Fantastic NEWS for MS patients. New hope in the horizon with OWN Peripheral Blood Stem Cells the way StemLife companies around SE Asia have been collecting and storing for the past 9 years. This novel phase US II/III study (click on the title to see the study) confirms what European scientists have been investigating in the past few years with dr Fassas in Northern Greece as one of them. So this study provides one more proof that in Patients with MS, their OWN Stem Cells can be their chance to live a normal life again!
If you wish a comprehensive list on MS, a presentation in pdf form is available after emailing to info@thaistemlife.co.th
Showing posts with label GCSF. Show all posts
Showing posts with label GCSF. Show all posts
Friday, January 30, 2009
Thursday, February 21, 2008
Bioengineering like the movies: Stem Cell Capturing Gadget
I'd hate to sound as if I was brought up on an entertainment diet of Hollywood movies, but back in the 1970's to 80's there was a real revolution in cinematic production and audience interest that led to a cult following of the science fiction genre.
Film directors often take what's probable in science and stretch them to the limits of our imagination, engaging us to just reflect on not only how far we've come but also how much further we can aspire. This next entry is a tribute to the 1987 movie "Inner Space"*.
In a recent announcement, MIT's bioengineers have designed an implantable device that is capable of capturing pure samples of stem cells from the circulating blood. The device is described as "a length of plastic tubing coated with proteins" which has been experimentally implanted into the bloodstream of rats.
The more accurate medical description of this plastic tubing is known as a "shunt" and the method of implantation would most likely involve the severance and reconnection of a small but high through-flow blood vessel. The proteins -known as selectins- attract and trap specific cells with the right signals on the surface (imagine a sticky mat). The cell capture devices are developed by chemical engineers led by Associate Professor Michael King from the Biomedical Engineering department at the University of Rochester. The technical details will be described in the March edition of the British Journal of Hematology.
(personal note: Mr. B.C. this is for you.)
WHY IS THIS DEVICE IMPORTANT?
The medical impact of this device could weigh in for cancer patients who may need to use autologous (one's own) stem cells for their treatment. These cancer patients are treated with chemotherapy to reduce and eliminate as many of the malignant circulating cancer cells as possible from the bloodstream and bone marrow. The treating doctor will collect the patient's own stem cells during this period of remission when the cancer load is at its lowest.
The patient's own stem cells are stimulated using GCSF (read about it here) and the stem cells are harvested and stored in anticipation of the possibility that the cancer cells will multiply again, requiring another round of chemotherapy which may damage the existing healthy marrow further. The collected stem cells will be infused back to the patient to ensure that the patient has sufficient stem cells to repopulate and replenish the marrow, thereby restoring normal cell levels to the bloodstream.
To address the concern that perhaps cancer cells from the patient might also be collected in the same fraction as the healthy stem cells (impossible to distinguish during harvesting) this device could lend a hand to filter out the cancer cells inside or out of the patient's body, i.e. the cancer cells would travel around the bloodstream until they reach the shunt, where they would then be immobilized.
Note though, that the inventors have conceded that this device will not be able to collect enough stem cells for a transplant, therefore the customary stem cell collection procedures will still need to be performed.
SOME INTERESTING STATISTICS
According the A/Prof. King, the shunt placed in an non-GCSF induced rat in a 2 hour period enabled the capture of 3-4 times the number of usual stem cells obtained in normal circulating bloodstream (approx 1%). Hence the device is thought to attract and specifically retain a significantly higher number of stem cells.
This stem cell number could be significantly higher in patients who have been mobilized.
WHAT ELSE CAN IT DO?
Well, it is a concept device which will be as good as its selectin coating. A/Prof. King has already forecasted the use of the device in trapping specific cancer cells in the body to prevent metastatic spread and layering in proteins which could help steer cell development processes by differentiating them while passing through the shunt. (analogy: think sticky mats for dust, sticky mats for cockroaches, sticky mats for cat fur...all requiring different levels of stickiness for its target)
WHEN CAN I BUY IT?
The entrepreneurial A/Prof. King has already started a company by the name of CellTraffix and the anti-metastasis implants are set for animal trials later this year in collaboration with bioengineers Professor Jeffrey Karp and Robert Langer at Harvard and MIT who will develop stable selectin coatings that will last over months than days. Meanwhile, the CEO of CellTraffix, Tom Fitzgerald has already announced that the company's first product for researchers to capture stem cells or cancer cells for lab experimentation will be marketed by early 2009, with clinical testing of the anti-cancer coatings in 2010.
Read how a chance encounter between a bioengineer and a haematology clinician gave rise to this work and watch the cells being captured here (note that you will need a high speed broadband connection as the video files are rather large).
*Why does this remind me of the movie Inner Space I hear you ask... well the term cell capturing device often conjurs up the image of a little machine (like the exploration submersible the protaganist uses) to grab and hold onto cells in circulation :)
Wednesday, August 15, 2007
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.
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.
Tuesday, April 24, 2007
Type 1 Diabetics benefit from Stem Cell Transplantation
If you or one of your family members has diabetes, I'm pretty sure that the recent news on stem cell transplantation providing a cure for Type 1 Diabetes (Type 1 DM) has you sitting upright and your full attention. I've had a lot of positive feedback on this news which has appeared in our newspapers here, from clients asking if this would be a cure resulting in an insulin independent life.
