The medication Joseph took after the
transplant made him look puffy, but
Dr. Wagner helped keep his spirits up.
Public cord-blood banks first began flourishing in 2005, when President Bush signed the Stem Cell Therapeutic and Research Act. The legislation restricted research on embryonic stem cells (which come from a frozen embryo that ultimately gets destroyed) but also devoted $79 million to expand the nation's cord-blood reserve for transplants and research. When parents decide to donate their baby's cord blood, a trained technician extracts about 3 teaspoons of blood minutes after the cord has been cut. Later, the blood is tested for various infectious and hereditary diseases. Today, there are 19 public banks in the country storing 160,000 units of cord blood at -196?C, which are available for anyone in the world who needs a transplant.
Cord blood is used primarily to treat children because one unit sometimes doesn't contain enough stem cells to be effective in an adult's larger body. Nearly 2,400 children have undergone cord-blood transplants so far, 500 of them last year. (In comparison, the NMDP was able to facilitate more than 4,000 marrow transplants in 2010 in children and adults.)
Even though a transplant could save Joseph, his parents knew that the entire treatment process was very risky. He first received high-dose chemotherapy and full-body radiation to destroy all the abnormal cells in his body. Because this wiped out his immune system, he had to spend nearly four weeks in a hospital room with purified air. "We left our shoes at the door, and wiped everything we could to avoid spreading germs," Mary recalls. She and Brian alternated sitting with Joseph, reading books and playing on a laptop with him, and taking care of the girls at the nearby Ronald McDonald House, where they also went to school.
Finally, Joseph received the cord-blood transplant through an IV into a large blood vessel in his chest. The stem cells miraculously travel through the bloodstream to reach the bone marrow, where they begin producing healthy blood and immune cells. Still, the first 100 days after a transplant are critical. Vulnerable to reactions and infections, Joseph stayed in the hospital for three weeks, and then he was allowed to live at the Ronald McDonald House with his family (wearing a face mask at all times). The first biopsy test of his bone marrow showed that 100 percent of the cells were the healthy donor cells, but a month later 10 percent of the cells were his own. Then he developed a high fever and a rash, signs of major complications including graft-versus-host disease -- and a recurrence of his illness.