Cord blood transplants a viable option in leukemia
6:30pm EDT
* Body less likely to reject cord blood
* Cord blood an option when matched donors are scarce
By Julie Steenhuysen
CHICAGO, June 15 (Reuters) - Adult patients with leukemia fare just as well when they get stem cell transplants taken from a cord blood bank as they do from a well-suited adult donor, U.S. researchers said on Tuesday.
They said umbilical cord transplants are a viable option for adults with leukemia who urgently need a bone marrow transplant to replace cells destroyed by chemotherapy or radiation treatments, but cannot find a donor.
"What we found is when you look at the outcome of leukemia-free survival, which is the likelihood of a patient being alive without disease, it's the same whether you are transplanting using an adult graft which is from an adult donor or a cord blood unit," said Dr. Mary Eapen of the Medical College of Wisconsin, whose study appears in the journal Lancet Oncology.
Cord blood worked even if it was not a great match, Eapen said in a telephone interview.
Only about half of all white adult patients can find a suitable donor, and the odds are much lower if the patient is African American or Asian, Eapen said.
"In general ... if you don't have an acceptable tissue match with a donor, your chances of having a complication are higher and it can result in death," she said.
But that is less so with stem cells from umbilical cord blood. "The body is more tolerant to the cells in the placental blood, even though they are not a perfect match."
Eapen and colleagues analyzed data from 216 transplant centers worldwide. They compared the results of 165 patients 16 or older with acute leukemia who had been received umbilical cord blood to 888 adults given unrelated stem cell transplants, and 472 who had been given unrelated donor bone marrow.
After two years, all the patient groups were equally likely to survive and be free of leukemia regardless of graft source.
"The beauty of umbilical cord blood is you can use that for transplant patients who are not a perfect match and still come up with an acceptable endpoint, which is leukemia-free survival," Eapen said.
She said most transplants being done with cord blood use public cord blood banks, in which parents have donated blood from their infant's umbilical cord.
These have undergone strict testing to ensure the cells are safe and well preserved.
Private cord blood banks, such as those run by Cord Blood America Inc, typically collect and store cord blood for private use for an individual or family member, she said.
In an accompanying comment, Paul Szabolcs of Duke University Medical Center in Durham, North Carolina, said the analysis should bolster efforts to increase donations to public cord blood banks, particularly by minorities, who have the most trouble finding a matched donor.
Public cord blood banks cover the costs to collect, test and store umbilical cord blood. Information on how to donate can be found at www.marrow.org/
The Other One.
Cord Blood Viable Option for Adults With Leukemia, Study Finds
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By Ellen Gibson
June 15 (Bloomberg) -- Adult leukemia patients who can’t find compatible donors for blood or bone-marrow cells needed for treatment may live just as long if they receive umbilical-cord blood, researchers reported in a study that may change medical practice.
Patients who received cord-blood transplants had similar disease-free survival as those given cells or bone marrow from a nonfamily donor, according to research reported online today in the journal Lancet Oncology. Among patients whose disease was in remission at the time they received their transplants, 40 percent to 55 percent were alive and leukemia-free at the two- year mark, regardless of the source of the graft, the study found.
While cord blood from public banks is used in children with leukemia, studies until now have shown conflicting results in adults. These findings support the use of cord-blood transplants for adults when a donor match cannot be found and when a transplant is needed urgently, the report said.
“Clinicians should not waste time if it is thought that a patient is in imminent danger of progression and should move toward cord-blood transplantation,” said Paul Szabolcs, a professor of pediatrics at Duke University Medical Center, in comment accompanying the research. This report “should bolster efforts to increase the inventory of public cord-blood banks,” he added.
For a leukemia patient in need of a transplant, the ideal donor is a sibling with a similar blood type. Otherwise, a non- relative with matched blood can be used, which is hard to find.
Runaway Blood Cells
Leukemia, a runaway growth of blood cells, starts in the bone marrow where blood cells are formed. Healthy bone marrow is transplanted into leukemia patients because it contains stem cells that help the body produce normal blood cells to replace the diseased ones. Umbilical-cord blood is another source of regenerative stem cells, one reason that many parents elect to bank their babies’ cord blood at birth.
Companies involved in collecting and processing cord blood include Cord Blood America Inc. and PerkinElmer Inc.
When patients search for a nonfamily donor with compatible cells, doctors may need two to three months to check the compatibility of the donor’s cells.
“If it’s your first remission, you may have time to play with, but if you’ve already relapsed once, you don’t have the time to sit around for three months when umbilical cord blood is readily available,” said Mary Eapen, lead author of the study and associate professor at the Medical College of Wisconsin. “Now we know that cord blood works just as well.”
Unrelated Donors
For the study, researchers in the U.S. and Europe compared the survival of 165 adult patients who received cord-blood to 1,360 patients who got blood cells or bone marrow from unrelated donors who were deemed compatible based on their blood types.
The cord-blood group showed a lower rate of acute graft- versus-host disease, a dangerous complication that occurs when a patient’s immune system attacks the newly transplanted material, according to the report. Yet patients who received cord blood took longer to recover and died more often from transplant- related complications than those who had other types of transplants, the paper said.
To contact the reporters on this story: Ellen Gibson in New York at egibson9@bloomberg.net.
Last Updated: June 15, 2010 18:30 EDT
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