BCSLS Telehealth Stem Cell Transplantation. Becky Luk, Patient & Transplant Liaison Specialist
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1 BCSLS Telehealth Stem Cell Transplantation Becky Luk, Patient & Transplant Liaison Specialist
2 Our Story Why is there a need for stem cells? What is OneMatch Stem Cell & Marrow Newtork s role in Stem Cell Transplant field? Lets show you how we can do this together 2
3 Diseases treated with stem cell transplants Acute Myelogenous Leukemia Acute Lymphoblastic Leukemia Other Leukemia Chronic Myelogenous Leukemia Chronic Lymphocytic Leukemia Myelodysplasia Hodgkin's Lymphoma Non-Hodgkin's Lymphoma Multiple Myeloma Other Malignancy Severe Aplastic Anemia Fanconi's Anemia Hurler Syndrome Hunter Syndrome San Fillippo Wiskott Aldrich Syndrome Adrenoleukodystrophy Thalassemia Other Non-Malignant Disease Histiocytosis-X Gauchers Combined Immunodeficiency Promyelocytic Leukemia Purtilo Refractory Anemia Chronic Granulocytic Leukemia Myelofibrosis Waldenstrom's Macroglobulinemia Osteopetrosis Juvenile CML Myeloproliferative Disease Sickle Cell Anemia Proxysmal Nocturnal Hemoglobinuria Congenital Erythropoietic Porphyria Severe Combined Immunologic Disease Familial Erythrophagocytic Lymphohistiocytosis 3
4 What is a stem cell?
5
6 Stem Cell Transplant Destroy diseased cells Destroys all blood cells Destroys immune system Replace hematopoetic stem cells from another person Restores all blood cells Restores immune system Disease is gone (intent)
7 7 Giving Someone 2 nd Chance in Life
8 Canadian Blood Services National Health Care Delivery Service (founded 1998) 915,585 whole blood donations 55,244 38, ,959 ~ 732 ~ 4,500 ~ 19,600 > $990 million plasma donations platelet donations active donors healthcare facilities served employees volunteers annual budget 41 permanent collection sites; 20,000 collection clinics 12 manufacturing centres; 3 blood-testing centres
9 Consists of: HLA Laboratory at Head Office OneMatch Stem Cell & Marrow Network Stem Cells National Systems Solutions National Public Cord Blood Bank 9
10
11 11 Recruiting for an Optimal Registry
12
13 Three Matching Scenarios Canadian Donor for Canadian Patient International Donor for Canadian Patient Canadian Donor for International Patient 13
14 14 How are stem cells collected?
15 How are stem cells given to the patient? The patient receives chemotherapy and/or radiation to destroy the diseased cells The donated cells are transfused directly into the blood stream The donor s cells travel to the marrow and begin to function and multiply 15
16 Transplantation with Stem Cells Bone marrow Blood Umbilical cord
17 Why Unrelated Donors? HLA Typing: inherited genetic markers Only 25% of patients have a match in family 75% must search for an unrelated donor Gabe and his mom Jeanine Unrelated donors are often from the same ethnic group as the patient 17
18 Number of Patients Canadian Patient Searches Demand and Need Continues to Increase All Patient Ethnic Origins /05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 Total 18
19 Canadian Stem Cell Recipients Canadian Unrelated Transplants International Donor Canadian Donor /03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 19
20 OneMatch Fast Facts September 2012 Searchable donors: 333,371 Canadian Transplant Centres: 18 Canadian Collection Centres: 10 International Registries: 66 Over 19,838,863 registrants worldwide International Cord Blood Banks: 44 Over 542,858 umbilical cord blood units 20
21 Ethnic Composition of OneMatch Database Caucasian, 75.6% Black, 0.8% Other, 3.9% Chinese, 6.1% Asian, 2.2% Hispanic, 0.2% Aboriginal, 0.9% Multi-ethnic, 0.9% Southeast Asian, 0.7% South Asian, 2.5% Latin American, 0.5% Filipino, 0.3% Japanese, 0.1% Korean, 0.2% Unknown, 3.2% East Indian, 1.4% Arab/West Asian, 0.5% 21
22 22
23 Age Composition of OneMatch Females % Females % Males % Caucasian Males % Ethnic Males % Males %
24 What this means for First Nations patients First Nations registrants are severely underrepresented on the Registry This means First Nations patients are going to have a more difficult time finding a matching donor More than half of Canadian patients are finding a match from an International donor First Nations patients have certain antigens only found in the First Nations population. Finding a matching donor from a country overseas is unlikely 24
