Umbilical cord blood is a rich source of stem cells. Some institutions are performing transplants using the umbilical cord blood obtained during the birth of a sibling or from preserved unrelated donor cord blood. The number of stem cells is usually sufficient for most children, but may not be adequate for heavier children or for adults. Engraftment, particularly of platelets, takes longer with this type of transplant than with stem cell transplants from other sources.
Our 15-month-old son, Garrett, was diagnosed with AML M4 and had CNS involvement. He relapsed on treatment, and the doctors recommended a cord blood transplant. There was one perfect match in Barcelona, Spain. It matched six out of six and was also a molecular match. I wanted to fly to Barcelona and hug everyone I could see.
He was so sick during treatment, which included a trip to the ICU and several periods of extended hospitalization for complications, that the transplant was almost anticlimactic. He had cranial radiation, TBI (total body irradiation), then chemotherapy. He engrafted on Day 12 and was out on Day 21. He did wonderfully—he only got one fever, no GVHD, no other problems. He has not been inpatient since, and it's been four years.
Graft-versus-host disease occurs less frequently and may be delayed in cord blood transplants than in peripheral blood or marrow transplants from similarly matched related or unrelated donors. In addition, cord blood is rarely contaminated by viruses such as cytomegalovirus (CMV) or Epstein Barr virus (EBV) that can cause life-threatening complications after a BMT. Cord blood stem cell transplantation is one of many promising new directions in the research efforts to improve stem cell transplantation.
Stem cell transplant protocols vary among institutions, and are continually evolving. Many aspects of stem cell transplantation—for example, the graft-versus-leukemia effect—are not well understood but are under intense scientific scrutiny. Research is also underway to identify those children most likely to benefit from a transplant, the best time to transplant, which new drugs best reduce the likelihood of infection, and the best methods to reduce post-transplant relapse.
For more information on types of transplants, write or phone BMT InfoNet, 2900 Skokie Valley Road, Suite B, Highland Park, IL 60035, (888) 597-7674. The BMT Newsletter is also published electronically on the Internet at http://www.bmtinfonet.org.
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