While this is certainly one type of stem cell (known as the pluripotent stem cell), there is another altogether different type known as the committed stem cell, which has been saving lives in South Africa
and around the world for 20 years.
“Our unit works specifically with committed stem cells, which are readily available in the adult body and which have nothing whatsoever to do with embryos,” says Dr Jackie Thomson, who is co-director of the Albert Alberts Haemopoitic Stem Cell Transplant Unit at the Netcare Pretoria East Hospital, which she helped establish two years ago with Dr David Brittain.
“Committed stem cells have already decided what they are going to be – in this case blood or bone marrow stem cells, medically known as haemopoitic stem cells.
“Pluripotent stem cells, by contrast, are still in the undetermined stage and have the potential to become any organ. At between eight and 14 weeks, pluripotent stem cells commit to becoming a particular organ, be it brain, heart, liver or any other part of the body,” explains Thomson, who has been doing blood and bone marrow stem cell transplants for the past eight years.
She started in Cape Town where there are two blood/bone marrow stem cell transplant units – one at the Constantiaberg Medi-Clinic and another at Groote Schuur. From there she moved to Pretoria. The Albert Alberts Stem Cell Unit performs 80 transplants a year – more than any other facility in Africa.
“We report to the European Group for Blood and Marrow Transplantation as well as the Centre for International Blood and Marrow Transplant Research, and we can say with confidence that our unit meets every international standard. We do as many transplants as some of the larger centres in Europe,” says Thomson.
The unit treats mainly blood disorders, lymph cancers, bone marrow cancers and metabolic disorders. Other conditions treated include sickle-cell disease, myelodysplastic syndrome, Ewing’s Sarcoma and Hodgkin’s disease.
There is no one single cause that can be identified as the trigger for any of these diseases. “Possible causes include a wide range of factors – from previous chemotherapy to certain viral infections to the fact that we are constantly exposed to so many toxins, pollutants and forms of radiation in modern society,” she explains.
“Fortunately we all have numerous haemopoitic stem cells in our bone marrow. As a result they can be harvested from a healthy donor whose blood and bone marrow is compatible with the patient’s.
“The healthy bone marrow is either extracted from the donor with a needle from the hipbone or the blood/bone marrow stem cells of the healthy donor are mobilised so that they start circulating in the blood. From here we can extract them using a blood filter – the process is very much like donating blood.”
Matching a patient with a donor (known as HLA typing) is not easy, with a one in 100 000 chance of a match between unrelated individuals. Siblings have the greatest chance of a match but even then there is only a one in four chance of a match.
Thomson says the majority of transplants undertaken at the unit are with stem cells from unrelated donors.
Most are from international donors and donor registries. The unit has performed stem cell transplants with donors from France, Germany, the UK and the US.
The international registries provide 14 million possible donors. Sixty percent of these are of Caucasian descent.
“There is a desperate need for black people of sub-Saharan descent to donate bone marrow to the SA Bone Marrow Registry, as only about 2 000 to 3 000 of the 63 000 donors on the South African Bone Marrow Registry are black,” says Thomson. A patient’s best chance of finding a genetic match is someone who shares the same ethnic and geographic ancestry.
All prospective donors should contact the Sunflower Fund.
Patients receiving blood/bone marrow stem cell transplants spend three to four weeks at the unit. During the first week, known as the “pre-conditioning” week, the patient receives near-fatal doses of radiation and chemotherapy to destroy their own blood/bone marrow stem cells. Their bone marrow is then infused with the donor stem cells through a drip. The bone marrow takes about two weeks to start recovering, and the period between the death of the old and the growing of the new is a high-risk zone.
“The success rate of the transplant often depends on the age and condition of the patient,” explains Thomson. “The younger they are and the sooner they come for the transplant the better.
“The longer they leave it, the more their body tends to deteriorate and the faster the cancer or disease can spread.”
The good news is that worldwide, there is now a 60 percent success rate for blood/bone marrow stem cell transplants, compared with the zero percent survival stakes of patients with severe blood/bone marrow diseases who do not have the transplant.
“Significant advances have been made in stem cell transplantation over the last 10 years and this procedure is truly life-saving,” says Thomson. “It is a great step forward in medicine which offers hope to people suffering from blood disorders.”
A NEW LIFE AT AGE 23
“I WAS born with a genetically inherited disease called sickle cell anaemia, which was diagnosed when I was three years old,” says 23-year-old Ems Tshuma, an accountant from Joburg.
