Stem cells for leukemia: New hope from newborns

BACKGROUND:  In 2012, there were 23,540 deaths from leukemia and 47,150 new cases in the United States.   Leukemia is cancer that starts in blood-forming tissue such as bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.  Most normal blood cells develop from cells in the bone marrow, called stem cells.  Bone marrow is the soft material in the center of most bones.  Stem cells will develop into different kinds of blood cells each with a specific job.  White blood cells fight infection.  Red blood cells carry oxygen to tissue throughout the body.  Platelets help form blood clots that control bleeding.  These cells are made from stem cells as the body needs them.  Most blood cells mature in the bone marrow.  Then they will move into the blood vessels.  When someone has leukemia, their bone marrow makes abnormal white blood cells, called leukemia cells.  (Source: www.cancer.gov)


RISK FACTORS:  The exact cause of leukemia is unknown.  Researchers do know that there are certain risk factors that increase the likelihood of developing the disease.  They include:

·         Radiation:  people exposed to high levels are more likely to get acute myeloid, chronic myeloid, or acute lymphocytic leukemia. 

·         Smoking:  cigarettes increase the risk of acute myeloid leukemia.

·         Chemotherapy:  cancer patients treated with certain types of drugs sometimes can get acute myeloid leukemia or acute lymphocytic leukemia.

·         Benzene:  exposure to benzene (found in chemicals, cigarette smoke, and gasoline) in the workplace can cause acute myeloid leukemia, chronic myeloid or acute lymphocytic leukemia. 

·         Inherited Diseases:  Down syndrome, blood disorders, Human T-cell leukemia virus type 1, family history of leukemia, and other inherited diseases increase the risk of developing acute leukemia. (Source: www.cancer.gov)


TREATMENT:  Treatment will depend on the type of leukemia, the patient's age, and whether leukemia cells were found in the cerebrospinal fluid.  Treatment options can include:  watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant.  Many leukemia patients use chemotherapy.  It uses drugs to destroy leukemia cells.  Patients with chronic myeloid leukemia may receive drugs called targeted therapy.  Imatinib tablets were the first targeted therapy approved for chronic myeloid leukemia, but there are now others.  Biological therapy is the treatment that improves the body's natural defenses against the disease.  Radiation therapy uses high-energy rays to kill leukemia cells.  Stem cell transplant allows the patient to be treated with high doses of drugs, radiation, or both.  After the patient receives the high dose of medications, the leukemia cells and normal blood cells in the bone marrow are destroyed.  Then the patient receives healthy stem cells through a large vein, similar to a blood transfusion.  New blood cells will develop from the transplanted stem cells.  (Source: www.cancer.gov)


NEW ADVANCES:  A different treatment option that is still in clinical trials is the use of cord blood stem cells from the placentas of newborn babies.  Umbilical cord blood, like bone marrow, is a rich source of stem cells for transplantation.  The cord blood for transplantation is collected from the umbilical cord and placenta after a baby is born.  The cells used in transplants can come from marrow, peripheral blood, and the umbilical cord blood.  The first successful cord blood stem cell transplant was done in 1988 in Paris, France on a boy with Fanconi anemia, a fatal and genetic type of anemia.  It has also been given successfully to patients with over 70 diseases, including acute lymphocytic leukemia, acute myelogenous leukemia, myelodysplastic syndromes, chronic myelogenous leukemia, juvenile chronic myelogenous leukemia, chronic lymphocytic leukemia, Hodgkin and non-Hodgkin lymphoma,   thalassemia, neuroblastoma, severe combined immune deficiency, Aldrich syndrome, and severe aplastic anemia.  The umbilical cord is routinely discarded after a baby is delivered unless the parents choose to do otherwise.  For certain patients, there are advantages to using donor cord blood stem cells instead of donor peripheral blood or donor marrow stem cells, including:  availability (cord blood is stored in a public bank, tested, and frozen); Human Leukocyte Antigen Matching does not have to be as close a match as a bone marrow or peripheral blood transplants; fewer patients get Graft-Versus-Host Disease; diversity; and less risk of obtaining an infectious disease.  (Source: www.lls.org)

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Colleen Delaney, MD

Associate Member

Fred Hutchinson Cancer Research Center

(206) 667-1385

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