REASON FOR OPTIMISM
I think that the news is very positive and certainly its a start to demonstrating that it may be possible to modulate diseases originating from a malfunctioned immune system through a patient's autologous (own) stem cell transplant. This concept has been tested before, systemic lupus erythmatoses for example is a case which has resulted in patients remaining SLE free after stem cell transplantation. In the case of Type 1 DM, experimental stem cell transplantation conducted previously on mice yielded results which indicated the prevention of the disease.
STEM CELL TRANSPLANTATION
It was based on these results* that the doctors Julio Voltarelli and colleagues from the Regional Blood Center, at the University of Sao Paulo in Brazil decided to initiate the study on how stem cell transplantation might assist in halting the deterioration of pancreatic beta cell function in newly diagnosed patients (patients who have had the disease for a long time may not have any pancreatic beta cells left as the immune system would have destroyed them all).
SOURCE: PATIENT'S OWN ADULT STEM CELLS
The stem cells were the patient's own stem cells, mobilized from their bone marrow to the blood stream where they were collected. Then, they were prepared for transplantation by suppressing their immune system (a form of chemotherapy) and wiping out their existing circulating immune cells. The stem cells were then administered back into their bloodstream. The patients stayed in isolation for 2 weeks, which is a typical length of time for the immune system to kick start (using stem cells from others would have taken more than 2 months to have the same result, barring no rejection issues).
SELECTION IS KEY
I have to tell you that patient selection is key in every trial, as not any one procedure will benefit everyone. Disease, timing and response varies from patient to patient and the trick is trying to find patients with similar symptoms and baseline measurements, but yet with no other organ complications. 15 patients were selected out of 100 initally screened, and took place over almost 3 years between November 2003 and July 2006, with observation up til February this year at the Bone marrow transplantation unit of the School of Medicine at Ribeirao Preto(otherwise known as Brazil's California... nice!).
The patients were monitored and gradually reduced their need for injectable insulin. The interesting and exciting results were that 14 out of 15 patients were insulin-independent for lengths from 1 to 36 months, where the insulin free period was nearly 19 months.
The doctors are wondering whether the effect was due to a reprieve of the immune system on the pancreas (hence allowing the remaining beta cells to regenerate) or whether it was truly due to the immune system modulation, which allowed the pancreas cells to work, but eventually give up (organ under stress).
WHAT IF YOU HAD TO HAVE INJECTIONS EVERY DAY?
Whilst there have been those who have pointed out the lack of a control group, it is clear that at least for a short while, these type 1 DM patients experienced a time when insulin injections weren't a mealtime affair**.
*"Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus."
Júlio C. Voltarelli, Carlos E. B. Couri, Ana B. P. L. Stracieri, Maria C. Oliveira, Daniela A. Moraes, Fabiano Pieroni, Marina Coutinho,Kelen C. R. Malmegrim, Maria C. Foss-Freitas, Belinda P. Simões, Milton C. Foss, Elizabeth Squiers, Richard K. Burt. JAMA. 2007;297:1568-1576. Vol. 297 No. 14, April 11, 2007.
** Quite a lot of us can't bear injections once a year, so compare that to several injections per day. Transplant specialists, get ready for the phonecalls.
ps. I do apologise that I haven't posted for a while... yes it has been really busy here at StemLife (in a good way) :)
REASON FOR OPTIMISM
I think that the news is very positive and certainly its a start to demonstrating that it may be possible to modulate diseases originating from a malfunctioned immune system through a patient's autologous (own) stem cell transplant. This concept has been tested before, systemic lupus erythmatoses for example is a case which has resulted in patients remaining SLE free after stem cell transplantation. In the case of Type 1 DM, experimental stem cell transplantation conducted previously on mice yielded results which indicated the prevention of the disease.
STEM CELL TRANSPLANTATION
It was based on these results* that the doctors Julio Voltarelli and colleagues from the Regional Blood Center, at the University of Sao Paulo in Brazil decided to initiate the study on how stem cell transplantation might assist in halting the deterioration of pancreatic beta cell function in newly diagnosed patients (patients who have had the disease for a long time may not have any pancreatic beta cells left as the immune system would have destroyed them all).
SOURCE: PATIENT'S OWN ADULT STEM CELLS
The stem cells were the patient's own stem cells, mobilized from their bone marrow to the blood stream where they were collected. Then, they were prepared for transplantation by suppressing their immune system (a form of chemotherapy) and wiping out their existing circulating immune cells. The stem cells were then administered back into their bloodstream. The patients stayed in isolation for 2 weeks, which is a typical length of time for the immune system to kick start (using stem cells from others would have taken more than 2 months to have the same result, barring no rejection issues).
SELECTION IS KEY
I have to tell you that patient selection is key in every trial, as not any one procedure will benefit everyone. Disease, timing and response varies from patient to patient and the trick is trying to find patients with similar symptoms and baseline measurements, but yet with no other organ complications. 15 patients were selected out of 100 initally screened, and took place over almost 3 years between November 2003 and July 2006, with observation up til February this year at the Bone marrow transplantation unit of the School of Medicine at Ribeirao Preto(otherwise known as Brazil's California... nice!).
The patients were monitored and gradually reduced their need for injectable insulin. The interesting and exciting results were that 14 out of 15 patients were insulin-independent for lengths from 1 to 36 months, where the insulin free period was nearly 19 months.
