Cord-blood transplants show promise in leukaemia treatment

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BONE marrow or stem cell transplants can save the lives of adults and children with leukemia, but an ideal donor often isn’t available. In those cases, umbilical cord blood may work as well as current alternatives — or even better in some cases, a new study suggests.
“Often, cord-blood transplant is thought to be only as the last resource for patients without donors. But cord blood does not have to be considered only an alternative donor source,” said study lead author Dr. Filippo Milano.
“In centers with experience, it can yield to great outcomes,” said Milano, an assistant member of the Clinical Research Division at Fred Hutchinson Cancer Research Center in Seattle.
At issue: How best to treat the blood cancer leukemia and a related condition called myelodysplastic syndrome? One approach replaces a patient’s blood-producing bone marrow through a transplant. The “gold standard” is to find a relative who can donate bone marrow or stem cells, preferably a “matched” sibling whose blood is compatible with the patient’s, Milano said. But for 70 percent of patients, this ideal fit doesn’t occur, the study authors noted.
Physicians then might recommend a transplant from a compatible donor unrelated to the patient or an unrelated donor who’s mostly (but not entirely) compatible.
This new study considers another option: A donation of cord blood from the placenta and umbilical cord of newborn babies. Like bone marrow or stem cell transplants, a cord-blood transplant can produce stem cells that create new blood. “However, cord-blood donors and recipients don’t need to be a perfect match,” Milano said.
To compare the success of the different options, researchers looked at 582 patients with leukemia or myelodysplastic syndrome. If a compatible bone marrow or stem cell transplant from an unrelated donor wasn’t available, the patients got either a cord-blood transplant or an incompatible bone marrow or stem cell transplant from an unrelated donor, Milano said.
“Our study showed that overall survival after cord-blood transplantation was comparable to the one observed after matched unrelated transplants,” Milano said. And patients who got cord-blood transplants seemed to live longer than those who got non-matching bone marrow or stem cell transplants from unrelated donors, he noted.
The cord blood approach appeared especially beneficial for a subset of patients with what’s known as “minimal residual disease.” This means small amounts of cancer cells remained after the chemotherapy that is required before transplant.

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