Thursday, July 12, 2007

Stem Cells Save Lives In Dubai

DUBAI, July 9 (Bernama) -- The Dubai Centre for Umbilical Cord Blood has provided stem cells for 34 patients with thalassaemia and other blood diseases since it was opened in June last year, Emirates news agency, WAM, reported.

The centre's director of laboratories, Dr Asma Al Asad, said the institution, which is considered the first of its kind in the region, has stored 800 units of umbilical cord blood in its first year of operation. She said the centre helps in the treatment of various blood diseases, cancers, thalassaemia and anaemia.

Dr Al Asad said the aim of the centre is to treat thousands of patients from UAE and abroad, through providing healing stem cells from umbilical cord blood.

Apart from the storing of umbilical cord blood, the centre has examined tissue similarities for more than 100 samples, she said.

Stem cells are stored from three categories: donors for themselves, donors for purposes of scientific research and donors for patients in general, Dr Al Asad said.

The centre has joined the International Organisation for Umbilical Cord Blood, a nonprofit United States governmental organisation considered a pioneer in the field of stem cell treatments.

The Dubai centre is the first in the Arab World to be made a member.

-- BERNAMA

http://www.bernama.com.my/bernama/v3/news.php?id=272194

Flesh and blood

An umbilical cord blood storage facility, promising stem cell therapy for serious ailments, is coming to town, reports Subhro Saha

http://www.telegraphindia.com/1070708/asp/calcutta/story_8026365.asp

A lab technician holds a sample of processed cord blood ready for storage at CordLife’s cord blood bank in Singapore. (Below) Cord blood samples being lowered into the cryogenic tank. Pictures by Subhro Saha

Little Treta (not her real name) has been undergoing blood transfusion for beta thalassaemia since she was two-and-a-half months old. Not yet two, she would have had to continue the painful process for the rest of her life. But now she has a ray of hope. Treta’s parents, young professionals, could opt to store the cord blood (blood from the umbilical cord) of their second-born to try and cure her blood disorder. Her mother, a few weeks pregnant, is going to AIIMS in New Delhi for a test to rule out thalassaemia in the second child. If all goes well, the cord blood of the second child can give the sibling a new lease of life.

Cord blood, collected after the umbilical cord is severed from the child, is a rich source of stem cells. These cells are found at different stages of foetal development and are also present in several types of adult tissues. Stem cells are the master cells of our body, which have the ability to grow into other tissues and have the potential to cure about 75 serious ailments, from blood disorders to heart and eye ailments to Type 1 diabetes.

If Treta’s parents decide on storing their second child’s cord blood after a proper HLA (human leukocyte antigen, through which the immune system recognises “self” and rejects “non-self”) match, the stem cells could be transplanted into Treta’s blood to cure her thalassaemia. That is stem cell therapy, which is being billed the future of medicine. However, to store her sibling’s cord blood in a bank now, Treta’s parents would have to travel to Gurgaon, Mumbai or Chennai, where banking facilities exist. Or store it with a Chennai-based company that collects the cord blood from the city. But things look set to change for Calcutta by the year-end — with a cord blood bank being set up in the city for the first time.

The bank is being set up by CordLife Sciences India Pvt Ltd, a wholly-owned subsidiary of CordLife, a company focused on tissue and cord blood banking based in Singapore and Australia. The facility, coming up off Diamond Harbour Road about 7 km from the Indian Institute of Management campus, is nearing completion. It will be able to offer cryogenic storage facilities for 40,000 samples to begin with. “However, we can go up to four to five times that capacity once demand picks up,” said Meghnath Roy Chowdhury, managing director, CordLife Sciences India, representing the local partners, Strassenburg Pharmaceuticals Ltd.

It means that parents from this part of the world can store the cord blood stem cells of their children, at a cost, but quite easily. Before delivery, the parents have to pay an initial deposit of Rs 35,000- Rs 40,000. The annual rental will be 10 per cent of the deposit and there will be the option of paying 18 years’ rental up-front to “avail discounts”. If that sounds like just another transaction, it holds the promise of a lot of health, for you, for your family. Actress Raveena Tandon and MP Priya Dutt have banked their newborns’ cord blood. Dutt has compared cord blood to “life insurance”.

