Jamie Peregrine, MD, PGY-4 KU-Wichita, OB/GYN Wesley Medical Center

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1 Jamie Peregrine, MD, PGY-4 KU-Wichita, OB/GYN Wesley Medical Center

2 Uses for umbilical cord stem cells Describe the indications and uses for umbilical cord stem cells. Counsel patients on the advantages and disadvantages of umbilical cord blood banking.

3 Bone marrow Peripheral blood Umbilical cord blood Autologous Allogeneic

4 Expanded donor pool Ease of procurement No donor attrition Don t need complete HLA match BMT match: 7/8 or 8/8 at 4 alleles: HLA-A, HLA-B, HLA-C, HLA-DRB1 UCBT match: 4/6, 5/6, 6/6 at 3 alleles: HLA-A, HLA-B, HLA-DRB1 Decreased GvHD

5 Increased risk of graft failure Delayed immune reconstitution Limited cell number Unavailable donor for additional donations

6 Leukemia (ALL, AML, CLL, CML, etc) Lymphoma (Hodgkins, Non-Hodgkins) Severe Anemias (aplastic*, Fanconi) Hemoglobinopathies Sickle Cell Disease Beta Thalassemia Major Immune system disorders Severe Combined Immunodeficiency Inherited Metabolic Disorders Lysosomal storage diseases Myelodysplastic, myeloproliferative disorders Neuroblastoma*, medulloblastoma*, retinoblastoma* *autologous

7 Alzheimer s Disease Autism Cerebral Palsy Type I Diabetes Graft-versus-Host Disease Hypoxic Ischemic Encephalopathy Lupus Multiple Sclerosis Traumatic Brain Injury *70% of trials being conducted in China

8 Indications for HCT:

9 Indications for pediatric HCT

10 Umbilical Cord Blood Transplants Presentation-Slides/

11 Role of Cord Blood in Transplants by Patient Race Presentation-Slides/

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20 PRIVATE OB/GYN often/usually charges patient fee for collection Cord blood reserved for use by the individual (autologous) or sibling (directed/family use) $$ for collection and storage Basically free to retrieve Multiple options PUBLIC OB/GYN asked to NOT charge patient for collection Cord blood available on BeTheMatch Registry, listed by tissue type Free collection (for pt) $$ for retrieval only (insurance) Donor must meet eligibility requirements 2 options for mail-in kits

21 Historical questionnaire Risk factors for infectious diseases Inherited immunologic/hematologic diseases Certain genetic diseases Cancer Maternal blood testing Hepatitis B, Hepatitis C, HIV-1 and -2, HIV p24, CMV, syphyilis Sometimes: HTLV-I/II, Chagas disease, West Nile virus Mother/neonatal hospital charts reviewed Signs/symptoms of congenitally acquired infection or L&D factors at risk for infection/chorioamnionitis

22 Good general health >34 weeks Single gestation Anticipate uncomplicated delivery

23 Positive GBS GDM Meconium Prolonged rupture of membranes Low grade maternal fever <39 Celcius

24 Unexplained fever Chorioamnionitis SVD with active genital herpes SVD with perineal HPV Delivery < 34 weeks Placenta previa or abruption Excessive bleeding in labor and delivery Stillborn Significant complications for baby Fetal malformations *if uncertain, collect and inform blood bank

25 1 in 2700 chance that autologous unit of cord blood will be used for a child or family member. Can t use autologous blood for leukemia AAP doesn t recommend that parents routinely store cord blood unless there is an immediate medically indicated use for a sibling Biologic insurance against future disease not recommended Recognize emotional vulnerability of parents who want to do everything possible for child s welfare

26 If private banking decided upon, advise pts be well-informed: Read contracts Know all costs Family use allowed? Financially stable company? Accredited by reputable agency? (AABB, FACT) Track record Resource: Parent s Guide to Cord Blood website

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28 Private (examples of kits that have been used to collect at Wesley) Viacord Cryo-Cell

29 Public (only 2 known to have mail-in options in US as of Oct 2014) LifeForce ic-donation/requirements.html public donations can t be collected between Friday 1500 and Sunday 1500 Carolinas Cord Blood Bank

30 For public banks, if there is insufficient cord blood to use for donation, pt provides consent for cord blood to be used for (nonembryonic stem cell) medical research

31 Public: CCBB: Yearly Training for Public Donation 7 minute slideset required at Longer, more detailed option also available as CME credit LifeForce: Recommended that providers review 2 page collection instructions at pdf/collection%20instructions.pdf Request physicians NOT charge for collection

32 Bethematchclinical.org/CCBB

33 Study n=542 Mean collection volume 103 ml (35 ml anticoagulant) Mean TNC: 9 x 10^8 Preferred TNC cutoff: 1 x 10^9 (10 x 10^8)

34 Heavier babies Larger placentas Lower parity Longer gestation Nonreassuring fetal heart rate tracing Meconium-stained fluid Cesarean section Shorter time between delivery and clamping?in utero collection Not African American

35 Bethematchclinical.org (National Marrow Donation Program/public) Parentsguidecordblood.org (Public & Private) UpToDate Collection and storage of umbilical cord blood for hematopoietic cell transplantation Selection of an umbilical cord blood graft for hematopoietic cell transplantation ACOG Committee Opinion #399