The Cancer Foundation has played an important role in the victories and advances obtained by Brazil in the area of marrow transplants. This support comes in many forms, all the way from campaigns to mobilize donors to management and logistical structuring of projects. The entity is a partner of INCA’s Bone Marrow Transplant Center (Cemo) – a national benchmark in the treatment of hematologic diseases.
The Cancer Foundation is responsible for managing the project for expansion of the Brazilian Network of Public Umbilical Cord and Placenta Blood Banks – Rede BrasilCord (the BrasilCord Network), which is technically supervised by INCA and financed by the Brazilian Development Bank – BNDES.
Created in 2004, the BrasilCord Network is made up of 13 public blood Banks that store donated samples of umbilical cord blood, which is rich in stem cells and capable of reproducing the fundamental elements of blood that are essential for marrow transplants. The blood banks are located in every single region of the nation – in the North [Belém in the State of Pará (PA)], in the Central-West [the nation’s capital Brasília (DF)], in the Northeast [Fortaleza in the State of Ceará (CE) and Recife in the State of Pernambuco (PE)], in the South [Porto Alegre in the State of Rio Grande do Sul (RS), Florianópolis in the State of Santa Catarina (SC) and Curitiba in the State of Paraná (PR)], as well as in the Southeast [Lagoa Santa in the State of Minas Gerais (MG), Rio de Janeiro in the State of Rio de Janeiro (RJ), and Campinas and Ribeirão Preto in the State of São Paulo (SP), plus two in the capital of the latter State – the City of São Paulo].
Since 2006, the Cancer Foundationhas been in charge of management of the project for expansion of this network, with funding provided by BNDES. The first phase of the project involved transfer of R$ 4 million for expansion of INCA’s umbilical cord blood bank. In the second phase, which involved transfers of no less than R$ 32 million, seven new blood banks were built and the four already existing were remodeled, so as to provide them with more appropriate equipment and better-trained personnel.
The third phase of the project began two years ago, in the month of July 2013, with transfer of R$ 23.5 million by BNDES. This latest phase includes construction of four new umbilical cord blood banks in the cities of Manaus (State of Amazonas – AM) in the North, Campo Grande (State of Mato Grosso – MS) in the Central-West, and São Luís (State of Maranhão – MA) and Salvador (State of Bahia – BA) in the Northeast, for a total of 17 umbilical cord blood banks. With conclusion of the project for expansion of the BrasilCord Network, slated for 2016, Brazil will have capacity for storing a total of 80 thousand pouches, expanding the chances of patients requiring marrow transplants.
The Foundation’s activities include the detailing of the architectural and engineering designs, contracting the civil construction, installation and specialized technical services, such as information technology, as well as purchase and installation of equipment and acquisition of operational and support materials. Our work also encompasses the logistics for training specialized personnel and controlling timetables so that the projects are delivered within the deadlines.
Umbilical cord donations
Donating the umbilical cord of a newborn infant to a public blood bank is voluntary and has to be authorized by the baby’s mother. The units stored are available for any person requiring a marrow transplant, such as patients with leukemia and other blood diseases. The more umbilical cords are stored, the greater the number of people who can benefit. The blood banks of the BrasilCord Network have agreements with certain maternity wards to pick up the cords. Donations can only be carried out at such credentialed hospitals, where there are teams on hand that have been trained to properly approach the pregnant woman, accompany her birth and gather the material at the moment the child is born.
The Brazilian National Register of Marrow Donors (Redome) was created in 1993 in São Paulo; as from 2000 it was transferred to Rio de Janeiro, where technical management was put under the charge of INCA’s Bone Marrow Transplant Center (Cemo); and ever since 2009 it has been able to count on the administrative and financial management of the Cancer Foundation. Now it is the world’s third largest register of voluntary marrow donors, with 3.5 million donors registered, putting it behind just the United States and Germany (the American register has almost 7.7 million donors while the German one has around 5.7 million).
Redome is linked to the registers of the entire world. At present searches for potential donors for Brazilian patients are carried out simultaneously in Brazil and overseas. The international registers also access the data of donor candidates based on specialized systems.
The functioning of Redome is directly related to the BrasilCord Network and to the Program for Search, Pickup and Transportation of Stem Cells for Non-Kin Marrow Transplants in Brazil and the National Register of Bone Marrow Recipients (Rereme).
The entire process for Redome consulting and searching is automated. The doctor in charge inserts the register and clinical information on the patient, including the results of their histo-compatibility exam – HLA (which identifies the genetic characteristics of each individual), — on the Rereme system. Once the data is approved, the search begins. When potentially compatible donors are identified, the information is transmitted to the doctor who, together with the Redeme search team, can analyze the best potential donors and make choices for the confirmation tests to be carried out.
After the search phase is concluded, if availability of the donor is confirmed and the patient is able to continue treatment, the donation procedures are commenced. The donor selected is invited to undergo clinical appraisal and removal of the material for donation can be performed at the qualified hospital closest to the donor’s residence. After removal, the material is transported to the center where the transplant will be conducted.
A marrow transplant is a type of treatment indicated for certain diseases that affect the blood cells, such as leukemia. It consists of replacing a diseased or deficient bone marrow with normal bone marrow cells, in order to reconstitute a new healthier marrow.
The transplant is performed based on material gathered from a donor or based on stem cells from the umbilical cords of the newborn, which are obtained and crio-preserved on the basis of voluntary donations authorized by the mothers of the babies. The blood banks of the BrasilCord Network (Rede BrasilCord) have agreements with maternity wards for pickup of the umbilical cords.
You have to be between the ages of 18 and 55, be in good health and not have any infectious disease that can be transmitted by blood. Donor candidates should seek out the blood bank closest to their homes, where they will be put on the schedule to clear up doubts regarding donations and then have a 5 to 10 ml blood sample taken in order to determine the type of their HLA (genetic characteristics that are important in selecting donors). The donor’s data are then inserted on the Redome register and, whenever a new patient inquiry is made, compatibility will be checked. Once this is confirmed, the donor will be consulted to decide on the donation.
A marrow transplant is a safe procedure and there are two manners of carrying it out, with the doctor choosing the most appropriate method for each case. One of the options is removing marrow from inside the donor’s pelvic bones by means of needle punctures. The procedure is carried out in a surgical center with the patient anaesthetized.
In the other transplant option, donors take medication that makes the bone marrow cells circulate through their blood veins. Such cells are then removed from the donor’s arm veins, and the procedure includes use of a specific machine (aphaeresis) to separate the blood cells required for the transplant.
In both procedures, the donor’s bone marrow is reconstituted in just 15 days.
Donor candidates should keep their data updated on the Redome. To access the form for doing this, click here.