Cord blood endorsed for adults

By Janet McConnaughey
The Associated Press

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Umbilical-cord blood, now used mostly to treat children with leukemia, each year could save thousands of afflicted adults who cannot find bone-marrow donors, two big studies indicate.

A European study found those who receive cord blood were as likely to be free of leukemia two years later as those who received marrow. A U.S. study on three-year survival yielded results almost as promising.

To Dr. Mary Horowitz, a Medical College of Wisconsin physician and senior author of the U.S. study, the message is clear: Umbilical-cord blood can save adults.

Leukemia patients often undergo radiation or chemotherapy to kill cancerous white blood cells — a treatment that wipes out their immune systems, too. To restore their immune systems, doctors give these patients an infusion of bone marrow or umbilical-cord blood, both of which contain stem cells capable of developing into every kind of blood cell.

Cord blood offers an important advantage: Its stem cells are less likely to attack the recipient's body. That allows a wider margin of error in matching up donors and recipients.

Until now, however, cord blood has been considered suitable only for children, because each donation has about one-tenth the stem cells in a marrow donation.

The two new studies, published in today's New England Journal of Medicine, suggest that is not a serious impediment.

In the European study, involving 682 patients, about one-third of both those who received matched marrow and those who were given cord blood that did not quite match their tissues were alive after two years. In the U.S. study of 601 patients, about one-third of those who received matched marrow were leukemia-free after two years, compared with about one-fifth of those who were given cord blood or unmatched marrow.

Both studies were based on records from transplants in the late 1990s and early 2000s.
 
Using cord blood could improve the odds of getting a transplant for the 16,000 U.S. adult leukemia patients each year who cannot find a compatible marrow donor, said the U.S. study's leader, Dr. Mary Laughlin of Case Comprehensive Cancer Center in Cleveland.

Still, Dr. Nancy Kernan, assistant chief of marrow transplantation at Memorial-Sloan-Kettering Cancer Center in New York, said such transplants in adults should be done only as part of studies to look at and improve their effectiveness.

Public cord-blood banks — where blood drawn from umbilical cords and placentas at birth is kept frozen — need to quadruple their supply to match every leukemia patient who needs one. With 4 million births a year in this country, that should not be a problem once more public money comes into play, doctors said.

A federal Institute of Medicine panel is scheduled to offer ideas for a national cord-blood supply in March.