Blood-forming stem cells circulate in an unborn baby's body and in the placenta. These stem cells can be taken from the umbilical cord and placenta after the baby is born. Cord Blood Banks around the world store these stem cells. The cells can then be used for stem cell transplantation to treat some certain of cancer and diseases. The availability of cord blood means that transplant therapy is now an option for almost anyone who needs a blood or marrow transplant (BMT) -- even people who have rare HLA types.

At University of Minnesota Medical Center, we individually tailor our care to meet the unique needs of each patient and family. We performed the first cord blood transplant for leukemia in 1990 and have continued our leadership in the field. We established the International Cord Blood Transplant Registry in 1992. We were also instrumental in the creation of the Midwest’s first public umbilical cord blood bank in 1999 — a joint effort of the University of Minnesota Medical Center and the American Red Cross.

Compared to using an unrelated bone marrow donor, the use of cord blood for transplantation has a number of advantages:

• There is less need for a perfect tissue type HLA match.
• Cord blood is more rapidily available than unrelated bone marrow. 
• There is a low risk of contamination of cord blood with common viruses.
• There is a lower risk of graft-versus-host disease (GVHD) with cord blood. 
• Cord blood is easy to harvest without risk to the newborn donor or mother.

Umbilical cord blood (UCB) is collected from healthy newborns at birth, frozen and stored in cord blood banks worldwide. Information about the cord blood unit is placed on a registry. If it matches a patient needing transplant, it can be shipped to University of Minnesota Medical Center for transplant. After thawing, it is infused into the patient much like a blood transfusion.

Umbilical Cord Blood Transplantation
Umbilical cord blood transplantation for patients with leukemia, bone marrow failure, storage disease or immunodeficiency offers a new chance for cure for many patients. New discoveries have led to new treatments. Examples of new treatments are:

• the use of two cord blood units to speed up engraftment
• the ability to expand stem cells
• the co-transplantation of stromal cells (the ‘nursing cells’ of the bone marrow)

Preimplantation genetic diagnosis is another exciting technique being pioneered at the University of Minnesota to identify healthy sibling donors for patients. It is important to consult with a transplant physician about this option to determine whether it is an appropriate option for the individual patient.

Umbilical Cord Blood Transplant Research
University of Minnesota physicians are the leading world experts on cord blood transplantation, especially for adults. They are researching a number of new strategies in cord blood transplantation. Adults experience more complications after transplantation than children. Adults also develop more severe GVHD after BMT. Umbilical cord blood transplantation is an attractive stem cell source for adult patients. It may cause less GVHD and pose a lower risk of infection than unrelated donor bone marrow.

However, a major obstacle with cord blood transplantation in adults has been the limited number of stem cells in the cord blood collection. If too few cells are available, there is a greater chance of life-threatening complications. Led by Dr. Claudio Brunstein, University of Minnesota professors are investigating the transplantation of two partially HLA-matched UCB units from different donors. This increases the number of stem cells transplanted which is known to predict better survival outcomes. It also makes cord blood transplantation an option for nearly all patients who are looking for a donor. University reseachers have also found that using tow cord blood units may result in a stronger anti-cancer effect. This can reduce the risks of relapse, especially for acute leukemia.

Another approach involves a lower dose chemotherapy and radiation treatment prior to UCB transplant. This is known as reduced intensity or non-myeloablative conditioning. This approach is being used for patients who cannot tolerate the high doses of chemotherapy and radiation used in conventional transplants. These two studies show promising results with high rates of engraftment and a low incidence of graft-versus-host disease.