Cord Blood Transplant Procedure

There are several steps in the cord blood transplant process. The steps are much the same, no matter what type of transplant you are going to have.

The cord blood transplant procedure is performed one to two days after preparation for the transplant has been completed.

You will first be evaluated to find out if you are eligible for a transplant. Also known as "Day Zero," it is common for the patient to feel fatigued and to still be experiencing symptoms of the preparatory regimen. Also Many different medical tests may be done, and questions will be asked to try to find out how well you can handle the transplant process.

If the stem cells being used for the cord blood transplant procedure are from an adult donor, the donation will be completed on the day of the transplant. However, if umbilical cord stem cells are being used, they will be transferred to the transplant center prior to the transplant procedure.

Stem cells are stored in blood bags and their appearance (color and fluid amount) will vary depending on whether the cells are derived from bone marrow, umbilical cord or peripheral blood, and whether or not the cells have been filtered.

During the transplant procedure, the cells are infused (transmitted into the body) using an IV line, similar to a blood transfusion process. This is usually fed through a central line - that is, a tube surgically implanted into the vein in the chest.

The transplant procedure usually lasts one hour and is generally painless. A nurse monitors the patient's pulse as well as blood pressure. During the procedure, the patient is awake, but a mild sedative might be administered.

After the transplant, the donated cells move through the bloodstream and settle in the bone marrow. They begin to produce red and white blood cells as well as platelets, a procedure that is known as engraftment.

After engraftment occurs, the patient's blood cell count will continue to rise, resulting in increased immune system strength. However, the patient's immune system will be weaker than average for several months following a cord blood transplant.

While still in the hospital, the patient's body temperature will be taken four times a day, as fever is an indicator of infection. The patient will usually be given antibiotics and will be monitored for pneumonia. Blood tests will also be performed in order to evaluate the patient's recovery and monitor potential complications.

After leaving the hospital, the patient should follow certain special care instructions in order to ensure proper recovery. This is because the individual is more prone to infection at this time.

Your transplant team is still available to help you. It is important that you talk to them about any problems you are having – they can help you get the support you need to manage the changes that you are going through.

Reference: www.pregnancy-info.net

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Unfavorable Aspects of Cord Blood Transplants from Unrelated Donors..!

A cord blood transplant may give the patient one of the rare genetic diseases of the blood or immune system. Families who donate cord blood are asked about their ethnic background and family history of genetic diseases. Cord blood is tested for common genetic diseases such as sickle cell anemia. And we obtain information about diseases that may be found in the infant before he or she is sent home after birth. However, some genetic diseases may not be apparent in the child for months or years and will not be found or even suspected by current screening methods. At present, it is also not possible to test for all of these rare diseases. Thus, there is a chance that a cord blood transplant may transmit to a patient a rare serious genetic disease that was not recognized beforehand.

The main disadvantage of cord blood is that the volume collected is fixed and relatively small. Therefore, the number of stem cells available for transplantation is low compared to the number of cells that can be collected in customizable bone marrow or peripheral blood stem cell harvests.

The average total nucleated cell dose (number of nucleated cells per kilogram of the patient's weight) in a cord blood graft, for example, is less than about 1/10th that of the average bone marrow graft. As a consequence, engraftment (the return of nucleated blood cells, red blood cells and platelets) to the patient’s blood is slower with cord blood than with bone marrow transplants. Cord blood transplant patients, therefore, may be more vulnerable to infection in the first two to three months after their transplant. This problem is greatest for adolescents and adults because they require a relatively large number of cells.

Another disadvantage of cord blood is that the donor cells come from a newborn infant that will not be available for an additional donation of cells or bone marrow. In bone marrow transplants, on the other hand, the donor may be asked to make a donation of white blood cells (T-lymphocytes or T-cells) to help fight a recurrence of leukemia or development of lymphoma. Or a second marrow donation might be needed if the first one fails to engraft.

T-cell donations and second transplants from the same donor are not available with cord blood. Another cord blood unit from a different donor would have to be given if the first one fails.

Source: www.nationalcordbloodprogram.org

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Bone Marrow Transplant or Cord Blood Transplant as a Treatment

A bone marrow transplant (also called a BMT) or umbilical cord blood transplant replaces diseased blood-forming cells with healthy cells. Diseases that may be treated with a bone marrow or cord blood transplant include:

• Leukemias and lymphomas
• Multiple myeloma and other plasma cell disorders
• Severe aplastic anemia and other marrow failure states
• Sickle cell disease and thalassemia
• Inherited immune system disorders, such as severe combined immunodeficiency (SCID) and Wiskott-Aldrich syndrome
• Inherited metabolic disorders, such as Hurler's syndrome and leukodystrophies
• Myelodysplastic syndromes

The healthy cells for a transplant can come from three sources:

• Bone marrow
• Peripheral (circulating) blood that has an increased number of healthy blood-forming cells (also called peripheral blood stem cells or PBSC)
• Umbilical cord blood that is collected after a baby is born

If you need a transplant, your doctor will choose the source of the cells. Your doctor will also decide whether to use cells collected from you or another person.

• An autologous transplant uses cells collected from your body.
• An allogeneic transplant uses cells donated from a family member or an unrelated marrow donor or umbilical cord blood unit.

Your doctor decides on the cells used for transplant based on your disease, other treatments you have had, and your overall health.

When a bone marrow or cord blood transplant is being considered as a treatment option, it is helpful to understand the transplant process.

Your Doctor Searches for a Marrow Donor or Cord Blood Unit

If you need an allogeneic transplant, your doctor will look for a marrow donor or cord blood unit that matches your HLA tissue type. HLA stands for human leukocyte antigen, a marker your immune system uses to recognize which cells belong in your body and which do not.

If a donor is not found in your family, your doctor can search for an unrelated donor or cord blood unit through the registry of the C.W. Bill Young Cell Transplantation Program, also called the Be The Match Registry®. The registry is a listing of potential marrow donors and donated cord blood units.

The registry is operated under Federal contracts by the National Marrow Donor Program® (NMDP). The NMDP has agreements with its global partners that provide access to more than 18.5 million potential marrow donors and more than 590,000 cord blood units.

Your Body is Prepared for a Transplant

Before your body can receive the healthy cells, the diseased cells must be destroyed. This is done using chemotherapy and sometimes radiation. The destruction of diseased cells is called a preparative regimen or a conditioning regimen.

You Receive the Cells for the Transplant

On the day of transplant, the cells from the marrow donor or cord blood unit are infused intravenously (go into your body through a large vein). These healthy cells move into the spaces inside your bones where they create new marrow. They grow and make healthy new red blood cells, white blood cells, and platelets.

Reference: http://bloodcell.transplant.hrsa.gov

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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

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