Giving The Gift Of Life Twice
Interviewed by Melissa Moniz
Wednesday - May 06, 2009
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Dr. Randal Wada
Pediatric Hematology/Oncology Associate Researcher
Associate Researcher of Cancer Research Center of Hawaii
Medical Director of Hawaii Cord Blood Bank and Hawaii Bone Marrow Registry
Can you talk about your journey with the Hawaii Cord Blood Bank?
By the time I left UCLA we had started doing umbilical cord blood transplants. I think we had done two or three at that point, and some leaders in the transplant community were suggesting that cord blood allowed you to get away with a less than perfect match and still have a successful outcome.
After moving home in 1996, I realized that many of the people here needing transplants are minority or mixed race, so despite all the great progress the Hawaii Bone Marrow Donor Registry has made, it’s still a challenge to find them a donor. I got introduced to Dr. Jana Hall, who was then at the Kapiolani Health Research Institute, and together we began talking to people about beginning a cord blood banking program here. There was a lot of interest, but the thing that turned our plans into reality was a generous donation from Mrs. Emily Castle. Thanks to her we were able to start the Hawaii Cord Blood Bank in 1998 at Kapiolani Medical Center for Women and Children. Since then we’ve been able to branch out to the Queen’s, Kaiser, Tripler and Castle. We’ve successfully banked more than 1,000 units and matched 35 of them for transplant.
What makes the blood in the baby’s umbilical cord so special?
Cord blood contains the same special cells that bone marrow does. These multi-purpose stem cells can give rise to all the cells that make up blood - the red blood cells, the white blood cells, and platelets. Cord blood has such a high concentration of these stem cells that the blood left over in the umbilical cord and placenta after the baby is born contains enough of them to do a transplant. Cord blood stem cells have greater rejuvenating power than adult stem cells, so you don’t need as many of them. Cord blood is also more forgiving than adult bone marrow, meaning that the match between the patient and donor doesn’t have to be as precise. Using cord blood can therefore make it easier to provide an appropriate match. The Hawaii Cord Blood Bank makes a great partner with the Hawaii Bone Marrow Donor Registry. There are currently more than 70,000 people in the Hawaii Bone Marrow Donor Registry. Where is all that bone marrow stored? The answer is that it’s walking around, so that when a match occurs we have to find that person and then arrange for them to come in. So there are time lags and other factors that cause people to fall through the cracks. Sadly, the rate of actual donor availability is not as high as we’d want it to be. Cord blood is the opposite because we collect it upfront and put it in a freezer. When there’s a match, the cells are guaranteed to be there. The downside is a large upfront cost to freeze and store each unit of cells, even though we know we’ll end up only using a small percentage of that inventory. With bone marrow there is a much smaller upfront cost, but the challenges are with availability.
Can you talk about umbilical cord blood banking and also the process?
I think the most important thing to mention is that it’s free of charge, as well as both painless and risk-free to mother and baby. To participate, families can find out about our program from their OB, or visit our website at www.HCBB.org, where they can find information and even download the necessary screening and consent forms. There’s now a program called Admit Screening, so it’s even possible for mothers to register as cord blood donors when they are admitted to the hospital for labor.
After the baby is delivered and the cord is clamped and cut, the doctor will insert a needle into the other end of the umbilical cord to collect the leftover blood into a sterile bag. With the help from the Blood Bank of Hawaii, collected cord blood units get flown to the Puget Sound Blood Center, where they are processed, tested and frozen. And these units become available to any patient, anywhere in the world.
Can you discuss the differences in private and public cord blood banking?
The Hawaii Cord Blood Bank is a public cord blood bank. That means the units we collect are made available to anyone who is seeking a match. Public cord banking is free to the donating family. Private cord blood banking is where a family pays a fee to a company and the cord blood is collected and stored for that family’s specific use.
Can you talk about cases you’ve worked with in which cord blood saved someone’s life?
The transplant team at Kapiolani performed its first unrelated donor cord blood transplant for a young boy from Waianae who developed leukemia due to a rare blood disease. Being of mixed race, we were unable to find him a suitably matched donor in the marrow registry. The patient had a perfectly matched brother who was an identical twin. However, although he had not developed leukemia, his brother could not be a donor because he himself was affected by the same underlying condition. Fortunately, we were able to find a cord blood unit, which was an incomplete match but still good enough to use. The patient got the transplant and is now alive and leukemia-free almost four years out.
And this was all thanks to a mother who decided that she’d rather donate her baby’s cord blood than have it thrown away. The boys are 8 years old now. Our patient’s twin brother is still affected by the blood disease. He has the same increased risk of developing leukemia, and so it’s easy to feel like his clock may be ticking. With every mother and every family who chooses to participate in the program, we get another chance to find children like him a donor. Which is why at HCBB we say, “On the day your baby is born, you can give the gift of life a second time.”
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