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Summer 2005 Volume 6, Issue 5:
IMF Hotline Coordinators Answer Your Questions
My father-in-law has myeloma and may be a candidate for a stem cell transplant. I am pregnant. Can my baby’s umbilical cord blood be used for his transplant?
The IMF Hotline 800-452-CURE (2873) is staffed by Nancy Baxter, Debbie Birns, and Paul Hewitt.
The phone lines are open Monday through Friday, 8am to 4pm (Pacific Time).
To submit your question online, please email TheIMF@myeloma.org.

Question: My father-in-law has myeloma and may be a candidate for a stem cell transplant. I am pregnant. Can my baby’s umbilical cord blood be used for his transplant?

Answer: First, let us provide some background information, and then you will better understand the answer to your question. The standard type of transplant used for myeloma patients involves harvesting and then reinfusing the patient’s own stem cells after high-dose chemotherapy. This is called an autologous transplant, with “auto” referring to “self,” the source of the stem cells. This procedure is generally well tolerated by myeloma patients and, on average, provides a remission of 18 to 36 months duration.

Transplantation of stem cells from a matched donor is called an allogeneic transplant, and its use in myeloma patients is still considered experimental. Because they are more fragile in the transplant setting than patients with other hematologic cancers, myeloma patients almost never undergo full allogeneic transplant with high-dose chemotherapy because the risk of death is considered too high. Instead, researchers have developed the “mini-allo,” a procedure in which lowered doses of chemotherapy are given to a patient prior to an infusion of stem cells from a matched sibling donor. The mini-allo is best performed on a patient with a low tumor burden, so it generally follows within 3 to 6 months after an autologous stem cell transplant. The desired result is to produce just enough graft versus host disease (GVHD) to allow the donor stem cells to fight the myeloma. Too much GVHD can kill the host, or leave the host debilitated. That is why in most cases, only the blood of a perfectly matched brother or sister can be used. Even then, clinical trials of mini-allo have reported treatment-related mortal-ity (death) as a result of GVHD to have occurred in 12-17% of patients involved in the studies. There is little long-term data on the patients who have had a mini-allo because it is still a relatively new procedure, and one that should be performed in the context of a clinical trial.

The use of umbilical cord blood in the allogeneic transplant setting is still experimental. There are two problems:

  1. The number of stem cells in an umbilical cord is too low to supply what is needed for an adult patient. Umbilical cord blood has been largely confined to use in pediatrics.

  2. It is highly doubtful that a grandchild would be an HLA match (a system of genetically matching blood) for a grand-parent. If the HLA match is not exact, then the risk of GVHD is increased, and the risk of death is increased.

One group of researchers recently reported results from a program in which umbili-cal cord blood was collected and used for transplantation in a sibling that has a disease and would benefit from a stem cell transplant. Data from 21 patients has been collected. The average age of the recipient of umbilical cord blood was 6 years. One-quarter of recipients had acute lymphoblastic leukemia (ALL). The rest of the recipients had other cancers or non-cancerous conditions that are treatable with stem cell transplants. None had myeloma.

Another group of researchers analyzed data from studies including umbilical cord blood transplants in 171 adults who were primarily diagnosed with leukemia. These patients did not have acceptable donors for allogeneic stem cell transplants and underwent transplants with umbilical cord blood. Following the cord blood transplant, acute GVHD occurred in approximately 32% of patients, and at 2 years, the incidence of chronic GVHD was 36%. Death related to the transplant procedure was 51%.

If you still wish to store the cord blood “just in case” for the future, there are private firms that provide this service. You may also wish to donate the cord to the Red Cross.

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