There are mainly three kinds of stem cell transplantation — of adult stem cells, embryonic stem cells and cord blood cells. But stem cell research is in an embryonic stage in the country and there are debates on the efficacy of various kinds of stem cells. (As there is an absence of uniform guidelines; cases of malpractice have been reported from different parts of the world.) Adult stem cells, mainly from the bone marrow of the patient, are mostly in use in India. Harvesting stem cells from the embryo is considered unethical in many quarters. Advocates of cord blood stem cell transplants believe that they are less prone to rejection than bone marrow or peripheral blood stem cells (another source of adult stem cells), perhaps because the cells do not develop the features that can be recognised and attacked by the recipient’s immune system.

Stem cell therapy is also a huge market, estimated to go up to $20 billion by 2010, according to a Frost & Sullivan study. The Indian market is estimated to touch $540 million by 2010. That is one reason why so many private players are into cord blood storage.

There are several cord blood storage facilities all over the country but the city’s advantages are clear to the Singapore company, which runs Southeast Asia's first AABB-accredited (the industry gold standard) cord blood bank in the island nation. “We needed a city, which is similar to us politically, in terms of the ability to allow us and our partners get things done. Besides Calcutta is geographically close to Singapore,” said Simon Hoo, India coordinator from CordLife. He added that this is “one of the first projects to materialise as part of the Singapore-Bengal initiative” kicked off by the chief minister’s Southeast Asia trip.

V.R. Chandramouli, CEO of LifeCell India Pvt Ltd, the cord-blood banking company headquartered in Chennai that collects samples from the city, agreed there’s a crying need to build capacity and is bullish on Calcutta as well. “Collection from Calcutta has been growing at 30-35 per cent month-on-month,” he said.

“Our presence in Calcutta will be a good start towards establishing a strong network. We think the Indian market is huge, specially with the fast-growing middle class, rising disposable income in major cities and a genuine increase in concern for the welfare of the children,” Steven Fang, CEO and executive director, CordLife, told Metro in Singapore.

The project has a lot of support. Director of drug control Sajal Roychowdhury feels that the bank “will open up a new vista” in treatment of critical diseases. “We will extend all necessary support,” he says. The medical community is on its side too. “This is the future of medicine. Stem cells form part of our blood and immune system and they rejuvenate other cells in our body’s system and thus can be a potent cure for cancer,” says city-based gynaecologist Ranjit Chakraborti. He feels the cord blood bank in “our own backyard” will inspire more confidence among clinicians. He hopes the company will also address the needs of the economically weaker sections.

Stem cell faqs

Why is every one so caught up with stem cell therapy?
Stem cells transform into the range of specialised cells that define us. Many of the most severe disorders occur because of problems during this process. Scientists believe that the disorders can be cured with the re-application of the stem cells, from the stored cord or extracted from bone marrow or from the small number of such cells present in the bloodstream.

What are the various kinds of stem cell therapy?
In Blood, 2005, one of the latest scientific papers available on the topic, the chance of use of cord blood samples for cell therapy was reported as one in 400. Past medical opinion had put the rate at around one in 20,000. One reason for the growing number of cord blood transplants is the greater ease of matching donors and recipients compared to bone marrow. “Cord blood banking can help us build capacity of haematopoietic stem cells, which are in huge demand for treating blood-related disorders,” said paediatric haematologist Arpita Bhattacharyya.

For bone marrow, a perfect 6 out of 6 HLA match is required, to prevent tissue rejection. In the case of cord blood, in some cases for some diseases, as few as two out of six match will suffice. But as cord blood can only be collected immediately after the birth, it’s scarce. There’s research to establish cord blood being applied in case of heart failure and diabetes, the two most potent killers in India.

What diseases can be cured with the therapy?
Cord blood stem cells are commonly used to treat different types of blood cancers, other blood disorders and various inherited disorders. Study has shown adult stem cells can also be used to treat autoimmune diseases such as lupus, multiple sclerosis, Crohn’s disease and rheumatoid arthritis. Clinical studies suggest these can even help avert corneal degeneration and restore vision in cases of blindness, can help restore proper cardiac function to heart attack sufferers and improve movement in patients with spinal cord injury.

What are the facilities of storing cord blood in Calcutta now?
LifeCell India collects samples from six medical facilities, including the Bhagirathi Neotia Woman and Child Care Centre, Belle Vue Clinic, Woodlands and AMRI Dhakuria.

