Word: bone-marrow
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...Exactly a year ago last week, Keone, now 13, became the first sickle-cell patient to receive a transplant of blood cells from the umbilical cord of a newborn infant. In effect, he got a new bloodmaking system. Other young sickle-cell patients have undergone transplants, but these involved bone-marrow cells and had to be matched precisely with the recipients' own blood. In Keone's case, though, his half-sister could not offer matching marrow. So his doctors decided to turn to more easily available cord blood. Consisting largely of immature stem cells, it does not require precise matches...
...unlikely allies as consumer-advocate groups and the American Medical Association support this reform. They argue that in attempting to practice cost control, HMOs end up practicing medicine. Even judges have voiced frustration. Ruling in favor of an HMO in an Oklahoma case in which the insurer delayed a bone-marrow transplant for a woman, who later died of leukemia, a three-judge panel in the 10th U.S. Circuit Court of Appeals wrote, "Although moved by the tragic circumstances of this case and the seemingly needless loss of life...we conclude that the law gives us no choice." Perplexed...
...doing everything you can to protect your children? What if, God forbid, your daughter developed leukemia and needed a bone-marrow transplant? What if neither you nor your spouse could offer a close enough match to donate marrow? If you'd had the foresight to preserve some critical blood cells found in the umbilical cord and placenta that nourished your other children in the womb, you might be able to save your daughter's life...
First, it helps to understand that bone-marrow transplants are the most unforgiving of all transplant operations, requiring closer matches in tissue types between donors and recipients than for, say, hearts or kidneys. Because the immune system comes from the marrow, a transplant of that reddish pulp is, in effect, an immune-system transplant. There's the usual possibility that the body may reject the graft as "foreign." Then there's the almost surreal danger that the transplanted immune system will attack and kill its host...
...important stem cells that can generate a new immune system. Even better, these cells are, as doctors put it, "naive," making them less likely to attack their new host. As a result, a cord-blood transplant doesn't have to match a recipient quite so closely as a bone-marrow transplant. This experimental treatment could prove especially helpful to African-American patients and other minorities whose greater genetic diversity often means they have trouble finding a good bone-marrow match...