Donation, storage and uses of umbilical cord and bone marrow stem cells
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Transcript of Donation, storage and uses of umbilical cord and bone marrow stem cells
Donation, storage and uses of umbilical cord and bone marrow stem cells
Jeevan Public Cord Blood Bank22 Wheatcrofts Road
NungambakkamChennai
www.jeevan.org
Background• JBBRC – 1995 (1992 – 1995)• ISO certified – 1999 , NABH Accredited - 2010
• JSCB - 2007 ( 2004 – 2007)• SUBASH - 2007• License – 2008• ISO certification – 2008
• Currently run along the best international standards of Netcord FACT
Stem Cell Donation
Adult Sources of stem cells• Umbilical Cord –
Blood, Wharton’s Jelly, Cord tissue
• Bone Marrow• Peripheral blood
• Fat • Small quantities in
almost every organ
WHAT is cord blood ?
The blood that remains in the umbilical cord (umbilical vein) after delivery of the baby and clamping of the cord.
Discarded as waste all over the world until 1988
WHY cord blood ?
• Increasingly preferred source by clinicians
• Easily available resource
• One lakh deliveries / day in India
• Donor attrition - not a problem
CORD BLOOD DONATION / Public Banking
Accessible to anyone across the globe subject to HLA compatibility.
Greater likelihood of usage.
Only 30% of allograft recipients have sibling donors
CORD TISSUE – MSCs – work going in , none validated or approved for clinical use as yet.
What is bone marrow / Peripheral Blood Stem Cell (PBSC)Donation
Operation Theatre
Anaesthesia
G-CSF – 5 days prior to donation SC Like a Pheresis procedure
Out Patient Procedure
The Need ?
• In India, every year, about 10,000 children are born with Thalassemia
• Every year, more than 10,000 men, women and children could benefit from a bone marrow transplant.
• Each year, more than 140,000 people are diagnosed with blood cancer, such as leukemia or lymphoma.
• Every 5 minutes someone is diagnosed with blood cancer and every 10 minutes, blood cancer takes a precious life.
• Leukemia is the most common disease children die of.
Comparison of Sources Comparison of Sources Feature Bone Marrow PBSC Cord BloodQty of harvest Larger Larger Much less
Engraftment Faster Faster Longer
GVHR 75 % 75% 38%
Risk of Contamination
More More Less
Collection Tedious & Painful Tedious Simple
Donor search time
Longer Longer Halved
HLA Typing 5/6 or 6/6 5/6 or 6/6 3/6 or 4/6
Donor supply Limited Limited -Autologous
Limitless
Telomeres Shorter Shorter Longer
Viability of banked stem cellsViability of banked stem cells
• Bone Marrow stem cells – Banked since 1968
• Human cord blood stem cells frozen in 1985 and 1986 – Broxmeyer
• Viability tests done according to schedule fixed by storage centre
Who can donate ?Cord Blood
Foetus – Full term, healthy
Mother – In good health, uneventful pregnancy
Father – No Transfusion Transmissible Infections
Aunts / Uncles – No Blood related disorder – genetic / malignancy
Bone Marrow / PBSC
• Men and women between 18-40 yrs who are truly altruistic.
• Healthy, no chronic illnesses
• All pre-requisites as for regular blood donors
Process of Stem Cell DonationUmbilical Cord Blood
1. Registration2. CB & Maternal sample
collection3. Acceptance of sample4. Processing, Screening and
Storage5. Used when required subject
to HLA Compatibility.6. The stem cells may be issued
any time after one year and can be stored indefinitely.
BM / PBSC
1. Registration2. Blood Sample / Buccal swab
taken for HLA Typing3. Data stored in registry4. Donor recalled if request for
specific HLA type5. Donor screened for TTI and
fitness to assess eligibility6. Donation for a specific person
who is HLA compatible 7. Used immediately / 6 months
Storage of Stem Cells
Acceptance, Processing , Storage and Issue of stem cells
• Guidelines – International and national / Jeevan
• Acceptance criteria • Processing – Manual / Automated• Storage - Depends on whether it is for
allogeneic / autologous use• Issue – Depends on recipient – Allogeneic /
autologous
Steps of Processing at JPCBB
1 2 3
54 6
Applications – Present & ? Future
Current applications Acute and Chronic
Leukemias Myelo-dysplastic
Syndromes Stem cell disorders Myelo-proliferative
disorders Lympho-proliferative
disorders Phagocyte disorders Inherited platelet
abnormalities
Inherited metabolic disorders
Histiocytic disorders Inherited RBC
abnormalities Inherited immune
system disorders Plasma cell disorders Solid tumours Other inherited
disorders
India-Transplant & Research Centres India-Transplant & Research Centres
o Tata Memorial Hospital, Mumbai o R&R Army Hospital, AIIMS , New Delhio Inlaks Hospital, Armed Forces Medical College, Puneo Sanjay Gandhi PGIMS, Lucknowo Apollo Hospital, Global Hospitals, NIMS, Hyderabado Narayana Hruduyalaya , Bangaloreo Christian Medical College, Velloreo Adyar Cancer Institute, Apollo Specialty Hospital, Madras ,
Madras
o Manipal Inst of Regenerative Medicine, NCBS, Bangaloreo Reliance Life Sciences, Mumbaio LVPEI Hyderabado Aravind Eye Hospital Madurai, o Niche-in-Centre for Regenerative Medicine, Stanley Medical
College, Sankara Nethralaya, Frontier Lifeline Hospitals Madraso Rajiv Gandhi Centre of Biotechnology, Trivandrum
Comparison of Outcomes of Unrelated BM and CB Transplants in Young Adult Leukemia Patients. Updated Results of Japanese Registration Study
ASH Annual Meeting San Francisco December 2014
These data suggest that CB may be the first choice alternative to 8/8 UBM for AML. For ALL, 8/8 UBM is the first choice, however, CBT will convey comparable outcomes with 7/8 UBMT. The survival after UCBT is approaching to that after 8/8 UBMT in recent years.
Stem Cell Issue
What Jeevan has done so far…• 2011- First Transplant • 2013 – Second Transplant• 14th October 2014 - Bone Marrow Donor
Worldwide www.bmdw.org • 17th Jan 2015 –NMDP - Be the Match Registry• July 2015 – Stem Cell Registry (Adult donors)
• 503 requests for match and found 12 units having a 10/10 match and 55 with a 9/10 match.
Who Benefits ?• Indians and a few from other ethnic origins.
• Genetic hematological illnesses such as Thalassemia, Sickle Cell Anaemia etc
• Hematological malignancies such as Acute and Chronic Leukemias of various types.
Blood forming stem cells can be used ONLY for the treatment of blood related disorders
Where is India ?
The role and potential of umbilical cordblood in an era of new therapies: a review
Roura et al. Stem Cell Research & Therapy (2015) 6:123
“As ethnic diversity increases in developing countries, it is imperative to find alternative stem cell sources when an adult-matched unrelated donor cannot be identified.”
“Since the first UCB transplant in 1988, UCB has increasingly been employed as an alternative source of hematopoietic cells for transplantation in the treatment of blood diseases”
All patients, depending on race and ethnicity 66 -93% African American or Black patients 66%American Indian and Alaska Native 82%Asian or Pacific Islander 73%Hispanic or Latino 72%White 93%
Source: NMDP Bioinformatics, 2010Note: Percentages are based on matching an adult donor only. Cord blood further increases the chance of finding a match
Likelihood of finding an adult donor match by race and ethnicity
“Luck can often mean simple taking advantage of a situation at the right
moment. It is possible to “make” your luck by being always
prepared.”
Michael Korda