Public Umbilical Cord Blood Banking Research Articles

Perspectives for the Use of Umbilical Cord Blood in Transplantation and Beyond: Initiatives for an Advanced and Sustainable Public Banking Program in Greece.

The umbilical cord blood (UCB) donated in public UCB banks is a source of hematopoietic stem cells (HSC) alternative to bone marrow for allogeneic HSC transplantation (HSCT). However, the high rejection rate of the donated units due to the strict acceptance criteria and the wide application of the haploidentical HSCT have resulted in significant limitation of the use of UCB and difficulties in the economic sustainability of the public UCB banks. There is an ongoing effort within the UCB community to optimize the use of UCB in the field of HSCT and a parallel interest in exploring the use of UCB for applications beyond HSCT i.e., in the fields of cell therapy, regenerative medicine and specialized transfusion medicine. In this report, we describe the mode of operation of the three public UCB banks in Greece as an example of an orchestrated effort to develop a viable UCB banking system by (a) prioritizing the enrichment of the national inventory by high-quality UCB units from populations with rare human leukocyte antigens (HLA), and (b) deploying novel sustainable applications of UCB beyond HSCT, through national and international collaborations. The Greek paradigm of the public UCB network may become an example for countries, particularly with high HLA heterogeneity, with public UCB banks facing sustainability difficulties and adds value to the international efforts aiming to sustainably expand the public UCB banking system.

Single laboratory evaluation of umbilical cord blood units processing methodologies for banking.

To compare the efficiency of 3 different processing methods (Sepax, AutoXpress [AXP], and manual processing with hydroxyethyl starch [HES] sedimentation) used at Stemlab during a 10-year period. Historical data were compiled and the analytical results obtained for the 3 different methods were compared. The manual processing (HES) method yielded the highest level of total nucleated cell recovery after processing, and the AXP system yielded the highest CD34+ cell number. The red blood cell reduction was also significantly higher with the HES method. Also, HES showed comparable results to Toticyte technology for umbilical cord blood (UCB) processing. These results show that the HES method is as effective as automated technologies for UCB volume reduction; hence, it is a suitable methodology for private and public UCB banks. The HES method also proved to be superior to Toticyte technology for medical applications, with higher recovery yields of total nucleated cells after thawing and equivalent CD34+ cell recovery and functionality.

P1352: THE INTRA-POPULATION HLA DIVERSITY IN CRETE AND THE IMPORTANCE OF THE REGIONAL PUBLIC UMBILICAL CORD BLOOD BANK IN HLA-BASED DONOR SELECTION FOR ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION

Background: Allogeneic hematopoietic stem cell transplantation is the elective treatment for several life-threatening hematologic diseases. The high genetic diversity of HLA across populations, combined with the complexity of its molecular variation and the limitations of traditional HLA typing, confines the effectiveness of matched unrelated donor registries and public umbilical cord blood banks (UCBB), particularly in populations with ethnic minorities. Aims: Prompted by our recent study describing a considerable HLA diversity between a representative Cretan cohort and the donors of DKMS, we set out to unravel the effect of potential intra-population diversity on HLA distribution. We used samples stratified by a specific Prefecture of origin aiming to signify the possible existence of a severe shortage of genetically HLA compatible samples and to justify the importance of the regional UCBB for an HLA-based donor selection in Crete. Methods: A combined cohort of 1,744 representative samples from the four Prefectures of Crete (Heraklion, Lasithi, Rethymno, Chania) were typed for HLA Class I (-A, -C, -B) and Class II (-DRB1, -DQB1) loci using 2nd field NGS. Fisher’s exact test was used for the comparison of g-grouped alleles with frequencies corrected by Bonferroni and of haplotypes estimated by Hapl-o-Mat with frequencies f≥1/2n. The average probability of finding a >6/10 compatible donor within and across the four Prefectures was also estimated using custom scripts in R. Results: In the combined cohort, HLA-B exhibited the highest allelic variability (n=74) and number of unique alleles (n=21/39). While the diversity of all loci, except for HLA-C, was attributed to the largest Prefecture, Heraklion, the high number of unique HLA-C alleles in Chania (n=4/8) contributed to both intra- and inter-population diversity. While the distribution of the most frequent common alleles across the 5 loci were similar between all Prefectures, significant differences (n=27 alleles) were revealed when each Prefecture was compared to the remaining pooled Cretan cohort. Such analyses substantiated the diversity of Chania (37.04%) mostly versus the geographically and genetically isolated Prefectures of Lasithi and Rethymno. Significant diversity was also observed among the 1,406 inferred haplotypes, with 80.2% being unique. The distribution of the top 10 out of the 21 common haplotypes in the combined cohort was 0.63%-1.38%. However, the most common haplotypes A*24:02~B*35:02~C*04:01~DRB1*11:04~DQB1*03:01 (1.38%) and A*33:01g~B*14:02g ~C*08:02g~DRB1*01:02g~DQB1*05:01g (1.38%) were mainly attributed to Rethymno with frequencies of 3.35% and 1.96%, respectively. The low frequency of A*24:02~B*35:02~C*04:01 ~DRB1*11:04~DQB1*03:01 in Heraklion (0.97%) and Chania (0.73%) resulted in a significant difference (p=5.8e-05) when both were compared to Rethymno. The diversity of Chania may underlie the higher probability of not finding a compatible donor in Lasithi and Rethymno (i.e. >30%) or Heraklion (i.e. >20%). Besides the lower distribution of the most common haplotypes, Heraklion seems a good pool for finding potential donors since 46.8-49.1% of common HLA haplotype needs are met between the former and each Prefecture. Summary/Conclusion: The in-depth immunogenetic profile of the Cretan population justifies the reported HLA diversity compared to the European populations of DKMS. The significant differences in the estimated haplotype frequencies between the Cretan Prefectures substantiates the importance of geographically or genetically isolated population clusters in the regional UCB banking and donor selection.