Wednesday, July 11, 2007

Former minister raises fear of HIV blood cover-up

· Lord Owen claims officials knew of hepatitis risk
· 1,700 dead and many terminally ill after blunder

Sarah Hall
Wednesday July 11, 2007
The Guardian
http://society.guardian.co.uk/health/story/0,,2123433,00.html

New concerns are raised today that government officials attempted to cover up evidence that they could have stopped thousands of people becoming infected with HIV from contaminated blood supplies. Lord Owen, who was a Labour health minister in the 1970s, says he has unearthed the first concrete proof that officials knew more than 30 years ago that there was an increased risk of contracting hepatitis from imported blood products.

More than 1,700 people went on to die and many are terminally ill after contracting hepatitis C and then HIV from infected blood during treatment for haemophilia in the 1970s and 80s. Lord Owen, who as health minister pledged that Britain would no longer import blood products, has found a document from the Department of Health which shows officials knew in February 1976 that imported blood products were "more costly" to the NHS and came with a "higher hepatitis risk" - something that has been consistently denied.

The discovery comes ahead of Lord Owen's appearance today at the independent public inquiry into the contaminated blood scandal, chaired by the former solicitor-general Lord Archer of Sandwell. Lord Owen is expected to query why several volumes of documents relating to the issue were destroyed at a time when a similar HIV-tainted blood scandal was erupting in France. "This may be a coincidence - but it may also be a reason why the documents were destroyed. The inquiry will find out if there is any deliberate cover-up or simply maladministration."

As health minister from 1974 to 1976 the then David Owen was concerned about the hepatitis risk when he pledged Britain should stop importing blood products in January 1975. For more than 20 years he has repeatedly been told by officials that there was no known risk. Describing the document as a gem, Lord Owen said: "We now at last have actual evidence from the department that corroborates ... that we knew [the imported product] was more likely to be contaminated. What is important is that here they are in February 1976 - and they more or less concede every argument: it is cheaper to go for self-sufficiency and there is higher hepatitis risk [from imported products]."

Since 1988 Lord Owen, who went on to become foreign secretary before later leading the SDP, has battled to see evidence backing up what he was told by doctors and officials at the Department of Health and Social Security (DHSS) during his time as health minister. The DHSS pulped his official papers 10 years after he left the department, without telling him - an action he describes as "inexplicable".

But in May the Department of Health released 68 documents following pressure from the inquiry into the scandal. The three-paragraph minute, dated February 20 1976, was among those documents.

Roddy Morrison, chair of the Haemophilia Society, described the discovery of the new memo as "very significant. It begs the question of why this information was not shared more widely with the haemophilia community so that they could make an informed choice on whether to be treated," he said.

Lord Owen said that he was "quite convinced" hundreds of patients with haemophilia would not have contracted HIV if self-sufficiency had been introduced.

A total of 4,670 people with haemophilia were infected with hepatitis C between the late 1970s and mid-1980s, and 1,200 of those were also infected with HIV.

Thursday, April 12, 2007

Overlooked Cancer Cure From Japan, The

Nature provides an anti-cancer molecule found in rice bran that exceeds the effectiveness and safety of most anti-cancer drugs. Yet it goes unutilized by modern medicine.

Most drugs are modeled after molecules found in nature. Nature’s molecules are then re-arranged so as to acquire a patent. Pharmaceutical companies can then justify the expense of conducting studies to prove the safety and efficacy of their pharmaceutical compounds. But frequently, nature cannot be improved upon. This is the case in regards to rice bran extract

Given that tumor cells utilize iron as a primary growth factor, cancer researchers are searching for a drug that would be able to attach to (chelate) iron molecules and remove them from the body, thus producing an effective anti-cancer drug. Researchers at Wake Forest University Health Sciences state that "iron chelators (pronounced key-lay-torz) may be of value as therapeutic agents in the treatment of cancer. They may act by depleting iron, a necessary nutrient, and limiting tumor growth." [Current Topics Medical Chemistry 4: 1623–35, 2004]

Another report says: "There is therefore an urgent need for an orally active, inexpensive iron-chelating drug, because the only currently available iron chelator cannot be administered orally, is expensive and side effects have raised doubts about its safety." [Hoffbrand AV, Current Opinion Hematology 2: 153–58, 1995]

