What are stem cells and how are they used?
Stem cell transplants are used as part of some treatment plans. They can be used in the treatment of lymphomas, leukaemia, myelomas, and myelodysplastic syndromes (CRUK, 2022). In their current use, stem cells are not necessarily used to kill cancer cells directly, but rather as a lifesaving measure after intensive treatments. However, as research progresses, there are some instances in which stem cells can be used to kill cancer cells directly, building on their current success. Needless to say, they are part of the future of cancer treatment.
Stem cells are undifferentiated (early cells with potential to grow into other cells). They are made in the bone marrow (CRUK, 2022). These stem cells develop into red blood cells, white blood cells and platelets, components of blood essential for life. Depletion of these would mean oxygen would not be carried around the body, we would be unable to fight infection, and blood would not clot.
High intensity chemotherapy and radiotherapy can cause damage to healthy cells, leading to depletion of the above cells mentioned. However, this is often necessary in treating cancer, to cause remission. If high intensity treatments were not used, remission would not occur in these circumstances. With these treatments, cancer cells will be killed, but healthy cells will also be killed, leaving the body in a vulnerable state – prone to serious complications from simple infections, and even death eventually. This is where a stem cell transplant would occur, to try and replenish these blood cells, allowing for a full recovery. Anthony Nolan refers to all donors as lifesavers, showing the very real potential stem cell donation has for patients.
Stem cell treatment can be used in causing remission, preventing relapse, and recently has shown promise in causing the graft-versus-tumour to affect, where donor immune cells can be directed against tumour cells (Lundqvist and Childs, 2009).
Methods of Donation
A donor joins a register by providing DNA and filling out a form, very simply through swabs. Once they become a match for a patient, they have blood tests to ensure they are a close enough match for the patient and proceed to donation after this. The time scale on this process can be weeks to months. Some people can go their whole lives on the register without being a match. However, I have been a potential match on two occasions in the last four years since I registered as a donor at the age of sixteen. By the decree of Allah, the donation did not end up happening, but it goes to show how under-represented our communities are on the register, and the demand there is for donors.
Stem cell donation does not have to be as invasive as people may think. According to Anthony Nolan, 90% of donors donate via their bloodstream. Donors will have a few injections in the days leading up to their donation to increase stem cells in their blood. Then, on the day of the donation, blood is filtered over a period of 4-5 hours to collect stem cells and put back into the patient. It is as simple as a needle in each arm.
10% of patients donate through their bone marrow directly, from the hip bone. This occurs under general anaesthesia and involves a night or two in hospital. It must be iterated that, at every stage of donation, the decision is in the hands of the donor, and they have the right to say no at any point
Stem Cells can also be found in umbilical cords. These can be donated at birth in few selected hospitals in the UK, making babies born lifesavers. This avenue is an exciting opportunity for Safeena and something I think we should endorse, due to it not requiring any extra surgery or procedures. Information can be found on the Anthony Nolan website.
Why is this important for Safeena?
As you can see from the above, stem cell transplants are already used in cancer treatments, and have a potential to be used further. According to DKMS, donors from BAME communities, are significantly under-represented on the donor register. Stem cell donation requires a very close DNA match to prevent rejection and potentially life-threatening complications. There is a very tedious process involved in verification of a donor. If there are few BAME donors available, there is a very little chance of BAME patients finding a match for their treatment, making this treatment inaccessible for them.
Safeena MCSN has a big opportunity in contributing to a greater cause. As the traffic that comes to our website have people who share an interest in the subject of cancer already, most of whom will be part of BAME backgrounds, we have an excellent opportunity to educate these people. From here, it is my hope that, education leads to awareness of this treatment, and increased number of BAME donors. The long-term goal is to reduce mortality in BAME communities, with increased stem cell donation as it becomes accessible.
As a Muslim organisation, the amount of barakah (blessings) in creating an opportunity for lives to be saved is immense, making inclusion of stem cells in our work a duty upon us.
Potential Complications
As with all cancer treatments, there are side effects including:
– Risk of infection
– Losing immunity to certain diseases – patients will need to have some vaccines again
– Anaemia
– Risk of bleeding
– Sickness and diarrhoea
– Sore mouth
– Difficulty eating and drinking
– Feeling tired and run down
– Loss of fertility
– Graft Versus Host Disease (donor immune cells attack own body cells – can be life threatening)
Statistics
For Safeena to endorse the use of stem cells, the benefits must heavily outweigh the risks. These numbers prove that they do.
According to GOSH
– 2021 – percentage of patients who developed grades 3 or 4 Graft Versus Host Disease = 5%
According to St Georges University Hospitals
– 2019 – Nationally – 89% of patients survive over 100 days post-transplant.
According to Anthony Nolan
– Over 2000 people in the UK need a bone marrow or stem cell transplant every year
– 72% of White, Caucasian backgrounds find the best possible match from a stranger
– Only 37% of BAME patients find the best possible match from a stranger
– Only 3% of the UK are registered as donors
Hopes for this project
– Setting up a partnership with one or more stem cell organisations to help with education of stem cells on our website. It is hoped this partnership could lead to easy registering for people to become donors – through our website, or at events where we are represented.
– Full education and dedicated section of stem cells on our website – including benefits and risks of donation and treatment – allowing services users to have all the information needed to make an informed decision – including links signposting to organisations.
– Recruiting specialised befrienders with experience of stem cells, guiding patients through the process, and providing help with potential complications.
Needs for this project
– Decision to be made collectively which organisation to partner with as they all differ slightly. For example, Anthony Nolan only accepts donors aged 16-30 (these donors have better outcomes for the patient) but these donors will stay on register until they are 61 unless they opt out. DKMS accept donors from 17-55.
– Lead on the project from health care background with extensive knowledge and experience in stem cell treatment
– Religious guidance on what’s allowed (donation? Umbilical cord?)
Islamic perspective
Ultimately the purpose behind this is to cure patients and save lives. In the Holy Qur’an, Allah informs us that saving one human is akin to saving all of humanity (5 :32). Therefore most scholars would agree that stem cell treatment is not only permitted, but also encouraged. The fact that the BAME community is struggling to find suitable matches reinforces the need to promote this method of healing. Donors would be fulfilling their religious obligations, as well as their social obligations in their own community.
There is of course the issue of sacredness of the human body. Islam reminds us at all times that man is the most noblest of all Allah’s creations (Qur’an, 17: 70). Muslims treat the body with utmost respect. Even trimmed nails and cut hair cannot be discarded like normal waste, but instead must be disposed of in a respectful manner. This is why some scholars would not consider such practices permissible because they consider it may disrespect the sanctiy of the human body.
Having said that, I am of the view that stem cells from the umblical cords would not be forbidden in Shariah. The ultimate purpose of the procedure is to provide shifa (healing), to help people will potentially fatal illnesses, and to serve mankind. Done with this intention, such donations will inshallah be rewarded.
Dr. Hafiz Ather Hussain al-Azhari
30.8.23
Useful Links
https://www.sciencedirect.com/topics/medicine-and-dentistry/graft-versus-tumor-effect
info on graft verus tumour effect
https://www.cancerresearchuk.org/about-cancer/treatment/bone-marrow-stem-cell-transplants
extensive information on stem cell transplants
organisations that provide education and opportunity to join stem cell registers
National and hospital data on clinical outcomes
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