James White was in his 60s when he was diagnosed with myelodysplasia, which progressed to leukemia. The traditional treatment for patients like White is standard chemotherapy, which brings a median survival time of about a year.

But Duke oncologist David A. Rizzieri, MD, offered White a regimen developed at Duke that includes less-intense chemotherapy and a stem cell transplant of halfmatched donor cells.

More than two years later, White is still in remission and doing well.

Traditionally, older, more infirm patients have not been candidates for treatment with stem cell transplants and the accompanying intense preparative chemotherapy.

“The combination of this less-toxic preparation with a mismatched immune system donor opens up transplant to the overwhelming majority of patients who don’t have a matched donor,” Rizzieri says.

In 1999, Duke pioneered the use of cord blood cells for adults who don’t have a matched donor. Today, under the leadership of Nelson Chao, MD, professor of medicine and cellular therapy, Duke physician-scientists have continued to expand the use of cord blood transplants.

For instance, Duke has developed a regimen that combines cord blood units from two different donors to perform transplants in adults. “Very few other places in the country attempt to perform cord blood transplants in adults,” Rizzieri says.

New innovations under way include novel approaches to improve immune-system function after transplant. Duke is conducting clinical studies of these immune-system boosting protocols, including vaccine therapies and selected lymphocyte boosts from donors.

Duke is also expanding the use of cellular therapy to other diseases, including autoimmune diseases such as sclerosis. Keith Sullivan, MD, leads a trial of stem cell transplant as a treatment for severe systemic sclerosis.

“It is very exciting and rewarding to see patients return to an almost normal life following a very debilitating and life-threatening illness,” says Sullivan.