Unrelated Cord Blood Transplantation
This information is for patients or parents who may be considering umbilical cord blood transplantation. It explains what it is and tells you about any possible risks or side effects. This section contains complex information so you might find it useful to write down questions as you read through it. You can then discuss these with the consultant at your next appointment.
What is cord blood?
After a baby is born and the umbilical cord (the cord that joins the mother to the baby) is cut. Some blood remains in the blood vessels of the placenta and the portion of the umbilical cord that remains attached to it. After birth, the baby no longer needs this extra blood. This blood is called placental blood or umbilical cord blood: "cord blood" for short.
Cord blood transplantation from an unrelated source is referred to as Unrelated Cord Blood Transplantation or UCBT. This means that the person having the transplant (the recipient) is not related to cord blood donor (the mother / baby).
Why might I need a cord blood transplant?
Cord blood can be used for stem cell transplants in the treatment of more than 70 different diseases. The most common disease treated has been leukaemia, followed by inherited diseases (of red blood cells, the immune system and certain metabolic abnormalities). Patients with lymphoma, myelodysplasia and severe aplastic anaemia have also been successfully transplanted with cord blood.
Why is cord blood used for transplants?
Cord blood contains all the normal elements of blood - red blood cells, white blood cells, platelets and plasma. It is also contains stem cells, which act as a sort of repair system for the body. For blood transplants, we are particularly interested in the haematopoietic stem cells, which form blood cells.
Cord blood is a lot richer in stem cells than bone marrow. For example, a litre
of bone marrow has 300 million
nucleated cells (NC) per kilo, whereas 50 ml
of cord blood contains 10 million
NC per kilo.
How is the cord blood collected?
Cord blood is collected from the umbilical cord of a newborn after it is clamped. The placenta and the cord are waste products after birth and are usually discarded. This does not result in any harm to the baby or the mother. The cord blood is only collected with the mother’s consent.
Whose Cord Blood shall be Used ?
Parents ie the Mother consents for collection of cord blood from the Umbilical Cord after it is cut from the delivered child along with the placenta. These cord blood units are voluntarily donated and stored in Public Cord Blood Banks. No one pays for the storage upfront. The cord unit is screened and HLA typed. The details are entered in a computed registry which is accessible to transplant centres worldwide.
Once the unit is found to be suitably matched for a patient, the transplant centre requests to the particular cord blood bank to procure the unit for transplantation after fulfilling the requisite criteria and paperwork from both sides. The transplant centre is charged the amount payable for issuance of the cord blood unit. This varies between 12,000 USD to 25,000 USD per unit. This is called Unrelated Cord Blood Transplantation’.
Can I store the Cord Blood of my child for my own family?
The chances of one’s own cord blood being used for his/her own transplant is extremely remote (less than one in a million). A child can donate bone marrow or peripheral blood for any family member above the age of 2 years if desperately needed. Thus the chance of using a cord blood unit for a family member is equally remote.
However, in a family where a child is affected with Thalassemia or leukemia for example and needs an urgent transplant, a cord blood unit from the newly born sibling if suitably matched can be used for transplantation. This is called ‘Directed Cord Blood Donation/Storage’.
As BMT physicians, we discourage private cord blood banking. We encourage donation of cord blood units to Public Cord Blood Banks to add to the pool of unrelated cord blood units available for BMT.
How much cord blood is needed?
On an average 20 million NC per kilo are needed for cord blood to engraft (in other words for the transplant to work). The higher the number of stem cells in the blood, the better the chance of survival and recovery after the transplant. The number of cells needed is related to the weight of the person having the transplant. It is easier to carry out UCBT in children and patients with low body weight.
Is this blood safe?
Cord blood is only collected after the health of the mother and the family is checked. Once collected, the cord blood is tested in a laboratory for infectious diseases, such as hepatitis and HIV. Only good quality blood with no infections is used for transplantation.
How will a match be found?
Unlike other types of stem cell transplant, cord blood transplants do not need to be a perfect match between the blood and the recipient. This matching process is known as tissue typing or HLA matching. However, we know that patients have a better chance of successful transplant and recovery when the match is closer.
Why is cord blood important for people from black and minority ethnic (BME) backgrounds?
Bone marrow registers have fewer matches for people from BME backgrounds, because:
- People from ABME backgrounds make up a smaller proportion of the population in the western countries where most public cord blood banks are located, so fewer donors are available.
- There is are more differences in the tissue types of people with Asian and African backgrounds than any other group.