The doctors are wondering whether the effect was due to a reprieve of the immune system on the pancreas (hence allowing the remaining beta cells to regenerate) or whether it was truly due to the immune system modulation, which allowed the pancreas cells to work, but eventually give up (organ under stress).
WHAT IF YOU HAD TO HAVE INJECTIONS EVERY DAY?
Whilst there have been those who have pointed out the lack of a control group, it is clear that at least for a short while, these type 1 DM patients experienced a time when insulin injections weren't a mealtime affair**.
*"Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus."
Júlio C. Voltarelli, Carlos E. B. Couri, Ana B. P. L. Stracieri, Maria C. Oliveira, Daniela A. Moraes, Fabiano Pieroni, Marina Coutinho,Kelen C. R. Malmegrim, Maria C. Foss-Freitas, Belinda P. Simões, Milton C. Foss, Elizabeth Squiers, Richard K. Burt. JAMA. 2007;297:1568-1576. Vol. 297 No. 14, April 11, 2007.
** Quite a lot of us can't bear injections once a year, so compare that to several injections per day. Transplant specialists, get ready for the phonecalls.
ps. I do apologise that I haven't posted for a while... yes it has been really busy here at StemLife (in a good way) :)
Friday, October 20, 2006
Adult Stem Cell Therapy for Cardiac Patients in Gujarat, India
I like these kinds of stories because firstly, it shows the forward thinking doctors who are willing to pioneer the concept of stem cell therapy in their geographical location and secondly (more importantly) because their work may have genuinely benefitted the patients.
Essentially, two Gujarati patients aged 35 and 58, Lakshmanbhai Bharwad and Ratanbhai Prajapati respectively, were the first to receive stem cell therapy for their failing hearts. Both patients had poor ejection fractions of 18% and 30% (versus the normal 60-70%), felt exhausted all the time and thus were generally quite unproductive.
The doctors Dr Shalin Thakore together with embryologist Dr Himanshu Patel, of the Krishna Heart and Super Specialty Institute had performed angioplasties for their patients and immediately after diagnosing and widening the relevant blocked arteries, proceeded to mobilize the patient's stem cells and collect them.
The article cites that "About three to four days later, stem cells were cultured into cardiac stem cells and reinjected into the newly reopened arteries via another angiography." I find this rather suspect reporting as I don't think its currently possible to culture and differentiate cells in 3-4 days and identify them morphologically. In any case, the stem cells were re-injected by angiography soon after harvesting.
The patients' ejection rate quite amazingly increased very dramatically, rising from 18% to 45% and 30% to 55% within two months, which is the highest jump that I have ever seen reported.
This rapid increase is unlike any that we've experienced and I am wondering if they are willing to publish their work. One important parameter that is likely to influence the outcome is the number of cells delivered to the injured site and the timing of the delivery.
My questions would be:
How many mobilizing injections did they give?
How many cells did they harvest and use?
How did they measure the ejection fraction? (some equipments are said to be notoriously variable in result)
Does this increase in EF only apply to those who have stem cells within 15 days of the heart attack?
Dr. Thakore's final statement was that this was a one-time procedure but could be repeated in 3 months should the results not meet expectations. Very interesting. I'm waiting to hear if they proceed with more cases and long term follow up.
StemLife currently offers stem cell therapy for cardiac conditions with 2 leading centers in Malaysia, HSC Medical Center and Gleneagles Intan Medical Center and look forward to serving more. Our patients have reported significant symptomatic improvements on 3 and 6 month follow ups.
If you would like to have stem cell therapy for your cardiac condition, please contact us at +6012 2050 165 and we'll be happy to refer you to a doctor or open the dialogue with your doctor in the hospital of your choice.
Friday, October 13, 2006
Adult Stem Cells Help Repair Radiation Damaged Tissue
I was excited to see this news release by the Director of the Clinic for Radiation Therapy as a result of the 25th Annual Congress of the European Society for Therapeutic Radiology and Oncology (ESTRO) held in Germany on the 9th of October.
In a nutshell, adult stem cells when infused after radiation therapy for cancers helps to alleviate the side effects of mucosa (think nasal passages, throat, digestive tracts etc) and skin.
The news release was so clear in its message that I'd like to post it almost in its entirety:
"Stem cell research will have many consequences for various fields of medicine", predicts Catherine Verfaillie, Director of the Stem Cell Institute of the University Leuven (Belgium), in a review lecture during the Presidential Symposium of the ESTRO conference on October 9. For example, stem cells that settle in the organ systems could be stimulated and then repair tissue damage. Radiation therapists have been following this track for some time in various projects that are presented at the ESTRO conference.
Even though the results were obtained in studies on mice, I hope that the radio-oncologists are taking note...!
INTERNATIONAL PROJECT. Rob Coppes of the University Groningen (The Netherlands) presents an EU-sponsored international undertaking at the conference, which is called the "FIRST Project" for short. (FIRST stands for "further improvement of radiotherapy through side effect reduction by stem cell transplantation").
The researchers have discovered that the side effects of a radiation therapy on various healthy tissues, such as skin and mucosa, can be reduced by treatment with adult stem cells. The stem cells migrate to the radiated tissue and support its regeneration. If studies confirm that this stem cell effect also occurs in humans, this would expand the treatment options for tumours because currently valid radiation dosage limits could be surpassed.