“The disease reduces the oxygen carrying capacity of the haemoglobin in the blood. As a result, blood cells start to harden and instead of being round in shape, they curve into a sickle shape and stick together within
the veins and arteries.
“This leads to many severe complications such as leg ulcers, strokes, severe fatigue and a shortened life expectancy (40 to 50 years).
“I thought my time was up a year ago when my kidneys started failing and my lungs were blocked. I was hospitalised for what I thought might be the last time when the doctor attending to me referred me to Dr Thomson.
“He said the one known cure for my disease is a bone marrow stem cell transplant,” Tshuma explains.
“My father was constantly at my bedside during the entire treatment and the staff were wonderful. “Since then I have started getting stronger and stronger and I am now in excellent health and physical condition.
“My whole outlook on life has changed because since the age of three, I was always aware that my life might not last that long. Regardless of this, I still went to school and tried to be as normal as possible.
“All these years later, I no longer suffer from any of the symptoms of sickle cell anaemia and I no longer have that nagging thought that I might not be around for very much longer.
“I get to truly experience life without restrictions. I literally have a new life at the age of 23.”
A BATTLE FOUGHT AND WON
FOR 10 years he fought and won the battle against cancer, first melanoma, then lymphoma. But in October 2009, Danie Jordaan, Professor of Media and Communications at the Nelson Mandela Metropolitan University in
Port Elizabeth, was told that the many sessions of radiation and chemotherapy treatment he had received to fight the cancers had destroyed his bone marrow and that his blood count was plummeting.
“I was no longer manufacturing red or white blood cells or platelets and my oncologist said it was the end of the road for me,” he explains. “I was told my only possible hope was a blood/bone marrow transplant and I was referred to Dr Thomson, whom he said is the best in country.”
He went to see Thomson and she said it was well worth giving the procedure a chance. They found a donor and I was booked into the Pretoria unit for a month.
“You feel really ill because of the high doses of chemotherapy at the start of the treatment, but the staff at the unit look after you so well that it makes it more bearable. “I could not have received better
care from Dr Thomson, Dr Brittain and their team.”
After the transplant, the long wait begins to see if the body accepts the new stem cells and to give them time to grow. Jordaan and his wife spent a further two months in Pretoria, staying at a B&B as he had to go to the unit
for regular check-ups and serum infusions.
“Slowly my blood count started improving,” he continues. “By the end of June, my red blood count was higher than it has ever been – the normal count for a male is between 15 and 18 and mine was 16. My white blood
cells and platelets also normalised and there were no signs of rejection.
“I can say with amazement that I am now fine. I will return to lectures one of these days – I still need to stay at home for a while so as not to contract any infections – but the transplant has given me back my life. At the
age of 54, I now have a normal life expectancy. It’s completely changed my entire family’s life because for 10 years they watched me go down.
“People often ask me how I managed to get through all this and I always say it’s your support structure and belief system – no matter what it is – that carries you through. My amazing wife, Christina, and our children have been so wonderful to me.
“I can only repay my wife for all the love and support she has given me by being really, really nice to her for as long as we live. We are now planning a December holiday, which will be our first in 10 years.”
ETERNAL OPTIMIST’S JOURNEY
“IT FEELS incredible,” says Patricia van Eeckhoven, a doctor’s receptionist from Pretoria who was severely incapacitated before receiving a blood/bone marrow transplant.
“I have something called mitochondrial neurogastrointestinal encephalopathy syndrome (MNGIE syndrome). I discovered this about 10 years ago when for no reason one of my eyelids started drooping.
“I went to see a doctor and he diagnosed MNGIE syndrome. He told me that the medical profession thinks it’s genetic but because I’m adopted, I had no way of finding out.”
She got progressively worse until she started losing her eyesight, she could no longer move her eyes from side to side, she had to wear a neck brace because she could no longer hold herself upright, she experienced enormous difficulty swallowing and breathing, and she could not open her fingers.
“Despite all this I’m an eternal optimist and I always had hope that a cure would be found,” says Van Eeckhoven.
After several years of living with her condition, she was advised to consult the Pretoria blood/bone marrow stem cell unit.
“The team immediately recommended me for a stem cell transplant and I went ahead. That was several months ago and I have got stronger ever since.
“I have regained my health, my strength, my eyesight and everything that I had lost. It feels incredible. I’m participating in my kids’ lives, getting involved in their sporting activities, visiting my friends, enjoying food and
enjoying time with my husband who stood by me through all this.
“In short, I’m living again.”