Umbilical Cord Blood Transplant: Effective New Leukemia Treatment For Adults

As detailed in the June 14th issue of The New England Journal of Medicine, a team led by Mary J. Laughlin, MD, showed that the transplantation of cord blood following high dose chemotherapy and radiation, can save the lives of about one-third of adult patients for whom other treatments are likely to fail.

“The patients we studied were unable to find a suitable bone marrow match among family members or donors in the nationwide bone marrow bank,” explains Dr. Laughlin, director of allogeneic transplantation at University Hospitals Ireland Cancer Center and assistant professor of medicine at CWRU. “We have shown that umbilical cord blood, which is rich in stem cells necessary for a successful transplantation, is a viable alternative for these patients, and the cord blood used does not have to be an exact match to be effective.”

Umbilical cord blood is retrieved from the placenta after the birth of a child. While normally the cord and placenta is discarded after birth, the cord blood can be saved, frozen and stored. The stem cells in the cord blood are immature blood-forming cells, a component of bone marrow, capable of maturing into red blood cells, platelets, or infection-fighting white blood cells. When transplanted into a cancer patient whose own bone marrow has been depleted after chemotherapy or radiation treatments, these stem cells provide the basis for a new healthy-blood forming immune system.

“For years, we’ve been able to use cord blood successfully to treat children with leukemia and other blood disorders. But researchers have wondered whether the small amount of stem cells in cord blood can create a whole new immune system in fully-grown adults, who are also more likely than children to reject a less-than-perfect transplant,” says Dr. Laughlin. “We’ve been able to show that just two ounces of blood harvested from an umbilical cord can generate a new blood-producing immune system, and we don’t even need a perfect match for a successful transplant because of the immature nature of cord blood stem cells.”

Dr. Laughlin and her colleagues conducted a retrospective study of 68 adults, ages 18 to 58, all of whom had received either intensive chemotherapy or total-body radiation to deplete their bone marrow. Following transplantation with cord blood, 90% of patients experienced the growth of new, healthy blood cells. The incidence of graft-versus-host disease (GVHD) was lower than expected, but still the cause of significant complications and mortality in many patients. Of the 68 patients who underwent transplantation with cord blood, 19 were alive (18 of those completely disease-free) at 40 months.

With support from The Leukemia & Lymphoma Society, Dr. Laughlin is continuing to work with cord blood stem cells in the laboratory, to grow them in vivo, hoping that a larger dose of stem cells used in transplant will cause blood counts to recover faster and lower the risk of infections. She is also trying to understand why umbilical cord blood is less likely to be “rejected” by the recipient after transplantation.

The Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University is a Comprehensive Cancer Center designated by the National Cancer Institute, the only NCI/CCC in northern Ohio. It is one of few centers in the country actively using umbilical cord blood in the transplantation of adults with blood disorders and cancers.