned through the right wrist. About 9 ounces of blood is outside one's body at any given time. The blood is chilled before being returned, which for some odd reason makes your nose itch. Over about four hours, the 4,750 cubic centimeters of blood in my body circulated through the centrifuge more than three times, passing 15,045 cubic centimeters through the machine to produce what my brother needed.

The process does indeed take up an afternoon, we usually recommend that donors bring their own DVD's or select from our wide range of entertainment ranging from a 2 hour foot reflexology, amusing conversations with our team members or music to make the time go by effortlessly. All whilst in the care of a very professional team.

I was surprised to discover how much the process had weakened me. On my first trip back to the elliptical trainer, where I usually exercise for an hour, I lasted only 15 minutes before staggering off. It would be weeks back in Hong Kong before I found myself fully recovered.

Interesting, on the contrary, our stem cell bankers return to normal work the very next day. Perhaps it is age? The author is 69 years old. However, our eldest donor is a very jolly 88 year old gentleman who didn't report any exceptional tiredness or side-effects..!

The Stanford Blood and Bone Marrow Center itself, where the procedure took place, is a remarkable institution, seemingly paying as much attention to patients' emotional and spiritual needs as their physical ones. Patients are provided with voluminous information about their afflictions, with complete descriptions of the emotional issues they face both prior to and after recovery, of sadness and depression two to three months after the transplant is completed. Extensive counseling services are provided both to recipients and donors. Gene's doctors at the facility set out to destroy the cancer cells in his bone marrow, and along with it the entire marrow itself, as well as his immune system. In the early years of the program, cancer patients were sequestered in sterile rooms for 100 days, because any contact with any kind of virus would kill them, before regenerated bone marrow cells were injected back into their bodies.

That, thankfully, is no longer necessary. Huge doses of antibiotics allow patients to live relatively normal lives, although they must wear inhalators when outside.

Nonetheless, it is a horrific process. For months, he underwent chemotherapy that cost him his hair and much of his vitality. He was required to drink three liters of water a day to flush out his liver and kidneys. If he didn't, the chemicals could destroy his vital organs.

Then, starting on March 15, the process of destroying the cancer cells accelerated drastically when a cocktail of virulent drugs was injected through a catheter in the center of his chest. The drug also delivered immediate side effects including nausea, vomiting, decreased appetite, diarrhea, fatigue, sores in the mouth and throat, and decreased blood cell counts. Later possible side effects could include sterility, cataracts, hypothyroidism, scarring of the lungs and second malignancies.

High-dose therapy, as it is known, kills all cells that form newly reproducing elements of the body -- not only bone marrow but hair, fingernails, semen, saliva and blood cells that reproduce to fight disease. It results in infertility because of the permanent damage to sperm cells in men and ova in women. In other words, the medical process comes as close as possible to killing the patient in an effort to eradicate the cancer cells.

On March 23, the process continued with the transplant of my DNA into my brother's body to seek to re-create his bone marrow and immune system. The toxicity of the chemotherapy was now so high that he required the constant injection of fluid through a catheter to keep the poisons from destroying his vital organs.

Would he make it? In the cold language of the disclosure statement of the Stanford University medical consent form, if both my DNA and the cells he donated as a backup failed to grow, "then this complication would be expected to result in death."

He ultimately grew so ill that the Stanford doctors became concerned that his body was rejecting my cells. He lost 26 pounds in two weeks, or nearly 15 percent of his body weight. But finally, on April 7, after virtually nonstop vomiting and diarrhea, his white blood cell count started to rise. "Engraftment,'' as his doctors called it, had begun. My cells had been transplanted, prompting a weak joke from him that he had suddenly become left-handed, as I am.

On April 21, he was finally able to return to his Sacramento home, weak, debilitated and raspy-voiced but on the mend. Along with everything else, the chemotherapy had destroyed his ability to produce saliva, making him sound like he had aged 20 years in a matter of weeks. He said he looked more like Uncle Fester of the Munsters than Yul Brynner.

Now, however, he is recovering his old vitality -- along with his hair, which oddly is coming back in different colors. He has regained 13 pounds, although he has continuing neuropathy -- numbness in his hands and feet -- and he is dizzy when he stands too quickly. But tests in mid-July showed that levels of IG (g) protein, an indication of his kidney function in battling myeloma, had fallen to healthy levels, meaning he is now cancer-free.

Ultimately, the process, according to Laport, should dramatically extend his time in remission, at which time other therapies should come into play.

On Sunday, April 30, two weeks after the final process was completed, Gene was able to return to the musical stage at a jazz festival in Jackson, pick up his cornet and front the Catsnjammer Jazz Band, as they have been called for nearly 30 years. He didn't play long, but he played. After all, in the 1920s, jazz cornetist Joe "King" Oliver wrote this song:

Hello central, give me doctor jazz

He's got the thing for me, I'll say he has

So when I'm in trouble and when I've got the blues

He's one who makes me put on both my dancin' shoes.


