Transcript Cord Blood : Past, Present and Future

CORD BLOOD :
PAST, PRESENT
AND FUTURE
Presented By: Mary C. Wiegel
Program Manager / Educator
ITxM Clinical Services
Dan Berger Cord Blood Program
ABOUT CORD BLOOD
 2005
– C.W. Bill Young Transplantation
Program, the Stem Cell Therapeutic and
Research Act of 2005 created the National
Cord Blood Inventory (NCBI) with the
goal of increasing the national supply of
publicly donated cord blood units
STATES WITH CORD BLOOD
LEGISLATION
BIPARTISAN LEGISLATION PROMOTING
LIFE-SAVING MEDICAL ADVANCES
CLEARS SENATE
The Stem Cell Therapeutic and Research
Reauthorization Act of 2010 (S. 3751),
unanimously approved by the Senate today,
reauthorizes the original 2005 act and
extends the C.W. Bill Young Cell
Transplantation and National Cord Blood
Inventory (NCBI) programs through Fiscal
Year 2015.
ACOG COMMITTEE OPINION
# 399. FEBRUARY 2008

Recommendations (Information to Patient)
›
›
›
›
›
›
balanced and accurate information on advantages
and disadvantages of public vs. private
Remote chance of autologous unit being used of 1 in
2700 individuals
Disclosure that demographic data will be
maintained, maternal infectious disease and genetic
testing, ultimate outcome of poor quality units
Provider not obligated to obtain consent for private
banking
Collection should not alter routine delivery
practices
Disclose any financial and conflict of interest for forprofit UCBB
CORD BLOOD DONATION COMES TO
WESTERN PENNSYLVANIA


October 8, 2007, the creation of the Dan Berger
Cord Blood Program was announced at MageeWomens Hospital of UPMC.
Named for the late Dan Berger, a prominent
Pittsburgh attorney and humanitarian who
underwent a successful unrelated stem cell
transplant to overcome cancer, but then
tragically died of a heart attack in 2006
CORD BLOOD PROGRAM



To educate all parents-to-be about their cord
blood options:
Private Banking
Donate to a Public Bank
Research
Throw away as medical waste
Hope that all parents-to-be will make an
educated decision to save / donate
Expand the program so that all expectant
parents know about their options and can make
a difference
PRINCIPLES OF THE CORD BLOOD
PROGRAM

To collect from an ethnically diverse donor pool

To bank large volume units to maximize clinical
usefulness

To have units of the highest quality

To support research in the area of cord blood
banking and transplantation
WHY START A CORD BLOOD PROGRAM?




Umbilical cords and placental tissue are
routinely discarded as medical waste
Stem cells from cords have been used to treat
more than 70 diseases
Stem Cell and Bone Marrow transplants account
for more than 10,000 transplants worldwide
(NMDP)
Easier to match stem cells from cord blood than
bone marrow:
Three Sources for stem cells:
Bone Marrow
Peripheral Blood
Umbilical Cord Blood / Placental Blood
STEM CELLS

Embryonic Stem Cells


Derived from four to five day old embryos
Adult Stem Cells

Undifferentiated cells found among differentiated
cells in a tissue or organ
EMBRYONIC STEM CELLS
Human Embryonic Stem Cells
 Obtained from donated embryos that have developed
from eggs fertilized in vitro (in the lab)
 Potentially unlimited capacity to replenish
themselves and are pluripotent, meaning that they
can differentiate into any cell type found in the
adult body.
 Embryonic stem cell therapies have been proposed
for regenerative medicine and tissue replacement
after injury or disease.
CORD BLOOD STEM CELLS



Cord blood contains embryonic-like stem cells.
Cord blood stem cell is not quite as primitive as
the controversial embryonic stem cells, which
can give rise to any tissue type of the body.
CB cells are more versatile than adult stem cells
such as those found in bone marrow.
ADULT STEM CELLS




