Abstract
Cord blood (CB) has been used as a viable source of hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) in over 35,000 clinical hematopoietic cell transplantation (HCT) efforts to treat the same variety of malignant and non-malignant disorders treated by bone marrow (BM) and mobilized peripheral blood (mPB) using HLA-matched or partially HLA-disparate related or unrelated donor cells for adult and children recipients. This review documents the beginning of this clinical effort that started in the 1980’s, the pros and cons of CB HCT compared to BM and mPB HCT, and recent experimental and clinical efforts to enhance the efficacy of CB HCT. These efforts include means for increasing HSC numbers in single CB collections, expanding functional HSCs ex vivo, and improving CB HSC homing and engraftment, all with the goal of clinical translation. Concluding remarks highlight the need for phase I/II clinical trials to test the experimental procedures that are described, either alone or in combination.
Highlights
F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty
Advantages of Cord blood (CB) hematopoietic cell transplantation (HCT) are ease of collection and storage of CB without significant risks for the delivering mothers, the ready and quick availability of HLA-typed frozen CB units in public and private CB banks, and elicitation of relatively low acute and chronic graft versus host disease (GVHD) in recipients after CB HCT, even with unrelated partially HLAdisparate donor cells, compared to that elicited by bone marrow (BM) or Mobilized peripheral blood (mPB)
This review focuses on enhancing the efficacy of “limited” numbers of hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) in CB collections for CB HCT
Summary
The history of cord blood transplantation/biology & perspective for future efforts to enhance the field. Broxmeyer HE, Cooper S: High-efficiency recovery of immature haematopoietic progenitor cells with extensive proliferative capacity from human cord blood cryopreserved for 10 years. Carow CE, Hangoc G, Broxmeyer HE: Human multipotential progenitor cells (CFU-GEMM) have extensive replating capacity for secondary CFU-GEMM: an effect enhanced by cord blood plasma. Lu L, Xiao M, Shen RN, et al.: Enrichment, characterization, and responsiveness of single primitive CD34 human umbilical cord blood hematopoietic progenitors with high proliferative and replating potential. Mayani H, Lansdorp PM: Biology of human umbilical cord blood-derived hematopoietic stem/progenitor cells. Piacibello W, Sanavio F, Garetto L, et al.: Extensive amplification and selfrenewal of human primitive hematopoietic stem cells from cord blood. Vormoor J, Lapidot T, Pflumio F, et al.: Immature human cord blood progenitors engraft and proliferate to high levels in severe combined immunodeficient mice.
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