Toxicity of iron-chelating drugs

The primary iron chelator utilized in anti-cancer studies, Desferal (desferrioxamine), can retard tumors. [Buss JL, Current Medicinal Chemistry 10: 1021–34, 2003] However, Desferal has a modest effect because of its poor ability to get inside tumor cells and remove iron. [Richardson DR, Critical Review Oncology Hematology 42: 267–81, 2002]

Adriamycin (doxorubicin), an antibiotic drug often used for cancer treatment, is an iron binder. One of the major drawbacks of Adriamycin is that it often results in severe damage to the heart. In certain circumstances this drug can release iron from its storage protein (ferritin), resulting in heart damage. [Thomas CE, Arch Biochem Biophysics 248: 684–89, 1986] The beating force of the heart is reduced by 50 percent with Adriamycin. [Husken BC, Cancer Chemotherapy Pharmacology 37: 55–62, 1995] Even if Adriamycin cures cancer, the patient is likely to die of a heart problem.

Recently, an oral drug that can remove iron from the body was introduced. Ferriprox (deferiprone) is the world's first and only orally active iron-chelating drug, which is effective and inexpensive to produce, but has similar toxicity to other chelating drugs. [Kontoghiorghes GJ, Current Med Chemistry 11: 2161–83, 2004]

I’ve gone to the trouble of citing these many scientific reports to make this undeniable statement – that iron-sequestering molecules are currently utilized to treat cancer and less toxic iron chelators are being sought. Many of the drugs and alternative therapies for cancer already involve iron chelation.

Rice bran extract (IP6)

Nature’s most effective iron-chelating molecule is inositol hexaphosphate (IP6), found naturally in seeds and bran. IP6 is a selective agent against cancer cells. Because cancer cells are high in iron content, IP6 directs most of its attention to abnormal cells. IP6 selectively removes iron from tumors cells, which deprives them of their primary growth factor. IP6 does not remove iron from red blood cells which are tightly bound to hemoglobin. Unlike cancer drugs, healthy cells are not affected with IP6, so IP6 has very low toxicity. [Deliliers GL, British J Haematology 117: 577–87, 2002]

There have been numerous lab dish and animal studies that conclusively prove IP6 is an effective and non-toxic anti-cancer molecule. But the National Cancer Institute has never seen fit to conduct a human trial even though IP6 made it on a list of promising anti-cancer agents. [Fox CH, Complementary Therapy Med 10: 229–34, 2003]

As an alternative to chelating drugs, IP6 has been shown to desirably alter the expression of proteins produced by the p21 and p53 genes that control cancer growth, but goes unused as a cancer treatment. [Saied IT, Anticancer Research 18: 1479–84, 1998]

IP6 enhances the anti-cancer effects of Adriamycin and Tamoxifen, two commonly used cancer drugs. [Tantivejkul K, Breast Cancer Research Treatment 79: 301–12, 2003] However, it goes ignored by cancer doctors.

While Desferal, an iron-chelating cancer drug, has a modest effect because of its poor ability to get inside tumor cells and remove iron, IP6 is found in every cell in the body and is essential for life. By virtue of its ubiquitous presence in living human cells, it is non-toxic. [Richardson DR, Critical review Oncology Hematology 42: 267–81, 2002]

In 2001 Food and Drug Administration researchers reported that 8 of 12 chelating agents tested were mutagenic (caused gene mutations). Among the four non-toxic chelators was IP6. [Whittaker P, Environmental and Molecular Mutagenesis 38: 347–56, 2001]

Bill Sardi in Wakayama, Japan

The obvious choice among available iron chelators is inositol hexaphosphate or IP6. IP6 meets all the requirements for a safe iron chelator to treat cancer. It penetrates inside cells. It is non-toxic, inexpensive, and very effective. It’s just not a drug.

Rice bran extract from Japan

In my many investigations involving cancer cures I traveled to visit the Tsuno Foods & Rice Company of Wakayama, Japan (near Osaka). This company sends trucks to rice processing plants in Japan to pick up rice husks. From rice bran, Tsuno Foods extracts many useful nutrients such as inositol used in baby formulas, tocotrienols used in dietary supplements, ferulic acid, a natural sunscreen agent, rice bran oil (which has twice the antioxidants as virgin olive oil), and inositol hexaphosphate (called IP6), which is nature’s most potent iron chelator.