- People with African and Asian backgrounds have unique tissue types.
As cord blood (unlike bone marrow) does not need such a close match, it can be used to treat more people from a wider variety of backgrounds.
What are the advantages of using cord blood for a transplant?
Cord blood has advantages over bone marrow and other types of stem cells for transplantation, including:
- Lower incidence and severity of graft versus host disease (GVHD) – see under “Are there any risks or side effects?”
- Lower risk of viral contamination (similar to being polluted).
- More immediate availability.
- More flexibility; cord blood does not need to be a perfect match.
What are the disadvantages of using cord blood for a transplant?
- Even though it is rich in stem cells, cord blood might not have enough stem cells for some larger patients.
- Cord blood transplants generally take longer to engraft.
- There is no possibility of a second donation from the same source if the first transplant is not successful.
Are there any risks or side effects?
Although cord blood transplants are a relatively new procedure in India, over several lakhs have been carried out in USA and Europe. They have also been carried out in other countries such as Japan and Australia. There are risks associated with any procedure but those specifically linked to cord blood transplantation are explained below.
- Even though the health of the mother and baby providing the cord blood are checked, the risk of transmitting a genetic disease cannot be totally removed.
- Cord blood transplants take longer to engraft (take effect); usually three to four weeks (instead of 10 to14 days for peripheral blood transplantation or bone marrow grafts). During this period, patients have fewer white blood cells (the body’s natural defence system) so are more at risk of infections. This is described as having lowered body immunity.
- General risks associated with transplantation are:
- Anaemia: caused by a fall in the number of red blood cells in your blood. It can make you feel weak and you might need blood transfusions until your body can make enough red blood cells again.
- Bleeding or bruising: caused by a fall in the number of platelets (which help your body to heal itself) in your blood. Again this can be treated by blood transfusion until your body can make enough.
- Infections: due to lowered body immunity, you will be at risk in the early phase after the transplantation. During this time, you will have to stay in isolation room of the BMT Unit at Dharamshila BMT unit. You will also be more prone to getting bacterial and at times fungal infections during this time. Once the white cells recover, the chances of getting these infections are reduced. However, there will still be a risk of getting serious viral infections and other odd infections. These are usually preventable with strict monitoring. This means that even after you leave hospital, you will have to attend the Day Care Unit for blood tests and examination. This is usually twice a week for monitoring.
- Graft versus host disease (GVHD): This is when the lymphocytes (a type of white blood cell) from the graft attacks the patient’s body. It is usually mild because you will be given medication to prevent it, but it can become more severe. In the acute form, symptoms include:
It can happen up to three months after the transplant. After this time, GVHD that happens is called chronic, which can cause the same symptoms along with those of:
- liver damage
Both the acute and chronic GVHD are treated with steroids and other medicines to suppress the immune system.
- dry eyes
- sore mouth
- joint pains
- tightening of the skin
- chest symptoms
- Recurrence of the original disease: Although the transplantation is carried out to cure the original disease, this is not always successful. This depends on various factors, such as:
- the stage of the disease
- response to previous treatment
- how many times the disease has recurred before transplantation.
- Readmission: You might even need to come back into hospital for treatment for infections, GVHD or other problems.
I have heard of double cord transplantation – what is it?
Doctors and scientists have started to look at transplants using cord blood from two different umbilical cords. The aim of double cord transplantation is to improve the recovery and survival for patients. So far about 5000 (by the end of 2013) double cord transplantations have been carried out in USA, Europe and Japan with positive results (although a slight increase in GVHD). Please ask if you have any questions about double cord transplantation.
What happens next?
It is very important that you fully understand the treatment process, so please ask for an appointment with our experts and discuss your case and ask as many questions as you need to ask. When it is decided that Cord Blood Transplantation is the right treatment for you, our experts will explain you the next steps.
Before any surgery you will be seen by the surgeon and / or the anaesthetist when you will have another opportunity to ask questions. You will also be asked to sign a consent form.
Can Cord Blood Units be used to cure other diseases like cerebral palsy, stroke or spinal cord accident etc?
Cord blood possesses more immature stem cells compared to that of an adult bone marrow.
There is a lot of research and interest in developing these cells to heal damage to other organs. However, this research is in its infancy.
Currently, there is no evidence that simple infusion of cord blood or bone marrow to an organ is of any benefit.
If you have any questions or worries, you might find it useful to write them down and bring them at the time of your first appointment with our experts.
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