1. What is cord blood?

Cord blood is the remaining blood in a baby's umbilical cord and placenta following birth and is usually discarded. It is rich in stem cells, the building blocks of the blood and immune systems and this cord blood can be collected and saved for potential medical use. 2. What are cord blood stem cells? Cord blood stem cells are the building blocks of the blood and immune systems. They are the origin of white blood cells that fight infection, red blood cells that carry oxygen and platelets that promote clotting and healing. 3. How are cord blood stem cells used? Cord blood stem cells are a major source of hematopoietic (blood) stem cells are mostly used to help regenerate a patient's blood and immune system that have been weakened or damaged by radiation or chemotherapy. Stem cell transplantation has been used to treat more than 80 malignant and non-malignant diseases in children and adults, including among others leukemias, anemias, lymphomas and immune disorders. 4. Why are cord blood stem cells preferred over bone marrow stem cells? Cord blood stem cells offer many advantages over other stem cells, especially bone marrow stem cells, including: o Umbilical Cord Blood is a rich and non-controversial source of stem cells. The collection procedure is quick and very safe and poses no risk or discomfort to mother or baby o There is less risk of viral infection using cord blood stem cells o Cord blood stem cells transplants cause less Graft vs. Host Disease (GVHD), a transplant rejection that is the leading cause of death in stem cell transplant patients o Cord blood stem cells can be successfully used even when there isn't a perfect match between donor and recipient. Bone marrow transplants not only require a perfect match, but finding a donor is difficult and time consuming o Cord blood stem cells occur in much higher concentrations than bone marrow and have greater capacity to proliferate o A related source of stem cells such as cord blood is the preferred treatment option 5. What is Graft vs. Host Disease (GVHD)? Graft vs. Host Disease or GVHD is a transplant rejection that sometimes occurs following transplants. In cases of GVHD, the host's body rejects the donor cells considering them foreign material and generating antibodies against them. 6. What is HLA matching? Human Leukocyte Antigens or HLA are six proteins that appear on the surface of white blood cells and other tissues in the body. These six HLA points determine tissue compatibility between a patient and a donor. The higher the tissue compatibility, the higher are the chances of a transplant to be successful. Although a perfect match is always preferred, studies have shown successful cord blood transplants even when there is a match of only three or four of the six HLA points.

7. What are the possible future applications of cord blood stem cells? New treatments continue to emerge as doctors and scientists research potential future treatments for a variety of diseases including Alzheimer's disease, Parkinson's disease, spinal cord injuries, heart disease, stroke, and diabetes. 8. Why should I collect and store my baby's cord blood? More and more parents decide to store their baby's cord blood at a cord blood bank not only for the present applications but also for the future potential uses of cord blood stem cells. Parents want the comfort and security of knowing that, if the need ever arises, their baby's cord blood stem cells are readily available through their cord blood storage. Banking a baby's cord blood is particularly important if a family has a predisposition to certain illnesses or for families with diverse ethnic backgrounds. It is also valuable for families adopting a newborn or using assisted reproductive techniques. 9. Should I collect and store cord blood for all of my children? We recommend that you store cord blood stem cells for all your children to ensure an exact match for each of them. In addition, collecting cord blood for all your children increases the chances of finding a match among family members. The same applies for multiple births. Not only will you have a perfect match for each baby by taking part in umbilical cord blood banking, but because the volume collected per baby in multiple births is usually smaller, you will also potentially ensure that an adequate stem cell volume is available if a transplant is ever needed. 10. Can I donate my baby's cord blood stem cells? You can donate your baby's cord blood, however, there are a limited number of hospitals and cord blood banks accepting donations mostly due to funds constrains. Because many families would like the option to donate their baby's cord blood, in August 2005, FamilyCord started offering a Public Donation OptionSM. Our Public Donation Option program is an elective program combining the best aspects of both private and public cord blood banking. It enables parents to store their baby's cord blood stem cells privately with the option to list their cord blood unit on a donation registry after a minimum of 10 years of private storage. Visit our Public Donation OptionSM page for more information, or please call a cord blood educator today at 800-490-2673.

Diseases Treated with Cord Blood Stem Cells

Cord blood stem cells are currently used in the treatment of 80 life-threatening diseases, including cancers, blood disorders, immune system deficiencies, metabolic disorders and bone marrow failure syndromes.

Cancers
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Acute Biphenotypic Leukemia Acute Lymphoblastic Leukemia (ALL) Acute Myelogenous Leukemia (AML) Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia (CML) Chronic Myelomonocytic Leukemia (CMML) Hemophagocytosis Hodgkin's Lymphoma Juvenile Chronic Myelogenous Leukemia (JCML) Juvenile Myelomonocytic Leukemia (JMML) Langerhans Cell Histiocytosis Lymphohistiocytosis Multiple Myeloma Myelodysplastic Syndrome (MDS) Neuroblastoma Non-Hodgkin's Lymphoma

Blood Disorders
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Blackfan-Diamond Anemia Glanzmann Thrombasthenia Myelofibrosis Pure Red Cell Aplasia Sickle Cell Anemia Thalassemia

Immune System Deficiencies

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Chronic Granulomatous Disease Common Variable Immune Deficiency Congenital Immune Deficiency DiGeorge Syndrome Griscelli Syndrome Lymphocyte Adhesion Disease Nezelof Syndrome Omenn's Syndrome Severe Combined Immunodeficiency Wiskott-Aldrich Syndrome X-linked Lymphoproliferative Disease

Metabolic Disorders
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Adrenoleukodystrophy

