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Using Cord Blood to Save Lives
The non-controversial stem cells, or “adult” stem cells, may be found in many tissues of our body, including the bone marrow and umbilical cord blood. For about forty years, bone marrow has been used to cure dozens of diseases of the blood, immune system, genetic diseases, and blood cancers. The pioneering research of CORD:USE’s Scientific Advisory Board Member, Dr. Hal Broxmeyer, led to the first cord blood transplant in 1988 to cure a child having a fatal inherited blood disease. This child is alive and well today.
Based on this single case, a study was launched in 1992 to determine whether cord blood could be collected, processed in a blood bank, stored frozen for several years, thawed and then used to save the life of a child with leukemia or some other fatal disease. The results of this landmark study published in 1998 concluded that indeed cord blood from an unrelated donor is a suitable alternative to bone marrow (P Rubinstein et al. Outcomes among 562 recipients of placental-blood transplants from unrelated donors. New England Journal of Medicine 339:1565-1577, 1998).
Advantages of Cord Blood As
Compared to Bone Marrow
- Cord blood is in abundant supply, as it is a natural byproduct of birth and is usually discarded as medical waste
- Collection is completely safe and noninvasive for mother and baby.
- Lower incidence of transmitting deadly
infectious diseases. - Cord blood is immediately available
for transplantation. - It takes about 4 months to receive bone marrow if a matched donor can be found.
- Lower incidence of and decreased severity of graft vs. host disease, which is a leading cause of life-threatening post-transplant complications.
- The tissue matching requirements are not as stringent, which means that there is a greater probability of finding a cord blood match.
- Transplant outcomes are as good as or better than with bone marrow.
Cord Blood for
Transplantation into Adults
Clinical experiences for the first several years using cord blood were limited, for the most part, to small children because cord blood contains fewer life-saving stem cells than bone marrow. However, as physicians gained more experience using cord blood, transplants were performed on adults. The first systematic study of 68 adults was published in 2001 (MJ Laughlin et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. New England Journal of Medicine 344:1815-1822, 2001). The authors concluded that cord blood, containing a sufficient number of stem cells, from unrelated donors is a feasible alternative source of stem cells for transplantation in adults.
More recently, to overcome the small number of cells in some cord blood units, transplantation of two cord blood units in adults has shown considerable promise (JN Barker et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance
engraftment in adults with hematologic malignancy. Blood 105:1343-1347, 2005). A comprehensive review of cord blood transplantation in adults, and a comparison with bone marrow transplantation, provides a very optimistic future for saving the lives of adults with cord blood (H Schoemans et al. Adult umbilical cord blood transplantation: A comprehensive review. Bone Marrow Transplantation 1–11, 2006).
Cord Blood May Replace Bone Marrow Transplantation for Children with Acute Leukemia
A recent study of children with acute leukemia compared transplantation of perfectly matched bone marrow with matched or mismatched cord blood. The results show that the 5-year leukemia-free survival using perfectly matched bone marrow was similar to that after transplants of mismatched cord blood and possibly higher after transplants using matched cord blood. (M Eapen et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukemia: A comparison study. Lancet, 369(9577): 1947-54, 2007).
References
P Rubinstein, C Carrier, A Scaradavou, J Kurtzberg, J Adamson, AR Migliaccio, RL Berkowitz, M Cabbad, NL Dobrila , PE Taylor, RE Rosenfield, CE Stevens. Outcomes among 562 recipients of placental-blood transplants from unrelated donors. New England Journal of Medicine 339:1565-1577, 1998.
Laughlin MJ, Barker J, Mambach B, Koc ON, Rizzieri DA, Wagner JE, Gerson SL, Lazarus HM, Cairo M. Stevens CE, Rubinstein P, Kurtzberg J. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. New England Journal of Medicine, 344:1815-1822, 2001
E Gluckman, HA Broxmeyer, AD Auerbach, HS Friedman, GW Douglas, A Devergie, H Esperou, D Thierry, G Socie, P Lehn, and et al. Hematopoietic reconstitution in a patient with Fanconi's anemia by means of umbilical-cord blood from an HLA-identical sibling. New England Journal of Medicine 321:1174-1178, 1989.
Juliet N. Barker, Daniel J. Weisdorf, Todd E. DeFor, Bruce R. Blazar, Philip B. McGlave, Jeffrey S. Miller, Catherine M. Verfaillie, John E. Wagner. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood 105:1343-1347, 2005.
H Schoemans, K Theunissen, J Maertens, M Boogaerts, C Verfaillie, J Wagner. Adult umbilical cord blood transplantation: A comprehensive review. Bone Marrow Transplantation 1–11, 2006.
M Eapen, P Rubinstein, MJ Zhang, C Stevens, J Kurtzberg, A Scaradavou, FR Loberiza, RE Champlin, JP Klein, MM Horowitz, JE Wagner. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: A comparison study. Lancet, 369(9577): 1947-54, 2007.