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April 01, 2008

New York Blood Center: treating hematologic diseases with umbilical cord transplant

I'm just starting to catch up with blogging about the various conferences I've been attending.

Last Friday I attended the annual New York Cancer Consortium review of the recent American Society of Hematology, and San Antonio Breast Cancer, and America Society of Clinical Oncology symposia. (I'll get to that in a future post.)

Yesterday, I was at the New York Blood Center's one-day conference on the current research being performed with umbilical cord blood, which is supplied via their public cord blood bank, the oldest and largest in the US.

The reality is this: last year, there were 4 million births, and in 99% of the cases, the cord blood was discarded as medical waste.

The parents to be do have the option of banking the infant's cord blood with a private bank. This could cost up to $2,000 for the collection procedure, and up to $200 per year for storing the sample. The American Academy of Pediatrics doesn't recommend this unless there is a family member who has a hematological disease and therefore might benefit if the match is close.

The New York Blood Center provides a public blood banking service where the sample is collected, analyzed for immunological markers, and then stored. These units are either used for research or used for transplantation depending if a close match can be made with the recipient.

The limiting factor now is the sample size. The success of a transplant is dependent on the recipient's weight. Right now the average cord blood unit is about 50 mL, or enough to transplant a 50 kg (110 lb patient). If the average adult with leukemia is to be treated, they need to be transplanted with two units of umbilical cord blood cells, which makes matching even that more difficult, and presents other problems.

The push is on to develop a technique where a lab could take a small umbilical cord blood sample and expand it ex vivo. This means finding the right culture techniques to allow the stem cells to reproduce without producing mature cells so that you can produce enough volume to transfuse an adult with a blood disease. The first researchers who can come up with a reliable technique will change the landscape of how these diseases are treated.

As of now, the 8/8 HLA-matched bone marrow transplants remain the gold standard, but with umbilical cord stem cells, there is less stringency with HLA matching, plus it can be done faster. Currently, it takes several months to prepare a bone marrow donor specimen. With cord blood it's just a matter of thawing the sample and then infusing into a patient through a catheter in the chest.

There is also the possibility that cord blood has some anti-leukemic properties, that is NK (natural killer) cells have been shown to attack leukemic cells. There is also lower graft-versus-host disease with cord blood stem cells.

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