Chapter 16 - Umbilical Cord Blood Expansion as an Alternate Graft Source for HSC Transplantation

Abstract

Allogeneic hematopoietic stem cell (HSC) transplantation is the transfer of HSCs from a healthy donor into an immunosuppressed host, with the goal of repopulating the host with a donor-derived hematopoietic system and thereby reestablishing functional immunity. Over the course of the past 50years, allogeneic HSC transplantation has proven to be a curative therapy for a wide array of both malignant and nonmalignant hematological disorders. During this time, the clinical practice of HSC transplantation has seen many advances, one of the most significant of which has been the extended use of “alternative donors.” For many years, convention held that the only donor that could be used was an HLA-matched sibling. This greatly limited the ability to perform HSC transplants on the majority of patients because only 30% of patients who require an allograft will have an HLA-matched sibling donor. Despite >20 million adult volunteer donors in the National Marrow Donor Program and affiliated registries, many patients, particularly patients of diverse racial/ethnic backgrounds, will not have a suitably matched, unrelated volunteer donor identified in the required time period. The realization that umbilical cord blood could be used as a source of HSCs has revolutionized the practice of allogeneic HSC transplantation by making it possible to perform this life-saving procedure in patients who otherwise lack a suitable HLA-matched donor.