You saved your brother with your adult stem cells. Thank you for sharing your story. It is so important that more people understand the process of stem cell collection and use in cancer treatment and to know that it really isn't hocus-pocus or useless. Perhaps you might like to come bank your own here with us in KL!

Lupus (SLE) Peripheral Blood Stem Cell Transplant for Texan lady at North Western Memorial Hospital

This article describes a patient by the name of Kim Freeman, who has lived with the disease for 10 years but lupus (SLE*) was taking its toll -attacking all her organ linings- causing her heart and lungs to fail. She seems brave and quite determined (and despite her insurance being unable to cover the costs of treatment) has managed to raise sufficient funds through her own effort plus a little help from her local philanthropists.

Her 5-week treatment involves peripheral blood stem cell mobilization to elicit the generation of new stem cells and immune cells, and to move these new cells from the bone marrow to the bloodstream. These newly generated and disease free stem cells are harvested, processed and banked for a subsequent return in the form of a bone marrow stem cell transplant. Chemotherapy is then administered after the stem cells have been harvested to remove the affected cells from her bloodstream and to wipe out the bone marrow cells to make way for the returning cells (presumably lupus affects the cells later on when they have become mature immune cells). She underwent this procedure on May 9th 2006.

Typical treatments range from drugs and chemotherapy to knock off or sequester the immune cells causing the problem to therapeutic apheresis (blood separation by specialized machine), which removes the cells from the blood circulation. In the worst case scenario where neither of these two techniques work, a stem cell transplant is performed to essentially turn back the bone marrow’s cellular clock to a time before the immune cells developed the wrong function.

In Chicago’s North Western Memorial Hospital, doctors have been steadily refining the protocols of stem cell transplantation for SLE and have successfully treated more than 50 patients. This procedure is still classified as “experimental” as each procedure is tailored to the patient’s given condition at the time and there are no guarantees of success, but for patients who have no other option this may buy them some quality of life back and some hope that their medication and its accompanying side effects can be simultaneously reduced.

It is estimated that 1.5 million Americans suffer from Lupus and I don’t know the figures for Malaysia or Thailand but I know it isn’t rare (but early, accurate diagnosis might still be a problem). At StemLife, we have met quite a number of lupus patients, mostly females in their early twenties whose lives have been almost ruined by the disease and caused grief and constant concern amongst family members.

Most of them seek us out to enquire if a treatment is available to which I’ve responded that the only work I know of is that mentioned in this article in the US. However, I have heard that the Singapore General Hospital has made a decision to treat this condition and have sent doctors to Chicago to learn the procedure. Perhaps these patients will be able to go to nearby Singapore in the near future to have their treatment as the US is awfully far away for these patients to travel.

The article estimates that it will be 6-12 months before we find out if it worked for Kim Freeman, which I hope it does.


If you have lupus and would like to find out about clinical trials for SLE, have a look at their website here.
*SLE = Systemic Lupus Erythmatoses

Isolation of stem cells from peripheral blood for heart disease

Baxter is funding a clinical trial for stem cells isolated from the peripheral vein for re-infusion into the heart vessels. I think this is a convenient way of collecting stem cells and hope that this will study will show good results.

Of course, if the results are positive, this will be a huge way forward for Baxter to sell its machines to a new set of medical centres and expand their services to patients. The costs of apheresis are not small and if the volume of patients undergoing this procedure increases, this could help make prices more affordable all around, including cancer patients who are the primary users of this procedure now.

StemLife collaborating with Doctors for Heart Stem Cell Therapy in Malaysia

I'm delighted to share that one of StemLife's collaborating doctors has announced the preliminary results of stem cell therapy for the failing heart in a local Malaysian newspaper.

Essentially, what we were doing was to marry two existing techniques from different medical applications. The first is angioplasty (common in heart patients, this involves the insertion of a catheter through blood vessels of the heart and using a balloon to open a blocked artery) and the harvesting of stem cells via the peripheral vein known as apheresis, routinely performed in many major hospitals for cancer patient treatment worldwide.

The stem cells which were harvested from a blood vessel in the arm, is then returned to a blood vessel in the heart. The stem cells are capable of forming new blood vessels thus provide better support for the heart muscles. This cell conversion ability is thought to be the reason for improved blood flow and restoration of the heart's pumping action (ejection fraction).

What I'd like to point out though, is that although StemLife is the first stem cell company to facilitate this procedure in Malaysia, this procedure and concept is not our own. We've been following stem cell therapy for the heart since we started and the first news that got us quite interested was this article describing peripheral blood stem cell use in heart damage in a young man.

Now, this procedure has been documented in reknown heart institutions in many countries, and patients with heart disease have another option should their current therapies fail to improve their condition or quality of life. Our work is well placed with the Baxter trial that I mentioned in my previous posting. One last thing, although the procedure is pretty safe, the preparation of the cells is important- at StemLife, we've worked out the protocols and are now ready to offer patients the opportunity to bank and use their stem cells for their heart if they wish to.

The Malaysian Star paper carried a follow up article in today's publication. Our work is just beginning and I'll provide more information as we go along. :)