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  The Evolution of an Ethicist  
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  Science and Politics Collide on Stem Cell Research  
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  Building Upon Our Strengths  
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FEATURES
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BONE MARROW PROGRAM MATURES INTO STEM CELL TREATMENT, RESEARCH

"" PHOTO — UC Davis hematologists Douglas
Taylor and Carol Richman direct the institution's pediatric and adult Hematopoietic Stem Cell Transplant programs.
 
UC Davis hematologists Douglas Taylor and Carol Richman direct the institution's pediatric and adult Hematopoietic Stem Cell Transplant programs.
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Earlier this year, a young man was the first adult to receive a cord blood transplant at UC Davis Health System. The milestone passed quietly but it marks a significant step in the changing face of bone marrow transplant medicine. Like most people currently receiving bone marrow transplants, he suffered from leukemia. Yet, unlike most recipients, he received life-giving stem cells from the umbilical cords of two unrelated donors. Bone marrow was not involved.

Bone marrow transplants have changed so much that UC Davis' own program – once called the Bone Marrow Transplant Program – is now called the Hematopoietic Stem Cell Transplant Program. The name reflects future treatments that will emerge from current laboratory research, says Carol Richman, professor of internal medicine, hematology and oncology, and director of the program.

"The kinds of diseases and the treatment options that are becoming available are gradually increasing the number of people who can benefit from hematopoietic stem cell transplants," Richman says. Hematopoietic cells give rise to the different types of blood cells in the body.

First program in region

UC Davis' program performed the region's first adult bone marrow transplant in 1993. Since then, the program has expanded to include children and is the largest and most experienced of its kind in inland Northern California. Last year, about 40 adult hematopoietic stem cell transplants were performed, while 10 transplant recipients were children.

Douglas Taylor, associate professor of pediatrics, is director of the pediatric portion of the program.

"I think a combined adult-pediatric program allows interaction and cross-fertilization that better informs all transplants," he says.

The program's growth in both number of patients treated and range of services is largely due to four factors, Richman says.

  • The center holds the sole designation for the region as a National Marrow Donor Program (NMDP) Transplant Center, giving UC Davis patients access to nearly 5.5 million registered donors, as well as 40,000 units of donated cord blood. The NMDP serves an estimated 20,000 patients a year.

  • Cord blood, the newest source of hematopoietic stem cells used in bone marrow transplants, has expanded the options for patients in need of transplants. The blood from umbilical cords, which contains a high concentration of hematopoietic stem cells, is collected, frozen and stored in banks for later use. Richman predicts the future will bring an increase in cord blood transplants, although the practice of banking cord blood has yet to become widespread.

    Traditionally, hematopoietic cells were retrieved either from bone marrow or peripheral (circulating) blood in a person serving as his or her own donor, called an autologous transplant, or from bone marrow or peripheral blood from another person, related or unrelated, called an allogeneic transplant.

    Most patients in need of hematopoietic stem cells have cancer, or malignancy, of the blood. Leukemia and lymphoma have long been treated with bone marrow transplants. Bone marrow, which replenishes the various types of blood cells in the body, is necessary to fight infection and carry on normal human bodily functions.

  • Improved transplant techniques also have allowed the UC Davis program to grow, Richman says. That's because, in addition to national affiliation and the availability of cord blood, more people are candidates for transplants due to improved transplant techniques, better medication and supportive care. "In the past, patients had to be able to withstand the rigors of high-dose therapy. Now, we are able to use lower doses and still get the cells from the donor to take," Richman says.

  • Blood stem cell transplants are also beginning to be used for treating diseases other than malignancy. "The safety of transplants has been improving with time, and transplants can now be offered for a wider range of conditions and diseases," Taylor explains. The UC Davis program treats malignancies of the blood as well as other cancers, such as pediatric brain tumors, whose bone marrow must be rescued after high-dose chemotherapy. Among the diseases researchers are working on treating with hematopoietic stem cell transplants are sickle cell anemia, thalassemia and various autoimmune disorders, such as lupus.

A boost for research

The expansion of the program has allowed it to become more self-sufficient. In 2005, the program established its own facilities for harvesting and processing donated cells. This not only cuts costs by eliminating the need for the use of a commercial facility, but it opens up all kinds of research possibilities, Taylor says. "Because hematopoietic stem cells are processed and stored here at the university, many of them will be available for research and will permit more rapid translation of basic research to patient care," Taylor predicts.

Though Richman has seen the field of hematopoietic stem cell transplant grow and change over her 30-year career, she believes scientists are just beginning to realize the full potential of stem cells to treat human disease. She and Taylor are both excited about being a part of the stem cell program at UC Davis.

"We're going to have new scientists at UC Davis developing a broader understanding of ways that we can use stem cells for regeneration," Richman says. "We'll be involved in helping to translate that work into clinical practice."

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  "We're going to have new scientists at UC Davis developing a broader  understanding of ways that we can use stem cells for regeneration. We'll be involved in helping to translate that work into clinical practice.  " — Carol Richman  
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