Advances Allow Expanded Use of Allogeneic Stem Cell Transplantation   Use of Umbilical Cord Blood Expands Option of Transplantation to More Children   House Call: Meeting Your Own Needs While Caring For Someone Else   Protecting the Interests of Young Donors, by Rebecca Pentz, PhD, Clinical Ethicist   Protocols: Clinical Trials of Allogeneic Stem Cell Transplantshttps://openworks.mdanderson.org/oncolog/1087/thumbnail.jp

Chalaire, Dawn

Pentz, Rebecca D., PhD

Wright, Kerry L.

English

Advances Allow Expanded Use of Allogeneic Stem Cell Transplantation Use of Umbilical Cord Blood Expands Option of Transplantation to More Children House Call: Meeting Your Own Needs While Caring For Someone Else Protecting the Interests of Young Donors, by Rebecca Pentz, PhD, Clinical Ethicist Protocols: Clinical Trials of Allogeneic Stem Cell Transplantshttps://openworks.mdanderson.org/oncolog/1087/thumbnail.jp

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University of Texas MD Anderson Cancer Center OpenWorks @ MD Anderson OncoLog MD Anderson's Report to Physicians (All issues) OncoLog MD Anderson's Report to Physicians 7-2000 OncoLog Volume 45, Number 07/08, July/August 2000 Kerry L. Wright The University of Texas MD Anderson Cancer Center Dawn Chalaire The University of Texas MD Anderson Cancer Center Rebecca D. Pentz PhD The University of Texas MD Anderson Cancer Center Follow this and additional works at: https://openworks.mdanderson.org/oncolog  Part of the History of Science, Technology, and Medicine Commons, and the Oncology Commons Recommended Citation Wright, Kerry L.; Chalaire, Dawn; and Pentz, Rebecca D. PhD, "OncoLog Volume 45, Number 07/08, July/August 2000" (2000). OncoLog MD Anderson's Report to Physicians (All issues). 81. https://openworks.mdanderson.org/oncolog/81 This Newsletter is brought to you for free and open access by the OncoLog MD Anderson's Report to Physicians at OpenWorks @ MD Anderson. It has been accepted for inclusion in OncoLog MD Anderson's Report to Physicians (All issues) by an authorized administrator of OpenWorks @ MD Anderson. For more information, please contact rml-help@mdanderson.org. REPORT TO 2 5 8PHYSICIANS ' JULY/AUGUST 2000 L45, N0.7/8 Oinical Trials Caregiver's 1'o-:Do list Umbilic.al Cord Protecting Included are studies Taking care of Blood Transplants Young Donors LNIVERSITYOFTEXAS of non ablative alloge- someone with can- An alternative source Who decides if a lvffiAN)ERSON neic transplants and cer? House Call offers of stem cells may child is capable of CANCER CENTER treatment of graft- suggestions for meet- allow more patients to donating blood or Making Cancer History- versus-host disease. ing your own needs. undergo transplants. bone marrow? MDAnderson Advances Allow Expanded Use of Allogeneic Stem Cell Transplantation by Kerry l. Wright he tendency of trans­planted stem cells to attack their recipient's cancer makes allogeneic transplants more likely than autologous transplants to cure disease, but when this cell-<m-cell activity is directed toward normal cells, it can also lead to graft-versus-host disease (GVHD). In the past, the threat of GVHD limited the number of patients who were able to undergo allogeneic transplantation, but Dr. Sergio Giralt (amter) and Dr. Issa Khouri ·aht), associate projes­:s in the Departmentof Blood and Marrow Transplantation, talk...... thanks to advances in immunosup­pressive therapies and cell manipula­tion techniques, that number has been steadily increasing. "In the beginning, bone marrow transplants were viewed as a way to give very high doses of chemotherapy and radiation, and the transplant itself was considered supportive care to help people recover from what would otherwise be permanent destruction of their bone marrow," said Richard E. Champlin, M.D., chairman of the Department of Blood and Marrow Transplantation at The University of Texas M. D. Anderson Cancer Center. The (Continued on next page)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      ....... }�'1/ .� �/ � r I . .. ring a recent follow-up visit�essor in the Department of Clinical Pediatri.cs, poses with_, an umbilical cord bl.ood transplant recipient. Since 1996, umbilical cord bl.ood transplantation has been an oj>tion at M. D. Anderson for patients who do not have a related ste-m cell donor: the greatest threat to patients. "The reported incidence of fatal complications in umbilical cord blood transplants exceeds 30% in the first 100 days," said Dr. Chan. The small number of stem cells contained in umbilical cord blood has also limited transplant recipients to children and low-weight adults, but a new protocol at M. D. Ander­son aims to expand umbilical cord blood transplantation to more adults by combining umbilical cord blood from two or three donors and trans­planting it into a single patient. "In adult singlMonor umbilical cord blood transplants, especially when the HLA mismatch is large, the engrafting is very delayed," said areas de Lima, M.D., an assistant ofessor in the Department of Blood and Marrow Transplantation and principal investigator of the study. "The majority of cases will en graft, but instead of the usual l 0 to 20 days for bone marrow and blood stem cell transplants, umbilical cord blood transplants may take 40 to 60 days to en graft," said Dr. de Lima. Dr. de Lima hypothesizes that combining umbilical cord blood donors will increase the number of stem cells available and decrease the time it takes for the transplant to engraft. This hypothesis is supported by preclinical animal experiments. While there have been verbal reports of this type of study elsewhere, there have been no published results. Dr. de Lima stressed that the protocol is an option for patients who otherwise would not be able to receive a transplant of any kind. "The major eligibility criteria for this protocol is patients who don't have an available bone marrow or blood stem cell donor," Dr. de Lima said. 'This treatment is very inten­sive, so it's mainly for patients age 50 and younger." lhe major advantage of umbilical cord blood transplantation is that transplant recipients can tolerate some mismatches in HLA type . While no results are yet available from Dr. de Lima's study, the overall survival rate reported worldwide in the literature for both pediatric and adult single-donor umbilical cord blood transplant recipients is only about40% With an overall success rate of 56%, Dr. Chan and his colleagues haYe so far had better results, due, in part, to a modification in approach. In most centers where pediatric umbilical cord blood transplants are performed, patients are given antithymocyte globulin (ATC), an immunosuppressive drug, to prevent rejection. At M. D. Ander­son, melphalan and fludarabine are used instead, and tacrolimus is used in place of cyclosporin to prevent graft-versus.host disease. Also, the protocol at M. D. Anderson calls for about 50% less radiation than most protocols at other institutions, said Dr. Chan. Because the experiences of other centers with umbilical cord blood transplants have not been as favor­able, Dr Chan said, most prefer to use unrelated bone marrow transplants or other methods. "Our success rate is such that we encourage umbilical cord blood transplants to be done," he said. "Our approach is different."• FoR MORE INFORMATION, contact Dr: Chanat (713) 792-7751 or Dr: de Lima at (713) 792-8750.MD Anderson OncoLog / 7 

OncoLog, Volume 45, Number 07/08, July/August 2000

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OncoLog Volume 45, Number 07/08, July/August 2000

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