In April, a 12-year-old boy with HIV and aggressive leukemia received an experimental treatment at the University of Minnesota—an umbilical cord blood transplant performed by three innovative doctors. If the boy remains free of the diseases at the 100-day mark—in August—he will potentially be cured of leukemia and absolutely cured of HIV. It will change everything.
Dr. John Wagner is the pediatric blood and marrow transplant physician on this case, part of the three-specialist team that came together at the U of M to tackle this unique challenge. Also on the team are an HIV expert and the child’s primary care physician, who is a leader in leukemia treatment.
It isn’t the first time Wagner has been involved in developing groundbreaking treatments. He conducted the world’s first cord blood transplant for leukemia in 1990 while at Johns Hopkins. A year later, he moved to Minnesota. “I came because I wanted to make bone marrow transplants safer,” he says. “I thought I could make an impact coming here. Minnesota had one of the largest centers for performing transplants.”
Wagner has since established the cord blood transplant program at two blood and marrow transplant centers here: one at the U of M and the other at Amplatz Children’s Hospital, with roughly 25 faculty members operating the facilities. “This is one of the reasons Minnesota plays such a prominent role in health care,” says Wagner. “We’ve done more cord blood transplants than any other institution in the world—1,400 and counting.”
A cord blood transplant is exactly what it sounds like: taking blood from an umbilical cord and placenta and injecting it into people needing treatment for autoimmune disorders such as leukemia and HIV. In some cases, cord blood can be superior to bone marrow, Wagner says. “Umbilical cord blood is more forgiving and allows us not to need an exact tissue match.” And because umbilical cord blood is pure—without exposure to viruses or antibiotics—it can be applied to anyone needing a transplant.
Plus, it contains a magic ingredient: T-regulatory cells, or T-cells. When a woman becomes pregnant, she produces T-cells that neutralize her immune system’s response to prevent her body from rejecting her baby, who has a different immune system and blood. “Umbilical cord blood,” Wagner says, “is a very potent source of various stem cells, including T-cells.”
So how does it work?
Before patients can receive a cord blood transplant, they need radiation and chemotherapy to break down the current damaged immune system’s defenses. Then, when the cord blood transplant is performed, the cord blood replaces the damaged immune system with a new one that is strong enough to fight off diseases such as HIV and leukemia. And the T-cells act as a neutralizer and help the recipient’s body accept the treatment.
The chances are high that this clinical treatment will work, Wagner says. Another one of his patients, a Maple Grove resident, is the second-longest survivor of an umbilical cord blood transplant from an unrelated source in the world. It’s been a revolution since the mid-1980s when the chances for finding a cure for leukemia were very low. Now there’s hope.
If Wagner and his team are successful and the umbilical cord blood has cured this boy’s HIV and, potentially, leukemia, millions of people around the world will have renewed hope—not just for HIV and leukemia, but for other diseases as well. “In the future,” Wagner says, “cord blood transplants could treat patients with autoimmune disorders such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis, or lupus.”
The world is watching.