Abstract
Unrelated cord blood transplantation has been used to treat patients with malignant and non-malignant hematopoietic disorders for whom an HLA-compatible hematopoietic stem cell donor is not available. The establishment of cord blood banks worldwide, the increased number of cord blood units frozen, and the shorter time to find a donor, have made it possible to use this source of hematopoietic stem cells to treat more than 2,500 patients. The Eurocord registry was established to study the clinical results of cord blood transplantation and to compare the outcomes of unrelated transplants using either cord blood or bone marrow. Briefly, we have found, in two distinct retrospective analyses of children or adults with acute leukemia given either an unrelated cord blood or bone marrow transplant, that leukemia-free survival and relapse were similar in both types of graft (with adjustment for confounding clinical factors). Cord blood recipients experienced a decreased incidence of acute graft-versus-host disease and delayed hematopoietic recovery compared to bone marrow recipients. To improve the delayed hematopoietic recovery after cord blood transplantation, certain approaches have been investigated such as ex vivo expansion of cord blood cells, double cord blood transplantation and reduced intensity conditioning regimen. We have also attempted to establish some guidelines for cord blood-donor choice based on cord blood cell dose and number of HLA disparities that have been found to be associated with hematopoietic recovery. In conclusion, an unrelated hematopoietic stem cell donor should be simultaneously searched for in cord blood banks and in bone marrow donor registries for patients lacking an HLA-identical sibling hematopoietic stem cell donor. The option of performing cord blood transplants should be based on urgency of the transplant, cord blood cell dose and number of HLA disparities.
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References
Barker JN, Davies SM, DeFor T, et al (2001) Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched pair analysis. Blood 97:2957–2961
Barker JN, Weisdorf DJ, DeFor TE, et al (2003) Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning. Blood 102:1915–1919
Bensinger WI, Martin PJ, Storer B, et al (2001) Transplantation of bone marrow as compared with peripheral blood cells from HLA-identical relatives in patients with hematologic cancers. N Engl J Med 344:175–181
Bittencourt H, Rocha V, Chevret S, et al (2002) Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation. Blood 99:2726–2733
Couban S, Barnett M (2003) The source of cells for allografting. Biol Blood and Marrow Transplant 9:669–673
Davey S, Armitage S, Rocha V, et al (2004) The London cord blood bank: analysis of banking and transplantation outcome. Br J Hematol (in press)
Fernandez MN, Regidor C, Cabrera R, et al (2001) Cord blood transplants: early recovery of neutrophils from co-transplanted sibling haploidentical progenitor cells and lack of engraftment of cultured cord blood cells, as ascertained by analysis of DNA polymorphisms. Bone Marrow Transplant 28:355–363
Frassoni F, Podesta M, Maccario R, et al (2003) Cord blood transplantation provides better reconstitution of hematopoietic reservoir compared with bone marrow transplantation. Blood 102:1138–1141
Gluckman E (2000) Current status of umbilical cord blood hematopoietic stem cell transplantation. Exp Hematol 28:1197–1205
Gluckman E (2001) Hematopoietic stem cell transplants using umbilical cord blood. N Engl J Med 344:1860–1861
Gluckman E, Broxmeyer HE, Auerbach AD, et al (1989) Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilical cord blood from an HLA-identical sibling. N Engl J Med. 321:1174–1178
Gluckman E, Rocha V, Boyer Chammard A, et al (1997) Outcome of cord blood transplantation from related and unrelated donors. N Engl J Med 337:373–381
Gluckman E, Rocha V, Arcese W, et al., on behalf of Eurocord group (2004) Factors associated with outcomes of unrelated cord blood transplant: guidelines for donor choice. Exp Hematol 32:397–407
Grewal SS, Barker JN, Davies SM, et al (2003) Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood 101:4233–4244
International Bone Marrow Transplant Registry/Autologous Blood and Marrow Transplant Registry (2003) IBMTR/ABMTR newsletter. 10:1–12
Jaroscak J, Goltry K, Smith A, et al (2003) Augmentation of umbilical cord blood (UCB) transplantation with ex vivo-expanded UCB cells: results of a phase 1 trial using the AastromReplicell System. Blood 101:5061–5067
Kurtzberg J, Laughlin M, Graham L, et al (1996) Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. N Engl J Med 335:157–166
Laughlin MJ, Barker J, Bambach B, et al (2001) Hematopoietic engraftment and survival in adult recipients of unrelated donor umbilical cord blood. N Engl J Med 344:1815–1822
Ooi J, Iseki T, Takahashi S, et al (2004) Unrelated cord blood transplantation for adult patients with de novo acute myeloid leukemia. Blood 103:489–491
Piacibello W, Sanavio F, Severino A, et al (1999) Engraftment in non obese diabetic severe combined immunodeficient mice of human CD34+ cord blood cells after ex-vivo expansion: evidence for the amplification and self renewal of repopulating stem cells. Blood 93:1–15
Piacibello W, Bruno S, Sanavio F, et al (2002) Lentiviral gene transfer and ex-vivo expansion of human primitive stem cells capable of primary and tertiary multilineage repopulation in NOD/SCID mice. Blood 100:4391–4400
Rocha V, Wagner JE, Sobocinski K, et al (2000) Comparison of graft-versus-host disease in children transplanted with HLA identical sibling umbilical cord blood versus HLA identical sibling bone marrow transplant. N Engl J Med 342:1846–1854
Rocha V, Cornish J, Sievers E, et al (2001) Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia. Blood 97:2962–2971
Rubinstein P, Stevens CE (2000) Placental blood for bone marrow replacement: the New York Blood Center’s program and clinical results. Baillieres Best Pract Res Clin Haematol 13:565–584
Sanz GF, Saavedra S, Planelles D, et al (2001) Standardized, unrelated donor cord blood transplantation in adults with hematological malignancies. Blood 98:2332–2338
Shpall EJ, Quinones R, Giller R, et al (2002) Transplantation of ex vivo expanded cord blood. Biol Blood Marrow Transplant 8:368–376
Volpi I, Perruccio K, Tosti A, et al (2001) Postgrafting administration of granulocyte colony-stimulating factor impairs functional immune recovery in recipients of human leukocyte antigen haplotype-mismatched hematopoietic transplants. Blood 97:2514–2521
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Gluckman, E., Rocha, V. Cord blood transplant: strategy of alternative donor search. Springer Semin Immun 26, 143–154 (2004). https://doi.org/10.1007/s00281-004-0157-3
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DOI: https://doi.org/10.1007/s00281-004-0157-3