|Dr. Randy Wada
Hawai'i Cord Blood Bank Medical Director
If a little bit is good and more is better, then too much is just right.
This is how we explain the rationale for hematopoietic stem cell (bone marrow) transplant to our pediatric cancer patients and their parents.
Transplant is “too much.” When the cancer seems responsive to regular doses of anti-cancer drugs, our strategy is to give really high doses of these drugs, possibly with the addition of radiation. The intent is to kill every last cancer cell… even those that were resistant to lesser doses.
The problem is that we also end up wiping out normal cells in the bone marrow called stem cells. These special cells renew the body’s supply of circulating blood cells that carry oxygen, fight infection, and stop bleeding. Without them, the patient would die, even if the cancer was eliminated. To get around this we have to rescue the patient by transplanting a fresh supply of stem cells, usually from a healthy matching donor.
Stem cell transplant is very intense therapy reserved for the most aggressive forms of leukemia, lymphoma, and other cancers. Transplant patients face significant risks of both short and long term toxicity, including the possibility of death. Even so, patients and families rarely decline this option once it is offered, since in most cases transplant is their last, best, and only hope for cure.
Unfortunately just a third of all patients needing a transplant have an appropriately matched related donor. Until recently, the sole alternative for the rest was in registries of adult volunteers who are willing to donate bone marrow or blood stem cells to perfect strangers. While there are over seven million of these wonderful donors in the United States alone (including over 66,000 in the Hawaii Bone Marrow Donor Registry), the racial and ethnic diversity of our local patients continues to pose a special challenge to finding matches. All too frequently we come up empty handed, with heartbreaking consequences for our patients, their families, and the medical team. It is one thing for a patient to decline a transplant because it seems too risky. It is another thing all together to tell them that they don’t even have a choice.
HCBB was founded with the goal of reducing the number of these sad conversations. The blood left over in a newborn baby’s umbilical cord contains the same kind of stem cells as bone marrow. After the baby is delivered and the cord is cut, this blood can be collected and the stem cells processed and frozen. Stored cord blood stem cells last for decades. If matched, they can be made available to any patient, anywhere, any time. Cord blood stem cells are more forgiving than those from bone marrow. They don’t have to match the patient as closely, and yet can give equivalent or perhaps better results than bone marrow. This makes it especially attractive for hard to match patients such as ours. Partially matched cord blood from two different donors can even be combined to transplant a larger adult patient. In the past year, cord blood surpassed bone marrow as a stem cell source for unrelated donor transplants in the United States, allowing many more patients to undergo transplant.
There is no charge to donate cord blood, and the process is quick, painless, and risk free. What better way to celebrate a baby’s birth than to give someone else a second chance at life? The placenta and umbilical cord are most often discarded. Through HCBB these can be recycled and turned into Hope.
Since its inception, HCBB has benefited from the Aloha of thousands of local families who chose to donate their babies’ cord blood; of over a hundred local physicians and countless more nurses who donate their time and expertise to do the collections; of generous supporters such as Emily Castle, Elizabeth Sturges, the Gamar Foundation, and the Alana Dung Research Foundation; of local hospitals which donate facilities and space; and of the Blood Bank of Hawaii which provides logistical and laboratory support.
In turn, we have shared this Aloha with the rest of the world in the form of readily available units of cord blood stem cells. These serve as a testament to our Island-born belief that we are all tied together by a common welfare. This sense of shared destiny underlies the Aloha spirit that blesses our local culture. And with Aloha, like transplant, too much is just right.