Can Cord Blood Transplant Save Lives

Some 16,000 leukemia patients diagnosed each year require a bone marrow transplant but have no matched relative or can’t find a match in the national bone marrow registry. However, cord blood transplant from umbilical cords that are normally discarded after birth could provide real hope for these patients.

Studies have been done with acute lymphoblastic leukemia, acute myeloid leukemia, chronic myeloid leukemia, or myelodysplastic syndrome. Thirty-four patients received a cord blood transplant mismatched for 1 human leukocyte antigen; 116 patients received a cord blood transplant mismatched for 2 HLA antigens; 83 patients received bone marrow with 1 HLA mismatch; and 367 patients received HLA-matched bone marrow.

The best disease-free survival was in the patients who received a matched bone marrow transplant. However, the rates were similar in the patients who received mismatched cord blood transplant.

Another study in Paris compared 682 adults with acute myeloid or lymphoblastic leukemia who received either a matched bone marrow transplant or a mismatched cord blood transplant. The research indicated no significant differences in cord blood transplant-related mortality, relapse, or disease-free survival between the two groups.

Cord blood transplants have been used successfully in children with leukemia, but this astounding discovery has some limitations when used in adults. One of the biggest problems with it is retrieving enough stem cells from the cord blood to populate the bone marrow of an adult.

One of the consequences of the reduced stem cells for adult cord blood transplant is the time it takes for neutrophil and platelet counts to return to normal after grafting. Due to this, infection-related deaths in the first 100 days following transplant are significantly higher in the cord blood transplant group than in either of the bone marrow groups.

But progress has been made in the area of cord blood transplant. New techniques include giving growth factors to stimulate white cell production, a growth factor that can stimulate platelet production, or platelets can also be transfused.

There are also some great advantages to cord blood transplants. There is no danger to the donor, because the blood is collected after birth before the placenta and umbilical cord is discarded. Also, once a suitable donor is found, the cord blood is available more rapidly than bone marrow.

Cord blood transplant results are best when a matched bone marrow donor is available, and researchers don not recommend cord blood as a substitute for a matched marrow donor.

Although the use of the cord blood transplant is increasing, the regulation of cord blood banks remains a topic of debate. There are differences between public and private cord blood banks. Private banks may be cost prohibitive unless insurance covers the fees and some of the new storage facilities for cord blood transplant may not have enough experience. However, the research shows that all in all, cord blood transplant techniques can help to save lives.