ONCOLOGIST'S WORK BROADENED POSSIBILITIES
BY MARTHA STODDARD -- Lincoln Journal Star

   The textbooks said it was impossible.
    Colleagues at the University of Nebraska Medical Center were openly skeptical.
    "I am on record as saying she was nuts," recalled J. Graham Sharp, a cellular biologist and fellow researcher.
    But Dr. Anne Kessinger, an oncologist and associate director of the Eppley Cancer Center, remained convinced stem cells could be found in circulating blood, not just in bone marrow.
    And she believed those stem cells could restore a patient's ability to produce red and white blood cells after chemotherapy had destroyed that ability.
    Study after study had found such cells in animal blood. But the scientific world persisted in believing only the bone marrow of humans contained stem cells - the unique self-renewing cells that create specialized blood cells.
    "I couldn't believe that the way the universe was made there would be stem cells in mice, rats, guinea pigs, baboons ... and not in humans," said Kessinger, who earned her medical degree from West Virginia University in 1967.
    In the early 1980s, doctors were doing bone marrow transplants to give cancer patients a better shot at beating the disease.
   They collected stem cells from bone marrow - either from the patients or matched donors - and stored it. Then they gave patients high doses of chemotherapy, which killed the remaining marrow cells. Finally, the stored cells were given back to restore the marrow.

Dr. Anne Kessinger, an oncologist and associate director of the Eppley Cancer Center at the University of Nebraska Medical Center in Omaha, is a pioneer in stem cell research. TED KIRK /Lincoln Journal Star

    But there was a problem. What if cancer had invaded the patient's marrow and no donors could be found?
    "You can't put tumor cells back into them. That's not nice," Kessinger said.
    So she suggested an experiment. Collect stem cells from a patient's blood, using the same kind of machine that separates platelets from other parts of blood, and do a transplant with those cells.
    "With our trepidation and Graham saying, 'No, no, no,' we did it," she said. "We did that in 1984 and nobody knew if it would work."
    The patient, who wanted to be part of the research despite her advanced case of cancer, died. But a few days before her death, white blood cells appeared in her bloodstream.
    Here was proof that Kessinger had been right, that circulating blood contained stem cells and there were enough stem cells to take hold and restore bone marrow function. The trial continued - successfully - with nine more patients.
    Still, many questions and much convincing remained. Medical journals rejected Kessinger's reports. Colleagues accused her of falsifying or misinterpreting her results.
    "People would throw tomatoes," she said. "They would call me a liar. This was heresy. I was going against the hematology world."
    Acceptance came with time, as did answers to early questions and to those that arose over the intervening years.
    Yes, stem cells taken from the blood lasted. Yes, stem cells could be taken from the blood of matched donors for transplants, not just from patients. Yes, stem cells could be taken from umbilical cord blood for transplants. Yes, the cells that restored the patient's marrow were the donor cells - genetics proved that.
    Yes, chemicals called growth factors could stimulate the body to produce more stem cells, so the collection could go faster. Yes, the transplants could be done with very short hospital stays. Yes, the transplanted cells actually attacked tumor cells, adding to the effect of the chemotherapy.
    Yes, the transplants "reset" the body's immune system and could send some autoimmune diseases such as rheumatoid arthritis into remission. And yes, it appeared transplants could work when doctors merely suppressed the patient's immune system instead of killing it.
    These days, only a few patients needing donor cells still get bone marrow transplants. The rest, including all those who get back their own cells, get the peripheral stem cell transplants pioneered by Kessinger.
    "This made it safer and cheaper," she said. "Now nobody does (autologous) bone marrow transplants anymore."
    Reach Martha Stoddard at 473-7251 or mstoddard@journalstar.com.