For instance, a radiation-biological research team led by Wolfgang Dörr of the Clinic for Radiation Therapy and Radiooncology at the Technical University Dresden reports that adult stem cells can reduce the side effects of radiation therapy on the mouth mucosa in mice. The scientists observed that the radiation tolerance of the mucosa was clearly increased if the animals received a bone marrow transplant prior to or during a fractionated radiation - during which adult stem cells are also transferred practically automatically.
A comparable effect was also observed by the scientists when they lured the stem cells from the bone marrow of the radiated animals into the blood circulation by injecting a growth factor, called G-CSF for short.
MESENCHYMAL STEM CELLS PROTECT. A team led by Dr. Michèle Martin of the Service de Génomique Fonctionnelle from Evry (France) also reports on studies in mice. The researchers had treated the animals with a radiation dose that led to tissue damage of the skin within three weeks. Without treatment, it took eight weeks until this damage had healed. Part of the mice was injected by the researchers with human mesenchymal stem cells 20 hours after the radiation exposure. The stem cells were adult stem cells from, e.g., the bone marrow that can differentiate into fat, cartilage, tendon, skin or muscle cells.
The scientists noted that the skin damage in the treated animals healed faster and better than in the untreated animals. In addition, the scientists examined tissue samples from the damaged skin areas. The stem cells - so the result - had indeed migrated to the radiated skin regions. As Martin reports, their morphology was similar to that of the epithelium.
I have a few friends who are currently undergoing chemo and radiotherapy. If eating and breathing could be made more comfortable, I'm sure they'll want to know about it. I'll tell them about it tomorrow.
Monday, August 07, 2006
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!
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!
Monday, July 03, 2006
Another wonderful Lupus story, patient saved by a stem cell transplant
Since the announcment that stem cell transplants can be performed successfully for lupus at Northwestern University Hospital, it looks like they'll announce each case as they proceed. I think that's a great way to keep everyone up to date.
In this latest story, a patient by the name of Edjuana Ross suffered the serious symptoms of lupus which include immune system failure, severe joint pain, facial scarring, heart damage and three strokes. Her medication of cortisone (steroids) caused her to put on more than 100 pounds which would probably have caused other complications. Her doctor, an immunotherapist by the name of Dr. Richard Burt recommended an adult stem cell transplant to fix her immune system.
Ms. Ross underwent mobilization by GCSF to harvest her stem cells, then chemotherapy to destroy the existing immune system and the transplant by her own stem cells to "reboot" her immune system.
Half the patients who have undergone the procedure are now lupus free and patients like Ms. Ross say that it has changed their life and removed their suffering. She has also slimmed down, which I am sure does a great deal for her own self confidence.
Whilst there are risks to transplantation, like the possibility of infection, or sterility (unable to concieve), with all the suffering that these patients go through, I just wonder why doctors don't start informing their patients about it earlier. If the procedure is well managed (right training and facilities are important) then I think that patients would be happy to know that this is an option to relieve their suffering earlier rather than later.
In this vein, perhaps doctors can find a way to keep re-booting that immune system should it malfunction again. I wonder if Ms. Ross has any stem cells leftover...? She'd be able to re-boot her system back to that date!
If you have lupus or know someone who does and would like to get in touch with the doctor, his contact details are as per below.*
Richard Burt, M.D.
Physician Referral
240 East Ontario St.
Ste 450
Chicago 60611
(312) 926-8400
rburt@northwestern.edu
*I received a letter recently from one of our clients who asked if we had a resource available with information on where stem cell treatments are performed and whom by. From now on, I'll do my best to start putting that down as a reference in this blog.
In this latest story, a patient by the name of Edjuana Ross suffered the serious symptoms of lupus which include immune system failure, severe joint pain, facial scarring, heart damage and three strokes. Her medication of cortisone (steroids) caused her to put on more than 100 pounds which would probably have caused other complications. Her doctor, an immunotherapist by the name of Dr. Richard Burt recommended an adult stem cell transplant to fix her immune system.
Ms. Ross underwent mobilization by GCSF to harvest her stem cells, then chemotherapy to destroy the existing immune system and the transplant by her own stem cells to "reboot" her immune system.
Half the patients who have undergone the procedure are now lupus free and patients like Ms. Ross say that it has changed their life and removed their suffering. She has also slimmed down, which I am sure does a great deal for her own self confidence.
Whilst there are risks to transplantation, like the possibility of infection, or sterility (unable to concieve), with all the suffering that these patients go through, I just wonder why doctors don't start informing their patients about it earlier. If the procedure is well managed (right training and facilities are important) then I think that patients would be happy to know that this is an option to relieve their suffering earlier rather than later.
In this vein, perhaps doctors can find a way to keep re-booting that immune system should it malfunction again. I wonder if Ms. Ross has any stem cells leftover...? She'd be able to re-boot her system back to that date!
If you have lupus or know someone who does and would like to get in touch with the doctor, his contact details are as per below.*
Richard Burt, M.D.
Physician Referral
240 East Ontario St.
Ste 450
Chicago 60611
(312) 926-8400
rburt@northwestern.edu
*I received a letter recently from one of our clients who asked if we had a resource available with information on where stem cell treatments are performed and whom by. From now on, I'll do my best to start putting that down as a reference in this blog.
Monday, June 19, 2006
Mobilized Peripheral Stem Cells for Retina Repair?
A welcome announcement from the researchers at University of Florida earlier in the month on the possibility of using patient's own mobilized bone marrow stem cells in peripheral blood to restore lost retinal pigment epithelium (RPE).
