Hi guys, I just found a great article, sorry it’s a tad long but quite interesting….
Myelodysplastic Syndrome Cancer News
Umbilical Cord Transplant May Be Effective Treatment Option for Some Patients with Myelodysplastic Syndromes
According to a recent article published in the journal Blood, an umbilical cord transplant may be an effective treatment option for patients with myelodysplastic syndrome that are not able to find a suitable donor for an allogeneic stem cell transplant.
Myelodysplastic syndrome (MDS) is a disease in which the cells in a person’s bone marrow are not functioning normally. The bone marrow (and circulating blood) contains early blood-forming cells called stem cells, which grow and mature into the 3 blood cell types: white blood cells, which protect the body from infection; red blood cells, which carry oxygen to the tissues; and platelets, which help the blood to clot. In the case of MDS, not enough normal blood cells are being produced and/or the blood cells die prematurely. This condition is sometimes referred to as a pre-leukemia or “smoldering” leukemia because it often develops into leukemia, a type of cancer. Some patients with MDS also have additional abnormalities, including genetic abnormalities of the blood cells, a high number of immature blood cells (called blasts) in the bone marrow, or decreasing numbers of red blood cells, white blood cells, or platelets. These individuals are at a higher risk for a more rapid progression to leukemia than are those who have more favorable cell features. There are five different stages, or extent, of MDS that include (in order of disease progression) refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, refractory anemia with excess blasts in transition, and chronic myelomonocytic leukemia. An allogeneic stem cell transplantation is considered the only curative therapeutic option for MDS.
Cancers are often treated with high doses of chemotherapy and/or radiation followed by a stem cell transplant. Although high-doses of therapy are more effective at killing cancer cells, many other cells in the body are also destroyed by the treatment procedure, including stem cells. Stem cells are immature blood cells produced in the bone marrow which mature into either red blood cells, white blood cells, or platelets. A stem cell transplant is a procedure that replaces the stem cells that are destroyed by high-dose chemotherapy and/or radiation therapy with healthy stem cells. In the case of an allogeneic stem cell transplant, stem cells are collected from the blood or bone marrow of a related or unrelated donor and infused into the patient after high-dose chemotherapy or chemotherapy plus total body irradiation. In addition to the anti-cancer effect of the high-dose therapy, an allogeneic stem cell transplant induces a second anti-cancer effect called the graft-versus-leukemia effect. This effect occurs after a transplant, whereby the presence of the foreign donor stem cells (ie, the graft) attacks the remaining cancer cells. However, the donor lymphocytes may also attack the patient’s healthy tissues, causing what is called graft-versus-host disease (GVHD). GVHD can be an acute or chronic disease and occurs in the majority of patients receiving allogeneic transplants.
In an effort to prevent or reduce GVHD, attempts are made to match 6 different proteins (HLA) found on stem cells between donors and patients. Many patients that could be cured with an allogeneic stem cell transplant do not have an appropriate stem cell donor. Over the past decade, researchers have learned that umbilical cord blood is a rich source of stem cells. Umbilical cord blood stem cells have been used to support high-dose chemotherapy treatment of infants and children. Now, there is a peaking interest in the use of umbilical cord blood as a source of stem cells for adult cancer patients who undergo allogeneic stem cell transplant. Recently, there has been a concerted government-funded effort to establish umbilical cord “banks” where umbilical cord blood is frozen and stored. These “banks” are now being integrated nationally and internationally with registries allowing patients to search for a stem cell donor. Thus, if a patient is unable to find a related donor, a search can be performed for an appropriate umbilical cord blood source of stem cells in various banks around the world.
The major disadvantage of using umbilical cord blood is the low number of stem cells collected. The lack of adequate numbers of stem cells in umbilical cord blood units has limited the use of this source of stem cells in adult patients, especially large adults who require more stem cells. Methods through which to expand the number of collected stem cells through laboratory processes are currently under investigation.
Researchers from Japan recently conducted a clinical trial to evaluate the effectiveness of umbilical cord transplants in 12 patients with advanced MDS. These patients were eligble for an allogeneic stem cell transplant, but an appropriate donor could not be found. Two years following therapy, 76% of patients were alive and cancer-free. Acute GVHD occurred in 75% of patients and chronic GVHD occurred in approximately 73% of patients.
The Researchers concluded that umbilical stem cell sources should be offered to patients with MDS who are eligible for an allogeneic stem cell transplant but are not able to find a suitable donor. Patients with MDS who are considering an allogeneic stem cell transplant but cannot find a donor may wish to speak with their physician about the risks and benefits of an umbilical cord transplant or the participation in a clinical trial evaluating this or other therapeutic options. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (http://www.cancer.gov) and http://www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.
Reference: Ooi J, Iseki T, Takahashi S, et al. Unrelated cord blood transplantation for adult patients with advanced myelodysplastic syndrome. Blood. Prepublished online February 23, 2003. Available at: http://www.bloodjournal.org/cgi/reprint/2002-12-3917v1.pdf. Accessed March 3, 2003.
Congratulations Terri and Bob!!! 
