UMBILICAL-CORD BLOOD STEM-CELLS

Even though there is recognized morbidity and mortality associated wit h bone marrow transplantation, this procedure has been performed succe ssfully in a substantial number of patients with thalassemia. Unfortun ately, finding a suitable related donor is often difficult, and the mo rbidity using unrelated donors is high. Several reports indicate that less than 30% of patients with thalassemia major have histocompatible siblings. Human umbilical cord blood (UCB) contains hematopoietic stem cells capable of reconstituting bone marrow. To date, approximately 2 00 transplantations have been performed using UCBs. Early results sugg est that even with substantial human leukocyte antigen (HLA) incompati bility, a significant decrease in graft-versus-host disease occurs wit h cord blood. The extent to which HLA incompatibility can be tolerated using cord blood has not been determined. These results raise the pos sibility that UCB obtained from unrelated donors could be used for tra nsplantation in thalassemia patients. This review summarizes current d ata using umbilical cord blood stem cells for transplantation in hemat ologic diseases. It also contains a discussion of the potential uses o f UCB for thalassemia patients and the value of a program designed to collect umbilical cord blood from newborns with thalassemia, from sibl ings of patients with thalassemia and from groups of ethnic minorities similar to those in which thalassemia is found.