Umbilical Cord Blood (UCB) Transplant

[jaxem]

The University of Minnesota has contacted my wife to have pre-tests performed prior to a long awaited UCB transplant. Having a fairly aggressive blast count, she has decided to have this fairly new procedure performed if her tests prove her body can withstand the rigors of the “mini” transplant and that her cancer is in remission and nowhere else in her body. she will probably undergo a chemo treatment (fludaribin) followed by total body irradiation, followed by an autoimmune drug regimen, then the double cord stem cell transplant. they want to make her part of a trial study of adding T Reg cells from a 3rd cord which we haven’t made up our minds about. It takes about a month for T cells to grow rather than about 10 days with an MRD ot MUD transplant. She’ll spend about a month in the hospital, then 3 more months near the hospital from which she’ll visit the clinic daily. GVHD is less with UCB patients, however, infection is greater (1/3), relapse is high (1/3) and overall success is about 40%. Scary time for us!!

[katiebear]

Good luck Jack. My thoughts and prayers are with you and your wife no matter which choice you make. I’m sure you will make the right one.

Katie

[Mary4Mike]

Jack,

I agree with Katie. I am sure your wife and you will make the right decision. Reading your posts makes it very clear that you are very educated in this disease and this particular procedure. Your wife is blessed to have someone who has taken it upon himself to learn about this. You are obviously blessed with a wonderful wife or you wouldn’t have made this generous effort.

My prayers will be with you both, either way, whatever you two decide.

[poppyshope]

Jack – if it looks like a go do it! I wish every day that I pushed my dad to go to Columbia sooner it was literally a two week window, and everything changed on us so fast- I just took my cue from him because he had just spent close to 3 months in Sloan Kettering- the one thing with this disease is the windows of opportunity – I will pray for you and your wife and know that whatever choice you make will be the right one for you with all the knowledge you both have in this insidious disease. Keep me posted I am in NY, the hudson valley, and if I can do anything let me know. There is also a great doctor Dr. Estey at MD Anderson he has since retired and is going to Seattle but he still answers calls there and I have a number to reach him e-mail me if you need it he is wonderful and is the reason I got into Columbia -Sloan couldn’t get us in there and discouraged it. Dr. Estey however, said to try Dr. Feldman he is really good to run ideas by and willing to do it even if it is over the phone with a fax of the medical records. Hope this helps – Take care, Jen

[jga_socal]

jack,
im curious why you chose ucb for transplant. i am getting a mud transplant soon and would be concerned about the negative issues with a ucb. for one thing i am 215 lbs so i’d need multiple cords. the longer grafting period concerns me. what about the match level? did you not find good mud matches? personally i’d be more willing to look into ucb if a good mud match was unavailable. since your wife is getting a mini xplant i guess the dangers posed by the no-graft scenario are minimal. is the gvhd issue the main reason you went ucb or was there a mud match problem?
thanx.
I just checked with the nmdp regarding gvhd attributed mortality. Post-transplant mortality by gvhd is 14% for either HLA-sibling or MUD. MUD data is not broken out by stem cell origin, but the UCB GVHD occurrence must be somewhat lower than 14%. I was surprised to see that a sibling match provided no better odds against gvhd than a mud match. I wish they broke down the numbers by match level, 8/10, 9/10, 10/10, etc… When looking at these charts is may get depressing to see a 30-40% 5 year survival rate for adult mds transplants from 1996-2001. But if you look at the 1 year survival trends you can find encouragement from the fact that there has been a 30% reduction in 1 year MUD mortality from 1999 to 2003. I would extrapolate that the future looks much more rosy for people transplanted today than for people transplanted 5-10 years ago. Positive progress is being made so fast you really cant read too much from data even a few years old.
I’m guess I’m just trying to get us psyched up for the upcoming wild ride

Jim

[jaxem]

jim
per Rainer Storb, noted hematologist at the Hutch, MRD is best, then MUD. If you can’t find a donor, like in my wife’s case, then UCB. After that, there are haplo’s, etc. GVHD is less with UCB then MRD or MUD but mortality rate at Minnesota is 27% because it takes about a month to start generating T cells whereas MRD’s & MUD’s about 10 days. i agree with everything you have stated. i went through nmdp web pages. there is a wealth of data there. If you have a donor, that’s the way to go! being 215 lbs, that may be a stretch to get enough stem cells from 2 cords, and success rate is much better with higher amount of stem cells. My wife is only 110 lbs. I wish you all the luck in the world in finding a suitable donor.

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