RPE is important as it forms the nourishing outer barrier of the retina and supports the cells that receive light for transmission through our optic nerve to our brain. Essentially, damaged RPE results in macular degeneration (important for fine work and reading) which often happens with age.
Interestingly, scientists were able to establish that RPE cells could replenish naturally in animals that received bone marrow cells. What they did was to use bone marrow stem cells from normal male mice and put them into albino females with acute RPE injuries. The scientists were able to track the male pigment producing cells in the female albino recipients, proof that the stem cells were the reason for regenerating the RPEs.
The interesting part is that the stem cells were able to travel to the site of injury from the blood stream and repair the damaged RPEs which were thought incapable of regeneration in adults.
"The dogma has been that we're born with a fixed amount of RPE, but there is growing evidence retinal progenitor cells exist in the adult," said Lawrence Rizzolo, Ph.D., a Yale University associate professor of anatomy and experimental surgery and of ophthalmology and visual science.
"To derive cells of neuronal lineage from cells of bone-marrow lineage is significant, if the finding stands up to the test of time. Compared to RPE transplantation, there are a lot of advantages if someone's own bone marrow could supply the cells, because it's a ready source and the cells would not be rejected by the patient. Further, if bone-marrow progenitors circulating in the blood could be attracted to sites of disease, surgery could be avoided."
Sight is such an important sense, probably more than smell and likely on par with hearing and touch. If a stem cell infusion could restore RPEs and at least help stop the progress of macular degeneration, this would really be a treatment categorized under anti-aging. Apart from mice, I'm wondering when they'll start enrolling humans into the trial.
RPE is important as it forms the nourishing outer barrier of the retina and supports the cells that receive light for transmission through our optic nerve to our brain. Essentially, damaged RPE results in macular degeneration (important for fine work and reading) which often happens with age.
Interestingly, scientists were able to establish that RPE cells could replenish naturally in animals that received bone marrow cells. What they did was to use bone marrow stem cells from normal male mice and put them into albino females with acute RPE injuries. The scientists were able to track the male pigment producing cells in the female albino recipients, proof that the stem cells were the reason for regenerating the RPEs.
The interesting part is that the stem cells were able to travel to the site of injury from the blood stream and repair the damaged RPEs which were thought incapable of regeneration in adults.
"The dogma has been that we're born with a fixed amount of RPE, but there is growing evidence retinal progenitor cells exist in the adult," said Lawrence Rizzolo, Ph.D., a Yale University associate professor of anatomy and experimental surgery and of ophthalmology and visual science.
"To derive cells of neuronal lineage from cells of bone-marrow lineage is significant, if the finding stands up to the test of time. Compared to RPE transplantation, there are a lot of advantages if someone's own bone marrow could supply the cells, because it's a ready source and the cells would not be rejected by the patient. Further, if bone-marrow progenitors circulating in the blood could be attracted to sites of disease, surgery could be avoided."
Sight is such an important sense, probably more than smell and likely on par with hearing and touch. If a stem cell infusion could restore RPEs and at least help stop the progress of macular degeneration, this would really be a treatment categorized under anti-aging. Apart from mice, I'm wondering when they'll start enrolling humans into the trial.
Wednesday, May 17, 2006
35 year-old Adult Peripheral Stem Cell Donor for Cancer Patient
This is a nice write up on a peripheral stem cell donation and procedure of transplant for a lady (Susan Butcher) with leukemia. It doesn't mention however, how many stem cells she requires from her donor and whether its the donor's first time. Notably though, the donor is young and the stem cells that the patient is receiving are healthy and hopefully will reconstitute her blood system in 2 weeks. Another more detailed article describing her chemotherapy and radiotherapy can be found here.
Sunday, May 07, 2006
Stem Cells Extend Life for Cancer Patient
Check out this nice blog entry by a columnist in the US, Rick Badie. He describes a golfer, Jim Gates who finds out that he has multiple myeloma* and has undergone his own stem cell harvesting (peripheral blood stem cells) at Emory University Hospital and the procedure has helped extend his life for an estimate of 2-6 years. At least this will give him enough time to set his affairs in order and spend precious time with his loved ones, which the most of us often take for granted.
It will be interesting to know if he can undergo a second round of transplantation to extend his life further. Mr. Badie, please keep us informed.
Another interesting stem cell transplant story for Multiple Myeloma where the patient, Brian MacLeod complemented his treatment with a medical combination of east and west, blending chinese acupuncture with herbal remedies. The transplant took place in the year 2000 and he's still fine 6 years after.
*Peripheral Blood Stem Cells Harvesting for Multiple Myeloma is well tolerated in elderly patients of 60 years old and older. A recent study at Mayo Clinic showed that mobilization (where stem cells are generated from the bone marrow into the bloodstream) was successful in 95% of the patients and that statistically there was no difference in treatment outcomes of elderly patients or younger patients with this technique.
It was concluded that elderly patients with intermediate-stage Non Hodgkins Lymphoma or Multiple Myeloma derive benefit from autologous stem cell transplantation, particularly those with a good prognosis.
It will be interesting to know if he can undergo a second round of transplantation to extend his life further. Mr. Badie, please keep us informed.
Another interesting stem cell transplant story for Multiple Myeloma where the patient, Brian MacLeod complemented his treatment with a medical combination of east and west, blending chinese acupuncture with herbal remedies. The transplant took place in the year 2000 and he's still fine 6 years after.
