“Latest Stem Cells News”

(…) Since 2006, according to NECBB records, the number of banked units used in transplants has doubled. The company attributes this increase in cord blood usage to the ever evolving research surrounding cord blood stem cells.

“We have always reminded parents that stem cell therapies are advancing very quickly and it is difficult to know what the possibilities are. The fact that more parents are using cells they stored suggests that the scope of treatments available is encouraging,” said Dr. David Matzilevich, Chief Scientific Officer of NECBB. “We are confident that the cells found in cord blood are extremely valuable and will only prove to be more so as time goes on.”

Over 80 diseases can be treated with the use of cord blood, including some types of juvenile diabetes and chronic leukemia. Cord blood collection poses no threat to the baby and therefore, circumvents the ethical issues of embryonic stem cells. The cells are taken from the cord after it is cut from the mother and baby.

For over 20 years, cord blood transplants have produced positive results. In 1988, a three-year- old girl received a cord blood transplant to treat Fanconi’s anemia. In 1991, another child was treated for myelogenous leukemia with cord blood stem cells and the transplant was a success. Since then, two-thirds of cord blood transplants performed have been for malignant conditions and overall have shown a high rate of success. The rising numbers of transplants reported by NECBB proves further that the achievements of cord blood banking will only grow (…)

from http://www.medicalnewstoday.com/articles/165571.php

Bond strengthened: Eight-year-old Thamirabharuni, holding her brother who donated the stem cells, did not suffer from rejection or graft versus host disease as the tissue match was perfect - Photo: V. Ganesan

Eight-year-old Thamirabharuni and her one-year-old brother Pugazhendhi share a special kind of bond not commonly seen among siblings. Thanks to her brother, Thamirabharuni no longer suffers from thalassemia disease.

The stem cells transplanted in March helped her get rid of thalassemia. And hundred days after the procedure, one can safely say that her disease has been cured.
The stem cells that were transplanted came from two different sources — her brother’s cord blood, which was harvested during the time of his birth, and his bone marrow. Stem cells from the bone marrow had to be transplanted as there was insufficient number of stem cells in Pugazhendhi’s cord blood.

In the absence of cord blood stem cells, about 200 ml of bone marrow would have been required. It is difficult to get this quantity of bone marrow from a nine-month-old baby.
The cord blood was collected by and stored at Chennai based LifeCell International Pvt. Ltd., a private cord blood bank.

Risk of infection

So is it all over? “One has to be still careful. There is a risk of infection till the end of the first year [after transplantation],” said Dr. Revathy Raj, Consultant Paediatric Haemato Oncologist, Apollo Speciality Hospital, Chennai. Dr. Raj had done the transplantation for Thamirabharuni and two other cord blood transplantations for thalassemia before this.
The fact that patients are on immuno suppressing drugs for one year makes them vulnerable to infections. The risk of rejection of the transplanted stem cells, and the graft versus host disease (GVHD) reduce with time.

Thalassemia arises when red blood corpuscles (RBC) production is defective. A person suffers from the disease only when he inherits a defective gene from both parents. He becomes a carrier when he inherits a defective gene from only one parent. The diseased person has to undergo blood transfusion once every month for the rest of his life.

Gold standard

Though stem cells separated from bone marrow have been used for more than 30 years to treat thalassemia, and is a gold standard in treating the disease, cord blood stem cells are slowly becoming an attractive alternative.
Contrary to what is projected by some cord blood banks, doctors are very reluctant to use cord blood stem cells to treat thalassemia in the absence of a full tissue match.

Perfect match

“We need a 6/6 [perfect match] for thalassemia. Even a 5/6 match is not sufficient,” asserted Dr. Raj. And doctors refrain from using stem cells from unrelated donors, even if there is a perfect match.

Apart from infections, there are two major challenges from transplantation — graft versus host disease (GVHD) and rejection of the donated stem cells. “There is a 30 per cent chance of having graft versus host disease even when it is from a fully matched related (sibling) donor.” This risk increases to 50 per cent when it is from an unrelated donor, even if there is 6/6 tissue match.

Rejection rate becomes an issue even when there is a perfect tissue match. According to her, in the case of thalassemia, the rejection rate can be up to 20 per cent even with related donors, and up to 40 per cent in the case of unrelated donors.
But why should rejection and GVHD be an issue at all when there is a perfect 6/6 tissue match, and why should it be so high when stem cells are from unrelated donors?

Minor HLAs not tested

“There are several minor HLA antigens that are not tested. So if we use stem cells from people belonging to some other ethnic background, there are greater chances of [minor] HLA differences,” Dr. Raj stressed. “And this causes rejection and GVHD.”
In general, greater the tissue match and higher the stem cell count in cord blood, lesser are the chances of rejection and GVHD.

“So why undertake procedures that are risky when thalassemia can be treated through monthly transfusions,” she noted.
Private banking of cord blood for use by the family therefore becomes important when one of the siblings is suffering from a disease that can be cured using it.

