Abstract
It has been 21 years since the first successful use of umbilical cord blood as a source of donor cells for hematopoietic stem cell transplantation (HSCT). Over those years, cord blood transplantation (CBT) has shown marked success as an effective modality in the treatment of children and adults with hematologic malignancies, marrow failure, immunodeficiency, hemoglobinopathy, and inherited metabolic diseases. Furthermore, transplantation without full human leukocyte antigen (HLA) matching is possible and, despite a lower incidence of graft-versus-host disease, graft-versus-leukemia effect is preserved. More than 20,000 cbts have been performed worldwide. Ontario is the most populated province in Canada, and its cbt numbers have increased dramatically in recent years, but most of the umbilical cord blood units are purchased from unrelated international registries. There is no public cord bank in Ontario, but there is a private cord banking option, and notably, Ontario has the largest number of live births in Canada [approximately 40% of all Canadian live births per year occur in Ontario (Statistics Canada, 2007)]. In this brief review, the pros and cons of private and public cord banking and the feasibility of starting an Ontario public cord bank are discussed.
Highlights
In 1989, Gluckman et al 1 published an account of the first successful hematopoietic stem-cell transplantation, which used a sibling cord for a child with Fanconi anemia
That procedure was followed by 2 successful transplantations in children that used partially mismatched, unseparated, unrelated umbilical cord blood banked through the Placental Blood Project at the New York Blood Center 2
Umbilical cord blood has emerged in recent years as an attractive alternative to bone marrow stem cells 6
Summary
In 1989, Gluckman et al 1 published an account of the first successful hematopoietic stem-cell transplantation (hsct), which used a sibling cord for a child with Fanconi anemia. That procedure was followed by 2 successful transplantations in children that used partially mismatched, unseparated, unrelated umbilical cord blood banked through the Placental Blood Project at the New York Blood Center 2. Thousands of cord blood transplantations (cbts) have been performed, with very promising results. Similar results were reported when 98 adults who received cbt were compared with 584 who received bone marrow stem cells 4. Umbilical cord blood has emerged in recent years as an attractive alternative to bone marrow stem cells 6. Utilization of umbilical cord blood for transplantation has increased in Ontario, in particular for children, because it is much easier to find a suitable cord with enough stem cells (total nucleated cells: >2.5×107 per kilogram of recipient body weight) for a child than for an adult. There is, no option for public cord donation in Ontario, and cord banking is possible through the private sector only
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