A few years ago Tsuno Foods & Rice Company sponsored a worldwide symposium on the role of IP6 rice bran extract and cancer. Researchers from around the world attended and extolled its potential as a cure for cancer. [Anticancer Research 19:3633–808, 1999] Efforts by Tsuno Foods & Rice Company to educate the world about the potential anti-cancer properties of IP6 rice bran extract have been ignored by cancer treatment specialists.

Meanwhile, the Japanese people who labor at Tsuno Foods & Rice Company in Wakayama, like most Japanese, are not given to boasting. They labor dutifully without fanfare for the miraculous molecules they have extracted from rice bran. Tsuno Foods, founded in 1947 by Masaji Tsuno, is now managed by his daughter, Fumi Tsuno, an exception in the male-dominated Asian business world. They must wonder why world cancer therapists and researchers have not continued to explore the use of IP6 for cancer prevention and therapy.

About 70% of the IP6 made by Tsuno Foods and Rice Company of Wakayama, Japan, is available to chelate (attach) to iron (as well as heavy metals), which are primary growth factors for tumors. IP6 as an extract from rice bran is a far more effective anti-cancer agent than rice bran or bran cereal alone. [Vucenik I, Nutrition Cancer 28: 7–13, 1997]

The safety record of IP6 is long standing. First, it is a normal dietary component and is found in every living cell of the body. Second, extensive studies have been conducted to confirm the lack of toxicity of IP6. In 1987 phytic acid researcher Ernst Graf reported that only 4 of 22 chelating agents studied, including IP6, block hydroxyl radical production. Only phytic acid IP6 was found to be economical, nontoxic, and effective. [Graf E, Journal Biological Chemistry 262: 11647–50, 1987]

Does it work? Case reports

Since writing a book about iron and IP6 (The Iron Time Bomb), numerous reports of dramatic cancer remissions involving this dietary supplement have been received. Some of them notably stand out.

An 80-year old man with terminal liver cancer took IP6 for a few weeks prior to a scheduled rescue procedure where an anti-tumor drug was to be injected directly into the liver. A cat scan performed just prior to the procedure revealed the liver tumor was completely necrotic – the tumor was a ball of dead cells.

A middle-aged woman whose husband worked for a prominent member of Congress, who had stage 4 breast cancer, experienced a rapid and complete remission following the consumption of IP6.

At age 70, a man was diagnosed with lung cancer. Radiologists had missed a lung tumor the size of a golf ball in an earlier x-ray. A year later it was the size of a softball. Chemotherapy reduced the tumor by 75 percent. In 1999 the man began taking IP6. By 2004 the lung tumor had completely disappeared, which was confirmed by bronchoscopy and x-ray.

A man with recurrent bladder tumors submitted to surgical removal in 1999, 2000 and 2001. He then embarked upon the use of IP6 as a dietary supplement and has not experienced a return of bladder tumors in 38 months.

IP6 rice bran extract, made by Tsuno Foods of Wakayama, Japan, is available under different brand names as a dietary supplement in health food stores throughout the USA. The National Cancer Institute (NCI) only makes brief mention of IP6 as "a substance found in many foods that come from plants, including corn, wheat, rice, and soybeans, and in large amounts in cereals and legumes. It is being studied in the prevention of cancer." According to the website, there are no current or planned human clinical studies of IP6.

http://thehealthmanual.blogspot.com/2007/04/overlooked-cancer-cure-from-...

Sunday, March 11, 2007

Vertex hepatitis drug has good results in trial

Vertex Pharmaceuticals Inc. says its proposed hepatitis C treatment has generated promising results in two mid-stage human clinical trials, based on a preliminary analysis.

The Cambridge, Mass., company (Nasdaq: VRTX) reported on Friday that the two trials of telaprevir (VX-950) helped reduce the virus to undetectable levels at rates over 60 percent, using the drug in combination with two other drugs.

Telaprevir accomplished this, according to the company, using half the standard treatment duration -- over a 24 week period instead of the typical 48 week treatment programs with current therapies.

Hepatitis C is a liver disease caused by an infection that affects 170 million people around the world.