Case for public banking

Despite the risk of rejection and GVHD, a less than perfect sample can be used to treat children suffering from life threatening diseases such as leukaemia and aplastic anaemia. This is where public cord blood banking gains significance.
There is a strong case for promoting public banks as depending solely on bone marrow samples will not be wise.

Even if a perfectly matched bone marrow donor is found, chances are that the person may no longer be interested in donating.
Collecting cord blood samples is easy, the number of samples that can be banked is limited only by resources, and samples can be made available at very short notice.

from  The Hindu

The Ospedali Riuniti of Bergamo is the top center for the collection of umbilical cord blood in the Lombardy region, said the hospital, which received an award at the Policlinico di Milano (where the umbilical cord blood bank is located) for the second consecutive year for its commitment and professionalism with which it carries out its work, providing an important source of stem cells.

“Our collection program started in 2004,” explained Bruna Pasini, the head obstetrician, also in charge of the collection of umbilical cord blood for the hospital. “At that time we started to collaborate with the Milano Cord Blood Bank, which allowed us to collect over 1,000 units of blood.”

The remaining blood in the placenta after birth contains stem cells similar to those in the bone marrow. They are considered the new frontier to treat many diseases. “About 40-50% of patients with leukemia and lymphomas, who need bone marrow transplants,” explained Mariangelo Cossolini, the organ and tissue transplant coordinator for the province of Bergamo, “do not find compatible donors in their family or in the international registry of voluntary bone marrow donors. Therefore, umbilical cord blood is very precious because it can replace marrow in stem cell transplants and is able to regenerate bone marrow and the entire immune system.”

A 300-euro bill has arrived for some couples that had stem cells taken from their child at birth three years ago. Sant’Anna has sent a bill to parents who decided to transport umbilical cord blood to Switzerland, which in Italy cannot be stored for personal use.

For the past year, the procedure is no longer free at Sant’Anna, but now the hospital is sending bills out to couples who had the procedure done in 2008 when the hospital was not yet making people pay and the operation was entirely free. Numerous couples in the past weeks have surprisingly received a bill from Sant’Anna and the complaints are rolling in, along with phone calls and e-mails, opinion columns in the newspapers and interviews on TV.

“Our first son was born in 2006,” said a couple of young parents who asked to remain anonymous. “We asked the hospital to keep the umbilical cord stem cells and send them to Switzerland where it is possible to pay for them to be stored for personal, future use. No one at Sant’Anna hospital told us that we would have had to pay for this service.”

A few weeks ago due to the upcoming birth of their second son, the couple returned to the hospital.

“We asked for the same service,” they explained, “and this time they asked us for a 300 euro payment in order to obtain the necessary certification to transport the blood to Switzerland. We accepted, despite the fact that 300 euros seemed excessive, because they only need a simple health document. We paid the bill, but recently we also received a second bill for the same amount and we discovered that the bill was for the birth of our first child 3 years ago.”

The same thing happened to about ten couples, which three years after receiving the same services from the hospital, were sent a bill by Sant’Anna Hospital. A 300-euro bill that was completely unexpected, since until the end of March 2008 the hospital had not set any price for the service.

Current laws in Italy do not allow people to store stem cells for personal use. Only free, voluntary, and anonymous donations of umbilical cord blood can be made, which are then made available to anyone who needs them, just like blood or organ donations.

“Voluntary donation is covered by the national health system,” said executives at the hospital through their press office. Donation for personal use is not covered because it is not part of the program. Orders from the healthcare ministry specify that public hospitals do not have to guarantee this service. The hospitals, like Sant’Anna, which make this service available, naturally have the right to charge patients for this service, since it is not covered by the national health system.”

At least until March 2008 there were no precise regulations on the matter.

“Regulations were set one year ago,” said heath-care officials, “and since then all of the couples are being informed that the cost of the service is 300 euros. This sum is needed in order to perform a detailed certification of the blood. This document is necessary to transport the stem cells across the border. The hospital must guarantee that the withdrawal was done in compliance with all of the regulations and that the sample is healthy, and that it has been collected and stored according to all regulations.”

However, Sant’Anna is sending out bills for children that were born before March 2008. “The couples knew that sooner or later they would receive a bill,” said hospital officials. “The sum was not established, but they were informed that this was not a free service.”

Expectant parents must make several important medical decisions. Among them: whether to have prenatal genetic testing, request pain medication during labor, strive for a natural birth or circumcise a male baby?
Perhaps one of the most overlooked parts of childbirth preparation is whether to save or donate the infant’s umbilical cord blood.

Umbilical cords are usually discarded as medical waste. But the potential uses for cord blood are growing, making it imperative that families understand their options, including whether to pay to have the blood stored for possible use in the event of their child’s illness or to donate it to a public bank so it’s available to any child who may need it.
“I think every couple who is pregnant should look into this and make a decision for themselves about what to do,” says Dr. Charles Sims, co-founder of the California Cryobank, which offers private storage. “Every doctor treating them should also be informed.”