Acute Lymphoblastic Leukemia and Stem Cells: Jiao’s Case
Jiao is a sixteen year old high school student with Acute Lymphoblastic Leukemia (ALL). First diagnosed with the disease when she was 10, Jiao underwent two years of intensive chemotherapy that initially put the disease into remission. Recently, though, Jiao had a relapse.
Doctors have determined that Jiao’s only hope for successful treatment is to receive very high doses of chemotherapy that will kill the cancerous white blood cells. However, the chemotherapy will also destroy the blood-forming cells in her body, and injections of stem cells from a matched donor are needed to rebuild her body’s blood system. Without those stem cells, there is a high risk of death after the chemotherapy. These blood-forming stem cells are usually taken from the bone marrow of a donor, but sometimes umbilical cord blood is used. Unfortunately, neither Jiao’s parents nor her seventeen year old brother Alex were suitable matches for a stem cell transplant (also commonly referred to as a bone marrow transplant). In addition, no matching donors were found through the Unrelated Bone Marrow Donor Registry. Although Jiao’s parents put her umbilical cord blood in a private cord blood bank when she was born, stem cells from that source could not help her either.
In desperation, Jiao’s parents, Jim and Zhen, have decided to try to have another child, in the hopes that this child’s umbilical cord blood will be able to provide the stem cells that Jiao needs for her treatment. Although they had not planned to have any more children, Jim and Zhen do not see any other way to save Jiao. Jim has had his vasectomy reversed, and Zhen will undergo in vitro fertilization with preimplantation genetic diagnosis (PGD) so that they can select an embryo that is the correct match for Jiao.
This decision could have a number of effects on Jiao’s family. The financial strain of the in vitro fertilization and PGD, coupled with the costs of a new baby, could jeopardize both Alex’s and Jiao’s plans to attend university, which the family had been carefully planning their finances for. Having a new baby in the house so long after Jiao and her brother have grown up will mean big lifestyle changes for everybody. Jiao may fear that the baby could be a ‘replacement’ for her if the treatment doesn’t work. Jiao may also feel guilty about the sacrifices that her family is making, and feel responsible for bringing a child into the world just to save her. This decision is difficult for Jiao as she does not want to die but can't see another solution to stay alive.
What are your thoughts about Jiao’s case?