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Amyloidosis Gaucher's Disease Hunter Syndrome (MPS-II) Hurler Syndrome (MPS-IH) Krabbe Disease Lesch-Nyhan Syndrome Mannosidosis Maroteaux-Lamy Syndrome (MPS-VI) Metachromatic Leukodystrophy Mucolipidosis Type II Niemann-Pick Disease Sandhoff Disease Sanfilippo Syndrome (MPS-III) Sly Syndrome (MPS-VII) Tay-Sachs Disease Wolman Disease

Bone Marrow Failure Syndromes

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Amegakarocytosis Aplastic Anemia Congenital Dyskeratosis Congenital Neutropenia Congenital Thrombocytopenia Fanconi Anemia Kostmann Syndrome Paroxysmal Nocturnal Hemoglobinuria Reticular Dysegenesis Schwachman-Diamond Syndrome Sideroblastic Anemia Thrombocytopenia

Other
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Osteopetrosis Refractory Anemia (RA)

Some very specific difficulties arise in the care of patients with advanced gynecologic cancers. Initial treatment for these tumors is often radical and associated with a large number of distressing side effects from which the patient takes some time to recover physically and longer to recover emotionally; she then faces the realization that these treatments, which aimed at cure, were futile. As the disease progresses towards her death, thoughts such as What did I go through all that for? often occur. It is almost impossible to say precisely when patients become terminally ill. The patient and her family should not be deprived of the benefits of palliative care because she is not actively dying. It can be helpful to think of the patient's disease progression, and hence her needs, as following the trajectory outlined in Figure 1. Although many problems are common in advanced gynecologic malignancy, some specific issues relate more closely with different primary sites. The mutilation of radical vulvectomy for carcinoma of the vulva is very difficult for a woman to adapt to psychologically.19 Those who have positive nodes at the time of radical vulvectomy have a poor prognosis and, in addition to the trauma of the treatment, will have to face death. Local recurrence with fungating tumor and concomitant problems of smell, exudate, and pain are accompanied by a high risk of hemorrhage, either through neovascularization in the recurrent tumor or erosion of an artery such as the femoral artery by inguinal recurrence. Patients with cervical carcinoma tend to be in a younger age group. They may feel stigmatized19 through the association of this malignancy with sexual activity. Any perceived failure of cervical cytology and screening gives rise to anger in the patient and her family. Noncompliance with cervical screening in the past may leave the woman feeling very guilty and angry with herself when she is diagnosed with advanced cervical disease. Disease recurrence tends to occur locally causing pain, fistulas, and fungation of tumor at the top of the vagina. Extension of the tumor posteriorly to invade the presacral plexus causes severe pain, as does bone involvement in the lower lumbar region and sacrum. Development of leg weakness may herald spinal cord compression, 31 and some patients may develop hypercalcemia. Ovarian carcinoma is also a disease of younger women, with all the social ramifications of a young mother's death. The association of ovarian cancer and breast cancer in some families makes a comprehensive family tree essential93; other women in the family who are at high risk may require genetic counseling. Transcoelomic spread of tumor predisposes women with ovarian cancer to a particularly high risk of bowel obstruction and ascites relatively early in the disease. Advanced carcinoma of the endometrium is relatively uncommon, tending to occur in older women. Local complications relate to tumor in the pelvis10 and the problems of bleeding.

General comments Primary treatment may have affected sexual function, fertility and body image and this will impact on coping strategies. Ovarian and vulval cancers often present late and so it may be appropriate for specialist palliative care input from the point of diagnosis. Genetic counselling should be considered for close female relatives of patients with ovarian cancer particularly if there is also a strong family history of breast cancer. Specific pain complexes
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Perineal and pelvic pain is common in all three of the common malignancies; cervical, ovarian and vulval carcinomas. There is nearly always a neuropathic element to the pain that will only be partially opioid sensitive. Adjuvant analgesics such as antidepressant and/or anticonvulsant medication may be needed as well as more specialist interventions such as nerve blocks

Other Complications:
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Lymphoedema develops with uncontrolled pelvic disease. It can develop at any time in a patients cancer journey and frequently affects both lower limbs. It needs to be actively managed if complications are to be avoided. Management includes good skin care, avoiding additional trauma to the affected leg(s) and appropriately fitting compression garments. Ascites is particularly common with ovarian cancer and can be difficult to manage. Oral diuretics, particularly spironolactone in combination with a loop diuretic such as frusemide may help a little. Repeated paracentesis may be needed. Consideration of a peritovenous (Leveen) shunt may be appropriate in some cases where prognosis is thought to be longer than three months. Complete or subacute bowel obstruction is often not amenable to surgical intervention and should be managed medically using a syringe driver containing a mixture of analgesics, anti-emetics and anti-spasmodics. Naso-gastric tubes are rarely needed, and hydration can often be maintained orally if the nausea and vomiting are adequately controlled. Renal impairment can develop in any patient with advanced pelvic disease. It may be a pre-terminal event. Ureteric stenting may be appropriate depending on the patients perceived prognosis, the patients wishes and future treatment options. Renal impairment increases the risk of a patient developing opioid toxicity as renal excretion of opioid metabolites may be reduced. Vaginal or vulval bleeding may respond to antifibrinolytic agents such as tranexamic acid, radiotherapy and/or surgery.

Offensive vaginal or vulval discharge can cause considerable distress to patient and carers. Topical or systemic metronidazole may help as can barrier creams. Deodorising machines may also help if the patient is confined to one room. Vesico-colic and recto-vaginal fistulae need a surgical assessment. These can be very difficult to manage and require a multidisciplinary approach with specialist input.