Abstract
Umbilical cord blood is an established source of hematopoietic stem cells for transplantation. It enjoys several advantages over bone marrow or peripheral blood, including increased tolerance for Human Leukocyte Antigen mismatches, decreased incidence of graft-versus-host disease, and easy availability. Unrelated cord blood does have limitations, however, especially in the treatment of adults. In the 24 years since the first umbilical cord blood transplant was performed, significant progress has been made, but delayed hematopoietic engraftment and increased treatment-related mortality remain obstacles to widespread use. Here we summarize the latest results of unrelated cord blood transplants, and review strategies under investigation to improve clinical outcomes.
Highlights
Since the first sibling human leukocyte antigen (HLA)-matched umbilical cord blood transplant (UCBT) was performed in 1989 by Gluckman and Colleagues on a pediatric patient with Fanconi’s anemia, cord blood stem cells have been recognized for their benefits [1]
Over the last 25 years, UCBT has become a valid source of hematopoietic stem cells, allowing for increased access to hematopoietic stem cell transplantation, in patients without available bone marrow transplants (BMT) or PBSC donors
Umbilical cord blood (UCB) engraftment has been the focus of intensive basic and early clinical research and recent progress indicates that several methods will become soon widely available to increase the applicability of this graft type
Summary
Since the first sibling human leukocyte antigen (HLA)-matched umbilical cord blood transplant (UCBT) was performed in 1989 by Gluckman and Colleagues on a pediatric patient with Fanconi’s anemia, cord blood stem cells have been recognized for their benefits [1]. Locatelli, and others on behalf of the Eurocord, showed that pediatric leukemia patients receiving a TNC dose above 3.7 × 107 had a higher probability of engraftment and survival [10, 15, 16], with a median time to neutrophil engraftment of 25 days compared to 35 days for those receiving
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