How did the umbilical cord blood stem cells change LB’s life?

The story of L.B. is the story of first umbilical cord blood stem cells treatment performed successfully in Europe for cerebral palsy.

L.B. is a German boy who at a young age has gone courageously through one of the toughest challenge in life.

It all started in November 2008...

When the 2,5 years old boy was admitted in pediatric intensive care unit of St. Joseph pediatric hospital, from Ruhr-Bochum, Germany.

He presented unspecific gastrointestinal symptoms with frequent episodes of vomiting accompanied by tachycardia (a heart beat frequency > 200 / min). Despite of the prompt treatment set up, on the 2nd day after admission, his condition continued to deteriorate, culminating with the onset of cardiac arrest.

During cardiac arrest, blood circulation and brain oxygenation is abolished. The more serious consequences are the longer resuscitation period is. Successful resuscitation means resumption of spontaneous circulation and respiration.

Despite that all the necessary maneuvers were initiated promptly, the evolution was marked by the occurrence of complications determined by the prolongation of the resuscitation time, over 25 minutes in case of the little boy.

At 5 days after cardiac arrest the boy was removed from artificial ventilation, but the long period of brain oxygenation deprivation had serious consequence.

Although spontaneous respiration occurred, child’s state of consciousness was profoundly altered, agitation and continuous whimpering being the predominant manifestations.

No motor activity, only minimal response to stimuli and a pathological posture of the body (decorticate posture) were found out during neurological examination.

In a few minutes, L.B.’life has changed completely.

From a healthy boy with a normal motor and cognitive development consistent with his age, he got in vegetative state, expressing a severe global brain damage documented by EEG and imaging, by examining brain MRI.

At 3 weeks, the little boy was guided to a recovery center, his condition being profoundly altered with the recovery prognosis extremely reserved.

The crucial decision of his parents…

After a preliminary assessment of all the options they had, L.B.’s parents decided to contact the obstetrician who, upon their request, had collected umbilical cord blood at birth of their son. The cord blood unit was stored in a family bank.

They decided to use the umbilical cord blood stem cells, as cellular therapy, after a thoroughly consulting with the obstetrician.  This was a totally new therapeutic approach in Europe.

Parents agreed to assume this decision even if the treatment by infusion of umbilical cord blood stem cells was in experimental phase, with limited clinical experience, in USA.

The treatment by infusion of own umbilical cord blood stem cells…

9 weeks after the cardiac arrest, the toddler was intravenously infused with his own umbilical cord blood stem cells for about 40 minutes.

During and following infusion, he was carefully monitored. It were noticed only a few transient adverse events (e.g. nausea, hypertension) which allowed him to be discharged from hospital at 36 hours.

L.B. has undergone daily recovery treatment by physiotherapy, ergotherapy and speech therapy, in a specialized rehabilitation unit, being periodically evaluated at 2, 5, 12, 24, 30 and 40 months.

Following infusion of umbilical cord blood stem cells...

Toddler’s post-infusion evolution was remarkable. Only a week later, the boy stopped being agitated, excited, and began responding to auditory stimuli.

At 4 weeks there was a slightly decrease in spasticity which allowed him to straighten on demand the upper limb and touch a "Big Mac".

At 2 months, “the motor control of his head improved, spastic paresis was reduced, and eyesight recovered in part, as did EEG. The patient could grasp, hold, bite, chew, and swallow a biscuit, developed social smiling, laughed when played with and spoke the words “ma-ma””

These improvements continued progressively, so that one year after infusion of his umbilical cord blood stem cells, L.B. was able to make cognitive acquisitions (e.g. to identify animals) to have social interactions and fine-tuned motor skills (e.g. the ability to catch with fingers and put peanuts in mouth by himself).

At 40 months he was able to form sentences, having a vocabulary of about 200 words, to go with a device, crawling with cross pattern and to stand upright.

The remarkable evolution of this courageous and tenacious boy, in his fight with the disease that risk to change the course of his life, can be seen in videos made at the Bochum Hospital on the occasion of regular visits.

Link to these videos are available at the end of this post.

The “take-away” messages…

I don’t want to finish before making some clarifications:

This is the first documented case in Europe of own umbilical cord blood stem cells infusion, a story with a happy-end for L.B. and his entire family.

But it is necessary to gather a much richer clinical experience before being possible to establish with clarity the position that umbilical cord blood stem cells infusion can have in the therapeutic algorithm applied to children with cerebral palsy. Its addressability may depend on the type of disease, the time from onset and the optimal way of administration.

We hope that within a few years, after finalizing the current ongoing studies, we will get the necessary answers to these questions. In case of positive answers, for children like L.B. it would be possible to give the chance for a better quality of life and future.

Source:

A. Jensen and E. Hamelmann "First Autologous Cell Therapy of Cerebral Palsy Caused by Hypoxic-Ischemic Brain Damage in a Child after Cardiac Arrest—Individual Treatment with Cord Blood" Case Rep Transplant. 2013

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