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Duke Takes First Deposit in Umbilical Cord Blood Bank

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Duke Health News 919-660-1306

DURHAM, N.C. -- The nation's third "bank" for umbilical cord
blood, the only known substitute for bone marrow
transplantation, has started building deposits at Duke
University Medical Center, officials said. The first donation
moves from holding status into the bank vault this week. The
bank will process and store units of umbilical cord blood
collected after birth from voluntary donors at three hospitals
in North Carolina, with a goal of increasing the pool of
available units for transplant by 6,000-7,000 over the next two
years, according to Dr. Joanne Kurtzberg, the primary
investigator for the project at Duke. Kurtzberg, a specialist
in pediatric hematology and oncology and a pioneer in umbilical
cord blood transplant, has performed about a quarter of the
transplants done worldwide.

Based at Duke, the Carolina Cord Blood Bank is supported by
a five-year, $8.8 million grant from the National Heart Lung
Blood Institute (NHLBI), part of the National Institutes of
Health. It is one of three newly funded cord blood banks in a
project that aims to both increase the chances of finding
patients compatible cord blood for potentially life-saving
transplants and to find the best ways to collect, process and
store the cord blood.

Just four years ago, umbilical cords were part of the
cast-off waste of afterbirth. But since the first successful
transplant of umbilical cord blood from an unrelated donor to a
young Duke patient, one-time medical waste has taken on a
viable second purpose, Kurtzberg said.

"I think of cord blood as the ultimate in recycling,"
Kurtzberg said. "It's a material that is normally discarded,
but it can be life saving."

Umbilical cord blood can substitute for marrow in a
transplant because the blood is rich in immature cells, called
stem cells, that generate developing and mature blood cells.
The tissue-type match between the donor and recipient doesn't
need to be as close as in bone marrow transplant, probably due
to that same immaturity of cells in the cord blood that would
normally trigger rejection of tissue, specialists said.

Cord blood from unrelated donors has been used in
transplants for about 500 patients for whom no matching donor
of bone marrow could be found. Without transplant, physicians
said all the patients would have died. With transplant, about
half have survived, Kurtzberg said.

Most of those transplants have been made possible through a
single cord blood bank established at the New York Blood Center
by Dr. Pablo Rubenstein. Since 1992, the New York bank has
collected about 8,000 units. With the addition of the three
NHLBI-funded banks – the Duke-based bank and another not yet in
operation on the East Coast, plus one on the West Coast -- the
overall pool is expected to be boosted by 15,000 units in the
next two years, Kurtzberg said.

Officials at the centers operating the new banks hope as
many as half the units collected will be from minority donors.
The Duke-based bank is expected to increase the pool for
African-American patients, while the bank based at the
University of California Los Angeles is expected to increase
the number of units available for Asian and Hispanic
patients.

"The number of potential bone marrow donors for minority
patients is so low that odds for an acceptable match are very
limited. We think we can increase the chances for successful
transplant by banking the cord blood of healthy minority babies
who are born full-term to healthy mothers," Kurtzberg said.

Duke will house the Carolina Cord Blood Bank (CCBB),
processing and storing cord blood collected at Duke Hospital
and Durham Regional Hospital in Durham, and at Carolinas
Medical Center in Charlotte. Mothers delivering babies at those
three hospitals will receive information about the project
during their pregnancy, and will be able to request more
information if they are interested in donating their babies'
umbilical cord blood after birth.

"Patients will first receive information at their doctors'
offices during a regular check-up," Kurtzberg explained.
"Later, a nurse will talk with them and give them the
opportunity to find out more about the project. Once the mother
indicates she wants to be a donor, a nurse from the bank will
meet with her and explain the process. There are medical
histories to be completed, blood to be obtained from the mother
during her admission to labor and delivery, and a number of
measures to ensure confidentiality."

Cord blood will be collected with permission of the mother
by a specially trained team working with the banking project,
Kurtzberg said. After the baby is born and separated from the
umbilical cord, the placenta and cord – or afterbirth – will be
taken from the delivery room. In another room, the team will
drain the remaining blood, usually 2 to 6 ounces, from the
placenta to a collection pouch containing blood thinner to
prevent clotting.

The unit of cord blood and mother's blood will be tested for
infectious diseases and abnormalities that could harm a
transplant recipient. Tissue typing also will be done. If the
unit clears all testing, a process that takes several weeks, it
will be deposited to the permanent bank of units available for
matching to patients and transplantation.

The short period of time between collection and availability
for transplant marks another advantage of cord blood over bone
marrow for some patients, Kurtzberg said.

"Speed is of the essence for some patients, such as those in
remission from leukemia or with progressive genetic diseases,"
she explained. "It takes two to six months from the point of
initiating a search for a potential bone marrow match to
transplant. It takes one to two weeks with cord blood. There
are times when it makes sense to go quickly to transplant, and
in those cases, cord blood has a practical advantage for the
patient."

As with unrelated bone marrow donation, the identity of the
source of the cord blood will be kept confidential. Individual
units will be marked only with bar codes, the original code and
donor name kept in sealed files to maintain anonymity. Only the
project directors and administrator will have access to the
locked files, Kurtzberg said. If the mother of the donor later
wants to withdraw her baby's unit from the project, it will be
possible to track the unit and remove it from the bank,
providing it has not been used in transplant.

An additional part of the study involves monitoring the
donor's health for the baby's first few years of life,
Kurtzberg said. "The mothers will give us permission to review
the charts of their babies after their well-care visits. Again,
the information will be kept confidential, but this will
provide another set of checks for us in determining safety and
effectiveness of cord blood transplants."

The cord blood units stored at the Duke bank and the West
Coast banks in the NHLBI project will be available for use at
seven approved transplant centers, which will be testing
"common treatment and care regimens for patients to learn more
about the best ways to use cord blood," Kurtzberg said.

The NHLBI-funded banks will operate as public banks,
Kurtzberg said, meaning that the cord blood will be available
to any patient whose medical condition warrants such a
transplant. The public banks are distinct from recently
developed commercial banking enterprises.

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