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Umbilical Cord Blood Helps Fight a Cancer

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Duke Health News 919-660-1306

DURHAM, N.C. -- Gayle Serls didn't know she was dying until she woke up one day and discovered lumps everywhere. All her lymph nodes were grossly enlarged and she soon found out they were engorged with masses of sick immune cells rapidly dividing and multiplying. She went to the hospital in August 1995 and came home with a diagnosis: "Yesterday I was fine. Today I have cancer." What she specifically had was acute lymphocytic leukemia, which, true to Serls' words, comes on suddenly like a speeding train that might just run you over. The bone marrow cells that normally develop into immune system fighters called lymphocytes become cancerous and replace normal cells. These white blood cells had no place to go but clog up in her lymph nodes. Likely, some of the cancerous cells were released into the bloodstream and transported to vital organs. Serls faced immediate treatment with chemotherapy.

But there were more unpleasant surprises in store for this Durham mother of two. Although the disease went into a brief remission, doctors at Duke University Medical Center determined she had a particular set of genes, dubbed the "Philadelphia chromosome," resistant to chemotherapy used for the disease. That guaranteed a relapse.

Now Serls was faced with the last option available to her: a bone marrow transplant. In this procedure, all of her cancerous white blood cells would be destroyed with high-dose chemotherapy and radiation. Her dead marrow would be removed, then replaced with marrow from a donor who had the same "immunity fingerprint" – the combination of HLA antigens that helps a body determine which is self and which is an invader. But another setback occurred. No donor marrow matched her profile, nor was there compatibility with her children's blood.

Serls then relapsed, massively. She was admitted to Duke Hospital, and underwent high-dose chemotherapy in an effort to buy time. She couldn't see because inflammation swelled her eyes shut and she was in terrible pain, for which she needed morphine. Her fatigue was profound. She made preparations for dying, such as a will and signing a power of attorney, but she didn't see death as "an option. It was totally incomprehensible. I continued to fight."

Duke physicians then turned to a procedure that had been successful with sick children, but was not tested in adult clinical trials. They decided to give Serls the marrow taken from a baby's umbilical cord, a small bag of fluid chock-full of new life. This placental blood is "friendly" to strangers -- it can be used when HLA types are 50 percent matched, as Serls' was, or even less.

But Serls wasn't small, like a child, and physicians were not sure that adults could be served by a single dose of the cord blood. She stood 6 feet tall and weighed 135 pounds. There was no other choice. In May 1996, Serls underwent seven days of treatment with total body irradiation and three days of intense chemotherapy. When her lymph system was wiped clean, Serls received the baby blood. What followed was "real drama," she remembers, the time spent waiting in a "clean room" while microscopic predators normally held in check within the body went wild. But her white blood cell count began to creep up, and she let herself believe that a substance normally discarded after birth had saved her life.

After seven weeks in the hospital, she went home, and learned to give herself shots and administer intravenous fluids. Serls' fatigue slowly ebbed and she realized in August 1997 that, two years after the onset, she began to feel like her old self. In the year 2000, five years after cancer attacked her, she will, technically, be able to call herself a "survivor."

Serls is one of 22 adults who have received cord blood at Duke. There are only a few academic medical centers in the country that have even tried to use the therapy on adults, and Duke has done the most.

Now, Serls can't help but think about the baby whose stem cells restored her. She says she has boy blood now – that's all she knows about the donor – and she playfully points out that different heritage. "My hair came back a lot darker, and curlier at first," she says.

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