If an unrelated donor was not available, patients were either provided with a cord-blood transplant or a bone marrow or stem cell transplant from an incompatible donor.
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However, there is another option for these patients, one that can easily match them with donors and may even be more effective: an umbilical cord blood transplant.
Patients with detectable amounts of cancer cells in their blood could benefit from choosing cord blood as the source of stem cells for their transplant over a traditional transplant, Milano said.
“With the inventory that we have right now worldwide, we can find cord blood that is suitable in about 95% of the cases, which is very unique”, said Dr. Filippo Milano, the lead author of the study. The study, led by researchers at Fred Hutchinson Cancer Research Center, found that in patients at high risk of relapse after transplant, cord blood transplant recipients seem to have better outcomes against leukemia and the related bone marrow disorder, myelodysplastic syndrome. When that too is a problem, an unrelated donor who is mostly compatible with the patient will be the next choice. Those with “minimal residual disease” have small residuals of cancer cells in their body after undergoing chemotherapy prescribed just before a transplant. This retrospective study was undertaken to compare outcomes after HLA-matched, HLA-mismatched, and cord-blood HSCT in patients with acute leukemia or myelodysplastic syndrome after myeloablative therapy.
Only about a third of patients with detectable cancer in their blood at the time of transplant will still be alive three years later, as compared to almost three-quarters of those without such residual disease.
Survival after allogeneic hematopoietic cell transplant was better in patients treated with cord blood than in patients treated with either HLA-matched or HLA-mismatched bone marrow or peripheral blood transplant. In addition to being as or more effective, cord blood is also more flexible than bone marrow in matching patients to donors.
Although this is still an emerging area of study, and widespread adoption of cord blood transplants would require changes to medical culture and infrastructure, the research points to a promising solution for patients in dire circumstances. On the other hand, he said that the risk of relapse was significantly lower in patients receiving cord blood transplants.
Delaney said the short-term risk to patients is a large reason caregivers are hesitant to adopt the procedure. Cord -blood transplant could be more expensive because more blood has to be used. But, he said, prices may drop thanks to technological advances that could allow less blood to be used.
A cord blood transplant is the last alternative treatment for those who have leukemia after other conventional methods have failed.
Dr. Marcos de Lima, a bone marrow transplant specialist, said the study results are surprising.
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Umbilical cord blood is a rich source of stem cells for transplantation. However, if there will be more research regarding this matter, doctors could be able to use less blood. And in 2016, some 171, 550 people are expected to be diagnosed with myeloma, lymphoma or leukemia, with new cases accounting for 10.2 percent of the 1,685,210 new cancer cases that will be diagnosed in the year in the country.
