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Patient Makes Miraculous Recovery After Umbilical Cord Blood Transplantation

Umbilical cord blood transplantation was a last resort for Adam McGillen of Sandwich, Ill. At only 23 years of age, he has spent most of the last two years of his life battling an extremely aggressive type of cancer. Just when he thought he had it beat, it would reappear with a vengeance in another part of his body. The umbilical cord blood transplant saved his life and has kept him in remission for nearly a year.

The ordeal started in December 2000 when he was bothered by strange aches and pains in his joints. The pain kept getting worse until he could no longer move his legs. Physicians found a cancerous tumor wrapped around his spinal cord and treated it with an aggressive course of chemotherapy. The tumor disappeared and in early 2001, McGillen faced the challenge of learning to walk again.

Even when others doubted his ability to recover, he persevered. "A lot of it was will power," McGillen said. "I told myself 'I'm going to be out of the hospital by my birthday.' " On Feb. 17, two days before his birthday, he went home.

McGillen and his mother - who has been his rock of support throughout all his treatments - searched for a second opinion for follow-up treatment and selected Kevin Barton, M.D., an oncologist at the Loyola University Health System's (LUHS) Cardinal Bernardin Cancer Center.

"He was amazing," McGillen said. "He wouldn't leave the room until he felt I understood completely any new treatment or drug."

McGillen continued with chemotherapy until June 2001 with no recurrence of cancer. He celebrated the end of his treatments by buying himself a dachshund that he named Max and affectionately refers to as "my baby." After all the time in the hospital and the multiple chemotherapy treatments, "I was feeling so dependent on everyone around me. I felt like I didn't have control over anything," McGillen said. "It was nice to have something that depended on me."

But McGillen's struggle with cancer was not over. Only six weeks after he completed chemotherapy, he started having difficulty moving his left eye. A few days later, the eye was paralyzed. A tumor was discovered at the base of his skull near the nerves that control eye function.

Since the tumor was wrapped around delicate structures, traditional surgery to remove it would likely leave him blind or with other impairments, so McGillen was referred to Edward Melian, M.D., a radiation oncologist at LUHS, for a high-tech procedure called stereotactic radiosurgery.

A team of specialists design a radiation treatment that targets a high dose of radiation precisely to the tumor cells while sparing the critical brain structures nearby. After one treatment in early September 2001, McGillen could move his eye again, and the tumor was gone.

Only a month later, though, a new tumor was growing over his right eye. Again, it was in a location that made surgery too risky. This time, the tumor would not respond to radiation, so McGillen had two choices: stop medical treatment and let the disease progress or undergo the most powerful type of chemotherapy followed by a bone marrow transplant. He wasn't ready to give up, so McGillen was referred to Patrick J. Stiff, M.D., director of the bone marrow transplant program at LUHS.

"When I first saw Adam, the tumor was visibly growing through his forehead, and he had double vision," said Stiff. "It was an extremely aggressive tumor, which had the capability to double its size everyday."

Chemotherapy strong enough to kill this wildly growing cancer would also kill other fast growing cells in McGillen's body, such as the cells in his bone marrow. Bone marrow is the factory for most of the body's blood cells, which carry oxygen and fight disease. Before McGillen could undergo the chemotherapy treatment, he needed the help of a donor who would provide some bone marrow cells to replace the ones he would lose during treatment.  

Family members are usually the most likely donors, but none of McGillen's family members matched his cell type. As each of his siblings were tested, "it was one let down after another," McGillen said. No matching donors were found on the national bone marrow registry.

Time was running out for McGillen, but Stiff was able to offer one more option: an experimental procedure using umbilical cord blood to replace the bone marrow McGillen would lose during chemotherapy. Cord blood is the blood that remains in the umbilical cord and placenta after a baby is born. The blood is collected after the umbilical cord has been clamped and cut. It is painless and safe. The donated cells are then stored and can be used to treat a variety of life threatening diseases.

Fortunately, a national registry of umbilical cord blood donors did yield a match for McGillen. A frozen donation of umbilical cord blood was shipped urgently to LUHS.

Stiff and his colleagues at LUHS have performed umbilical cord blood transplants for four years on more than a dozen patients. The procedure most often is used to treat children. Worldwide, only about 70 to 80 adults have had the treatment, which is still considered experimental and is used only on patients with no other treatment options who are facing imminent death.

The advantage of cord blood transplantation over bone marrow transplantation is that the cell type of donors and recipients does not need to match as precisely. The disadvantage is that a donation of cord blood yields fewer cells, so it takes longer for the cells to grow and replace an adult's lost bone marrow. Recovery is longer and more difficult, with greater risks of complications.

To help patients through that painful, slow recovery period, Stiff's team of physicians and nurses apply their considerable expertise in patient care. "Because we have so much experience with bone marrow transplantation, we are able to push the envelope to optimize patient care while blood counts are low," said Stiff.

In early January 2002, McGillen had the chemotherapy treatment. He readily admits that it was the hardest thing he had to endure throughout his battle with cancer. A few days after the chemotherapy, he had a 15-minute infusion of the precious cord blood cells that would help his body rebuild bone marrow. It was a long and painful recovery period. In his darkest moments in the bone marrow transplant unit, he didn't think he could see the light at the end of the tunnel. "I couldn't imagine ever feeling like I do now," McGillen said.

Nearly a year later, Stiff says that, considering the type of cancer McGillen had: "It is phenomenal that he is alive right now. The fact that he is still in remission is a very good sign."

McGillen is now trying to put his life back together and focus on the future. This fall he started working full time at a tuxedo rental store. He is thinking about going back to school in the spring. He wants to spend time with other people battling cancer to show them that recovery is possible and give them hope. Because he knows that beyond the cutting-edge treatment and highly skilled medical professionals, his hope for recovery was a key ingredient to keeping him alive and getting him where he is today.

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