Umbilical cord blood transplantation
Umbilical cord blood transplantation is a medical procedure that involves the infusion of healthy stem cells sourced from umbilical cord blood into a patient whose bone marrow has been destroyed through chemotherapy, with or without radiation. This process aims to treat various cancers such as leukemia, lymphoma, and myeloma, as well as other disorders like immunodeficiency and metabolic diseases. The procedure relies on the successful matching of human leukocyte antigens (HLA) between the donor and recipient, which is crucial for minimizing complications and maximizing transplant success.
During the transplantation process, the patient’s immune system is suppressed to prevent rejection of the new stem cells. The donor stem cells are then infused through an intravenous line, and the patient is closely monitored for engraftment—the process where the new cells begin to populate the bone marrow and produce healthy blood cells. While umbilical cord blood has the advantage of causing less graft-versus-host disease (GVHD) compared to other sources of stem cells, risks such as infections and graft failure still exist.
Despite its benefits, umbilical cord blood transplantation faces limitations, particularly in adult patients due to the smaller volume of stem cells collected from a single donation. Advances in technology and multidisciplinary care have improved success rates, but ethical considerations surrounding the use of one individual's biological material for another's benefit persist. Furthermore, the storage lifespan of cord blood is limited to about fifteen years, adding another layer of complexity to the decision-making process regarding its use.
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Umbilical cord blood transplantation
ALSO KNOWN AS: Cord blood transplantation
DEFINITION: Umbilical cord blood transplantation is the administration of healthy stem cells obtained from umbilical cord blood into an individual after their own bone marrow has been eradicated by chemotherapy with or without radiation. These healthy stem cells move into the bone and reconstitute the bone marrow, producing new, healthy blood cells.
Cancers treated:Leukemia, lymphoma, myeloma, and neuroblastoma; other disorders treated include immunodeficiency, hemaglobinopathies, and metabolic disorders
Why performed: In patients with various cancers and diseases, a cure can be achieved when the patient’s affected bone marrow is obliterated and replaced with healthy stem cells. Umbilical cord blood is discarded after birth. Donated umbilical cord blood is an accepted source of hematopoietic stem cells for marrow reconstitution. Two transplant-dependent variables affect long-term recipient survival: donor-recipient human leukocyte antigen (HLA) match grade and the dose of stem cells. HLA is a genetic fingerprint on white blood cells and platelets, composed of proteins that play a critical role in activating the body’s immune system to respond to foreign agents. There are six HLA factors. The more of these factors that match between the donor and the recipient, the more likely the transplant is to be successful and complications to be prevented.
Patient preparation: To confirm the donor-recipient match, repeat HLA tissue typing is done. Then, the recipient’s bone marrow is destroyed by chemotherapy with and without radiation. This process kills diseased bone marrow. Since the patient's immune system has been obliterated, they must be protected to prevent infection.
Steps of the procedure: An intravenous (IV) device is placed in the recipient’s vein, and a solution containing the donor stem cells is infused.
After the procedure: The patient will be monitored for engraftment, the process in which stem cells enter the bone marrow and begin to produce blood cells. The patient will remain in an environment free from infectious agents until the new stem cells engraft and produce disease-fighting white blood cells. The patient will be monitored for relapse (return) of the original disease.
Risks: The risks of this procedure are infection, graft failure (the absence of or inadequate production of blood cells), and graft-versus-host disease (GVHD), in which the donor stem cells attack the recipient’s body. GVHD can be either acute or chronic.
Results: Umbilical cord blood stem cells produce less GVHD than other forms of stem cell transplants. Umbilical cord blood transplant is limited in adults because of the relatively limited number of stem cells that can be harvested from one placenta and umbilical cord. Umbilical cord blood transfusion is used to treat an increasing number of cancers, as well as metabolic, congenital, and hematological diseases. Advances in technology have also increased the number of stem cells that can be harvested from single donations. Multidisciplinary care management teams and increased patient management have increased success rates. Ethical concerns regarding umbilical cord blood transplantation remain, however. The process involves using one individual's tissues for the benefit of another, which is not without controversy. Additionally, some risk occurs in taking cord blood from a child, who may develop their own diseases due to mutated cells. In this case, the transplant recipient would have received these mutated cells as well. Finally, umbilical cord blood can only be stored for up to fifteen years.
Bibliography
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