*Peripheral Blood Stem Cells Harvesting for Multiple Myeloma is well tolerated in elderly patients of 60 years old and older. A recent study at Mayo Clinic showed that mobilization (where stem cells are generated from the bone marrow into the bloodstream) was successful in 95% of the patients and that statistically there was no difference in treatment outcomes of elderly patients or younger patients with this technique.
It was concluded that elderly patients with intermediate-stage Non Hodgkins Lymphoma or Multiple Myeloma derive benefit from autologous stem cell transplantation, particularly those with a good prognosis.
Reversing Liver Cirrhosis with Adult Stem Cells
Finally! Some news about adult stem cells for liver cirrhosis. Hammersmith hospital in London has started investigating whether autologous (one's own) peripheral blood stem cells can be used to repopulate and regenerate damaged liver cells. This initial trial was designed as a safety check for the procedure where a small number of stem cells were injected back into the hepatic artery and recovery in function may or may not happen due to insufficient stem cell dose.
Stem cells have already been shown to be useful in regenerating liver cells and 5 patients have received this novel therapy. If it is safe, a bigger trial will be designed to see how much needs to be administered for various stages of liver disease for the procedure to work. If successful, 6000-7000 patients (perhaps more) awaiting a suitable liver donor in the UK may benefit from this procedure.
Patients who may also wish to explore this option as a first line approach, rather than a last resort are those who don't want to undergo an organ transplant and live with immunosuppression drugs for the rest of their lives (click here and scroll about half way down for drug list). The head of liver surgery at Hammersmith conducting the trials, Professor Nagy Habib is already pleased with the initial patient response saying that the patient's blood results were already improving.
Potential liver patients in Asia:
In Malaysia, I couldn't find exact statistics for liver disease but it is estimated to be about 34,000. A significant contributor to the disease is alcohol consumption and viral hepatitis. In a 1990 study by doctors at Universiti Kebangsaan in a KL hospital documented that 36% of liver cirrhosis was due to alcohol (largely Indian patients) with male:female ratio of 4.4:1.
Thailand is estimated to have more than 95,000 patients suffering from liver disease as viral hepatitis is known to be high.
Prof Nagy, I hope you succeed in this safety trial and move on to ascertaining dose and number of administrations required. StemLife offers peripheral blood stem cell banking services in Malaysia and Thailand (we do so for patients requiring stem cells for oncology and cardiac applications) and we have many patients in the Far East who I am quite certain have already waited a long time for a donor liver, but unable to obtain one. I look forward to your updates :)
Tuesday, April 04, 2006
A 2nd Stem Cell Transplant, and a Chance at Life
A very nice story written from Oregon about a young lady only 22 years of age who needs a stem cell transplant. Amelia Worth was first diagnosed with Acute Myeloid Leukemia (AML, same condition that Angel was diagnosed with) in 2003. After chemotherapy and radiation treatments, she had her own stem cells harvested (adult stem cells, peripheral blood) and transplanted this into her own marrow. The transplant worked and she went into remission in Feb 2004. Unfortunately, in mid 2005, her condition deteriorated and she was diagnosed with myelodysplastic syndrome (MDS), which caused her bone marrow to stop producing blood cells effectively.
“The best donor would be a sibling, but I'm an only child,” Amelia Worth said. “So now we're trying to match my genetic markers with one of the seven potential donors my doctors have found.”
MDS is considered a pre-cursor to leukemia, which is why many of the symptoms are the same, but if she has a transplant and her body begins to produce blood cells more effectively, she could remain in remission. If the transplant doesn't work, or if she comes down with host-versus-graft disease (with someone else's stem cells), she could die. The situation is dire for most AML patients who develop MDS, and Amelia's doctors say her chance of survival is now about 19.8 percent.
Stem cell transplants are expensive procedures and the first transplant she went through used up most of her insurance money. Her friend who was suffering from leukemia came forward to pay for a new insurance policy before she died, which enabled Amelia to cover most of the medical costs for the second transplant. However, obtaining a matching stem cell unit is expensive and this cost is not covered by insurance.
“We're paying $1,500 for each test for a possible donor,” said the mother of the patient, Patricia Worth. (Cost of matching amongst 7 potential donors is 7x1500= USD 10,500!)
The biggest cost is the transplant, which alone has a price tag more than $500,000 at Oregon Health and Science University hospital in Portland. While their insurance, Blue Cross, will pay a great portion of the transplant cost, the Worths will be facing bills for around 20 percent of all medical costs, or for tests, procedures and consultations that aren't covered under the insurance policy.
I hope Amelia Worth finds a good match and makes it through her second transplant. She has a long way ahead of her.
“The best donor would be a sibling, but I'm an only child,” Amelia Worth said. “So now we're trying to match my genetic markers with one of the seven potential donors my doctors have found.”
MDS is considered a pre-cursor to leukemia, which is why many of the symptoms are the same, but if she has a transplant and her body begins to produce blood cells more effectively, she could remain in remission. If the transplant doesn't work, or if she comes down with host-versus-graft disease (with someone else's stem cells), she could die. The situation is dire for most AML patients who develop MDS, and Amelia's doctors say her chance of survival is now about 19.8 percent.
Stem cell transplants are expensive procedures and the first transplant she went through used up most of her insurance money. Her friend who was suffering from leukemia came forward to pay for a new insurance policy before she died, which enabled Amelia to cover most of the medical costs for the second transplant. However, obtaining a matching stem cell unit is expensive and this cost is not covered by insurance.
