Sunday, February 24, 2008 E-mail this | Print page
Adult stem cells offer hope for gravely ill
By Laura Ungar
lungar@courier-journal.com
The Courier-Journal
Caryn Morris leaned forward on a hospital bed with her head in her
hands, the hair from her brunette wig hanging down over her face as
chemotherapy medication dripped into her body.
For the second time in nine years, the 36-year-old Louisville woman
is fighting a rare and potentially deadly illness called Castleman
Disease, an overgrowth of the lymph nodes similar to lymphoma.
Chemotherapy is part of her preparation for a stem-cell transplant at
the University of Kentucky that will use cells from her own bone
marrow.
"This is a way for us to get rid of this, so she can get on with
life," said her mother, Alice Jones, sitting beside her in a small
chemotherapy room at Consultants in Blood Disorders and Cancer in
Louisville.
Jones and Morris are putting their hopes on one of the most promising
areas of medical research and treatment -- stem cells, which can
divide and renew themselves for long periods and become different
types of cells within the body.
Therapies using adult stem cells are being used to treat a growing
list of diseases, such as leukemia, neuroblastoma and sickle cell
anemia. Researchers also are looking at using them to treat
autoimmune disorders such as multiple sclerosis.
Adult stem cells are different from the controversial embryonic cells
that have not been used in treatments. Some people hope embryonic
stem-cell research, which involves the destruction of human embryos,
will someday lead to more cures, while others believe using them
destroys human life.
Many people see stem cells as potential miracle cures. Doctors won't
go that far, but they do say that current stem-cell therapy
represents the best hope for many patients.
Dr. Roger Herzig, director of blood- and bone-marrow transplants at
the University of Louisville's James Graham Brown Cancer Center, said
about 100 people in the Louisville region receive stem-cell
transplants each year.
"It can turn an incurable disease into a curable disease," he
said. "And it can take people who have essentially no chance for cure
and give them a 20 percent chance for a cure."
Morris said she hopes to be one of lucky ones.
"We're going to see this through," she said. "We did it before and
we're going to do it again."
FIrst signs of trouble
The first sign that something was wrong came in 1999, when Morris
developed unexplained high blood pressure and the whites of her eyes
began to swell. Eventually she became so short of breath she had to
rock back and forth to breathe normally.
Doctors couldn't figure out what was wrong, and she eventually was
hospitalized with congestive heart failure.
Then, one Sunday in 2001, she woke up with her neck so swollen it
looked like a double chin that reached down to her chest.
Doctors did more tests and told her she most likely had lymphoma, a
cancer. At Mayo Clinic in Arizona, she finally was diagnosed with a
systemic form of Castleman Disease, which acts like cancer, affecting
groups of lymph nodes and lymphoid tissue.
Doctors don't know exactly how many people have the disease, but the
National Institutes of Health classifies it as rare, striking fewer
than 200,000 Americans. Consequently, there's no accepted protocol
for treatment.
"I was happy they finally had something," said Morris, who works in
finance at Papa John's. "But I was scared because doctors don't know
that much about it."
Doctors gave her interferon shots, then a chemotherapy regimen.
Morris, who always loved having pretty hair, asked her then-
boyfriend, Rob Morris, to shave her head so she didn't have to watch
it fall out in clumps. He shaved his, too.
Jones, 76, and Morris' aunt accompanied her to almost all of her
doctors' appointments and treatments, bonding over shopping and
restaurant meals afterward and jokingly calling
themselves "princess," "queen" and "court jester."
They tried to make her forget that she was putting her life on hold --
delaying marriage plans with Rob because she was so sick.
In 2003, Morris was pronounced in remission. Her hair grew back; she
began feeling normal again. She married Rob in 2005.
Then, last September, she found a swollen lymph node in her neck.
Again, she put plans on hold, interrupting her classes at Sullivan
University, where she had hoped to earn a bachelor's degree.
She had one word for how she felt: "Devastated."
She began chemotherapy again, this time receiving a lymphoma drug
called Rituxan in preparation for the stem-cell transplant.
One of her physicians, hematologist and oncologist Dr. Nicholas Code
of Louisville, said stem cells from her bone marrow, which can make
all types of blood cells, will be removed and frozen, allowing her to
get chemotherapy at a much higher dose than otherwise possible.
Then doctors will put the stem cells back into her body to "rescue"
her from the effects of the therapy.
Such transplants can cost more than $100,000, and Morris is appealing
a recent decision by her health insurer, Anthem Blue Cross Blue
Shield, denying payment. Anthem officials wouldn't comment on her
case but said members can appeal denials through internal and
external medical review.
Morris' secondary insurer has approved the transplant, however, and
she's hoping to get it soon.
"She is so young, we are trying to be as aggressive as possible,"
Code said.
Donor stem cells
Morris' case represents one way to treat disease with adult stem
cells. Another is to collect them from a donor.
That's more risky, and Morris' doctors are reserving it as a second
option if the transplant using her own cells doesn't cure the
disease.
Using a donor's cells has the benefit of conferring a healthy
person's immunity. But it's limited by the possibility of rejection
and the fact that donors and recipients must be a perfect genetic
match.
"The key is to make it safe enough, and we're getting close to that,"
said Dr. Suzanne T. Ildstad, director of the Institute for Cellular
Therapeutics at the University of Louisville.
Ildstad is known for discovering a cell that allows bone marrow to be
transplanted from one person to another without rejection. If such
transplants become routine, they could treat conditions such as
lupus, diabetes and Crohn's disease.
Researchers also talk about using adult stem cells for "regenerative
repair," regrowing damaged or missing tissue -- an area Ildstad said
is "still in its infancy."
A team of U of L researchers led by Dr. Mariusz Ratjaczak is among
several across the nation studying such possibilities.
Team members announced in late 2005 that they had coaxed stem cells
from adult mice to change into brain, nerve, heart and pancreatic
cells. Ratjaczak called these stem cells, from adult mouse bone
marrow, "a counterpart for embryonic stem cells."
In 2001, citing ethical concerns about the destruction of embryos,
President Bush restricted federal funding of research to existing
lines of embryonic stem cells.
While many Americans support that decision, others urge such funding,
saying embryonic stem cells hold the best potential for medical
research and should be allowed as another option.
Ratjaczak said he hopes his discovery and similar ones involving
adult stem cells eventually could "negate the ethical concerns."
Although treatments are most likely many years off, the research
holds promise for such conditions as heart disease, stroke and
Parkinson's disease.
Jones, who has been reading up on stem cells ever since learning
Morris needed a transplant, said she's intrigued by the
possibilities. But most of all, she's thankful for the promise stem
cells offer her daughter.
"We've been up the mountain. We've been down in the valley," Jones
said. "We are so excited to see the end of this."
Reporter Laura Ungar can be reached at (502) 582-7190.
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