Vertex is presenting the data during the 58th Annual Meeting of the American Association of the Study of Liver Diseases in Boston from Nov. 2 - 6.

Source: http://milwaukee.bizjournals.com/boston/stories/2007/10/29/daily63.html

Sunday, September 29, 2002

Cord Blood Transplants

SGH scores another first in stem cell transplants

Singapore General Hospital, in collaboration with the National University Hospital, has chalked up another world-class achievement in stem cell therapy. Doctors in the team treating a 5 year old boy with Thalassaemia Major have successfully performed the first case of cord blood transplant from an unrelated donor.

This is the first known case in the world of such a transplant conducted successfully for a patient with Thalassaemia Major. It marks yet another significant milestone in the development of leading edge stem cell therapy conducted at SGH. In 1995, SGH successfully performed the world's first recorded case of peripheral blood stem cell transplant from an unrelated donor for a patient with Thalassaemia Major. In that case, the stem cells were extracted through the blood instead of the conventional method of extraction from the bone marrow, making the ground breaking transplant the first of its kind in the world. Today, the patient is a healthy 10 year old boy attending primary school.

A lifeline for child with Thalassaemia Major
This current medical breakthrough involves a 5 year old Malaysian Chinese boy, born with Thalassaemia Major, a hereditary blood disorder where the body is unable to produce enough haemoglobin leaving the patient persistently and severely anaemic, requiring frequent and regular blood transfusions. Frequent blood transfusions often leave sufferers of Thalassaemia Major at risk of infections like hepatitis and possible iron overloading resulting in multiple organ failure. There is also a general immune suppressive effect. The majority of patients die of heart failure and do not have a life expectancy beyond 15 to 20 years. In this particular case, there were no matched sibling donors for either a bone marrow transplant or a cord blood transplant. When the boy was first referred to Associate Professor Patrick Tan, Head of the SGH Department of Haematology, a search with the Singapore Bone Marrow Donor Programme found no matched donor then. A/Prof Tan reviewed the case again this year, for consideration for a cord blood transplant and a new search was activated. Fortunately, a good cord blood sample was found and the cord blood transplant took place on 3 July 2001, at the National University Hospital, where the patient is being co-managed by the Department of Paediatrics.

Success factor - good sample of cord blood
One of the success factors attributed to the transplant was the availablity of a good sample of cord blood. The cord blood was collected from a Chinese baby delivered in SGH in 1998. The exceedingly high cell dose in the sample and the fact that it fully matched in the direction of rejection ensures a high chance of engraftment - a critical issue in all transplants for Thalassaemia Major. The cord blood sample contains 60-million cell dose per kilogram. Cell dose refers to the number of cells per kilogram of the patient's body weight and is a critical factor in predicting the patient's survival. The success of the cord blood transplant depends directly on the dose of stem cells received in the transplant - the larger the cell dose, the better the outcome. In this case, the cell dose contained in the sample is four times higher than the international recommended cell dose of 15-million cell dose per kilogram for cord blood transplant, which means that it has excellent potential for a successful transplant.


All signs pointing to complete recovery
Since the transplantation, the patient has not required any red cell transfusions. Preliminary blood studies show that he no longer has Thalassaemia Major and the
stem cells are functioning properly within his marrow by producing various kinds of blood cells. He is now producing normal red cell corpuscles unlike those seen in Thalassaemia Major, which are small and pale. The patient was discharged on 8 August, 36 days after the transplant. However he will still require to be monitored at the specialist clinic twice a week for 100 days.

Cord blood transplantation is a viable option
With the results indicating that the patient has been cured of Thalassaemia Major, cord blood transplantation from an unrelated donor has now been proven to be a valid alternative to bone marrow transplant from a sibling. This breakthrough achievement not only sets a milestone in the medical history of Singapore, it also highlights the successful outcome that arose from the close collaboration and teamwork between the SingHealth and the National Healthcare Group, the two healthcare clusters to which SGH and NUH belong to.


Article reproduced from Singapore General Hospital website

Bone Marrow Transplants v/s Cord Blood Transplants

what are the differences and what are the advantages of each ?

BONE MARROW TRANSPLANTATION
Bone marrow transplant is curative for Thalassaemia Major patients. When successful, it is an absolute cure.