An adult stem cell is an undifferentiated cell found in a
tissue or organ.
Produces more stem cells and can also give rise to
specialized cell types of the tissue or organ they are
located in.
The main job of an adult stem cell is to maintain and
repair the tissue in which it is found.
When compared to embryonic and cord blood stem cell,
adult stem cells are believed to be more limited in the
type of cells that they can generate.
CORD BLOOD OPTIONS

Private Banking -- “Family Banking”

Public Banking – “Donation”

Research

Throw away
PRIVATE BANKING
(FEE-BASED COMPANIES)
Over 29 Private banks in the U.S.
 Pay initial collection and processing fee: Ranges
between $1500 to $2500
 Annual storage fee: ranges from $100 to $150
 Each company has different payment plans and
discounts. Contact to discuss costs
 Cord Blood stem cells survive after freezing for
up to 15 years
 ACOG Committee Opinion;
“Parents should not be sold this service without a
realistic assessment of their likelihood of return on
investment”

PUBLIC DONATION (NO COST)
Donate to a public bank, can benefit anyone who
needs a match
 Greater Access by the general public
 There are approximately 40 diseases that are
utilizing cord blood stem cells in their treatments
 In regards to the NMDP, National Marrow Donor
Program, a baby’s donated cord blood can assist
anyone in the nation / world in need of a stem cell
transplant.
 Cord Blood stem cells survive after freezing for
up to 15 years

RESEARCH (NO COST)



There are multiple research projects looking for
treatments to certain diseases.
Some Hospitals have a research facility
associated with them to offer this option to their
patients
Public donation banks offer units to be utilized in
research projects
THROW AWAY AS MEDICAL WASTE



One option everyone is trying to eliminate
Don’t care which option you choose, just choose
one
Don’t let something so vital get thrown away as
garbage when it could help someone
WHAT GETS THROWN AWAY IN THE
BUCKET
CORD BLOOD COLLECTION AND
PROCESSES

For private banking, anyone is eligible to store
their own baby’s cord blood.
For donation to a public bank:
Must be 18 years of age or older.
Delivering a single birth.
Can not donate with multiple births. This is
a regulation from the NMDP (National Marrow
Donor Program).
In general, Good Health.
 No change in obstetrical delivery and processes
 Only in uncomplicated delivery ; no risk to
mother or infant

CORD BLOOD COLLECTION






Once you have made your decision, whether private or
public, you must obtain your kit (private) or forms /
paperwork (donation) 4 weeks before your due date.
You will keep your kit at room temperature and pack
your kit (private) or forms / paperwork (donation) with
your clothes to go to the hospital / facility.
If you have decided to donate your baby’s cord blood to
the public bank, you will fill out the paperwork that will
be sent to you before you are admitted to the hospital.
If you have decided to privately bank, you will make
arrangements for the cord blood to be picked up from
the company at the hospital. Usually, a courier is
notified.
Once admitted, let the nurses know in Labor & Delivery
(L&D), that you are donating or banking your baby’s
cord blood.
3 maternal samples are draw prior to deliver for
infectious testing.
CORD BLOOD COLLECTION (PG. 2)
The delivery stays the same. The cord blood is
collected immediately after baby’s birth. The baby
is delivered and after the umbilical cord is clamped /
cut and the baby taken way for weighing and such,
the cord blood is collected at this time. It is
collected outside your body, so you will feel nothing
 The moment after delivery is the only opportunity to
harvest a newborn’s stem cells.
 Since blood is taken from the cord only after it has
been clamped / cut, there is no risk to the baby or
mother.
 Can be collected regardless if a woman delivers
naturally or by Cesarean section.

23
1ST CORD BLOOD TRANSPLANT :
OCTOBER 6, 1988
•More experience
•Higher cell dose
•Low risk of genetic
disease transmission
•Immune reconstitution
•Donor recall is possible
•Readily available
•Less GVHD
•Fewer HLA restrictions
•Low viral transmission
•No donor risk
CORD BLOOD TRANSPLANTATION
CORD BLOOD TRANSFUSION
ADVANTAGES OF CORD BLOOD

Biologically, a greater degree of human
leukocyte antigen mismatch between the donor
and recipient is tolerated by patients, allowing
more patients, including those from diverse
racial and ethnic background, to receive a cord
blood transplant
›


