 1) WHAT ARE STEM CELLS?
A stem cell is a master cell, a
building block within the body,
capable
of dividing or reproducing into other
types of cells: red blood cells(which
carry oxygen throughout the body);
white blood cells(which fight
infection)
and platelets (which aid in blood
clotting). Stem cells build and repair
organs and tissue throughout our
lives.
These master cells are the building
blocks of the blood and immune system.
2) HOW IS CORD BLOOD COLLECTED ?
Immediately after delivery of your
baby, following the cutting of the
cord, your delivery team (usually led
by your delivering physician or
midwife) will collect the UCB that
remains in the placenta and umbilical
cord using the collection kit. After
sterile preparation of a four-inch
segment of the umbilical cord the
collection needle is inserted into the
vein of this prepared area. A general
yield between 70 and 100 mls
(approximately 5 to 7 tablespoons) is
collected by gravity flow, with the
entire process taking approximately 3
to 5 minutes. Following the UCB
collection, the bag is secured,
labelled and transported back to
CryoGENESIS for processing. There is
no
pain involved with the UCB collection
procedure, and the process is not
harmful to mother or newborn.
For Adults and older children
ReGENESIS UK will collect stem cell-
rich bone marrow from the pelvis or
from your peripheral blood. The
procedure can be carried out under
local anaesthetic and does not require
hospitalisation. We are reliably
informed by people who have used this
service that it is no worse than a
visit to the dentist!
Please contact us for more information.
3) HOW DO THE UCB STEM CELLS WORK?
They actually work in the same fashion
as bone marrow stem cells, but have
many advantages as noted previously,
as
well as being more versatile and
better
able to transform into any other cell.
Once the stem cells have been
administered, these amazing cells
migrate
into the bone marrow and begin
producing new blood cells, as well as
supporting the weakened immune system.
UCB stem cells are especially valuable
when these systems have been damaged
by
radiation or chemotherapy.
4) HOW ARE THESE STEM CELLS USED IN
MEDICINE TODAY?
Stem cell transplants are most
commonly
used in three different types of
treatment:
1) treatment of blood cancers, such as
Lymphoma, Leukaemia, Myeloma and
Anaemia.
2) treatment of solid tumour cancers,
such as Neuroblastoma, Breast and Lung
cancers.
3) treatment of genetic disorders.
such as Sickle Cell Anaemia and Beta
Thalassaemia.
When stem cells are used for the
treatment of blood cancers, patients
have (typically) been treated with
chemotherapy and/or radiation to
destroy the cancer cells invading the
body. Stem cells are then given (or
transplanted) to regenerate the
patients' blood and immune systems.
Whether the bone marrow has been
damaged by medical treatment, such as
chemotherapy or radiation, or by the
disease itself, a stem cell transplant
usually becomes necessary. Stem cells
have been used in treatment therapy
for
50 to 60 different cancers, genetic
disorders and immune deficiencies. To
date, approximately two-thirds of the
UCB stem cell transplants have been
for
treatment of malignant conditions and
the other one-third for a variety of
genetic blood disorders. Some of the
most familiar uses being for:
Leukaemia, Aplastic Anaemia,
Hodgkinson's Disease, Non-Hodgkin’s
Lymphoma, Multiple Myeloma,
Neuroblastoma, Fanconi’s Anaemia,
Lupus, and Severe Combined
Immunodeficiency.
Although cord blood has only recently
begun to receive greater media
attention, it's use instead of bone
marrow transplants has been increasing
steadily due to the documented
advantages and demonstrated successes.
5) HOW WILL UCB STEM CELLS BE USED IN
THE FUTURE?
The uses for stem cells in different
treatment therapies are increasing
every day. In addition to the already
documented 80 to 90 present uses for
stem cells, researchers are
anticipating their use in treatments
for diabetes, heart disease, stroke,
and muscular dystrophy. Repair of
spinal cord injuries, blood vessel
growth, treatment of Alzheimer’s and
Parkinson’s disease are other areas of
anticipated use. Multiple Sclerosis
patients are also benefitting from new
advances in treatments using these
amazing healing cells. As the causes
of
more diseases are discovered it is
being projected by researchers that
the
uses for cord blood stem cell
transplantation will undoubtedly
increase.
“Given the enormous promise of stem
cells to the development of new
therapies for the most devastating
diseases, when a readily available
source of stem cells is identified, it
is not too unrealistic to say that
this
research will revolutionize the
practice of medicine and improve the
quality and length of life.” National
Institutes of Health, May, 2000
NOTE: We are not referring to
embryonic
stem cells.
6) WHAT ARE THE BENEFITS OF UCB
TRANSPLANTATION?
• Easily obtained after delivery
without any risks to mother or baby
• Can easily be stored for
personal use (private banking), or
donated for others to use (public
banking)
• More accessible for ethnic
minorities for whom bone-marrow donors
are frequently difficult to locate
• Possibility of infectious
disease contamination is greatly
reduced
• Less stringent HLA-matching
required for transplantation use
• Significantly fewer instances
of Graft versus Host disease, as well
as the chances of side effects, after
transplantation
• Biological insurance in an
inexpensive form.
