The Duke team has already applied their findings in the laboratory toward strengthening cord blood's ability to wage an immune response. Doctors ultimately plan to infuse these bolstered immune cells into transplant patients to more effectively fend off opportunistic infections, said Paul Szabolcs, M.D., assistant professor of pediatrics and immunology at the Duke Pediatric Bone Marrow and Stem Cell Transplant Program.
Children are at highest risk of infection during the first 100 days after transplant, when their new immune system struggles to take hold or "engraft." Even after engraftment occurs, cord blood lymphocytes may remain relatively immature and "nave" to viral infections because they have never been exposed to nor vaccinated against viruses.
As a result, almost half of all deaths after cord blood transplantation are caused by infections, and among those, viruses are by far the most common. The children who live, however, are typically cured of their deadly cancers, immune disorders and rare metabolic diseases. Which patients will succumb to infection and which will survive has been a mystery.
In an effort to predict a child's risk of infection, Szabolcs studied the immune status of 102 children at the Duke Pediatric Bone Marrow and Stem Cell program. He looked for immune system differences that could explain why some children succumb to infections and die while others do not.
"Our goal was to predict which children would be at greatest risk for infection so that, in the near future, we can reinforce a child's immune response immediately following their transplant," said Szabolcs. "Un
Contact: Becky Levine
Duke University Medical Center