Donation, storage and uses of umbilical cord and bone marrow stem cells

Jeevan Public Cord Blood Bank22 Wheatcrofts Road

NungambakkamChennai

www.jeevan.org

Background• JBBRC – 1995 (1992 – 1995)• ISO certified – 1999 , NABH Accredited - 2010

• JSCB - 2007 ( 2004 – 2007)• SUBASH - 2007• License – 2008• ISO certification – 2008

• Currently run along the best international standards of Netcord FACT

Stem Cell Donation

Adult Sources of stem cells• Umbilical Cord –

Blood, Wharton’s Jelly, Cord tissue

• Bone Marrow• Peripheral blood

• Fat • Small quantities in

almost every organ

WHAT is cord blood ?

The blood that remains in the umbilical cord (umbilical vein) after delivery of the baby and clamping of the cord.

Discarded as waste all over the world until 1988

WHY cord blood ?

• Increasingly preferred source by clinicians

• Easily available resource

• One lakh deliveries / day in India

• Donor attrition - not a problem

CORD BLOOD DONATION / Public Banking

Accessible to anyone across the globe subject to HLA compatibility.

Greater likelihood of usage.

Only 30% of allograft recipients have sibling donors

CORD TISSUE – MSCs – work going in , none validated or approved for clinical use as yet.

What is bone marrow / Peripheral Blood Stem Cell (PBSC)Donation

Operation Theatre

Anaesthesia

G-CSF – 5 days prior to donation SC Like a Pheresis procedure

Out Patient Procedure

The Need ?

• In India, every year, about 10,000 children are born with Thalassemia

• Every year, more than 10,000 men, women and children could benefit from a bone marrow transplant.

• Each year, more than 140,000 people are diagnosed with blood cancer, such as leukemia or lymphoma.

• Every 5 minutes someone is diagnosed with blood cancer and every 10 minutes, blood cancer takes a precious life.

• Leukemia is the most common disease children die of.

Comparison of Sources Comparison of Sources Feature Bone Marrow PBSC Cord BloodQty of harvest Larger Larger Much less

Engraftment Faster Faster Longer

GVHR 75 % 75% 38%

Risk of Contamination

More More Less

Collection Tedious & Painful Tedious Simple

Donor search time

Longer Longer Halved

HLA Typing 5/6 or 6/6 5/6 or 6/6 3/6 or 4/6

Donor supply Limited Limited -Autologous

Limitless

Telomeres Shorter Shorter Longer

Viability of banked stem cellsViability of banked stem cells

• Bone Marrow stem cells – Banked since 1968

• Human cord blood stem cells frozen in 1985 and 1986 – Broxmeyer

• Viability tests done according to schedule fixed by storage centre

Who can donate ?Cord Blood

Foetus – Full term, healthy

Mother – In good health, uneventful pregnancy

Father – No Transfusion Transmissible Infections

Aunts / Uncles – No Blood related disorder – genetic / malignancy

Bone Marrow / PBSC

• Men and women between 18-40 yrs who are truly altruistic.

• Healthy, no chronic illnesses

• All pre-requisites as for regular blood donors

Process of Stem Cell DonationUmbilical Cord Blood

1. Registration2. CB & Maternal sample

collection3. Acceptance of sample4. Processing, Screening and

Storage5. Used when required subject

to HLA Compatibility.6. The stem cells may be issued

any time after one year and can be stored indefinitely.

BM / PBSC

1. Registration2. Blood Sample / Buccal swab

taken for HLA Typing3. Data stored in registry4. Donor recalled if request for

specific HLA type5. Donor screened for TTI and

fitness to assess eligibility6. Donation for a specific person

who is HLA compatible 7. Used immediately / 6 months

Storage of Stem Cells

Acceptance, Processing , Storage and Issue of stem cells

• Guidelines – International and national / Jeevan

• Acceptance criteria • Processing – Manual / Automated• Storage - Depends on whether it is for

allogeneic / autologous use• Issue – Depends on recipient – Allogeneic /

autologous

Steps of Processing at JPCBB

1 2 3

54 6

Applications – Present & ? Future

Current applications Acute and Chronic

Leukemias Myelo-dysplastic

Syndromes Stem cell disorders Myelo-proliferative

disorders Lympho-proliferative

disorders Phagocyte disorders Inherited platelet

abnormalities

Inherited metabolic disorders

Histiocytic disorders Inherited RBC

abnormalities Inherited immune

system disorders Plasma cell disorders Solid tumours Other inherited

disorders

India-Transplant & Research Centres India-Transplant & Research Centres

o Tata Memorial Hospital, Mumbai o R&R Army Hospital, AIIMS , New Delhio Inlaks Hospital, Armed Forces Medical College, Puneo Sanjay Gandhi PGIMS, Lucknowo Apollo Hospital, Global Hospitals, NIMS, Hyderabado Narayana Hruduyalaya , Bangaloreo Christian Medical College, Velloreo Adyar Cancer Institute, Apollo Specialty Hospital, Madras ,

Madras

o Manipal Inst of Regenerative Medicine, NCBS, Bangaloreo Reliance Life Sciences, Mumbaio LVPEI Hyderabado Aravind Eye Hospital Madurai, o Niche-in-Centre for Regenerative Medicine, Stanley Medical

College, Sankara Nethralaya, Frontier Lifeline Hospitals Madraso Rajiv Gandhi Centre of Biotechnology, Trivandrum

Comparison of Outcomes of Unrelated BM and CB Transplants in Young Adult Leukemia Patients. Updated Results of Japanese Registration Study

ASH Annual Meeting San Francisco December 2014

These data suggest that CB may be the first choice alternative to 8/8 UBM for AML. For ALL, 8/8 UBM is the first choice, however, CBT will convey comparable outcomes with 7/8 UBMT. The survival after UCBT is approaching to that after 8/8 UBMT in recent years.

Stem Cell Issue

What Jeevan has done so far…• 2011- First Transplant • 2013 – Second Transplant• 14th October 2014 - Bone Marrow Donor

Worldwide www.bmdw.org • 17th Jan 2015 –NMDP - Be the Match Registry• July 2015 – Stem Cell Registry (Adult donors)

• 503 requests for match and found 12 units having a 10/10 match and 55 with a 9/10 match.

Who Benefits ?• Indians and a few from other ethnic origins.

• Genetic hematological illnesses such as Thalassemia, Sickle Cell Anaemia etc

• Hematological malignancies such as Acute and Chronic Leukemias of various types.

Blood forming stem cells can be used ONLY for the treatment of blood related disorders

Where is India ?

The role and potential of umbilical cordblood in an era of new therapies: a review

Roura et al. Stem Cell Research & Therapy (2015) 6:123

“As ethnic diversity increases in developing countries, it is imperative to find alternative stem cell sources when an adult-matched unrelated donor cannot be identified.”

“Since the first UCB transplant in 1988, UCB has increasingly been employed as an alternative source of hematopoietic cells for transplantation in the treatment of blood diseases”

All patients, depending on race and ethnicity 66 -93% African American or Black patients 66%American Indian and Alaska Native 82%Asian or Pacific Islander 73%Hispanic or Latino 72%White 93%

Source: NMDP Bioinformatics, 2010Note: Percentages are based on matching an adult donor only. Cord blood further increases the chance of finding a match

Likelihood of finding an adult donor match by race and ethnicity

      “Luck can often mean simple taking advantage of a situation at the right

moment. It is possible to “make” your luck by being always

prepared.”

Michael Korda