Mary Webb's family thought her 4-year-old son, Quentin Murray, was complaining about pains that moved around his body as a reaction to the excitement of moving back to Patterson, La., from Dallas in April 2007 and news his mother was pregnant. Webb wasn't so sure.
Her nightmare started the first day her family arrived in Patterson. Murray awoke with a swollen eye that persisted on and off all summer. By Memorial Day, pains moved up his arm to his chest and down his legs. Within a year, Murray would become the first person in the United States to receive a transplant using stem cells from both an umbilical cord and placenta his mother donated when she gave birth to Murray's sister, Jory.
"A lot of people thought I was paranoid because I was pregnant," says Webb, who consulted half a dozen doctors who conducted a variety of tests — including an MRI — to identify what was making her son sick. It wasn't until July 2008 that Webb finally got a diagnosis: leukemia. The next day, she and her son were on their way to Children's Hospital in New Orleans.
"The doctor said his platelet count was down to six," Webb says. "He could get a little cut and bleed to death."
Dr. Lollie Yu, a pediatric oncologist at Children's Hospital, says Murray was diagnosed with acute lymphoblastic leukemia (ALL), a cancer of the white blood cells that normally fight infections.
"He had ... a factor that caused (the leukemia) to be very high risk for him," Yu says. "With conventional treatment — chemotherapy — his outlook (for survival) was about 35 percent. At the time, his mother was pregnant, and we told her the best way to improve his outcome was (for him) to have a bone marrow transplant." Yu also informed Webb the best bet for a match, 25 to 35 percent, would be a sibling, her unborn child.
"He was diagnosed in July," Webb says. "He went into remission 30 days later. I thought remission was a cure, but it just means (doctors) don't see any irregular cells. The next week his chromosome test came back and he was in the highest bracket (for the leukemia) to return. What they didn't tell us is that if you do relapse, there's only a 30 percent survival rate. We decided to do the transplant."
The procedure was simple, Webb says. After she gave birth Dec. 3, 2007, an obstetrician extracted blood from Jory's umbilical cord and the placenta. The stem cell-rich blood was transported to Celgene, a multinational biopharmaceutical firm, to determine whether it was a match for Murray. Webb found out it was a match right after Mardi Gras, and a transplant was scheduled for March 28, 2008.
"The transplant itself was a transfusion-like thing," Webb says. "I looked at the stem cells. They were the color of pink lemonade and had the consistency of a gel. They put it in a needle and pumped it in. It took 20 minutes or so. It was kind of anticlimactic."
Murray had to remain isolated at Children's Hospital until July because his immune system was extremely vulnerable while the stem cells worked to build up his white blood cells.
"After the transplant he went from being himself to being really low, sick and just fragile," Webb says. "He was skin and bones. Even when he started to get better and put some weight on, he still was super tiny. ... When he got to come home in July, you could tell he had turned the corner."
Dr. Robert J. Hariri, CEO of Celgene Cellular Therapeutics, says his company developed the technology to turn stem cells from the placenta into treatments for a range of illnesses including leukemia, cancer, multiple sclerosis, Crohn's disease, stroke, inflammatory conditions and more.
"[Murray] was in need of rebuilding his blood and immune system with a bone marrow transplant," Hariri says. "In these situations, the best source of material is the hematic stem cells that exist in (umbilical) cord blood. The problem is the number of cells you can get from the cord unit is relatively small. What we know is that these stem cells always do best when the count is high. We developed technology to dramatically increase the potency by supplementing the cord blood cells with cells from the placenta. In this case it was very successful."
The placenta has unique traits (it is not rejected, even in birth surrogates impregnated with someone else's genetic material), and Celgene harnesses those qualities for therapeutic uses, he says. Not only did Murray's body accept the transplant, but the stem cells prompted his system to make all types of blood cells only 28 days after the transplant, Hariri says: "That's very fast."
- Quentin Murray has to wear a face mask to protect his fragile immune system from germs before his stem cell transplant at Children's Hospital.
"The use of stem cells as medicine is a very active area of development throughout the world," he says. "We think that placenta stem cell medicine is a very exciting platform. What we've seen in the clinic tells us that our technical approach has been a sound one. It's already bearing fruit, and we're excited about what the future holds."
Webb says she knew little about stem cells before Murray got sick. "I feel that stem cell research is so under the radar," she says. "I'm flabbergasted that ... the only thing I knew about stem cells was the controversy over embryonic stem cells. Why isn't this more in our household vocabulary?"
Bruce Bunnell, director of Tulane's Center for Gene Therapy, says "80 to 90 percent of the public supports stem cell research," and results look promising for umbilical cord, placenta and adult stem cell therapies. Those areas are making significant progress because they don't stir the controversy that underlies research using embryonic stem cells.
"Umbilical cord blood stem cells are ... the infant composition of what is in our bone marrow," he says. "Why people like to use them is we think they are less defined than in an adult. They are ideally suited to treating (leukemia) because the umbilical cells' preferred route of differentiation is to become a bone marrow cell or a blood cell."
Tulane researchers use only adult stem cells and find they can have many uses. "There are plenty of stem cells in adults," Bunnell says. "We can extract stem cells for almost any organ of the body. We think they're there to do some amount of repair and to replace cells that are lost on a daily basis. Adult stem cells prefer to become the same type of cells as the place you took them from, but we're finding you can re-educate adult stem cells and make then become something else."
Today, Murray is a normal adolescent who plays with his little sister — his lifesaver — and hones his skills on the baseball field.
"Now it's like we're normal people," Webb says. "Where we had been racing up and down the highway to get him to appointments, now we're racing up and down the street to get him to practice."
Webb, a former news reporter who will teach English and writing this fall at Westgate High School in New Iberia, has penned a book about the experience, The Summer of Superheroes and the Making of Iron Boy, much of it based on emails she sent friends and family to keep them updated about Murray's condition. She hopes there will be no future chapters to add.
Yu says the prognosis is good. "The overall survival rate for children with cancer is 80 percent for all types of cancer," the doctor says. "Without research, we couldn't have come this far. In the early '70s, it was a death sentence, but now a patient comes in with ALL, and I can tell the parents there's a good chance we can cure them."
It's been about two years since Murray's transplant, a threshold that gives doctors guarded optimism he won't develop another malignancy. He will visit Yu once every six months for two years, then annually.
"He came through all this very well," Yu says. "I've been doing this for many years and it still amazes me how children can handle this. Children are very resilient. They really humble me."
The Summer of Superheroes and the Making of Iron Boy sells for $15.95 and is available at the New Orleans Community Book Center and The Afro-American Book Stop as well as www.amazon.com and www.createspace.com/3458326. A percentage of the proceeds will benefit Children's Hospital of New Orleans, The Leukemia & Lymphoma Society and The JL Foundation, which provides financial assistance to families dealing with leukemia.