Good news for the world of stem cell transplants: the Anthony Nolan Trust has been given a grant of around £1.5 million in order to expand their pioneering cord blood collection program. The program that has developed over the past 40 years enables the use of stem cell transplants in order to fight disease – most notably leukaemia.

The Legacy

Anthony Nolan was born with a rare genetic disorder called Wiskott Aldrich Syndrome which is characterised by a low platelet count in the blood and severe immune deficiency. His mother, Shirley Nolan, developed the idea of a Bone Marrow Register that would link unrelated bone marrow donors much in the same way that a blood donor register. In 1974 the register was founded and since then has grown in reputation to make it the first choice of bone marrow donors for today’s NHS.

The importance of blood donation is obvious to anyone who has had an operation or needed a blood transfusion at some point in their lifetime. Bone marrow transplants, although much less common knowledge, provide a lifeline to people suffering from certain diseases such as blood or lymph cancers.

In certain disorders such as leukaemia or lymphoma where the blood or lymph cells are affected, intensive chemotherapy is currently the mainstream treatment. The success of chemotherapy has risen over the years with the development on new drugs and treatment regimes. Sometimes however, chemotherapy cannot be enough on its own to cure an individual of their disease. This is where a bone marrow transplant comes in.

Forms of Leukaemia

The formation of leukaemia occurs in the bone marrow where mutated blood cells will multiply abnormally so much that normal cell development is prevented. The cancerous cells can build up in the blood, displacing healthy blood cells due to their sheer volume. As healthy cells are in such low numbers in a leukaemia sufferer, the immune system loses its efficiency at fighting infection or disease meaning illness is much more commonplace. Displaced red blood cells mean a loss of deliverance of oxygen to vital organs meaning tissue damage also occurs. These effects can occur over a short or long period of time dependent on the form of leukaemia. Acute leukaemias have a rapid onset, characterised by a sharp increase in abnormal blood cells over a very short period of time. Chronic leukaemias represent the opposite situation, a gradual build up of abnormal cells in the blood over a long time period.

Acute and chronic leukaemias can be specified even further in their classification: myeloid leukaemias develop from myeloid cells which include red blood cells, platelets or a form of white blood cell called a macrophage. Lymphoid leukaemias develop from T, B and Natural Killer (NK) cells, all of which are present in the lymphatic system. The resulting diagnoses of leukaemia can come in four forms: acute myeloid leukaemia (AML), acute lymphoid leukaemia (ALL), chronic myeloid leukaemia (CML) and chronic lymphoid leukaemia (CLL).

Treating Leukaemia with Stem Cells

When chemotherapy alone cannot defeat leukaemia, bone marrow transplants are often recruited to aid in treating the disease. Sometimes a patient’s own bone marrow can be harvested and given back to the patient following chemotherapy. The theory behind this treatment is that the chemotherapy will destroy any cancerous cells whilst the stem cells present in the bone marrow transfusion will begin to repopulate the patient’s blood, hopefully with new, healthy cells.

In some cases however, it may not be possible or feasible to use a patient’s own bone marrow, perhaps through disease progression or illness. In these cases a donor bone marrow transplant is needed. The donor bone marrow will house haematopoietic stem cells (HSCs) which are responsible for proliferation into the many types of blood cell the patient needs to recover. If a matching bone marrow unit is found then this can be administered into the patient following chemotherapy, hopefully with as little rejection or side effects as possible. Certain disorders such as graft vs host disease – where immune cells present in the transplant can attack the patient’s own cells – can occur if the marrow is not a match.

Cord Blood Collection

As well as revolutionising the donation of bone marrow, the Anthony Nolan Trust has pioneered the collection of umbilical cord blood in order to offer an alternative in cases where no donor can be found. The practice of cord blood collection involves harvesting blood directly from the umbilical cord using a syringe following birth with approval from the parents. The blood can then be sent to a lab where it is determined whether it can be used as a donor sample (adequate number of stem cells) or as an experimental sample for cases where stem cell count is particularly low.

The Impact of Cord Blood Collection

When considering the umbilical cord is usually disposed of, it begs the question of just how many potential stem cell donations have been wasted over the years? The Anthony Nolan Trust themselves claim that 65,000 litres of cord blood was wasted last year alone when 50,000 litres could have met 80% of all transplant requests. When put into this context, it is clear to see why an expanding Anthony Nolan cord blood collection program should be celebrated.

Now that they have been given the £1.5 million grant, the Anthony Nolan Trust will become the largest cord blood collection program in the UK where they can continue to improve the chances of those unfortunate enough to face blood cancer or blood disorders.

Find out more:

The Anthony Nolan Trust website: http://www.anthonynolan.org/

A general overview of leukaemia: http://www.patient.co.uk/health/leukaemia-a-general-overview

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