Umbilical Cord Blood Microtransplantation in Newly Diagnosed, Elderly Patients with Acute Myeloid Leukemia

Objective: We observed the efficacy and safety of umbilical cord blood microtransplantation (UCBMT) in the treatment of newly diagnosed with acute myeloid leukemia (AML) in the elderly.Methods: Prospective one-arm phase I clinical study. The patients should meet the following criteria: 60-80-year-old; newly diagnosed AML; receive the treatment of chemotherapy combined with UCBMT.Result: In total, 11 patients newly diagnosed with AML received chemotherapy in combination with UCBMT, from November, 2019 to January, 2021, including 7 males and 4 females. The average age was 71 (60-80). For the patients, 7 cases with normal chromosome karyotype, and 2 cases with +8 chromosome, 1 case with 7q- chromosome, and 1 case with karyotype of monomer. In the 7 patients with normal chromosome karyotype, 3 cases were FMS-liketyrosine kinease 3 (FLT3) positive (2 of them in combination with nucleophosmin 1 (NPM1) mutation); in addition, in 4 patients of the 7, one showed double mutation of CEBPA, one showed NPM1 mutation, one showed IDH1 mutation, and one showed IDH2 mutation. In 4 patients with chromosomal abnormalities, one patient showed no special gene, one patient showed ASXL1 mutation, one patient was IDH1 mutation, and one patient was TP53 mutation. All of the patients were treated with IA (IDA 8-10 mg/ m 2/day x 3 days, cytarabine 100 mg/ m 2/day x 7 days) for inducing chemotherapy. For the patients with 60-70-year-old, they were treated with IDA (8 mg/ m 2/day); and for the patients with 70-80-year-old, they were treated with darubicin (10 mg/ m 2/day). In the consolidation phase, the patients were treated with cytarabine (1 g/ m 2, q12h) for 3 consecutive days. There were 3 courses of consolidation chemotherapy. Next, patients received single unrelated cord blood transplantation (UCBT) from China's public umbilical cord blood bank, HLA matching was performed for all patients before treatment. A total of 4 units of UCB with HLA 0-3/6（HLA-A,-B,-DR）matching and the ABO blood type matched with the patient were transfused after induction and consolidation chemotherapy for 24-48 hours, then with follow-up. At the same time, the immunological characteristics of these patients were fully analyzed. We demonstrated that, 8 of 11 patients received one course of induction chemotherapy, and achieved a complete response. The complete response rate was 72.7%. What's more, the median time for neutrophils ≥ 0.5 x 10 9/L and platelete ≥ 20 x 10 9/L was 12 days. There were no treatment-related deaths during induction therapy. The median follow-up was 14 (7-31) months. 1 patient showed monomer karyotype with P53 gene mutation, and got complete remission after one course of induction chemotherapy with IA. However, the patient died for AML recurred. For the other 10 patients, they were alive, and the OS of 1 year was 89.8%. Moreover, we found the expression of PD-1 on CD8 +T cells decreased, while the expression of CD38 increased after therapy. Besides, the proportion of NKp30 +NK cells, as well as the IFN-γ +TFN-α +NK cells increased significantly.Conclusion: UCBMT therapy for newly diagnosed elderly AML patients could accelerate the recovery of hematopoietic function and improve the safety of chemotherapy. This method is effective and worthy of further promotion. DisclosuresNo relevant conflicts of interest to declare.

