Treatment with Cord Blood
The first treatment using cord blood was in 1988 for a child with Fanconi Anaemia. Since then, cord blood has become a trusted and reliable alternative source of stem cells for Haematopoietic (Blood-forming) Stem Cell Transplants1.
Stem cells from cord blood are unique and can overcome some of the limitation of adult stem cells from bone marrow. As naïve or new born cell, it can easily adapt to alternative environment compared to stem cell from an adult.
Stem Cells in Haematopoietic Stem Cell Transplants (HSCT)
Stem cells are primarily used in transplant medicine to regenerate a patient’s blood and immune system after the patient has been treated with chemotherapy and/or radiation to destroy the cancer cells. These stem cells used in HSCT, can be obtained through bone marrow, peripheral blood donation or cord blood, after a baby’s birth.
While chemotherapy and radiation destroy the cancer cells in a patient, they also destroy the precious stem cells. Therefore, an infusion of stem cells or a stem cell transplant is performed after the chemotherapy and/or radiation treatment. The infused stem cells then migrate to the patient’s bone marrow where they multiply and regenerate all the blood cells necessary to create a new blood and immune system for the patient.
Cord Blood Transplants
Over 35,000 cord blood transplants have been performed around the world to treat a number of diseases including blood cancers like leukaemia and lymphoma. Many of these transplant patients received unrelated cord blood that was generously donated to a public cord blood bank2.
a) Allogeneic (Related or Unrelated) Cord Blood Transplants
Unrelated allogeneic cord blood transplants use cord blood from an unrelated donor, normally through cord blood donations to a public cord blood bank. This is the most common type of allogeneic transplant for haematological conditions, where the histocompatibility of the donor closely matches the patient.
related allogeneic cord blood transplant is when stem cells are received from the patient’s sibling, collected at birth after the safe delivery of the sibling. This is usually collected through a physician requested cord blood collection, i.e. storage for a sibling with a medical need. When a child that is already diagnosed with a medical condition that requires a blood-forming stem cell transplant and the mother is expecting another, it is recommended that the baby’s umbilical cord blood is stored, in anticipation that it can be used for the sibling with the medical condition. This is only available with a referral from the biological sibling’s Haematologist / Oncologist.
b) Autologous (Self) Cord Blood Transplants
Autologous cord blood transplants are when the patient’s own cord blood unit, collected and stored at birth, is used for transplant. Autologous transplant may be an option for patients with certain non-genetic diseases. Depending on a patient’s disease and health status their doctor may recommend an autologous or an allogeneic transplant.
1 Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122(4):491-498. doi:10.1182/blood-2013-02-453175.
2 Watt SM, Hua P. Chapter 6: Umbilical Cord Blood Hematopoietic Stem and Progenitor Cell Expansion for Therapeutic Use. In: Watt SM, Hua P. Umbilical Cord Blood Banking for Clinical Application and Regenerative Medicine. Open Access, InTech: Chapters published under CC by 3.0 license; 11 January 2017
SCBB, Singapore’s only public cord blood bank, has facilitated 242* allogeneic cord blood transplants for haematological conditions for both adults and children in Singapore and across the world. Cord blood units from SCBB are listed on international donor database like Bone Marrow Donors Worldwide (BMDW), and National Marrow Donor Program (NMDP), accessible by Transplant Centres worldwide.
Cord blood is a precious resource that can offer recipients a new lease of life when a suitable match is found. Many patients depend on a public cord blood bank like SCBB for their live-saving cord blood unit(s) to survive.
* as of 2nd November 2018
SCBB has facilitated transplants for the following conditions:
- Aplastic Anaemia
- Congenital Dyserythropoietic Anaemia (CDA)
- Fanconi Anaemia
- Myelodysplastic Syndrome (MDS)
- Systemic Mastocytosis
- Thalassemia Major
- Leukaemia (ALL, AML, ANLL, ANKL, aBLL, CLL, CML)
- Lymphomas (Hodgkin & Non-Hodgkin, NK/T-cell, SPTCL)
- Myelofibrosis with Myeloid Metaplasia
- Granulocytic Sarcoma
- Multiple myeloma
- Hunter Syndrome
- Chronic Granulomatous Disease (CGD)
- Haemophagocytic Lymphohistiocytosis (HLH)
- Hyper-IgM (HIGM) syndrome
- Severe Combined Immuno-Deficiency (SCID)
- Omenn's Syndrome
- Wiskott Aldrich Syndrome
Other Inherited Disorders
- Adrenoleukodystrophy (ALD)
Patients who are diagnosed with a blood-related condition should consult their Haematologist and Transplant Physician. Treatment depends on the patient’s disease and many other factors. Please note that not all patients will benefit from a cord blood transplant.
Developments using Cord Blood
Cord blood continues to play an important role in blood-forming stem cell transplantation. Over the years, there have also been a number of developments in biomedical research and clinical trials with the role of regenerative medicine1 emerging in recent years. There have been clinical trials on the use of one’s own cord blood for cerebral palsy, hypoxic-ischemic encephalopathy, autism, etc., with increasing interest in new therapies for non-homologous use of cord blood2. While clinical trials are underway, trial outcomes and efficacy of treatment (e.g. improved function in cerebral palsy patients) are difficult to measure compared to haematological conditions34.
In response to requests from parents, family cord blood banking offers the opportunity to families to participate in future clinical trials in partnership with SCBB.
1 O’Connor MAC, Samuel G, Jordens CFC and Kerridge IH. Umbilical cord blood banking: Beyond the public-private divide. (2012) 19 Journal of Law and Medicine 512
2 Roura S, Pujal JM, Galvez-Monton C and Bayes-Genis A (2015) The role and potential of umbilical cord blood in an era of new therapies: a review. Stem Cell Research & Therapy 2015, 6:123
3 Sun J, Allison J, McLaughlin C et al. Differences in quality between privately and publicly banked umbilical cord blood units: A pilot study of autologous cord blood infusion in children with acquired neurologic disorders. Transfusion 2010;50:1980-1987.
4 Ballen K. Umbilical Cord Blood Transplantation: Challenges and Future Directions. Stem Cell Translational Medicine 2017;6:1312-1315
Blood Cancers in Singapore
According to the Singapore Cancer Registry (2015), Lymphoma and Leukaemia (Blood cancers) are amongst the top ten most frequent cancer causing deaths in Singapore. Every year, 40% - 60% of patients in Singapore who need a haematopoietic stem cell transplant (HSCT) to survive are unable to find a suitable stem cell match from bone marrow donors and other public cord blood banks. These patients need not succumb to their disease if efforts to boost SCBB’s cord blood inventory continues to gain support.
Importance of Ethnicity
Ethnicity is a critical factor in finding a suitable stem cell match. For Singaporeans and Asians, finding these matches remains a challenge as the majority of Stem Cell Registries are of Caucasian ancestry. With more than 70% of patients unable to find a match within their families, many rely on adult stem cell registries and public cord blood banks like SCBB for hope. Mirroring Singapore's ethnic profile, SCBB increases the prospect of a life-saving match for these patients, with a public cord blood inventory of Chinese, Malay, Indian and Pan-Asian origins.
Data has shown a higher incident of blood cancer among Malay and Indian Communities in Singapore1. Public donation from these communities is thus even more urgent to ensure that a stable inventory of high quality cord blood units is always available.
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1 National Registry of Diseases Office (NRDO), Singapore Cancer Registry Annual Registry Report 2015, released 19 June 2017