Umbilical-cord blood a lifeline

Dr. Donna Wall, director of the Manitoba Blood and Marrow Transplant Program, said umbilical-cord blood is rich in stem cells and could give the desperately ill patient more than a 50 per cent chance of recovery. The patient will be the first Manitoba adult to receive a stem-cell transplant from an umbilical cord, or what medical experts commonly refer to as "cord blood."

Wall said local transplant surgeons have infused cord blood into more than five children to treat illnesses such as leukemia in the last few years, and are now experienced enough to try the technique on adults. Due to privacy concerns, she wouldn't say what the patient's illness is, but said cord blood is generally used to treat leukemia, immune deficiencies and metabolic disorders.

"The people we treat are desperately ill and the majority of people we treat would not be around in the next year without a transplant," Wall said. "We change a desperate situation into better than a 50-50 chance of a cure."

Stem cells are immature cells that can develop into any healthy cell present in the bloodstream, such as white or red blood cells. They're also found in bone marrow.But experts such as Wall say it's harder to find a bone-marrow or blood donor, as the immune type has to be an exact match.

Wall said immune systems are like fingerprints, and matches are extremely rare if a patient can't find a match among their relatives. Immune types are inherited from parents, and there's only a one in four chance a patient has the same immune type as a sibling. Outside the family, a match can be even harder to find, particularly for people of certain ethnic backgrounds where there is a shortage of donors.

But Wall said the body can tolerate cord-blood stem cells that aren't an exact match.

"This is a huge benefit for us in transplantation, because some people have very, very rare immune types, and even if we had everyone in the world typed up and willing to donate, they're basically unique," she said. "By using cord blood, we can use very mismatched products."

There is no umbilical-cord blood bank in Manitoba, and the placenta is discarded as medical waste post-delivery. Canada has no national cord-blood bank, except in Quebec, although Canadian Blood Services is trying to establish a countrywide network.

Sue Smith, executive director of CBS's One Match stem-cell and marrow network, said CBS has submitted a proposal to every province and is awaiting a reply from deputy ministers.

Wall said a national cord-blood bank would give new immigrants and aboriginals with life-threatening blood disorders a better shot at recovery, as the country could build up a supply of donations from small communities. Wall, who used to practise in the U.S., said before she did cord-blood transplants, less than half of her African- American and Hispanic patients could find a stem-cell match. Afterwards, she said she was able to find donors for nearly all her patients.

Elsewhere in the world where cord-blood banks exist, a cup of blood from a healthy baby's umbilical cord is collected after delivery. The mother has to agree to donate cord blood, and a detailed medical history is taken. Once the blood is collected, it's screened for any infectious agents, tested for potency, frozen, and kept in liquid nitrogen.

Wall said the stem cells can remain potent for several decades.

Manitoba has imported cord blood from worldwide banks in the handful of transplants done here.

Before the transplant, Wall said doctors have to ensure the patient is clear of any infections and the blood disease is under good control. The patient will receive chemotherapy or radiation therapy the week before treatment to reduce the chance their body will reject foreign stem cells, Wall said, and to increase the likelihood of success.

A Popsicle-size cylinder of the frozen cord blood is thawed in a laboratory before it is transfused into the patient. Wall said the entire process is simple, painless, and takes only 30 minutes.

She said the adult patient awaiting transplant won't be the last. Transplant experts are already searching out cord-blood options for other patients in need.

jen.skerritt@freepress.mb.ca

Republished from the Winnipeg Free Press print edition January 25, 2009 A3