Relevant to African Americans
The incidence of acute and chronic graft versus
host disease is decreased with UCBU
Cord blood is stored and readily available for
those needing transplantation.
ADVANTAGES OF CORD BLOOD (PG. 2)

Hematopoietic progenitor (stem) cells from cord
blood have advantages over bone marrow






Unlimited supply
Ethnic diversity easier to achieve
Painless collection
Higher proliferative capacity
Lower rate of acute graft vs. host disease (a greater
HLA mismatch is better tolerated)
No donor attrition as with bone marrow
INDICATIONS FOR TRANSPLANTATION

Malignant Hematological Diseases
Acute leukemia: Lymphoblastic or myelogenous
› Hodgkin’s lymphoma and non-Hodgkin’s lymphoma
› Chronic myelogenous leukemia
›

Nonmalignant / Hereditary Hematological
Sickle cell anemia and thalassemia
› Fanconi’ Anemia
› Chronic granulomatous disease
› Severe congenital neutropenia
›
EMERGING TREATMENTS OF CORD BLOOD
STATISTICS AND DATA

For those who need a Stem cell transplant:
30% will have a sibling (family) match
70% will need an unrelated donor

By Privately storing, your child has a 1 : 2700 chance of
even utilizing their own cord blood. ACOG states that
number can be larger.

These stem cells are from the umbilical cord blood and
are NOT embryonic stem cells (that are controversial).

In the Catholic News Service, Pope Francis I endorses
stem cell research and therapy utilizing stem cells
harvested from adults and umbilical cord blood.
TOTAL GROWTH OF THE
BE THE MATCH REGISTRY® 2009
Adult Donors
34
Cord Blood Units
GROWTH OF CORD BLOOD UNITS ACCESSIBLE
THROUGH BE THE MATCH REGISTRY® 2009
35
DIVERSITY OF CORD BLOOD UNITS ON THE
BE THE MATCH REGISTRY® 2009
36
NMDP TRANSPLANTS BY CELL SOURCE
PEDIATRIC RECIPIENTS (AGE YOUNGER THAN 18 YEARS)
37
NMDP TRANSPLANTS BY CELL SOURCE
ADULT RECIPIENTS (AGE 18 YEARS AND OLDER)
38
NMDP TRANSPLANTS FOR MINORITY
PATIENTS BY CELL SOURCE
39
ROLE OF CORD BLOOD IN NMDP TRANSPLANTS
40
ROLE OF CORD BLOOD IN NMDP TRANSPLANTS
BY PATIENT RACE
41
National Marrow Donor Program
Transplants by Product
Calendar Years 2005 - 2009
6,000
5,000
4,000
3,000
2,000
906
1,099
494
725
2,936
1,938
2,611
1,701
2,224
821
876
868
910
926
2005
2006
2007
2008
2009
287
1,000
-
Marrow
PBSC
Cord Blood
42
National Marrow Donor Program
Single vs. Multi Cord Transplants
Calendar Years 2005 - 2009
1,200
1,000
338
800
248
168
600
400
200
86
37
250
408
658
557
761
2005
2006
Single Cord
2007
2008
2009
Multi Cord
43
National Marrow Donor Program
Caucasian vs. Minority Patient Cord Transplants
Calendar Years 2005 - 2009
1,200
1,000
360
800
241
215
600
400
137
82
200
205
357
510
665
739
2008
2009
2005
2006
Caucasian
2007
Minority
44
NMDP TRANSPLANTS DISTRIBUTION
OF CELL SOURCE
45
THANK YOU FOR ATTENDING THE CORD
BLOOD PROGRAM
Any questions, please contact:
Mary C. Wiegel
Program Manager / Educator – Western PA
ITxM Clinical Services
Dan Berger Cord Blood Program
412-209-7479
[email protected]

Thank you to the following individuals for their
assistance regarding the slides:
NMDP (National Marrow Donor Program)
Dr. Rakesh K. Goyal (Children’s Hospital of UPMC –
Pgh)
Dr. Haywood L. Brown (Duke University)