Bone Marrow of Fetus Fits Ailing Sister’s

A Walnut couple having a baby in hopes of providing a bone marrow donor for their ill teen-age daughter disclosed Friday that the fetus’ marrow cells appear to be nearly identical to the girl’s and may be able to save her life.

Doctors at the City of Hope National Medical Center in Duarte announced the match and said a bone marrow transplant from a compatible donor has a 70% chance of thwarting the type of leukemia afflicting 17-year-old Anissa Ayala.

But medical experts cautioned that the unusual case may give false hope to desperate parents of young leukemia patients.

This is because there is only a one-in-four chance that siblings with the same mother and father will have closely compatible bone marrow cells, and conceiving a baby solely for the purpose of donating bone marrow to a sibling raises troubling ethical issues.

“This is our baby, this is our miracle baby,” said a jubilant Abe Ayala, Anissa’s 45-year-old father, speaking to reporters at the Covina-based Life-Savers Foundation of America, which recruits donors for the 9,000 Americans who are awaiting bone marrow transplants.

“We are all very, very blessed,” sobbed Mary Ayala, 43, who is due to give birth to a girl in mid-April. “I feel my baby is a blessing from God.”

Their daughter, Anissa, was diagnosed in 1988 with chronic myelogenous leukemia, a form of leukemia that can be cured only with a bone marrow transplant, according to City of Hope physicians who are caring for the Walnut High School student.

But a search by the National Marrow Donor Program for unrelated donors and testing of Anissa’s family members failed to locate a suitable donor.

At the press conference, Anissa cried when asked about her parents’ decision to have the new baby. “A lot of people think, ‘How can you do this? How can you be having this baby for your daughter?’ ” she said. “But she’s my baby sister and we’re going to love her for who she is, not for what she can give me.”

Last fall, when Mary Ayala was about three months pregnant, she underwent amniocentesis. In this procedure, an obstetrician inserts a needle into the uterus through the abdominal wall. A sample of the fluid from around the fetus, which contains fetal cells, is obtained for laboratory analysis.

Amniocentesis is normally recommended for all pregnant women over the age of 35 because of the increased risk of birth defects in babies of older mothers. As part of the test, the sex of the fetus is learned.

In the Ayala case, the physicians also determined the tissue type of the fetus. The results of the tissue typing indicated that the siblings’ bone marrow cells will almost certainly be compatible, doctors said Friday.

“We knew about (the positive results) within the past month, but the family didn’t want it out because of all the questions coming up, the ethical questions,” said Dr. Patricia Konrad, a pediatric oncologist at City of Hope who is caring for Anissa.

Konrad and other medical experts not connected with the case have expressed concern about the vexing issue of conceiving a baby solely for the purpose of trying to save another sibling’s life. Konrad warned that the Ayalas’ experience may not be an example for other parents to follow.

“I would never advise a family to have a baby for that purpose,” she said. “Besides, there are very few families with identical situations.”

A Seattle tumor specialist recalled other isolated attempts, both successful and unsuccessful, where a child was conceived with the hope that it would be a bone marrow donor.

Dr. Patrick Beatty, a medical oncologist and head of the tissue typing laboratory at the University of Washington’s Fred Hutchinson Cancer Research Center, said Friday that he knew of several cases where a baby conceived as a possible donor turned out to have compatible bone marrow. In these cases, however, laboratory tests to determine the compatibility of the bone marrow were not performed until after the child was born.

“This (case) disturbs me a lot,” Beatty said.

About one in 200 times, amniocentesis results in a miscarriage. If Mary Ayala had been under age 35, the procedure probably would not have been recommended as a screen for birth defects.

“This brings up other issues,” Beatty added. “When you get the results back, if it’s not a match, would a couple then think about abortion?”

Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota in Minneapolis, said he was concerned about the impact on the donor child if the procedure fails.

“That’s a terrible burden to place on the person,” he said. “It means they failed the purpose for which their parents conceived them.”

When the baby is at least 6 months old, Konrad and Dr. Stephen Forman, director of hematology and bone marrow transplantation at the hospital, plan to destroy Anissa’s diseased bone marrow with chemotherapy and radiation. Then they plan to obtain marrow from the baby’s hipbone and inject it into Anissa through a vein, similar to a blood transfusion. The marrow cells can travel through the bloodstream to the bone marrow, where they grow.

If the leukemia disappears and does not relapse within two years after the procedure, Anissa will be considered completely cured, Forman said.

Doctors said the search for an unrelated donor for Anissa will continue because there is a chance that she will need medical help before her sister is 6 months old.