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Spring Survey Results 2012

Umbilical Cord Blood

Program: Advances in Stem Cell Transplants
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Andrew Schorr:

In that you go into the database, Caucasian man, donor, things match up. You do all that typing. Things match up. Of course had he had a twin, identical twin, maybe that would be better but things have worked out. But there are people who you see at M.D. Anderson and they don't have a match. So help us understand this whole area that's gotten some press about cord blood and where that can come into play. What are these cells in cord blood. Can they be pooled, if you will, to create enough to help an adult?

Dr. Kebriaei:

Right. You're going to see numbers everywhere, but I would say 50 to 70 percent of people can find a match on the volunteer donor registry. If you look through the NMDP, the National Marrow Donor Foundation, I think they have over seven million donors. For those we can't find a donor, and often those are patients from minority groups where you just have less representation in that large donor pool that you're searching among, umbilical cord blood transplantation is increasingly being used or offered as an option.

The advantage of umbilical cord blood cell transplantation is that we don't have to do the HLA matching as extensively. So we talk about matching a ten of ten for instance for an unrelated donor, and that's just referring to the numbers of points that we need to match in the HLA system. Well, on a cord blood, we basically can match half of the numbers that we do for the adult stem cell source, since the stem cells don’t cause as much graft versus host disease.

The disadvantage is that the actual blood-forming cells in one umbilical cord blood unit is about one tenth from what we get from an adult donor. So one umbilical cord blood unit is not typically enough for an average-sized American adult. So what we do is we use two umbilical cord blood units for each transplant, and that seems to have overcome the limitations of having fewer blood-forming cells that we need.

Andrew Schorr:

Is it as effective?

Dr. Kebriaei:

So with regards to disease control it appears to be as effective. With regards to graft versus host disease it appears to be as effective as a ten of ten matched unrelated donor. We do see more infections, because again all of the cells that we're giving are more immature including those cells that help to form your immune system, so it takes longer for the immune system to recover, to develop. So the period of getting infections is longer. You have an increased risk of viral infections, fungal infections.

And then we also still have a higher risk of graft failure, because remember again there's this battle between the donor and the recipient, and if you don't have adequate numbers of donor cells there's a higher likelihood that the recipient is going to reject these new cells. So we do have higher rates of graft failure with umbilical cord blood transplants. And we're continuing to tweak the conditioning regimen for cord blood to improve on those issues.

Andrew Schorr:

Now, I have a bunch of questions, and I think we've got questions coming in as well as we discuss this. But Sarah from Houston wrote in. She said, "I'm pregnant with my first child. I've heard about blood cord banking. What are the benefits to me, and where can I get more information?"

And I have to tell you, after I was diagnosed with leukemia it was with the confidence of Dr. Keating at M.D. Anderson that we started--he said--we wanted to have a third child. You're going to live a long time, have another child. When that child was being born we thought should we try to bank the cord blood. This was years ago now, 11 years ago.

Dr. Kebriaei:

Right.

Andrew Schorr:

So this whole idea of banking if you're going to have another kid or your sister's kid or whatever, could that be what you need now or in the future or would you really be looking at it coming from a bank or somewhere else?

Dr. Kebriaei:

You know, it ultimately becomes a personal decision, and everyone asks me that. My general recommendation is that if you have high frequency of cancers in your family, and there's certainly those families out there, then it may be reasonable to bank the cord for your child. We do know that even though you really need to match by half the HLA that we do for adults, regardless, the better the HLA match of even umbilical cord blood units with the recipient, then the better the outcome of a transplant. So if you have a child that ends up needing a transplant, if they have their own umbilical cord blood banked, it may lead to a better outcome.

Otherwise, in general, cancer in children is relatively rare and so then I say if you don't have an increased risk of cancers in the family I don't see a strong indication to bank your own cord blood. —However, it's always good if you would donate the umbilical cord product to a cord blood bank so others can use it.

Andrew Schorr:

Right.

Dr. Kebriaei:

And you can ask your obstetrician about donating the cord blood.

Andrew Schorr:

I know in the New York area I've been over to the New York Blood Center and they have a program with a number of hospitals including ones in New York where routinely pregnant women are asked would you donate the cord blood mand then it goes into a in a sense, a community blood bank.

Dr. Kebriaei:

Right.

Andrew Schorr:

And that's neat, I think. And that can help people not just with cancers but I know a variety of genetic conditions as well.

Dr. Kebriaei:

Exactly. And we have cord blood bank that we have developed here at M.D. Anderson as well, and we have a system with the hospitals here where you can donate.

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