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As leukaemia strikes patients in India, doctors are considering cord blood transplants as a viable option to save patients.
Leukaemia is a disease in which the normal process of blood cell production changes. The bone marrow (the soft tissue inside bones) is a site where blood cells are made; all blood cells begin as stem cells in the marrow[1]. However, when a person develops leukaemia, the bone marrow starts producing too many immature/abnormal cells called lymphoblasts, which crowd out other healthy blood cells in the marrow, blood stream and the lymphatic system.
The lymphoblasts can travel to the rest of the body via the blood. While some leukaemias manifest themselves through visible signs that doctors can see, others develop slowly with symptoms that the patient will only be able to describe as ‘pain’ or ‘discomfort’.
The symptoms of leukaemia
The symptoms of leukaemia are many and diverse. Broadly, they have been identified as: fatigue, loss of appetite, loss of weight, recurring fever, anaemia, pale skin, dizziness, bleeding (in nose, gums, bloody vaginal discharge or bleeding between menstrual periods), cold sores and red sores on the skin, respiratory infections, boils around the anus, vomiting, headache, bone or joint pain, enlarged lymph nodes in neck, groin, underarms, abdominal discomfort or pain, bloated feeling in abdomen, cloudy or blurry vision, swollen testicles, etc. There may be other extremely painful symptoms of leukaemia like Leukocytoclastic Vasculitis (with sores on the extremities) and Sweet’s Syndrome (which is accompanied by high fever and painful boils on the body).[2]
Treating ALL and APL with cord blood
Traditionally, bone marrow transplants have been the preferred treatment option for acute leukaemia, but the process is fraught with delays and complications. The chances of the procedure being successful are high when the eligible recipient gets a marrow donor who matches for six HLAs (Human Leukocyte Antigens) – these antigens help the immune system recognise its own cells, hence the chances or rejection are lower.[3]
Many types of leukaemia remain untreatable. However, the Acute Promyelocytic Leukaemia (APL), which was first discovered in France in the 1950s, is now in the ambit of treatable leukaemia.[4] It has been found that adults with APL who need bone marrow transplants but do not have matching donors for important HLAs can undergo stem cell transplants using umbilical cord blood. The chances of success are much higher with one’s own cord blood.
Also, stem cell transplantation from cord blood does not cause any delays, since the appropriate blood units are procured within days. Also, the incidence of more people getting the transplant is higher with cord blood cells than with matching bone marrow.
[1] Leukaemia facts and types, The University of Texas MD Anderson Cancer Centre
[2] ‘Signs and symptoms of leukaemia’, Canadian Cancer Society
[3] Christensen, Damaris, ‘Umbilical Cord Blood Offers Another Option for Leukemia Patients’, Journal of the National Cancer Institute, Volume 97, Issue 4
[4] Kotiah, Sandy, ‘Acute Promyelocytic Leukemia’, emedicine.medscape.com