Seizing Nature's Lifeline

PAULETTE LEBED'S FEET DANGLE several inches above the carpet as she cradles her newborn sister in her lap. "I love to hug her and kiss her and hold her," says the vivacious 7-year-old as she tenderly pinches the baby's cheeks. So far, Paulette shows no outward signs of the acute lymphocytic leukemia that she has battled for more than two years. If all goes well, her tiny sister may help her survive to enjoy a healthy sibling rivalry. When Mariajose was born, on April 4, doctors at Jackson Memorial Hospital in Miami drained three ounces of blood from her umbilical cord and froze it in liquid nitrogen. In a few weeks, those blood cells will be injected into Paulette; doctors hope that they will revive her immune system, damaged by high-dose chemotherapy. "I haven't slept for months," says their father, Jaime. "This is a gift from God."

Umbilical cords are ordinarily discarded at birth. But researchers now know they are a rich source of stem cells, which produce platelets and red and white blood cells, even when transplanted into ailing patients. Traditionally, stem cells have been extracted from bone marrow, but that process is expensive (as much as $25,000) and painful to the donor. Extracting cord blood costs far less, requires no invasive surgery and donors and recipients need not match perfectly. Since 1988, only 200 cord-blood transplants have been performed worldwide. But doctors are excited about this new source of stem cells, private firms are seeking to get into the business and the National Institutes of Health plans to establish four cord-blood donor banks.

To date, cord blood has been used mainly to treat leukemia and severe anemia in children. It doesn't always work miracles; last week baseball star Rod Carew's 18-year-old daughter, Michelle, died of leukemia even after a transplant. But 65 percent of cord-blood recipients are still living, researchers say. "It's given us years, birthdays and Christmases we would not have had," says Barbara Miller, whose son, Eric, received cord blood from his newborn brother six years ago. Today, at 12, Eric shows no signs of Fanconi anemia, a rare blood disease that once threatened his life, and he plays competitive ice hockey.

Several private firms are so enthusiastic that they are trying to persuade expectant parents to preserve their newborn's cord blood, in case the child or a sibling needs it in the future. One of the largest, ViaCord in Boston, promotes the service as "biological insurance" in direct-mail appeals to pregnant women. ("You are expecting a baby, and we have something important to tell you," begins one solicitation letter.) ViaCord charges $1,500 to harvest the cord blood and $95 a year for storage. CEO Cynthia Fisher says interest is growing at a "phenomenal rate," particularly among couples with a family history of blood diseases. "I thought it was a great idea," says Moira Motyka of Westborough, Mass., whose brother died of leukemia for lack of a bone-marrow donor. She had her children's cord blood saved so they could serve as their own donors, if necessary. Families with no history of disease are signing on, too. Says Penny Osborne, who banked her son's cord blood last August: "This was a small price to pay to be able to save a child."

Some researchers think it's not such a small price-particularly when the chances that a child will develop a severe blood disease are only about 1 in 10,000. There are other unknowns, too: experts aren't sure how long frozen cord blood will stay viable, or what diseases it will prove useful in treating. ViaCord's literature lists AIDS and lung cancer among its possible uses, but NIH officials are leery of over-promising. "it could get a bad name before we know how good it is," says NIH's Paul McCurdy. Critics also think private firms are preying on vulnerable parents. it may make more sense, medically and economically, to donate cord blood to a public bank instead. A matching sample could be found later if needed, and children who need transplants sooner would have a ready supply.

The Food and Drug Administration has proposed subjecting cord blood to clinical trials and licensing procedures. But some doctors fear that a long review could deny kids transplants they need now. The Lebeds couldn't wait. Last fall, Paulette's mother was in her first trimester of pregnancy with Mariajose when Paulette's leukemia relapsed and they suddenly needed a stem-cell donor. Tests showed that her sister was a close match, and ViaCord provided fast assistance. Now Paulette's doctors are optimistic, and she is planning her future. She wants to be a model - or a doctor.