Cord Blood Banking

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Cord Blood Banking

• Module 5

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Todays Topics

• What sort of cancers / Thalassaemia are stem
  cells used in ?
• Transplant process
• FAQs test format

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Cancers and stem cells in India

• All types of Leukemia
• AML Acute Myeloid Leukemia
• CML
• ALL - Acute Lymphoblastic Leukemia
• CLL
• Hodgkin's and Non Hodgkin's Lymphoma (NHL)

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Leukemias

• Usually below 55 years of age
• More mortality when over 55 years
• If over 55, mini stem cell transplants along with
  chemotherapy offered

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Solid Tumours

• Hodgkin's and NHL as long as bone marrow is
  unaffected
• Ovarian and Breast- no longer treated with stem
  cells as monoclonal antibodies proving to be more
  effective.
• Nueroblastomas

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Thalassaemia

• According to classification
• Grade 1 Good prognosis
• Good kidney and heart function
• Grade 2 Average
• Not badly affected
• Grade 3 Poor
• Affected badly

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Ideal time for transplant in Thalassemics

• Usually after 3 years
• Between 3 to 10 yrs
• Beyond 10 yrs- transplant less well tolerated
• Beneficial effects of transfusion better
  appreciated
• More receptive to transplant

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Transplant process
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Steps of Transplant

• Week 1 Preconditioning therapy.
• Week 2 Blood preparation.
• Week 2 Transplant 5 minutes.
• Week 2 Recovery 2 to 4 weeks.
• Week 4 Discharge to a local recovery
  residence.
• Weeks 5 - 15 Preparation for Release
• Weeks 5 - 15 Preparation for Release

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Week 1

• Physical examination, a bone marrow examination
  and many blood tests to make sure the organs are
  in good condition
• A consent form
• Then chemotherapy with or without irradiation
  (depending on the disease)
• Antibiotics and anti-fungal drugs

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Week 2

• Cord blood collected at birth from a sibling or
  an unrelated donor and frozen in liquid nitrogen
  is thawed and washed to eliminate any
  preservatives.
• It is brought by courier from a storage facility
  in a dry ice shipper

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Actual Transplant

• Takes 5 minutes
• CB fed through the Subclavian or Jugular vein
• Or through the chest wall into the heart

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How it works..

• Arrival of the thawed umbilical cord blood
• During those few minutes, the blood is fed
  painlessly through a tube in the chest. The tube
  is an old friend worn one nearly nonstop
• Called a Hickman catheter, the tube rests near
  the collar bone
• The other end inserts directly into the right
  ventricle of the heart.
• As with so many medications and chemotherapies
  before, the blood bag was attached to the Hickman
  catheter.
• Without fanfare, a small amount of umbilical cord
  blood is infused quickly and quietly

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Post transplant

• Takes 2- 4 weeks for engraftment
• Patients very vulnerable to any infection-
  antibiotics, anti-fungals, anti rejection drugs
• Visitors screened carefully
• All activities within the room
• Discharge to an intermediary place after 4
  weeks-still very vulnerable so they must wear
  masks
• Infection control measures in place at this place
• Between 5-15 weeks, they attend school within
  this facility
• Discharge ONLY after blood counts are normal

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Some more details

• Di methyl sulphoxide (DMSO) has to be washed off
• More intense pre-conditioning regimen in
  non-malignant conditions
• HLA compatibility and blood group are not related
• However blood group is also checked prior to
  transplant
• Unmatching blood groups can also be used but
  care has to be taken with medication

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Scotts story

• On May 28, 1999, Scott left for home. His
  tests at that time showed that he was free of
  leukemia and his bone marrow was "100 percent
  donor" - from that unrelated donor in New York.
  However, Scott relapsed in May of 2000. He
  underwent a second cord blood transplant in
  August that same year. Scott relapsed again in
  February of 2001. He died June 7, 2001. 

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Stem cells Rose with the thorns