Umbilical cord blood transplantation.

Abstract

Since Gluckman et al ’s first description of successful haemopoietic stem cell transplantation using umbilical cord blood (UCB) as the source of marrow progenitors in 1989,1more than 500 umbilical cord blood stem cell transplants have been performed. Umbilical cord blood banks have been set up in the USA and Europe to store these cells, which in the past have been considered a waste product of reproduction. Although most UCB haemopoietic stem cell transplants have taken place in the past three years, recently published reports2-5 have given an important insight into the clinical potential of UCB as a source of haemopoietic progenitor cells for transplantation. Allogeneic bone marrow transplantation (BMT) can potentially be used to cure a variety of diseases including haematological malignancies, bone marrow failure syndromes, haemoglobinopathies, immunodeficiencies, and some inborn errors of metabolism.6 The use of allogeneic BMT is limited by the need for adequate tissue matching of host and donor cells to reduce the risks of rejection and the severity of graft versus host disease (GVHD) in the short term, while allowing immune reconstitution in the longer term. Many patients who might benefit from allogeneic BMT are prevented from doing so because there is no adequately matched donor available. In part, this problem has been addressed by the establishment of large panels of unrelated adult donors who are prepared to donate their bone marrow. Approximately five million donors are available worldwide. Despite these large numbers the need for precise tissue matching compounded by the predominantly white European ethnicity of the donor panels means that a significant number of patients remain unable to benefit from BMT. There is a need for a source of haematopoietic stem cells with a less rigorous requirement for tissue matching that could be used for transplantation into patients who do …