Saving Sabrina: Double Umbilical Cord Transplant - NewsChannel5.com | Nashville News, Weather & Sports

Saving Sabrina: Double Umbilical Cord Transplant

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MIAMI (Ivanhoe Newswire) - Every four minutes, one person in the U.S. is diagnosed with a blood cancer. Blood stem cell transplants have become a standard way to treat children with leukemia and other blood disorders, but has been limited for only small children. Now, doctors are saving older children by transplanting not just one, but two umbilical cords.

From playing Uno to dancing with her sibling, you would never have guessed that just last year 15-year-old Sabrina Couillard was fighting for her life.

“I was getting really skinny. I was getting bruises everywhere,” Couillard told Ivanhoe.

She was diagnosed with leukemia.

“I just broke down [and] cried,” Sabrina’s mom, Marta Gonzalez told Ivanhoe.

Her only hope for a cure was a bone marrow transplant, but doctors couldn’t find a match from a family member. That’s when her doctor, Kamar Godder, turned to an alternative stem cell source: the umbilical cord.

“We knew that when you give it to somebody who is heavier, a heavier child or adult it will not quote unquote take,” Kamar Godder, MD, Pediatric, Hematologist/Oncologist, Miami Children’s Hospital, told Ivanhoe.

Couillard’s doctor gave her a double umbilical cord transplant.

“Initially the thought was just to give more of [the] cells,” Dr. Godder explained. “Eventually only one will take over, that’s the interesting thing.”

Dr. Godder said that earlier studies have shown that cell count is the most important factor after degree of match for successful transplant.

It worked for Couillard, who is now cancer free!

“I’m feeling good,” Couillard said. “I just have to keep walking more [and] strengthening my legs.”

Doctor Godder said the treatment is proving to be an effective alternative for older children with blood diseases.

There is no added risk to using two umbilical cords. The risks are much the same as you would get with the unrelated cord blood which is the risk of rejection.

RESEARCH SUMMARY

DR GODDER: Originally the source of transplant was from the bone marrow of a matched sibling. From somebody within the family who has the same tissue type and that’s what we called HLA matched, but, obviously only one-third of patients will have that option available to them. So, researchers started looking at other sources and the next was an unrelated donor, adult unrelated donor transplant. The unrelated donor transplant was very successful in their finding, and what is connected with that as well is the understanding and the better tissue typing that improved so that the matching can be much improved and prevent complications. Still the unrelated registry is limited because of the variability or the changes were all different especially in the United States where the population is so heterogeneous. And small minorities and ethnic groups did not have the right to enough representation in that. So next was what was found is cord blood; in other words, the area that is discarded placenta. The cord blood contained blood from the baby that’s not going to be used and that also contains the same hematopoietic stem cells, in other words blood stem cells, that can populate or that can build a new bone marrow.

REQUIREMENTS: “The nice thing about cord blood is you don’t need to have the same degree of matching. Because the assumption in those cells from the cord are naïve and were not exposed to any other antigens or any other proteins, that’s why they are less likely to cause complication in the recipient. So actually we don’t need a full match when you use cord blood.”

“With cord blood we learned the degree of match is only one of the factors, and the other factor is the number of cells in the cord blood bag. This is a given number, it’s not a number that we can manipulate or make any change to. That’s why we and others have started using it for only for small children. Because we knew that when you give it to somebody who is heavier, a heavier child or adult, it will not “take.” It will not do the job, it will not engraft; that’s the terminology. And that’s what led to the trial of different ways to make those stem cells from cord blood a little bit stronger. Some people try in the lab to make more of them, to expand their population and that’s more on an experimental level. And the other approach was to use more than one unit and initially the thought was just to give more cells. With time, it turns out, eventually only one takes over and that’s the interesting thing: we don’t know yet who will be the one that will take over; is it by number or is it by other genetic factors? What we do know is that when you give, one unit is serving as the major one and the other unit is more the supporting unit.”

INTERVIEW

Kamar Godder, MD, Pediatric Hematologist/Oncologist, Director of the Bone Marrow Transplant, Miami Children’s Hospital, talks about an alternative source of stem cells.

Originally a transplant would have come from bone marrow, right?

Dr. Godder: Yes, originally the source of their transplant was from the bone marrow of a matched sibling. From somebody within the family who has the same tissue type and that’s what we called HLA matched. Obviously only one-third of patients will have that option available to them. So, then people started looking at other sources and the next was an unrelated donor, adult unrelated donor transplant. The unrelated donor transplant was very successful in their finding, and what is connected with that as well is the understanding and the better tissue typing that improved so that the matching can be much improved and prevent complications. Still the unrelated registry is limited because of the variability or the changes were all different especially in the United States where the population is so heterogeneous. And small minorities and ethnic groups did not have the right to enough representation in that. So next was what was found is cord blood; in other words, the area that is discarded placenta. The cord blood contained blood from the baby that’s not going to be used and that also contains the same hematopoietic stem cells, in other words blood stem cells, that can populate or that can build a new bone marrow.

What are the requirements to be a donor for the umbilical cord?

Dr. Godder: Actually the nice thing about cord blood is you don’t need to have the same degree of matching. Because the assumption in those cells from the cord are naïve and were not exposed to any other antigens or any other proteins, that’s why they are less likely to cause complication in the recipient. So actually we don’t need a full match when you use cord blood.

How many cells do you think you can get out of just one umbilical cord?

Dr. Godder: With cord blood we learned the degree of match is only one of the factors, and the other factor is the number of cells in the cord blood bag. This is a given number, it’s not a number that we can manipulate or make any change to. That’s why we and others have started using it for only for small children. Because we knew that when you give it to somebody who is heavier, a heavier child or adult, it will not “take.” It will not do the job, it will not engraft; that’s the terminology. And that’s what led to the trial of different ways to make those stem cells from cord blood a little bit stronger. Some people try in the lab to make more of them, to expand their population and that’s more on an experimental level. And the other approach was to use more than one unit and initially the thought was just to give more cells. With time, it turns out, eventually only one takes over and that’s the interesting thing: we don’t know yet who will be the one that will take over; is it by number or is it by other genetic factors? What we do know is that when you give, one unit is serving as the major one and the other unit is more the supporting unit.

Are there any risks along with this, are there any downsides?

Dr. Godder: The risk is very much the same risk as you would get with the unrelated cord blood anyway, which include an increased risk of non-engraftment. So there is a little bit of a higher risk.

Is a double cord transplant now a possibility for adults?

Dr. Godder: Yes, it actually started from adults and we adopted it for young adults and teenagers.

FOR MORE INFORMATION, PLEASE CONTACT:

Dr. Kamar Godder
The Division of Hematology/Oncology
Miami Children’s Hospital
305-663-6851 or toll free at 1-888-MCH-BMT2

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