25 Canadian Aboriginal Recipients Registry data ( ): 102 recipients identified as aboriginal 40 transplanted (39%) 2 full HLA match, rest various degrees of mismatch 7 from Canadian donors Median time to transplant 8.2 months Vs. 5.8 months for non-aboriginal recipients 50 searches cancelled Too sick, died, took too long etc 25
26 Optimal donors needed years of age Healthy Committed Ethnically diverse Special need for male donors 26
27 OneMatch working to improve searches for All Patients Working with partners: A.N.A.C., OtherHalf, SA4L etc. to organize awareness events in the community Organize swab events in communities across the country in collaboration with Band Councils and community volunteers Engaging youth leaders in post secondary and high schools and in community organizations 27
28 Registration is easy Register on-line to become a potential stem cell donor: Registration information received into database within 20 minutes. Buccal swab mailed to registrant next business day after initial contact. Complete and return to OneMatch 28
29 Spread the word Tell family, friends and colleagues how easy it is to save a life Organize a Swab Event in your community Become a OneMatch Ambassador Encourage youth engagement Erik Blaney OneMatch Program Advocate 29
30 But OneMatch has more to do
31 Need for Additional Stem Cells OneMatch is an active member of the International Network of stem cell registries 19.8M potential adult donors from 66 registries in 48 countries; and 543K public CBUs from 46 cord blood banks in 30 countries. source: BMDW, September 7,
32 However Need for Additional Stem Cells Fail to find matches for 50% of our Canadian recipients Even less for ethnically non dominant Canadians 32
33 Need for Additional Stem Cells US National Marrow Donor Program: AABB million donors on registry Adds 1 million per year to registry big Rate of 8/8 match (HLA A B C DRB1) Caucasian 80% Asian 30 40% South Central American Black 15% Due to under representation in donor pool AND increased diversity in the minority groups 33
34 Need for Increased HLA Diversity Increasing donor number has less impact vs pre 2004 Duplication of common HLA haplotypes Need to increase less common haplotypes even more so than common ones Eg assume equal registry size probability of match if African ancestry = 30% vs 60% in non Africans Due to HLA diversity WITHIN the population 34
35 Need for a National Public Cord Blood Bank increasing majority of all unrelated paediatric stem cell transplants in Canada are with cord blood increase in the adoption of cord blood for adults (two cords used) 35
36 Canadian Patients Transplanted Using Cord Blood Stem Cells Cord Blood Transplants /03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 Hema-Quebec Cords Cord Blood Transplants 36
37 Need for a National Public Cord Blood Bank Cord blood has distinct advantages over bone marrow or PBSCs: More lenient HLA matching requirements Units are available immediately (1 day 2wks vs 3 10 mos for adult stem cells) Lower risk of graft-vs.-host disease (GvHD) Minimal risk to donor (mother and baby) 37
38 Need for a National Public Cord Blood Bank All cord blood units supplied by Canadian Blood Services for unrelated transplant are imported from international sources. The cost of importing cord blood units continues to increase $42,000 ea. International banks cannot meet the needs of Canada s unique First Nations and Aboriginal populations 38
39 Cords and Ethnic Diversity Higher likelihood of match as only 6/6 required HLA A B DR US NMDP data 150,000 CBU and add 25,000 per year Likelihood of 6/6 match European descent: 15% adult recipient, 35% child Likelihood of 4/6 match 75% in ALL adult populations Virtually all children in all ethnic groups 39
40
41 CBS OM National Cord Blood Bank
