New Bank for Cord Blood is a Lifesaver
by Karen Hines
The nation's second "bank" for umbilical cord blood, the only known substitute for bone marrow transplantation, began taking deposits last December at the medical center.
The bank will process and store units of umbilical cord blood collected after birth from voluntary donors at three hospitals in North Carolina, with a goal of increasing the pool of available transplant units by 6,000 over the next two years, according to Dr. Joanne Kurtzberg, the primary investigator for the project at Duke. Kurtzberg, a specialist in pediatric hematology and oncology and a pioneer in umbilical cord blood transplant, has performed about a quarter of the transplants done worldwide.
Bone marrow transplants are performed to treat patients with leukemia and certain other cancerous blood diseases and inherited metabolic diseases. Patients need new bone marrow, which generates disease-fighting white blood cells, to replace their own, which is destroyed as a side affect of the high doses of chemotherapy and radiation used to eradicate their diseases.
Based at Duke, the Carolinas Cord Blood Bank is supported by a five year, $8.8 million grant from the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health. It is one of three newly funded cord blood banks in a project that aims to both increase the chances of finding patients compatible cord blood for potentially life-saving transplants and to find the best ways to collect, process and store the cord blood.
Just four years ago, umbilical cords were part of the cast-off waste of afterbirth. But since the first successful transplant of umbilical cord blood from an unrelated donor to a young Duke patient, one-time medical waste has taken on a viable second purpose.
"I think of cord blood as the ultimate in recycling," Kurtzberg said. "It's a material that is normally thrown away, but it can be life-saving." Umbilical cord blood can substitute for marrow in a transplant because the blood is rich in immature cells, called stem cells, that can become bone marrow.
The tissue-type match between the donor and recipient doesn't need to be as close as in bone marrow transplant, probably due to that same immaturity of cells in the cord blood that would normally trigger rejection of tissue, researchers believe.
Cord blood from unrelated donors has been used in transplants at Duke and other institutions for about 500 patients for whom no matching donor of bone marrow could be found.
Without transplant, doctors said all the patients would have died. With transplant, about half have survived, Kurtzberg said. Most of those transplants have been made possible through a single cord blood bank established in New York at Mount Sinai Hospital by Dr. Pablo Rubenstein. Since 1992, the New York bank has collected about 8,000 units. With the addition of the three NHLBI-funded banks, two on the West Coast and the Duke-based bank on the East Coast, the overall pool is expected to be boosted by 15,000 units in the next two years, Kurtzberg said.
Officials at the centers operating the new banks hope as many as half the units collected will be from minority donors. The Duke-based bank is expected to increase the pool for African-American patients, while the banks based at Orange County (Calif.) Children's Hospital and University of California Los Angeles hope to increase the number of units available for Asian and Hispanic patients.
"The number of potential bone marrow donors for minority patients is so low that odds for an acceptable match are very limited. We think we can increase the chances for successful transplant by banking the cord blood of healthy minority babies who are born full-term to healthy mothers,"Kurtzberg said.
Duke will house the blood bank, and handle the processing and storing of cord blood collected at Duke Hospital, Durham Regional Hospital and Carolinas Medical Center in Charlotte. Mothers delivering babies at those three hospitals will receive information about the project during their pregnancy, and will be able to request more information if they are interested in donating their babies' umbilical cord blood after birth.
Cord blood will be collected with permission of the mother by a specially trained team working with the banking project, Kurtzberg said. After the baby is born and separated from the umbilical cord, the placenta and cord-or afterbirth- will be taken from the delivery room.
In another room, the team will drain the remaining blood, usually 2 to 6 ounces, from the placenta to a collection pouch containing blood thinner to prevent clotting.
She said the short period of time between collection and availability for transplant marks another advantage of cord blood over bone marrow for some patients.
"Speed is of the essence for some patients, such as those in remission from leukemia or with progressive genetic diseases," she explained. "It takes two to six months from the point of identifying a potential bone marrow match to transplant. It takes one to two weeks with cord blood. There are times when it makes sense to go quickly to transplant, and in those cases, cord blood has a practical advantage for the patient."
The cord blood units stored at the Duke bank and the West Coast banks in the NHLBI project will be available for use at seven approved transplant centers which will be testing "common treatment and care regimens for patients to learn more about the best ways to use cord blood," Kurtzberg said.
The NHLBI-funded banks will operate as public banks, Kurtzberg said, meaning that the cord blood will be available to any patient whose medical condition warrants such a transplant.
The public banks are distinct from recently developed commercial banking enterprises where parents can store a newborn's own cord blood.
"That service - the commercial bank - is being offered as an insurance policy," Kurtzberg said, "but there are very few children who will ever need a transplant, and fewer who could use their own cord blood for transplant.
"The public bank, in contrast, makes units available to anyone who matches. It seems to be a better use of resources."