Bone marrow allograft from matched siblings have been carried out extensively for Thalassaemia Major patients. Allograft refers to transplantation of tissue from another person, be it a sibling or an unrelated donor. There have been approximately 2,000 cases world-wide. In a good risk patient, the success rate is 90% . However, bone marrow allograft from matched unrelated donors for Thalassaemia Major patients is uncommon.

In general, there is a one-in-four chance of receiving a bone marrow transplant from a matched sibling. However, with decreasing family size, many patients are unable to find a matched sibling for bone marrow transplant.


CORD BLOOD TRANSPLANTATION
The umbilical cord provides a lifeline between mother and child during pregnancy. Like bone marrow, the umbilical cord is rich in haemopoietic stem cells, the same cells found in bone marrow which are the primitive cells from which all types of blood cells evolve.

Cord blood an opportunity for an alternative transplant source, besides bone marrow and peripheral blood stem cells, which will give new life to patients suffering from leukaemia, and other fatal blood disorders (Thalassaemia Major included).


Advantages of Cord Blood Transplants
Cord blood transplants offer some potential advantages over unrelated bone marrow transplants :

Lower risk of rejection - Patients transplanted with cord blood have a lower risk of severe graft-versus-host disease than those of unrelated bone marrow transplants, as the umbilical cord blood has not been exposed to outside antigens so the chance of graft-versus-host disease is reduced. Graft-versus-host disease is caused by the incompatibility between transplanted cells and their new host where the grafted cells reject their new host, causing a number of complications, including death.

Greater match tolerance - Cord blood transplant allows a mismatch, as the degree of histoincompatibility that can be tolerated is greater with cord blood than with bone marrow. In unrelated bone marrow transplants, a full tissue match is crucial. Unfortunately, most tissue typing has racial significance. It is very difficult to find any unrelated donor for an Indian patient for example, from the registries in Asia which are predominantly Chinese, or the USA, which are predominantly Caucasian. In cord blood transplants, two or even three mismatched antigens are acceptable. Significantly, cord blood transplant allows racial disparity.

Rapid availability - the preparation time for cord blood transplants is faster as the cord blood has been immunologically typed and is frozen, ready and available. Once a match is found, the cord blood only needs to be thawed and it can be used immediately, compared with the two to three months of preparation required for a normal marrow transplant.

Ease - harvesting cord blood is a painless, non-invasive procedure with no risk to the newborn of the mother.
No donor risk - in addition, there is no donor attrition and no donor risk as no donor is involved. For ordinary transplants, the selected matched donor may refuse donation or be unavailable. There is also a small risk to the donor, eg. from the general anaesthesia required during the marrow harvest. In constrast, when cord blood donation is required, the blood is simply taken out from the cord bank, processed in the laboratory and given to the donor.

Collecting cord blood
After the baby has been delivered, the umbilical cord is clamped, cut and separated from the baby. While waiting for the placenta to be delivered, the physician will collect the cord blood by inserting a needle into the umbilical vein after cleansing the cord. The entire process is non-invasive, painless and does not interfere with the birthing process.

Success factor - good sample of cord blood
A critical issue in all transplants for Thalassaemia Major is the availability of a good sample of cord blood. The exceedingly high cell dose in the sample collected for this transplant and the fact that it fully matched in the direction of rejection ensured a high chance of engraftment.

The cell dose in the cord blood is important to the success of the transplant because the larger the cell dose, the better the coutcome. In this case, the cell dose contained in the sample was 60-million cell dose per kilogram, four times higher than the international recommended cell dose of 15-million cell dose per kilogram.


Our local Cord Blood Registry - the first in Asia
Singapore is the first country in Asia to set up a functional cord blood bank. The SGH Department of Haematology, in collaboration with Singapore's Bone Marrow Donor Programme, started the cord blood collection programme in August 1997.

The Obstetrics and Gynaecology departments of SGH, NUH and a few private hospitals have been actively supporting the programme. There are now about 1,000 cord blood units stored at the cord blood bank.

As placentas and cords do not contain a set volume of blood, the stem cells contained most cord blood collection are usually sufficient for a small child. As a result, cord blood transplants are for now limited for paediatric patients.

© Singapore General Hospital 15 August 2001

Article reproduced from Singapore General Hospital website