Optimization of the criteria for cord blood unit selection for transplantation in recipients of the different age groups: current view and prospects in Ukraine

Umbilical cord blood has been widely used to treat both malignant and non-malignant hematological diseases for over 30 years. During this time, more than 40,000 successful hematopoietic stem cell (HSC) transplantations of umbilical cord blood have been performed. However, today in Ukraine there is no public umbilical cord blood bank established for unrelated HSC transplantation to patients with oncohematological disorders (both children and adults). In this regard, the HSC units must be purchased abroad or the patients are sent to foreign clinics for high-cost treatment. The organization of a public umbilical cord blood bank in Ukraine would help in a short time to meet the needs of patients with oncohematological disorders for donor HSCs for unrelated transplantation and save significant funds for the treatment of patients abroad. According to the experience of the world's leading oncohematological centers, when it is impossible to find either a related or haploidentical donor or in all available registries – a unrelated transplant, the search continues in the registers of public cord blood banks and an umbilical cord blood unit that matches the criteria is usually found. The optimal choice of umbilical cord blood unit is crucial to maximize the likelihood of successful transplant engraftment and recipient survival after the transplantation, so the criteria for cord blood unit selection for unrelated transplantation are a bit broader than those used when matching donor-recipient pairs. The review presents the main criteria for cord blood unit selection according to the assessment of its quality, cell dose, HLA matching for unrelated transplantation to recipients of different age groups in accordance with international guidelines developed by the National Marrow Donor Program (NMDP), USA Center for International Blood and Brain Transplantation Research (CIBMTR), in collaboration with the NMDP Council Advisory Group, as well as in accordance with the American Society for Transplantation and Cellular Therapy (ASTCT) and the Seventh Edition of the NetCord-FACT International Standards for Cord Blood Collection, Banking, and Release for Administration.

Identifying Barriers to Umbilical Cord Blood Banking in Jordan: A Cross-Sectional Survey of Obstetricians.

Background: The expansion of umbilical cord blood (UCB) banking necessitates a greater understanding among obstetricians in order to responsibly inform parents about UCB collection and storage. Gaps in knowledge can compromise public UCB banking efforts and result in missed opportunities and public misguidance about UCB banking. Materials and Methods: A cross-sectional survey was disseminated among obstetricians in Amman, Jordan. The questionnaire aimed to evaluate obstetricians’ knowledge of and attitude toward UCB storage and applications, as well as current practice patterns. Results: Ninety-six obstetricians responded (55% response rate), most of whom were Jordanian (71%), female (83%), resident physicians (59%), and working in either private (43%) or public (42%) hospitals, with an average of 6.5 years in practice. Only 26% had personal experience in UCB collection, and 20% had received education on UCB collection. Nearly 75% said their hospitals lacked standard operating procedures, guidelines, or infectious disease screening for UCB units. Overall knowledge about UCB was moderate, and the internet was the most common information source (54%). Overall attitudes were positive, especially in desire to expand personal knowledge about UCB, integrate information into medical residency curricula, and establish a public UCB bank in Jordan. However, many believed that ethical (61%) and religious (56%) controversies surround UCB donation. Conclusion: This study identifies deficiencies in quality control and experience in UCB collection in Jordan, as well as areas of inadequate knowledge and ethical controversies among obstetricians. These issues contribute to public misinformation and limit public UCB donation programs, and requires improved medical education on this topic

Стовбурові клітини пуповинної крові: клінічне застосування алогенного матеріалу, проблеми та перспективи банківського зберігання

Human umbilical cord blood (UCB) is an important source of hematopoietic stem cells (HSCs), successfully used for allogeneic transplantation to treat a wide range of serious diseases. This article discusses a number of topical problems associated with the functioning of public low-temperature banks of UCB. The principles of standardization, quality control and the effective selection of the cryopreserved units at the transplant centers request are considered from the point of view of the world transplantation practice for this unique biological material. The issues related to the trends in therapy using mesenchymal stromal/stem cells from the fetoplacental complex tissues and their cryopreservation are also deliberated. Special attention is paid to the issues of biomedical ethics and the prospects of public UCB bank establishing in Ukraine, its role in the development of the national HSCs unrelated transplantation. Probl Cryobiol Cryomed 2020; 30(3): 213–235

Values in tension. Clinical quality and civic participation in umbilical cord blood banking in Italy.