7) WHO CAN USE THE UCB STEM CELLS?
If your family chooses to privately
bank your baby’s UCB, you will have
access to your stem cell samples
(vials) at any time, should you ever
need them. There is currently no
established centralised registry for
publicly donated UCB units, thereby
lengthening the search time necessary
to find a suitable transplant match.
Private UCB banking recognises this
search time and assures immediate
availability of your baby’s stem
cells.
This ensures a 100% HLA (tissue) match
for the donor baby with at least a 25%
chance for a sibling match.(UCB stem
cells need only between a 3 or 4 to 6
HLA match). There is also a potential
use for parents, grandparents or other
blood relatives with an adequate HLA
match. At the present time we are
aware
that there are certain diseases that
cannot be treated with one’s own stem
cells.
8) HOW ARE STEM CELLS ADMINISTERED
WHEN
NEEDED?
Most commonly the stem cells are
infused intravenously through a
central
catheter, much the same way IV fluids
are administered. Most stem cell
recipients (transplant recipients)
will
have a central line, or central
catheter, already in place from their
chemotherapy. Administration of the
stem cells through this catheter is
the
transfusion, or transplantation of
stem
cells. Stem cells have also been
delivered by direct injection into
the “target” site, as done with a
patient who had experienced a heart
attack. The heart muscle was actually
noted to generate healthy muscle cells
after using this alternative method of
administration. Although the direct
injection method is much less commonly
used at present, it may gain
popularity
as research and technology advance, as
a smaller amount of stem cells are
required for effectiveness.
9) IS CORD BLOOD COLLECTION PAINFUL?
Absolutely not! The cord blood
collection is done after the baby’s
delivery, and after the umbilical cord
has been clamped and cut. The
collection can be done after a vaginal
or a C-Section delivery; and can be
done with the placenta in utero (still
inside the mother, attached to the
uterine wall), or ex utero (placenta
outside of the mother, no longer
attached to the uterine wall). There
is
absolutely no pain or risk involved
during the collection for the mother
or
baby. The umbilical cord and placenta
actually have no sensation or feeling –
much like hair or fingernails.
10) WHICH FAMILIES CHOOSE TO STORE
THEIR BABY'S UCB?
Most families that choose to store
their baby’s UCB have no family
history
or medical condition pre-disposing
them
to an immediate need. These families
are preserving their baby’s cord blood
for simple “peace of mind”, a type of
biological insurance. A growing number
of families are choosing UCB
cryopreservation based on the
increasing body of knowledge as well
as
recent research suggesting multiple
areas of medicine that may use stem
cells. In addition, minority families
and families of mixed ethnicity are
storing cord blood simply because it
is
more difficult for them to find a stem
cell match, if ever needed. Families
with in vitro pregnancies are also
making this valuable choice.
CryoGENESIS believes that preserving
your baby’s cord blood is a rational
option. If your delivering physician
does not mention the possibility of
collecting your baby’s UCB please do
not hesitate to initiate the subject
yourself! As a parent, CryoGENESIS
supports your family, and your
position
to be your baby’s best advocate.
11) WHAT MAKES UCB STEM CELLS SO
UNIQUE ?
If collected and stored after birth,
UCB stem cells are available when
needed, versus an average 3 to 6 month
search for matching bone marrow stem
cells. This wait may be critical to a
recipient’s survival. There is
absolutely no pain or risk to anyone
during the collection of UCB stem
cells, versus that experienced during
bone biopsy and general anesthesia
when
bone marrow stem cells are collected.
UCB collection is also much less
expensive because of these drastically
different procurement procedures. It
requires less frequent
hospitalizations
due to fewer post transfusion
complications (Graft Versus Host
Disease and a lower risk of infection,
such as CMV, EBV, HIV, Hepatitis B,
and
possibly HHV-6), thereby providing for
a higher quality of life. Other
advantages that UCB stem cells have
over bone marrow and peripheral stem
cells are:
• a higher rate of engraftment
(acceptance by the body) in children.
A
smaller amount of UCB stem cells are
needed than other sources of stem
cells, as they contain a higher number
of progenitor cells (CD34+ cells) and
they are more proliferative (8 to 10
times).
• greater tolerance of tissue
mismatches; (less than perfect HLA
match required; possibly as low as 3
or
4 to 6 HLA mismatch tolerated with UCB
stem cells, as opposed to a 6 of 6 HLA
match needed for bone marrow
transplants).
• a lower incidence and severity of
acute and chronic GVHD.
• provision of a 100% perfect match
for
the donating baby; at least a 25% or
greater chance of matching a sibling,
and potentially a match for parents,
grandparents and other blood
relatives!
12) WHAT IS THE HISTORY OF UCB STEM
CELL TRANSPLANTATION?
In 1988, the first cord blood
transplantation was performed in
Paris,
France on a five year old boy with
Fanconi’s Syndrome, or Fanconi’s
Anemia, using his sister’s UCB stem
cells. To date he remains disease free
and very healthy!
In 1989, the first cord blood stem
cell
transplant occurred in the United
States, at the University of
Cincinnati. In 1991 a transplant was
performed on a child with chronic
myelogenous leukemia. These two
transplants were highly successful,
thereby “setting the stage” for cord
blood transplants in situations where
bone marrow transplants had
traditionally been used.
