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Treatments > Cord Blood Transplant

Last update: 06/05/2012

TOPIC SEARCH: PubMed | Medscape 

Overview

Best Pract Res Clin Haematol, 2010:
Should double cord blood transplants be the preferred choice when a sibling donor is unavailable?

"Umbilical cord blood transplant is an important alternative stem cell source for both children and adults with hematologic malignancies. Umbilical cord blood units are rapidly available and have less stringent human leukocyte antigen (HLA) matching requirements.

Mismatch at two antigens actually improves the risk of relapse for umbilical cord blood transplant recipients with relatively low risk of severe acute or chronic graft vs host disease. However, umbilical cord blood transplant is associated with an inferior neutrophil recovery rate when compared to other stem cell sources.

It is for this reason that we have explored ‘double unit umbilical cord blood transplants,’ not only as a platform for evaluating the safety and effectiveness of new methods of ex vivo expansion or methods of enhanced homing, but also as an approach itself to remedy the problem of limited cell dose, particularly for adults.

A stem cell transplant* may sometimes be medically necessary for patients with lymphomas. 
 
With a stem cell transplant, the stem cells** obtained from bone marrow, peripheral blood, or umbilical cord blood are given back to the patient following high dose treatment, which can damage or ablate (kill off) these vital cells.  The engrafted stem cells can then restore bone marrow function**  impaired or destroyed by the high dose conditioning therapy.

A stem cell transplant is sometimes called a bone marrow transplant.

*The terms stem cell transplant, infusion, rescue, engraftment, or support may be used interchangeably and essentially have the same meaning. 

** Stem cells are "immature cells known as hematopoietic or blood-forming stem cells. Hematopoietic stem cells divide to form more blood-forming stem cells, or they mature into one of three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen; and platelets, which help the blood to clot. Most hematopoietic stem cells are found in the bone marrow, but some cells, called peripheral blood stem cells (PBSCs), are found in the bloodstream. Blood in the umbilical cord also contains hematopoietic stem cells. Cells from any of these sources can be used in transplants" [in order to restore bone marrow function.] - cancer.gov

The different types of stem cell transplants are named from the
origin of the stem cells:

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allogeneic - stem cells harvested from donor (following reduced for full intensity therapy)

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autologous - stem cells harvested from self

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syngeneic - stem cells harvested from identical twin

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cord blood  - stem cells from saved cord blood, from self or donor

Cord blood is now being investigated as a source of stem cells for patients receiving high dose treatment for lymphoma and other cancers. 

Q&A:  How does a cord blood transplant compare with other types?

"Cord Blood Cord blood transplants are a "type" of allogeneic transplant. The reason they are different is that the stem cells found in the cord blood are more immunologically naive than the stem cells from marrow. As a result, they are more "forgiving" when it comes to inducing graft versus host disease (GVHD). This is when the donor cells start attacking the host (or recipient) of the transplant as if it were an infection. 

GVHD is one of the more feared complications of allogeneic transplantation. The biggest problem is that "some" GVHD is helpful in that it helps to control the leukemia. This "beneficial" part is termed graft versus leukemia (GVL) effect. You need some of the GVL, and can tolerate some GVHD, but you do not want too much as it can be lethal.

Cord blood, because it is less developed immunologically is thought to cause less GVHD. We do not yet know if it the less GVHD results in less GVL and less effectiveness in controlling the disease. " 

~ Rick Furman, MD (Sept 2008)

Also see: How are umbilical cord stem cells obtained for transplantation? Cancer.gov


Resources:

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Best Pract Res Clin Haematol, 2010: Should double cord blood transplants be the preferred choice when a sibling donor is unavailable?
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Excellent videos explain the history of stem cell rescue, when it's needed, what it is, and how it's improved over time.
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MSKCC About transplants (stem cell rescue) - an excellent overview!
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MSKCC: Transplant (stem cell rescue) innovations
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Bone Marrow Transplantation (BMT) and Peripheral Blood Stem Cell (PBS) Transplantation: 
Questions and Answers - cancer.gov 
 1)  What are bone marrow and hematopoietic stem cells?  Cancer.gov
 2)  What are bone marrow transplantation and peripheral blood stem cell transplantation? Cancer.gov
 3)  Why are transplants used in cancer treatment?  Cancer.gov 
 4)  What types of cancer are treated? Cancer.gov 
 5)  How are the donor’s stem cells matched to the patient’s stem cells in allogeneic or syngeneic transplantation? Cancer.gov
 6)  How is bone marrow obtained for transplantation? Cancer.gov  
 7)  How are peripheral blood stem cells (PBSCs) obtained for transplantation? Cancer.gov 
 8)  How are umbilical cord stem cells obtained for transplantation? Cancer.gov 
 9) Are any risks associated with donating bone marrow? Cancer.gov 
10) Are any risks associated with donating PBSCs? Cancer.gov
11) How does the patient receive the stem cells during the transplant?  Cancer.gov 
12) Are any special measures taken when the cancer patient is also the donor (autologous transplant)? Cancer.gov 
13) What happens after the stem cells have been transplanted to the patient?  Cancer.gov 
14) What are the possible side effects of BMT and PBSCT? Cancer.gov 
15) What is a “mini-transplant”?  Cancer.gov 
16) What is a “tandem transplant”?  Cancer.gov
17) How do patients cover the cost of BMT or PBSCT? Cancer.gov 
18) What are the costs of donating bone marrow, PBSCs, or umbilical cord blood? Cancer.gov 
19) Where can people get more information about potential donors and transplant centers?  Cancer.gov
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Cord blood banking, and overview: cancer.umn.edu/ 
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Modified Bone Marrow Cells Engraft More Efficiently ~ Karla Gale - Medscape (free login req.)
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Cord Blood Banking for Potential Future Transplantation: Subject Review AMERICAN ACADEMY OF PEDIATRICS Work Group on Cord Blood Banking - Recommendations aap.org 
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Cord Blood Transplant Resources - GrannyBarb & Art's
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Re-immunization after SCT


Research News:

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StemEx to expand cord blood-derived stem cells

Transplantation of ex vivo expanded cord blood cells using the copper chelator tetraethylenepentamine: a phase I/II clinical trial  nature.com/bmt

One limitation of cord blood-derived stem cells is insufficient quantity of  stem cells from this source. This clinical study applied a new technology  (use of StemEx to expand the number of stem cells (cd34+)) with the goal of  making SCT feasible for people without a matched donor. 
TOPIC SEARCH Cord blood derived Stem Cell transplantation PubMed

added December 12, 2007

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Comparable results of umbilical cord blood and HLA matched sibling donor hematopoietic stem cell transplant after reduced-intensity preparative regimen for advanced hodgkin's lymphoma.
Blood. 2005 Dec 29; PMID: 16384924
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Stem cells derived from the umbilical cords of newborn babies are a viable and effective transplant source for thousands of leukemia patients who have no other treatment option ~ EurekaAlert.org Nov 2004
 
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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