• Kirk Hartley

Save a Life – Donate Cord Blood – New Science Shows Cord Blood Donations May Cure Leukem

Are cord blood donations important ? You bet ! Great new science documents that children and others with leukemia (and perhaps other lymph cancers) may obtain cures through transplants of two units of cord blood even when there is no perfect match available. This is promising news because today’s increasing diversity means that children from diverse marriages have more difficulty in finding perfect matches for marrow stem cell donations. The published medical article is in the journal Blood and can be downloaded here for personal use. Set out below is summary from Science Daily.

University of Minnesota (2009, November 15). Two Units Of Umbilical Cord Blood Reduce Risk Of Leukemia Recurrence. ScienceDaily.

Two Units Of Umbilical Cord Blood Reduce Risk Of Leukemia Recurrence

ScienceDaily (Nov. 15, 2009) — A new study from the Masonic Cancer Center, University of Minnesota shows that patients who have acute leukemia and are transplanted with two units of umbilical cord blood (UCB) have significantly reduced risk of the disease returning. This finding has the potential to change the current medical practice of using one unit of UCB for treatment of patients who are at high risk for recurrence of leukemia and other cancers of the blood and bone marrow.

Michael Verneris, M.D., and John Wagner, M.D., who specialize in research and treatment of children with cancer, led the research team on this breakthrough study. The results are published in the current issue of the scientific medical journal Blood. This study was funded with grants from the National Cancer Institute and the Children’s Cancer Research Fund.

Verneris and his colleagues studied 177 patients treated at the University of Minnesota Medical Center, Fairview and the University of Minnesota Amplatz Children’s Hospital between 1994 and 2008. The average age of the patients in this study was 16 years. Eighty-eight patients had acute lymphoblastic leukemia (ALL) and 89 had acute myeloid leukemia (AML).

“Our analysis showed that patients in first or second remission from the leukemia had a significantly lower likelihood of leukemia recurrence if they were transplanted with two UCB units than if they were transplanted with one (19 percent vs. 34 percent),” says Verneris.

“We believe our finding provides evidence that using two units of UCB for transplantation may be more effective in preventing leukemia relapse and gives hope to patients with hematological malignancies so that they may live cancer-free,” he says.

Blood and marrow stem cell transplantation has been a mainstay treatment for patients with high risk leukemia and other hematological malignancies for the past 30 years. In the last decade, the blood in the placenta and umbilical cord has been collected and banked for public use. Now, UCB is routinely used throughout the world as an alternative to bone marrow transplantation.

However, because of the limited number of cells in UCB, this stem cell source has been reserved for young children and small adults. The practice of using two UCB units (from two different individuals) was pioneered at the University of Minnesota approximately 10 years ago. By using two UCB units, nearly all patients can now use this stem cell source for transplantation.

Previous research studies have also shown that about 25 to 30 percent of patients suffer leukemia relapse after transplant. The relapse or disease recurrence rates are similar regardless of whether the stem cells used for transplantation are from bone marrow, peripheral blood, or umbilical cord blood.

Verneris and his colleagues compared the outcomes of patients who were transplanted with one verses two UCB units. Forty-seven percent of the patients received one unit of UCB; the remaining patients received two units. The choice to receive one versus two units was based on the number of stem cells contained in the UCB. Since the number of stem cells needed for a successful transplant varies with the patient’s weight, older patients and those who weigh more need more stem cells than infants and young children.

“Given that adult patients were more likely to receive two UCB units and that they tend to have more aggressive leukemia, we think that the lower relapse rates with two UCB units is remarkable,” says Verneris. He notes that while promising, these results will have to lead to a national study comparing one verses two cord blood units in children with leukemia.

“Prior to the research done by my predecessors, the co-infusion of two UCB units had not previously been performed,” says Verneris. “We now know that without this double transplantation procedure, the majority of the patients treated would have had no other reasonable treatment option for their leukemia. The fact that they had less leukemia relapse was a wonderful surprise.” (emphasis added)

Set out below is the abstract from the medical article.

Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units

Michael R. Verneris,1,2 Claudio G. Brunstein,2,3 Juliet Barker,2,3 Margaret L. MacMillan,1,2 Todd DeFor,1,2 David H. McKenna,4 Michael J. Burke,1 Bruce R. Blazar,1,2 Jeffrey S. Miller,2,3 Philip B. McGlave,2,3 Daniel J. Weisdorf,2,3 and John E. Wagner1,2

1Department of Pediatrics, 2Blood and Marrow Transplant Program, 3Department of Medicine, and 4Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis

Umbilical cord blood (UCB) transplantationis potentially curative for acute leukemia. This analysis was performed to identify risk factors associated with leukemia relapse following myeloablative UCB transplantation. Acute leukemia patients (n 177; 88 with acute lymphoblastic leukemia and 89 with acute myeloid leukemia) were treated at a single center. Patients received a UCB graft composed of either 1 (47%) or 2 (53%) partially human leukocyte antigen (HLA)-matched unit(s). Conditioning was with cyclophosphamide and total body irradiation with or without fludarabine. The incidence of relapse was 26% (95% confidence interval [CI], 19%-33%). In multivariate analysis,relapse was higher in advanced disease patients (> third complete remission [CR3]; relative risk [RR], 3.6; P < .01), with a trend toward less relapse in recipients of 2 UCB units (RR 0.6; P .07). However, relapse was lower for CR1-2 patients who received 2 UCB units (RR 0.5; P < .03). Leukemia-free survival was 40% (95% CI, 30%-51%) and 51% (95% CI, 41%-62%) for single- and double-unit recipients, respectively (P .35). Although it is known that transplantation in CR1 and CR2 is associated with less relapse risk, this analysis reveals an enhanced graft-versus-leukemia effect in acute leukemia patients after transplantation with 2 partially HLA-matched UCB units. This trial was registered at http://clinicaltrials. gov as NCT00309842. (Blood. 2009;114: 4293-4299).


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