“We're paying $1,500 for each test for a possible donor,” said the mother of the patient, Patricia Worth. (Cost of matching amongst 7 potential donors is 7x1500= USD 10,500!)
The biggest cost is the transplant, which alone has a price tag more than $500,000 at Oregon Health and Science University hospital in Portland. While their insurance, Blue Cross, will pay a great portion of the transplant cost, the Worths will be facing bills for around 20 percent of all medical costs, or for tests, procedures and consultations that aren't covered under the insurance policy.
I hope Amelia Worth finds a good match and makes it through her second transplant. She has a long way ahead of her.
Monday, April 03, 2006
StemLife attends Cord Blood Transplantation Conference in Biopolis, Singapore (3)
Sorry to break this up into 3 posts, its just easier to manage my thoughts whilst looking through my notes. There's much more detail but I'm summarizing the points which I feel are particularly relevant and important to StemLife.
On the 2nd day of the conference, the discussion moved onto expansion (increase in numbers) of umbilical cord blood stem cells. One of the major challenges in cord blood banking is having sufficient cell numbers to support larger adult patients. Prof. EJ Shpall joked that in Texas (where she works), the average weight of a typical patient ranges from 80- 100 Kg, almost one and a half times of what the average weight is in Asia. Thus, a transplant based on cell count and patient weight would "weigh" in at a disadvantage for those on the heavier side of the scale. Everyone agreed that if this challenge could be overcome, umbilical cord blood stem cell transplants for adults would be on prime time.
The 2 ways of improving engraftment from a cord blood stem cell unit:
A) Increase cell number by amplification of the necessary cells
B) Improve immunosuppression methods and achieve engraftment through better understanding of myeoablation and marrow interaction.
(A) was covered in extensive detail by Viacell's Dr. Michael Choi, Prof. Ian McNiece and Prof. EJ Shpall. (B) was described in some detail by Dr. Ping Law but much research is still in progress. In this entry, I will focus on (A).
Dr. Choi described the isolation and attempt at expansion of a rare stem cell known as the Unrestricted Somatic Stem Cell (USSC). These stem cells he said were found in extremely small numbers in cord blood and had multipotential capability of forming other tissue types. In addition, USSC's are also thought to require less immunosuppression and thus may be suitable for use in other individuals. Viacell plans to make this form of cellular medicine available to its 65,000 strong client base and others needing the service.
Prof. McNiece dug deep into the scientific detail of his experiments explaining the different cocktails of growth factors and stimulants he used to encourage the stem cells to grow. First of all, he starts off with 2 cord blood stem cell units. Let's name them UCB1 and UCB2. The outline of the experiment was to thaw UCB1, pass the cells through an automated machine (Clinimacs) which selects of a specific type of stem cell that he want to investigate, grow the stem cells in culture between 7x to 18x which may take a few weeks. When the cells have reached the desired numbers, UCB2 is thawed and both the expanded culture plus the uncultured unit are co-infused into the patient. To ensure that the patient's immune system recovers, GCSF is administered post transplant.
Essentially, stem cells take about a week to get to confluency (uniform growth to layer the entire surface of one flask, but several flasks are needed to get adequate cell numbers) and the McNeice method describes using only 10% of the cord blood unit as a seed culture.
In another experiment, 3 stem cell units were involved. Bone marrow, UCB1 and UCB2. Bone marrow was harvested and combined with a thawed UCB1. This combination was then selected for stem cells, expanded ex-vivo for 14 days which yielded between 7x-24x expansion. The patient was given the necessary high dose chemotherapy prior to the transplant and the cultured cells was infused together with a thawed UCB2. Additionally, the patient was given GCSF to ensure no lack of immune cells and to ensure the cultured cell survival in the body.
What are the problems with the existing method?
(1) Expansion numbers still cannot be well controlled or predicted- the range is very variable between 2x, 5x to 18x depending on the type of cells you're after.
(2) Cord blood units contain a type of stem cell known as CD34+. Upon thawing, the cells can be found in the unit. However, after a selection procedure, the total count can DECREASE by 400x! This may be very problematic for transplants as patients need the supporting cells as well.
(3) Thus far, all expanded products have used serum derived from animal sources (provides the nutrition for the cells to grow) and there is a concern about applying animal products in human use. However, a medium derived from human sources has yet to be developed which can provide the same growth support in the lab.
Prof. EJ Shpall's talk discussed the clinical aspects of transplanting ex-vivo expanded cord blood stem cells in the "University of Colarado Cord Expansion Trial" where they were trying to improve time to engraftment and to reduce the graft failure rate in patients. The study recruited 40 hematologic malignancies (blood cancers) and 3 breast cancer patients. The key difference from the studies mentioned before is that in this study, the CD34+ cells were selected out from the UCB unit, expanded in culture and then re-infused to the patient with the remainder of the UCB unit. This means that its the same as a UCB transplant except that specifically selected stem cells would be greater in number. The conclusion from the study was that it is feasible and suitable for adults.
Prof. Shpall's team also collaborates with Prof. McNiece's team (they have been doing so for a decade) and now both parties are also collaborating with Viacell to do the research in Singapore on expanded cord blood stem cell units for transplantation.
