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An experimental treatment still in its infancy

Tuesday, May 19, 1998

By Mary Niederberger

Cord blood transplants are still experimental and cord blood collection and storage is not regulated by the Food and Drug Administration, although regulations are expected within a year.

Worldwide, between 650 and 700 cord blood transplants have been performed - mostly on children - since the first one took place in France in 1988 to treat a boy with a blood disease called Fanconi's anemia. At the time, such transplants were not being performed in the United States.

The boy, Matthew Farrow of Salisbury, N.C., is doing well and continues regular checkups at Duke University Medical Center, which now has become a major center for cord transplants.

Duke and the University of Minnesota, which both regularly perform cord transplants, report nearly identical success rates: 50 percent in children and 38 percent in adults.

Nationally, bone marrow transplants for all ages have a 50 percent success rate, although with some cancers it's as high as 70 percent.

The only cord blood transplant performed at Children's Hospital in Oakland was unsuccessful.

In April 1994, Apryl Purington, 4, of Kittanning, received a transfusion of cord blood from her infant sister, Tesla, to try to arrest her aplastic anemia, a condition that destroys healthy bone.

Apryl died shortly after the transplant.

Stem cells from the cord blood transplants are supposed to restore the bone marrow's ability to produce healthy blood.

These transplants can treat leukemia, lymphoma and childhood cancers known as neuroblastomas as well as such nonmalignant diseases as aplastic anemia, sickle cell anemia, immune deficiencies and genetic diseases such as Hunter Syndrome. Stem cell transplants also have been used to treat breast and ovarian cancer.

As gene therapy treatments increase so will applications for cord blood use, medical experts predict.

Researchers also are experimenting with growing or expanding the number of cord blood cells available in each sample.

There are several advantages to cord blood transplants over bone marrow transplants:

Cord blood is easier to collect than bone marrow, which requires a one-day hospital stay and a painful procedure for the donor.

Graft vs. host disease, another complication of bone marrow transplants, appears to occur less when the cord blood donor and transplant recipient are unrelated. There would be no complications if a child's own cord blood was used.

In transplants performed on patients unrelated to the donor, cord blood appears easier to match.

Between 10,000 and 15,000 Americans each year need a bone marrow transplant but can't find a donor. Racial minorities and people with mixed ethnic backgrounds have the most difficulty finding matches. Public cord blood banks might provide such matches.

The first cord blood transplants were mostly among children who received cord blood from newborn siblings. Later transplants were performed on unrelated donors and patients and then tried on adults. Doctors originally questioned whether there would be enough stem cells in the cord blood to treat adults.

So far, the heaviest adult treated weighed 195 pounds.

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