|
Utilization & Outcomes: Promising Results
The number of cord blood transplants using matched units from
the New York Blood Center's National Cord Blood Program has more than quadrupled since the November 26, 1998 publication on
the outcomes of its first 562 patients in the New England Journal
of Medicine (NEJM). These more recent transplants confirm the importance
of both cell dose and HLA (human leukocyte antigen) matching for the outcome of cord blood transplants.
In addition to the NEJM report cited above, there have been many other reports about cord blood transplants involving hundreds of patients, both children and adults. Abstracts can be found in the news and articles section of this website. All support the conclusion that "...cord blood is a viable alternative to bone marrow and peripheral blood as a source of stem cells capable of hematopoietic reconstitution." [Source: Review Article "Umbilical Cord Blood Transplantation: Where Do We Stand?" presented by Drs. R.C. Wadlow and D.L. Porter and published in Biology of Blood and Marrow Transplantation 8:637-647 (2002)]
In a recent collaboration with the International
Bone Marrow Transplant Registry (now called the Center for International Blood and Marrow Transplant Research or CIBMTR), we found that young
patients (under 16 years old) with leukemia or myelodysplasia have
three-year survival rates after unrelated cord blood transplants that
are as good as, if not better than, those of patients receiving equally well-matched unrelated bone marrow (data presented by Dr. Mary
Horowitz at the American Society for Hematology (ASH) in 2001). These data highlight the need for
larger cord blood inventories so that every patient will have access to a cord blood unit that is at least a 5/6 or 6/6 match and a good cell dose.
Recent results in adults are also
promising. Two new studies using cord blood to treat adult patients appeared in the November 25, 2004 issue of the New England Journal of Medicine (NEJM). One of these reports, a collaboration between the NCBP and CIBMTR (Dr. Mary J. Laughlin, lead author and Dr. Mary Horowitz, senior author) showed that adult patients given cord blood with a 5/6 or 4/6 HLA match did as well as adults given bone marrow from unrelated donors when
the HLA match was 5/6. This study involved 600 adult patients and concluded: "HLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor." The abstract of this article (Outcomes after Transplantation of Cord Blood or Bone Marrow from Unrelated Donors in Adults with Leukemia) can be found in NCBP Scientific Publications.
The second report was a European study similar in scope, involving 682 adult patients with acute leukemia who received a hematopoietic stem cell transplant from an unrelated cord blood or bone marrow donor. This study reported similar findings, concluding that: "Cord blood from an unrelated donor is an alternative source of hematopoietic stem cells for adults with acute leukemia who lack an HLA-matched bone marrow donor." The abstract of this article (Transplants of Umbilical Cord Blood or Bone Marrow from Unrelated Donors in Adults with Acute Leukemia) can be found in Related Publications.
The editorial by Miguel A. Sanz, M.D., Ph.D. in the same issue of the NEJM is telling in its title: "Cord Blood Transplantation in Patients with Leukemia--A Real Alternative for Adults." Click here to read the complete editorial.
The 2005 Patient Statistics Report on Cord Blood Transplants Worldwide (noted on the NCBP homepage) shows that more than 500 NCBP cord blood transplant recipients (27%) fall into the "age 18+" category, so far. Nearly one third of that age 18+ group (147 patients) were age 40 or older (ages ranged between 40 and 69).
Dr. Juliet Barker, from the University
of Minnesota, reported at the 2003 ASH on a strategy to compensate for the lower number of progenitor cells available in cord blood transplants to adult patients. Two cord
blood units were transplanted after patients were given a reduced-intensity conditioning regimen in preparation for the
transplant. Adults in this Minnesota study had better than 60% survival at two years. This encouraging study will soon be published in Blood.
Using cord blood as an alternative source to search for a stem cell match continues to allow a growing number of patients to proceed to transplant who otherwise would have no chance. In 2005, NCBP has doubled the number of patients who have gotten NCBP units for their cord blood transplants--more than 350 units shipped. The rate of units shipped to patients worldwide continues to increase in 2006. You can read some of our patients' own inspiring words in Patients' Stories noted at the top of this webpage.
A MESSAGE TO PATIENTS, FAMILIES
AND CAREGIVERS
This website is developing a Reference Page of specific resources that will be especially helpful to patients (and their families and caregivers) who may be considering a stem cell transplant. We are pleased to begin with the following listings:
The Leukemia & Lymphoma Society
www.leukemia-lymphoma.org
The Leukemia & Lymphoma Society is the world's largest voluntary health organization dedicated to funding blood cancer research, education and patient services. Their Website offers extensive online patient support resources, printed materials and current information on blood cancer diseases, treatments, clinical trials and research.
The Bone Marrow Foundation
www.bonemarrow.org
The mission of The Bone Marrow Foundation is to improve the quality of life for bone marrow and stem cell transplant patients and their families by providing financial aid, education and emotional support. The Foundation was created in 1992 to respond to the critical gap in financial coverage for patient support services. It's Resource and Education Center provides support and encouragement to patients and families dealing with the challenge of a life-threatening disease.
BMTinfonet
www.bmtinfonet.org
(Blood & Marrow Transplant Information Network)
If a stem cell, bone marrow or cord blood transplant is in your future, BMT InfoNet can help. Since 1990, BMT InfoNet has provided quality information and support to more than 100,000 transplant patients, survivors and their families and caregivers. This link also provides an excellent Transplant Center Directory.
|
