幹細胞論壇

美國臍帶血庫(Americord Registry) 醫學主管暨美國食品藥物管理局(FDA)小兒諮詢委員會顧問-Dr. Robert Dracher 發表目前臍帶血應用趨勢--自體臍帶血移植的顯著成長

2010年召開的國際細胞治療協會(ISCT)公佈臍帶血自體移植成長趨勢，結至2009年，共有211例自體臍帶血移植案例，且光2008-2009占全部73%。然而在2008年以前，許多美國小兒科醫師對自存臍帶血的使用機會抱有懷疑的看法。

在2005年以前，自體臍帶血移植只適用固態瘤(Solid tumor)或後天性免疫異常疾病；自2005年起，臍帶血開始進行「再生醫學」的臨床試驗，也就是利用臍帶血幹細胞進行受損組織的修補。自體臍帶血移植的大幅成長，其中原因為發現臍帶血可治療一些腦性疾病，例如腦性麻痺(CP)、缺氧缺血性腦病變(HIE)和先天性水腦症等。根據統計，10歲以下的病童接受異體臍帶血移植的比率是1/5000，而美國疾管局(CDC)統計，美國5-10歲孩童發生腦性麻痺的機率為1/300，若臍帶血有12%治癒機會，則利用自體移植治療腦性麻痺機率比異體移植治療惡性或血液疾病高兩倍。

自存臍帶血能提供病患本身100%吻合，或是提供25%吻合機率給兄弟姐妹移植使用。傳統方式收集的臍帶血，一袋臍血平均含有8億顆有核細胞數(TNC)，能提供給30kg以下病童進行移植使用。

自體臍帶血移植趨勢增加，為了加強移植效益，美國約翰霍普金斯大學的研究生發明自動化臍帶血收集器，使用FDA核可的藥劑，促進幹細胞分裂，並利用特殊裝置加強臍帶血的收集，且比起傳統法，可收集高達10倍的臍帶血幹細胞。

臍帶血收集技術創新，增加一袋臍血的移植效益，擴大病患移植的年齡範圍。自體臍帶血移植的顯著成長，讓美國小兒科醫師開始重新檢視自存臍帶血的重要性。

Dramatic Rise in Autologous Therapy Spurs Interest in Private Blood Banking

By Dr. Robert Dracker, Executive Medical Director, Americord Registry
Jul 28, 2011 - 5:28:07 PM

Significant Trend in Autologous Therapy

At the 2010 annual meeting of the International Society for Cellular Therapy (ISCT,) Drs. Francis Verter and J.J. Nietfeld compared the rates at which cord blood is being used for the child who banked it (‘autologous’ therapy,) against cord blood given from a donor to a matching patient (‘allogeneic’ therapy). They found that there were more than 200 cases of autologous therapy by the end of 2009, 70% of which occurred in the last two years of that period. This is a significant increase when you consider that, as recently as 2008, a number of medical professional societies had been insisting that the odds of a child using cord blood stored in a family bank were “negligible.”

This rapid rise in autologous therapy can be partially attributed to an increase in the number of patients with some form of brain injury – the most common being Cerebral Palsy (CP) and Hypoxic-Ischemic Encephalopathy (HIE). According to Nietfeld, the statistics show that the cumulative probability of a child receiving an allogeneic stem cell transplant by age 10 is low, only 1 in 5000. Autologous therapy treatments are actually more likely. The U.S. Centers for Disease Control (CDC) discovered that CP is found in 1 in 300 U.S. children from the ages of 5-10. If cord blood therapy proves effective for only 12% of patients with CP, the number of children receiving autologous cord blood therapy for CP alone would be double the total number of allogeneic transplants for all pediatric cancers and blood disorders.

Given these numbers and the conclusion Drs. Verter and Nietfeld have made about autologous therapy eventually surpassing allogeneic therapy, it’s only a matter of time before the AAP considers a revised policy statement endorsing private cord blood banking for autologous cord blood stem cell therapies.
Private Cord Blood Banking Makes Sense

Cord Blood Harvesting Technologies

New techniques for cord blood harvesting have emerged, designed to provide more treatment options to a greater variety of patients. In June, Johns Hopkins graduate students announced the invention of a system that significantly boosts the number of stem cells collected from a newborn’s umbilical cord and placenta, which could allow more patients with leukemia, lymphoma and other blood disorders to be treated with these cells. Without adequate collection methods, 90% of these cells are discarded.

A private firm has developed a proprietary technology that collects stem cells from the placenta and umbilical cord blood, preserving up to 10 times more stem cells than traditional cord blood collection methods. It has the additional advantages of a) using an FDA-approved drug to mobilize stem cells from the placenta tissue, and b) relying on devices designed to enhance the collection process.

Dr. Robert Dracker, Executive Medical Director, Americord Registry, is a leading hematologist, transfusion medicine specialist and recognized leader in cord blood and stem cell banking. Dr. Dracker was recently named as a consultant to the Food and Drug Administration’s (FDA) Pediatric Advisory Committee.

http://www.healthnewsdigest.com/news/Guest_Columnist_710/Dramatic_Rise_in_Autologous_Therapy_Spurs_Interest_in_Private_Blood_Banking.shtml