In the dominant narrative of bioethics and biomedical discourse on public Umbilical Cord Blood (UCB) banking, the ethical value of donating UCB is unproblematically associated with the clinical quality of collected UCB. This article shows that this view is analytically untenable as it overlooks tensions and conflicts between the social values of donation and the clinical value of banked UCB in concrete arrangements regarding the logistics of UCB donation and collection. Adopting the notion of registers of valuing (Heuts and Mol 2013: Valuation Studies, 1, 2, 125-46) and analysing the case of the Italian network of public UCB banks and collection sites, this article shows how conflicting registers of valuing concerning UCB can shape different organisational models of UCB donation and collection, in which social values and clinical value are not unproblematically conflated. The article aims to demonstrate that the functioning of biobanking arrangements is dependent on how different values are accomplished and aligned in concrete practices of tissue donation and collection.

Anchoring hopes in a regime of truth. The legitimizing use of cord blood-derived products in Italy

Public Umbilical Cord Blood (UCB) banking is defined by the dominant bioethics and biomedical literature as working in a regime of valuation that connects the social value of solidarity and the clinical value of collected quality UCB. Adopting the notion of registers of valuing (Heuts, F., and A. Mol. 2013. “What Is a Good Tomato? A Case of Valuing in Practice.” Valuation Studies 1 (2): 125–146), this paper challenges the aforementioned view. By exploring the Italian public system of UCB banking, it discusses disputes around the organization of the logistic of UCB donation, inspired by divergent registers of valuing enacted by involved actors. This paper focuses on the Italian public UCB banks’ involvement in experimental clinical protocols, using cells derived from UCB. It demonstrates how these experimental applications are deployed by Italian UCB bank practitioners to legitimize their work and to advance claims of jurisdictional monopoly over UCB banking and donation. It concludes that concrete arrangements of UCB banking are the outcome of negotiations among involved actors.

New HLA-C alleles identified in two donors from the Colombian public umbilical cord blood bank.

Two novel HLA-class I alleles discovered: HLA-C*08:162 and HLA-C*03:296:02.

Umbilical Cord Blood (UCB) Banking: Which One to Choose?

This article focuses the pros and cons of various UCB banking models. We also discuss here the recommendation by various medical societies in this regard as well as the future direction in the subject of UCB banking. On the practical grounds education of general population, obstetrical care providers and paediatricians on the current banking strategies and potential uses of UCB is essential. While providing this education it has to be kept in mind the limited number of public UCB banks in many countries across the world; declaring an urgent need to simultaneously have government policies to make such banking services available to the potential donors.

Following the banking cycle of umbilical cord blood in India: the disparity between pre-banking persuasion and post-banking utilization

To address critique of the rare uptake of umbilical cord blood (UCB) in private banks, hybrid-banking models would combine the advantages of “public UCB banking” and private UCB banking by responding to both market forces and public needs. We question both by following the cycle of UCB banking in India: the circulation and stagnation of UCB as waste, gift, biological insurance, enclaved good, source of saving lives and commodity through various practices of public, private and hybrid UCB banking. Making the journey from “recruitment,” “collection” and “banking” to “research” and “therapy” allowed us to identify concerns about the transparency of this cycle. Drawing on archival research and fieldwork interviews with different stakeholders in UCB banks in India, this article shows how private/hybrid cord blood banks are competing for their market share and its implication for the circulation of UCB: speculation, stagnation and opacity.

Cord blood clinical processing, cryopreservation, and storage.

Allogeneic umbilical cord blood (UCB) hematopoietic stem cell transplantation has become a crucial advancement in the treatment for a variety of diseases including hematopoietic and non-hematopoietic malignancies, BM failure syndromes, hemoglobinopathies, and metabolic and immunodeficiency disorders. It has been well documented that the success of UCB engraftment is tied to UCB banking processes, and now there are established guidelines for standardization of collection, banking, processing, and cryopreservation for unrelated UCB units with purpose of achieving consistent production of high quality placental and UCB units for administration. In 2011, Canada's Ministry of Health has announced Canada's first national, publicly funded umbilical cord blood bank, which aims to provide altruistic donations for unrelated allogeneic hematopoietic stem cell transplant. In this chapter, we describe specific protocols for clinical processing, cryopreservation, and storage of UCB used by the Canadian Blood Services National Public Umbilical Cord Blood Bank.

