According to results presented at the 31st meeting of the European Bone Marrow Transplant Group, parents of a child that could benefit from a stem cell transplant should consider collecting and banking umbilical cord blood from a newborn sibling.
Stem cell transplantation is the only curative treatment option for some types of leukemias, other types of cancer, or other diseases. Stem cell transplantation includes the use of high doses of chemotherapy and/or radiation. The higher doses of treatment tend to kill more cancer cells than moderate doses of treatment; however, the high-dose treatment regimens also tend to kill more healthy cells in the body, such as blood cells, leading to increased rates of severe side effects. Following the high doses of treatment, patients receive infusions of hematopoeitic stem cells (immature blood cells that mature in the body) to replace the blood cells that are killed during treatment. In an allogeneic stem cell transplant, patients receive a donor’s hematopoietic stem cells following treatment. The donor’s cells must be “matched” to the patient’s, meaning that sequences of 6 specific proteins (HLA) found on the outside of the cells must be similar to that of the patient’s. If all HLA match between the donor and patient, it is referred to as a perfect match. Unfortunately, many patients in need of an allogeneic stem cell transplant cannot find a matched donor and are therefore denied treatment. Donor hematopoietic stem cells provide an added anti-cancer attack in that they attack the patients’ cancer cells. However, they also may attack the patients’ healthy tissues, resulting in a condition referred to as chronic or acute graft-versus-host disease (GVHD), which can lead to debilitating consequences.
Hematopoietic stem cells can be found in the bone marrow (spongy material inside large bones), circulating blood and the umbilical cord of infants at birth. Unfortunately, the rich source of stem cells within the umbilical cord is discarded in thousands of births that occur daily. Researchers have been evaluating the use of umbilical cord stem cells for the treatment of allogeneic stem cell transplants in the hopes of utilizing them for patients who cannot find a donor match. Previous trials have indicated their effectiveness in transplants, as well as a reduction in GVHD with the use of mismatched hematopoietic stem cells. Trials are ongoing to determine the role of cord blood in stem cell transplants.
Researchers from Italy recently reported results from a program in which newborn infants have their cord blood collected and used for transplantation in a sibling that has a disease and would benefit from a stem cell transplant. So far, data from 21 patients has been collected. The average age of the recipient of umbilical cord blood was 6 years. One-quarter of patients had acute lymphoblastic leukemia (ALL) and other patients had other cancers or non-cancerous conditions that are treatable with stem cell transplants. Following umbilical cord transplants, only one case of acute GVHD occurred, and no causes of chronic GVHD have been reported. Eighteen patients are alive and have a complete disappearance of detectable cancer or disease (complete remission). One patient died from infection, one died from a recurrence of leukemia, and 1one patient is alive, but has a recurrence of neuroblastoma.
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The researchers concluded that umbilical cord transplants conducted with cord blood from a sibling appears to be a highly effective way in which to undergo stem cell transplantation. Parents who have a child with a disease that is treatable with a stem cell transplant, and who are planning on having another child, may wish to speak with their physician about banking the cord blood of their infant.
Reference: Bergamaschi P, Perotti L, Bellotti A, et al. Dedicated cord blood for related allotransplants: a single bank experience. Bone Marrow Transplantation 2005;65 (supplement 2):S120, abstract P497.
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