Q&A with Rajneesh Nath 

University of Tennessee Cancer Institute hematologist/oncologist

Memphis rocker Arthur Lee has something new to sing about. Two weeks ago Lee, 61, became the first adult in Tennessee to receive a bone-marrow transplant using stem cells extracted from an umbilical cord.

After being diagnosed with acute myeloid leukemia, Lee was treated with three rounds of chemotherapy. When that didn't work, his doctors began looking for an adult stem-cell donor, who is most often a sibling. But Lee is an only child, and no one in the registry of volunteer donors was a close enough match.

Instead, doctors found a suitable stem-cell match in an umbilical-cord blood bank. Prior to Lee's surgery, the only cord-cell transplants in Tennessee had been done in children. The Flyer talked with Lee's doctor, Rajneesh Nath, to find out why.

-- By Shea O'Rourke

Flyer: Why hasn't this type of surgery been performed on an adult?

Nath: Cord-cell transplants have been done for quite a while in children. Generally, you need a specific number of cells to do this kind of transplant. With cord blood, what is stored is stored. You have to take what there is, in contrast to a volunteer donor where you can go and collect as many cells as you want over a few days' period.

Children need fewer cells compared to adults. Because of this, there was a lot of reluctance in the past to do the procedure in an adult, but now it has been seen to work in adults sometimes. If we reach a target number of cells, cord blood can be used as an alternative to a volunteer donor. It's an advantage that you can get them whenever you need them.

What's Lee's prognosis?

Because of his disease, at the most he has about a 20 percent chance of a cure, versus no chance without the transplant. There are two aspects: number one, whether the transplant has been successful or not, and we'll know within 45 days or so. The second aspect is whether we're able to eradicate the cancer or not. We would need to follow him for about two years to know that.

What's the difference between umbilical- cord stem cells and the more controversial embryonic stem cells?

The general feeling is that [umbilical-cord stem cells are] not going to be as useful or as advantageous as embryonic stem cells. Embryonic stem cells have a lot of potential, like making totally different, new organs, whether it's liver or the cord or whatever. Cord-blood stem cells have been used for -- and are known only to produce -- bone-marrow cells.

Is there any controversy surrounding umbilical stem cells?

No. The reason they are not controversial is that we are not using an embryo -- that's where the controversy is. Basically, when you cut the umbilical cord, the portion that is away from the baby is attached to the placenta, and whatever blood is available in that cord is generally otherwise thrown [away]. That blood is used for the transplant.

What's the future of umbilical-cord cell transplants?

I think these transplants are going to be increasing over time, because we do not need that stringent degree of a match, and more and more cord-blood stem cells are being stored. Currently, only a few hundred thousand are being stored, while we have about 10 million volunteer donors worldwide. As the number of cord-blood donors increases, I think we will have a donor for everyone who needs a transplant.



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