IN 2008, Melbourne leukemia patient Graham Barnell was the eighth person in the world to receive a revolutionary stem cell treatment in Seattle.
The experimental therapy to replace his diseased bone marrow used stem cells from umbilical cord blood which had been multiplied in the laboratory to increase the chances of transplant success.
At first, it was. The father-of-two was cleared of the rare and fatal type of acute myeloid leukaemia.
After battling one infection after another, he died in 2009 from pneumonia.
His wife, Samantha MacRae, believes if a similar treatment had been available earlier in Australia, things may have turned out differently.
"If we had been able to go straight to a stem cell transplant I think the chances of survival would have been much higher," Ms MacRae told AAP.
A stem cell researcher, Associate Professor Louise Purton from St Vincent's Institute in Melbourne, hopes her new project will lead to the first treatments in Australia using expanded umbilical cord blood stem cells.
The research aims to increase the number of stem cells derived from cord blood and accelerate the rate at which the cells develop into mature blood cells.
Prof Purton said if successful the treatment could overcome a number of problems with transplants using cord blood.
Umbilical cord blood is becoming a popular source of stem cells for patients requiring bone marrow transplants who may have been unable to find an exact match.
According to the New York Blood Centre, more than 80 different diseases have been treated to date with unrelated cord blood transplants.
There have been more than 30,000 cord blood transplants throughout the world so far, with most patients having been affected by leukemia, lymphoma, severe aplastic anemia, and other blood or immune system diseases or inherited metabolic diseases.
Public cord blood banks around the world freeze the precious samples and distribute them as needed when an appropriate match is confirmed.
Cord blood has several advantages over stem cells derived directly from bone marrow for transplants, says Ngaire Elwood, the chair of Australia's cord blood collection network, AusCord.
A bone marrow donor has to be a perfect match with the recipient. Not so with cord blood, she says.
"One of the most fantastic things with cord blood is that you don't need a perfect match between the patient and the cord blood," Dr Elwood said.
"That means there is a much higher chance of finding a suitable match for someone and, nowadays, almost anyone who needs a bone marrow transplant will be able to find a cord blood unit that matches."
But there are drawbacks with cord blood.
For one, there are often not enough stem cells in a single cord blood unit to use in an adult transplant, although this has been partially overcome by infusing two unrelated units.
But there is a major issue restricting the use of cord blood stem cells for transplantation.
Cord blood stem cells, which are more immature than those found in bone marrow, can take longer to start developing into oxygen-carrying red blood cells, infection-fighting white blood cells and platelets, responsible for clotting.
"After a cord blood transplant some patients might die, or get really bad infections, because it's taking longer for their immune (white) cells to recover," Dr Elwood said.
At the Murdoch Children's Research Institute, where Dr Elwood is the head of cord blood stem cell research, investigations are under way to determine whether some cord blood samples are more effective than others at developing into mature blood cells.
In a different approach, Prof Purton is trying to increase the number and quality of cord blood stem cells by growing them in the laboratory.
She has proven the method works in mice and is now aiming to do the same with human cord blood.
To increase the number and quality of stem cells, she will use compounds derived from vitamin A.
She has previously found that activating or inhibiting the vitamin A pathway can both increase the number of immature stem cells and speed up the process to convert the cells into mature blood cells.
"The whole goal ultimately will be to start off with one cord blood unit, treat it with the vitamin A compound that causes the stem cell numbers to increase, then take a portion of that and culture it with the one that will cause the stem cells to become more mature, combine the two, and transplant them," Prof Purton said.
She received human ethics approval in January to start collecting 400 umbilical cord samples from babies born at St Vincent's Private hospital in Melbourne over the next four years for use in the research.
The samples will be obtained only from infants whose parents give their informed consent.
If the pre-clinical research proves successful, the Fred Hutchinson Cancer Centre in Seattle, where Prof Purton completed her post-doctorate studies, will conduct clinical trials testing the safety and efficacy of the procedure on patients, in collaboration with the Melbourne scientist.
The centre has carried out clinical trials with expanded cord blood cells - the same as those used in Graham Barnell's transplant - but employing a different scientific method than Prof Purton.
"The ultimate dream would be to get the treatment up and running in Melbourne," Prof Purton said.
"But that's quite far in the future."
"At the moment, no one is doing expanded cord blood cell transplants in Australia."
For Samantha MacRae's family, travelling to Seattle for the experimental treatment, which ended up costing about $A1.3 million, carried the best chance of her partner's survival at the time.
A bone marrow match could not be found for him despite a nine-month search and an unexpanded cord blood transplant was unlikely to work, given the shortcomings in treating adults.
Accessing an expanded cord blood treatment in Australia was "essential" for people who can't find a bone marrow match, Ms MacRae said.
"With those stem cells I think you've got more options for people," she said.