42 OneMatch Public Cord Blood Bank Model Includes at least four collection cities and two manufacturing facilities for processing, storage and distribution. Please note: We will also be working on cord blood collection kits that can be sent to targeted areas outside of cities listed below to reach Aboriginal communities, for e.g. Canadian Blood Services OneMatch National Public Cord Blood Bank (inventory of 20,000 units within 8 years*) Medical and Scientific Advisory Committee Searching, Matching OTTAWA Manufacturing Facility (April 2, 2013) EDMONTON Manufacturing Facility (2014) CBS Support HLA Testing Transmissible Disease Testing CBS Research Ethics Committee (units unsuitable for transfusion) Marketing & Recruitment *Optimal size of a national cord blood inventory is currently estimated to be approximately 20,000 units, which can be achieved within eight years using this Model. Canadian Transplant Programs International Registries OTTAWA Collection Hospital(s) (April 2, 2013) TORONTO Collection Hospital(s) (2014) EDMONTON Collection Hospital(s) (2014) VANCOUVER Collection Hospital(s) (2014) Canadian Research Scientists 42
43 Scope and Timelines The Canadian Blood Services OneMatch Public Cord Blood Bank will consist of collection sites (hospitals) in Ottawa, Toronto, Edmonton and Vancouver, with processing and storage sites at our two existing stem cell manufacturing facilities in Ottawa and Edmonton. The goal is to reach a minimum of 20,000 cord blood units in storage for transplantation by March 31, 2019 eight year period beginning April 1, Phase I of the cord blood bank will be operational in Ottawa in April 2, 2013, and in the remaining sites, Phase II, in FY 2011/12 FY 2012/13 FY 2013/14 FY 2014/15 Ottawa Collection & Manufacturing Edmonton Collection & Manufacturing Vancouver Collection Toronto Collection PHASE I PHASE II PHASE II PHASE II 43
44 Awareness Marketing Objectives 1. To develop strategy to raise awareness of the public cord blood bank among prospects to facilitate recruitment 2. To implement tactics to support recruitment 3. To develop strategy for donor recognition 44
45 Recruitment Our target group is specific and localized, i.e., healthy pregnant women who plan to deliver at the designated collection hospitals: Discussions begin during the antenatal period with their health care professional Education, information gathering, questions (becoming informed of process in advance of day of delivery) Arrive on special day with Permission to Collect form ready No advance registration 45
46 46 Maternal Information Booklet
47 Collection Method Ex-utero: Fully supported by CBS OMPCBB designated staff In-utero(non-supported): Entire process completed by hospital staff. This model is intended for future remote sites e.g. northern Canada. 47
48 Need for Additional Stem Cells OneMatch is an active member of the International Network of stem cell registries 19.8M potential adult donors from 66 registries in 48 countries; and 543K public CBUs from 46 cord blood banks in 30 countries. source: BMDW, September 7,
49 Processing Sepax System Fully-automated, mobile, GMP compliant system for the efficient and reproducible processing of umbilical cord blood, bone marrow and peripheral blood Hands-free operation automated, closed, sterile system Quick, accurate data tracking Consistently high mononuclear cell recoveries 49
50 Cryopreservation Volume reduced cord blood unit Cryo-protectant added (DMSO) Controlled rate freezing using ThermoGenesis BioArchive freezer Holds up to 3,636 units Liquid nitrogen storage (-196 C) Inventory controlled / tracked Must be stored within 48 hours of collection; can be stored indefinitely 50
51 Searching and Matching Listed on OneMatch Registry Banked inventory of cord blood units Cords listed, searched and requested Searched both nationally and internationally OneMatch Stem Cell National Systems Solution (IT system) Physicians / Clinical Transplant sites request OneMatch banked cord blood unit Build on current OneMatch process 51
52 Distribution Requested Cord Blood for Transplant Manufacturing selects, releases, packs and ships Transport courier 52
53 53 You could be the one match to help save a life.
54 Thank you 54
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