Umbilical Cord Blood Transplants

Umbilical cord blood is playing an important and growing role in the treatment of leukemia, lymphoma and other life-threatening blood diseases.

Researchers at the Fred Hutchinson Cancer Research Center have found a way to make umbilical cord blood transplants safer and more effective. *)http://www.cancer.org

The technology, developed in the lab and being tested in a phase I clinical trial of leukemia patients, expands the number of stem cells in a unit of cord blood to give patients a safer, more rapid engraftment and recovery after a transplant. The research -- published this week in Nature Medicine and supported by grants from the American Cancer Society, National Institutes of Health (NHLBI), and the Damon Runyon Cancer Research Foundation -- offers potential promise to leukemia patients in need of intensive treatment.

If you have been told a bone marrow transplant is a possible treatment for your disease, a cord blood transplant may be an option. Umbilical cord blood is one of three sources for the blood-forming cells used in transplants. The other two sources are bone marrow and peripheral (circulating) blood.

Bone marrow transplants are similar to stem cell transplants. They are a way of giving very high dose chemotherapy, sometimes with radiotherapy, to try to cure some types of cancer. Because higher doses of treatment can be given, there may be more chance of curing a lymphoma.

The use of cord blood transplants has grown for both children and adults. Cord blood is used more often in children because a cord blood unit has a limited amount of blood-forming cells. Smaller patients need fewer cells and larger patients need more cells. Because some cord blood units may not have enough cells for larger patients, they are sometimes transplanted using two or more cord blood units combined.

Another method being studied is to grow the number of cells in a cord blood unit in a laboratory before giving it to the patient.

Reasons doctors may choose cord blood

When your doctor contacts the NMDP to search the Be The Match Registry, he or she will choose the best cell source for you. That may be marrow or peripheral blood from an adult donor or it may be a cord blood unit. A doctor might choose cord blood because of some of the ways it differs from marrow or peripheral blood.

• More tolerant matching - A close match between the patient and the donor or cord blood unit can improve a patient's outcome after transplant.
• More quickly available - Your doctor may choose cord blood if you need a transplant quickly.
• Less graft-versus-host disease - Graft-versus-host disease (GVHD) is a common complication after an allogeneic transplant (which uses cells from a family member, unrelated donor or cord blood unit).

Reasons doctors may not choose cord blood

There are also reasons a doctor may choose not to use cord blood for a transplant, including:

• Number of Cells - There may not be enough blood-forming cells in a cord blood unit for the size of the patient.
• Time to Engraft - It usually takes longer for cord blood cells to engraft (begin to grow in the patient and create new blood cells and an immune system). Until the cells engraft, the patient is at a high risk for infection.
• Backup Cells - Patients cannot get backup cells from the same cord blood unit. If a patient's transplanted marrow or peripheral blood cells do not engraft or the patient relapses, the patient may be able to get a second donation from the same adult donor. After a cord blood transplant, this option is not available. However, doctors may be able to use a different cord blood unit or a backup adult donor instead.
• Newer Option - Cord blood is a newer treatment approach for transplant. Doctors do not have as much information about patients' long-term results after cord blood transplants as they do for marrow transplants.

Cord blood transplants also have all the same risks as marrow and peripheral blood transplants. The risk of infection may be higher after a cord blood transplant because of the longer time to engraft. The risk of GVHD may be lower, but the risk is still there.

If you have questions about whether a cord blood transplant is right for you, talk with your transplant doctor. Every patient's situation is different. Your transplant doctor knows your situation and can help you make choices about your treatment.

Reference: http://marrow.org