In 1992, the first private storage of
a
baby’s UCB occurred.
In 1993, the UCB Bank at the New York
Blood Center was founded by Dr. Pablo
Rubenstein. This is the largest public
cord blood bank in the United States;
with over 1,000 cord blood transplant
units used to date.
In 1995, in the Lancet Report, Wagner
and his colleagues studied cord blood
transplants with “related recipients”.
The results showed survival and
engraftment rates similar to bone
marrow transplants.
In 1997, in a NEJM report, Gluckman
and
colleagues published results of the
overall survival rates at one year, of
both related and unrelated cord blood
transplant recipients. Survival rates
were noted to be 63% for related
donors
and 29% for unrelated donors.
In 1998, the first ever autologous
transplant of privately banked UCB
stem
cells occurred, when a family in
Brazil
with a history of cancer in a young
son
decided to bank their next child’s
UCB.
The baby developed Neuroblastoma and
underwent a successful autologous stem
cell transplant (her own stem cells).
In 2000, in a retrospective
comparison,
Roche and colleagues demonstrate
results of lower acute and chronic
GVHD
in cord blood stem cell transplants as
compared to bone marrow transplants.
In 2001, the first study of cord blood
transplants in adults was published;
reporting that 90% of the transplants
engrafted. On 12/10/01 – the first
autologous cord blood transplant from
a
private bank occurred in the US. Also
in December of 2001, several clinical
trials were underway to study the
results of multiple mis-matched cord
blood units in adults.
In 2003, over 3,000 cord blood
transplants have been completed
worldwide since 1988, with the
majority
of these being done in the last 2 to 3
years.
Into 2004, research indicates that
unrelated UCB stem cell use in adult
transplantations is a viable option
for
these patients and should continue to
be studied.
13) HOW LONG CAN MY BABY'S UCB STEM
CELLS BE STORED?
It is believed that stem cells can be
successfully stored for a very long
time in a cryopreserved state, at the
current time, no expiration date need
be assigned to cord blood stored
continuously under liquid nitrogen”.
Ultimate length of cryopreservation
storage time, continuing to yield a
viable stem cell has not been
determined. This is because stem cell
cryopreservation is a newer science or
procedure. We know for sure stem cells
can be successfully cryopreserved for
at least 20 years and continue to
yield
a viable / useful unit for
transplantation; as 20 years ago is
when this science of cryopreserving
stem cells began!
14) WHAT IS GRAFT VERSUS HOST DISEASE
(GVHD)?
This is one of the most common and
severe (sometimes fatal) reactions
following a transplant. GVHD may occur
in either an acute or chronic form,
and
occurs when the donor’s white blood
cells attack the recipient’s tissue
because the donor’s lymphocytes
recognize the tissues as foreign (if
the “HLA” match is not perfect). The
skin, liver and gastrointestinal tract
are most susceptible to attack from
the
donor’s white cells. UCB stem cell
transplants in children have a
noticeably lower incidence of GVHD.
15) ARE STEM CELLS FOUND ONLY IN UCB?
UCB is only one of three sources of
hematopoietic stem cells; the other
two
sources being bone marrow and
peripheral blood. The stem cells found
in cord blood have several significant
advantages over the stem cells found
in
bone marrow and those that are found
in
peripheral blood. UCB contains 10 to
20% more stem cells than bone marrow.
UCB stem cells are 8 to 10 times more
proliferative (they increase more
rapidly) than those from bone marrow.
UCB stem cells have a greater chance
of
matching other family members because
they are “immunologically immature”,
or
naïve, and they have a higher rate of
engraftment. UCB stem cells are
more “pure”, as they are cryopreserved
shortly after birth and therefore do
not experience “aging” or different
viral/disease “exposure” as do more
mature stem cells from peripheral
blood
or bone marrow (those generally
collected from adults).
16) WHAT ARE THE DIFFERENT TYPES OF
UCB
STEM CELL TRANSPLANTS?
There are two basic types of stem cell
transplants:
• Autologous — an autologous
transplant
uses your own individual stem cells
that have been previously collected
and
banked. An example of this would be a
child receiving their own UCB stem
cells that had been collected after
birth and stored with a private bank.
• Allogeneic — allogeneic stem cells
for transplantation can be acquired
from three different sources: a blood
relative, or “related donor”; or an
unrelated donor.
o Syngeneic — a syngeneic
transplant is a form of allogeneic
transplant and uses stem cells that
have been collected from an identical
twin.
o Mini-transplantation — a type
of allogeneic transplantation, it is
sometimes called the “mixed chimerism
transplant”. These patients often
display a “mixed” HLA type; known as
chimerism. The goal of this new
therapy
is to give multiple mismatched units
of
UCB stem cells to obtain a high enough
stem cell count to ensure rapid
engraftment in an adult. The end goal
is to produce a harmonious coexistence
between the donor and the recipient’s
immune systems. It is a relatively new
transplant therapy and is being used
to
treat various high risk diseases.
Email: CryoGENESIS International Limited |
