In an interview on NPR’s FRESH AIR, author-screenwriter Delia Ephron discussed her diagnosis of the blood disease, leukemia, as well as finding love and marriage with Dr. Peter Rutter during her treatment. Treatment began with chemotherapy, under the care of her physician, Dr. Gail Roboz, Division of Hematology and Medical Oncology, WDOM, and subsequently included a bone transplant led by Dr. van Besien.
The particular type of bone transplant utilized, which as been honed over recent decades, is known as a haploidentical (haplo)-cord transplant. This type of transplant combines an infusion of umbilical cord blood (UCB) with CD34-selected cells, usually from human leukocyte antigen (HLA) mismatched donors. It can be used when a donor match cannot be found and has been successful in delivering survival and progression-free outcomes. In Delia’s case, she has had no evidence of leukemia on any test for four years.
Delia and her sister, Nora Ephron, co-wrote the 1998 romcom “You’ve Got Mail.” In light of Nora’s death in 2012 from leukemia, a particularly virulent form that runs in families, Dr. Roboz had been monitoring Delia’s blood tests closely over the years. All was well, until one day, the test came back showing acute leukemia.
As there was no match to be found for Delia from an adult donor, Dr. van Besien implemented the haplo-cord transplant. Mismatched cells from an adult donor and stem cells from umbilical cord blood were administered; essentially, Delia received stem cell donations from two donors. The stem cells from umbilical cord blood, being the cord blood of an infant, are adaptable in the way they interact and multiply in the recipients’ bone marrow where blood is produced. They play a key role in creating beneficial blood cells that increase and ultimately lead to a patients’ survival.
Dr. van Besien explains, “We were able to administer a novel type of transplant that produced a positive outcome for our patient. The team and I have been using haplo-cord transplants for well over ten years and it’s gratifying to see increased success rates. Haplo-cord transplant may be especially suitable for older patients who are at increased risk for myelodysplastic syndrome and leukemia and who often lack matching family or unrelated donors. Like other recipients of umbilical cord grafts, they have low rates of graft versus host disease and excellent quality of life. Thanks to the additional infusion of adult donor cells, they recover rapidly from the early complications of transplant.”
Dr. van Besien’s many articles on breakthroughs in bone marrow transplantation include:
van Besien K, Hari P, Zhang MJ, Liu HT, Stock W, Godley L, Odenike O, Larson R, Bishop M, Wickrema A, Gergis U, Mayer S, Shore T, Tsai S, Rhodes J, Cushing MM, Korman S, Artz A. Reduced intensity haplo plus single cord transplant compared to double cord transplant: improved engraftment and graft-versus-host disease-free, relapse-free survival. Haematologica. 2016 May;101(5):634-43. doi: 10.3324/haematol.2015.138594. Epub 2016 Feb 11. PMID: 26869630; PMCID: PMC5004373.
van Besien K, Artz A, Champlin RE, Guarneri D, Bishop MR, Chen J, Gergis U, Shore T, Liu H, Rondon G, Mayer SA, Srour SA, Stock W, Ciurea SO. Haploidentical vs haplo-cord transplant in adults under 60 years receiving fludarabine and melphalan conditioning. Blood Adv. 2019 Jun 25;3(12):1858-1867. doi: 10.1182/bloodadvances.2019000200. PMID: 31217161; PMCID: PMC6595267.