What's the final take on stem cell expansion? It's possible, but not yet well defined in protocol, cell yield or patient recovery. Many patients didn't make it through the procedure well (but in early stages of medical development, this is expected). And, no one has dared to breathe a price tag on it, because the culture methods are expensive and customized to each patient (Clinimacs selection sorters are also very pricey). More work needs to be done before this technology can be effectively commercialised for supporting stem cell transplants worldwide.
Until then, every cord blood stem cell unit collected must be maximised for numbers. The first step of collection is still fundamentally important, and if cell expansion succeeds, the benefit to patients will be even greater.
On the 2nd day of the conference, the discussion moved onto expansion (increase in numbers) of umbilical cord blood stem cells. One of the major challenges in cord blood banking is having sufficient cell numbers to support larger adult patients. Prof. EJ Shpall joked that in Texas (where she works), the average weight of a typical patient ranges from 80- 100 Kg, almost one and a half times of what the average weight is in Asia. Thus, a transplant based on cell count and patient weight would "weigh" in at a disadvantage for those on the heavier side of the scale. Everyone agreed that if this challenge could be overcome, umbilical cord blood stem cell transplants for adults would be on prime time.
The 2 ways of improving engraftment from a cord blood stem cell unit:
A) Increase cell number by amplification of the necessary cells
B) Improve immunosuppression methods and achieve engraftment through better understanding of myeoablation and marrow interaction.
(A) was covered in extensive detail by Viacell's Dr. Michael Choi, Prof. Ian McNiece and Prof. EJ Shpall. (B) was described in some detail by Dr. Ping Law but much research is still in progress. In this entry, I will focus on (A).
Dr. Choi described the isolation and attempt at expansion of a rare stem cell known as the Unrestricted Somatic Stem Cell (USSC). These stem cells he said were found in extremely small numbers in cord blood and had multipotential capability of forming other tissue types. In addition, USSC's are also thought to require less immunosuppression and thus may be suitable for use in other individuals. Viacell plans to make this form of cellular medicine available to its 65,000 strong client base and others needing the service.
Prof. McNiece dug deep into the scientific detail of his experiments explaining the different cocktails of growth factors and stimulants he used to encourage the stem cells to grow. First of all, he starts off with 2 cord blood stem cell units. Let's name them UCB1 and UCB2. The outline of the experiment was to thaw UCB1, pass the cells through an automated machine (Clinimacs) which selects of a specific type of stem cell that he want to investigate, grow the stem cells in culture between 7x to 18x which may take a few weeks. When the cells have reached the desired numbers, UCB2 is thawed and both the expanded culture plus the uncultured unit are co-infused into the patient. To ensure that the patient's immune system recovers, GCSF is administered post transplant.
Essentially, stem cells take about a week to get to confluency (uniform growth to layer the entire surface of one flask, but several flasks are needed to get adequate cell numbers) and the McNeice method describes using only 10% of the cord blood unit as a seed culture.
In another experiment, 3 stem cell units were involved. Bone marrow, UCB1 and UCB2. Bone marrow was harvested and combined with a thawed UCB1. This combination was then selected for stem cells, expanded ex-vivo for 14 days which yielded between 7x-24x expansion. The patient was given the necessary high dose chemotherapy prior to the transplant and the cultured cells was infused together with a thawed UCB2. Additionally, the patient was given GCSF to ensure no lack of immune cells and to ensure the cultured cell survival in the body.
What are the problems with the existing method?
(1) Expansion numbers still cannot be well controlled or predicted- the range is very variable between 2x, 5x to 18x depending on the type of cells you're after.
(2) Cord blood units contain a type of stem cell known as CD34+. Upon thawing, the cells can be found in the unit. However, after a selection procedure, the total count can DECREASE by 400x! This may be very problematic for transplants as patients need the supporting cells as well.
(3) Thus far, all expanded products have used serum derived from animal sources (provides the nutrition for the cells to grow) and there is a concern about applying animal products in human use. However, a medium derived from human sources has yet to be developed which can provide the same growth support in the lab.
Prof. EJ Shpall's talk discussed the clinical aspects of transplanting ex-vivo expanded cord blood stem cells in the "University of Colarado Cord Expansion Trial" where they were trying to improve time to engraftment and to reduce the graft failure rate in patients. The study recruited 40 hematologic malignancies (blood cancers) and 3 breast cancer patients. The key difference from the studies mentioned before is that in this study, the CD34+ cells were selected out from the UCB unit, expanded in culture and then re-infused to the patient with the remainder of the UCB unit. This means that its the same as a UCB transplant except that specifically selected stem cells would be greater in number. The conclusion from the study was that it is feasible and suitable for adults.
Prof. Shpall's team also collaborates with Prof. McNiece's team (they have been doing so for a decade) and now both parties are also collaborating with Viacell to do the research in Singapore on expanded cord blood stem cell units for transplantation.
What's the final take on stem cell expansion? It's possible, but not yet well defined in protocol, cell yield or patient recovery. Many patients didn't make it through the procedure well (but in early stages of medical development, this is expected). And, no one has dared to breathe a price tag on it, because the culture methods are expensive and customized to each patient (Clinimacs selection sorters are also very pricey). More work needs to be done before this technology can be effectively commercialised for supporting stem cell transplants worldwide.
Until then, every cord blood stem cell unit collected must be maximised for numbers. The first step of collection is still fundamentally important, and if cell expansion succeeds, the benefit to patients will be even greater.
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