Abstract
Over the last two decades umbilical cord blood (UCB) transplantation (UCBT) is increasingly used for a variety of malignant and benign hematological and other diseases. The main factor that limits the use of UCB to low weight recipients, mainly children and adolescents, is its low progenitor cell content. Various alternatives have been exploited to overcome this difficulty, including the transplantation of two UCB units (double umbilical cord blood transplantation, dUCBT). Following dUCBT, donor(s) hematopoietic stem cells (HSC) can be detected in the peripheral blood of the recipient as soon as 14 days post-transplantation. Sustained engraftment of HSC from one or both donors can be observed- dominance or mixed chimerism respectively, although single donor unit dominance has been observed in over 85% of patients. The underlying biology, which accounts for the interactions both between the two infused UCB units- cooperative or competitive, and with the recipient’s immune system, has not been elucidated.
Highlights
In attempting to explain single unit dominance in dUCBT, both intrinsic properties of the infused units and immune interactions between the recipient and the donors are
The main factor that limits the use of UCB to low weight recipients, mainly children and ly adolescents, is its low progenitor cell content. n Various alternatives have been exploited to o overcome this difficulty, including the transplantation of two UCB units
Avery et al reported an association between higher CD3+ cell dose and unit dominance in patients undergoing dUCBT following myeloablative regime.[10]
Summary
In attempting to explain single unit dominance in dUCBT, both intrinsic properties of the infused units and immune interactions between the recipient and the donors are. CD3+, degree of HLA/sex mismatch, ABO group, viability, order and route of infusion.[4] Avery et al reported an association between higher CD3+ cell dose and unit dominance in patients undergoing dUCBT following myeloablative regime.[10] Cell viability is a controversial issue.
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