UMBILICAL-CORD BLOOD CELLS OFFER NEW HOPE.

Byline: Damaris Christensen Medical Tribune News Service

Blood cells taken from a newborn's umbilical cord may offer new hope in treating children and adults with leukemia and various other blood-related disorders, new research shows.

Typically, people with such disorders would be candidates for a bone-marrow transplant, using donated bone marrow, preferably from a relative.

Two new studies have found that umbilical-cord blood from an unrelated donor can be successfully substituted for the donated marrow.

Not only is cord blood easier to obtain, it may result in fewer side effects, said Dr. Joanne Kurtzberg of the Duke University Medical Center in Durham, N.C.

For example, graft-vs.-host disease, an illness caused when transplanted immune cells attack the body of the recipient, may be avoided, she reported recently in the New England Journal of Medicine.

Umbilical-cord blood is rich in stem cells, rare and elusive cells that give rise to the entire immune system. In adults, the stem cells are found only deep within the bone marrow, and thus are more difficult to obtain than the ones circulating within the umbilical-cord blood.

In Kurtzberg's new study of 25 people ages 8 months to 23.5 years who received umbilical-cord blood from unrelated donors, the infused cells successfully reproduced in 23 of the patients.

The patients had blood-related disorders such as leukemia and a severe form of anemia, according to the study.

After seven to 32 months, 48 percent were still alive and had not suffered major complications, Kurtzberg reported. Over half of the patients died during the study.

``We had a very high success rate,'' she said, ``although I wish it were better, of course.''

About 10 percent of patients experienced graft-vs.-host disease, Kurtzberg reported.

Previous research has shown that roughly 30 percent to 50 percent of people undergoing bone-marrow transplants from unrelated donors experience the illness, she noted.

``The work by Kurtzberg and her colleagues is very suggestive,'' said Dr. Paul McCurdy of the National Heart, Lung and Blood Institute in Bethesda, Md. ``But this is only 25 cases and some have been followed less than a year. Before we say this is the cat's pajamas, we need to look at a few more cases.''

The NHLBI currently is spending $24 million to research cord-blood transplant, according to McCurdy. Clinical trials are scheduled to start in September.

In another study in the same journal, Dr. Jean-Philippe Laporte of Hospital St. Antoine in Paris reported a case of a 26-year-old woman with leukemia who successfully received a cord-blood transplant.

Eight months after the transplant, the woman returned to work, he reported.

``Our experience indicates that the transplantation of cord-blood stem cells is feasible,'' he wrote.

The results of the two new studies are ``very hopeful,'' said Dr. Leigh Jefferies of the University of Pennsylvania School of Medicine in Philadelphia, who co-authored an accompanying editorial.

``Right now, the most important thing is to prove that cord blood transplants are safe and effective,'' she said.

Cord-blood transplants may offer a good alternative to many people who cannot find a matching bone-marrow donor, Jefferies said.

But cord-blood transplants raise some interesting issues, such as whether the mother should be required to give informed consent for the harvesting of the blood, she said.