Are hybrid umbilical cord blood banks really the best of both worlds?

Since the first use of umbilical cord blood (UCB) as a medical therapy, the number of UCB banks worldwide has grown. Public UCB banks offer the option of altruistic donation,...

The Royan Public Umbilical Cord Blood Bank: Does It Cover All Ethnic Groups in Iran Based on HLA Diversity?

Background: Umbilical cord blood (UCB) stem cells allow the transplantation of partially human leukocyte antigen (HLA)-matched grafts and are a valuable resource for the treatment of hematologic malignancies and heritable hematologic, immunologic and metabolic diseases, especially when a compatible bone marrow donor is unavailable. The aim of this study was to determine how many ethnic groups in Iran are covered by the available UCB units based on HLA diversity. Methods: From 2009 until mid-2013, 4,981 (30.3%) of the 16,437 UCB samples collected met the storage criteria and were cryopreserved at a public cord blood bank (CBB) in Tehran, Iran. HLA-A, -B and -DRB1 were typed in 1,793 samples. Results: The mean volume of the cryopreserved samples was 81.25 ± 20.3 ml. The range of total nucleated cells per unit was 51 × 10⁷-107 × 10⁷. The most common HLA alleles were HLA-A*2 (17%) and HLA-A*24 (15.6%), HLA-B*35 (16.8%) and HLA-B*51 (13.9%), and HLA-DRB1*11 (20%) and HLA-DRB1*15 (14%). The predominant haplotypes were HLA-A*24-B*35-DRB1*11 (2%), HLA-A*02-B*50-DR*07 (1.8%), and HLA-A*02-B*51-DRB1*11 (1.5%). Conclusions: Based on the HLA-DRB1 profiles, the UCB units available at the Royan public UCB bank are a potentially adequate resource for hematopoietic stem cell transplantation for Iranian recipients belonging to particular ethnic groups. Regular educational programs to improve the public knowledge of UCB for transplantation can enhance the public CBB stocks for all Iranian ethnic groups in the future.

Knowledge about umbilical cord blood banking among Greek citizens.

Umbilical cord blood supplies in Greece are not sufficient to meet the high transfusion needs. This study was designed to determine Greeks' opinion about umbilical cord blood, identify the reasons for the lack of motivation to donate umbilical cord blood and allow experts to establish better recruitment campaigns to enrich the donor pool. The attitudes and knowledge about umbilical cord blood of randomly selected Greek citizens (n=1,019) were assessed by means of a standardised anonymous questionnaire. The results were analysed using the χ2 test and Spearman's correlation coefficient. Forty-eight percent of respondents knew about umbilical cord blood and had full knowledge about what storage/donation offers. Media (35%) and doctors (25%) were the main source of information. The information from the state was considered either inadequate or non-existent by 85% of the responders. Ninety-five percent of the people questioned would like further information regarding umbilical cord blood transplantation and umbilical cord blood storage/donation. Six percent of the respondents who had children and were in favour of umbilical cord blood transplantation, had stored/donated UCB. With regards to future decisions, 84% of the sample would store/donate umbilical cord blood, of whom 57% would keep the umbilical cord blood in a private bank. It was concluded that Greek citizens receive information about umbilical cord blood from both the state and advertising campaigns by the Ministry of Health and Social Solidarity. A kind of cooperation between all hospitals and public umbilical cord blood banks would be advisable in order to facilitate access to umbilical cord blood donations.

A Review of Factors Influencing the Banking of Collected Umbilical Cord Blood Units

Umbilical cord blood banking efforts have increased dramatically in the past two decades in response to increasing demand for alternative sources of blood stem cells to support patients requiring hematopoietic stem cell transplantation. Transplant centres have accumulated increasing expertise in their understanding of umbilical cord blood characteristics that are associated with improved outcome following transplantation. These characteristics and factors can assist transplant centres in selecting cord blood units from the worldwide inventory of banked units. Umbilical cord blood banks, therefore, need to remain agile in adjusting the inventory of the banks to address shifts or changes in the needs of transplant centres. Public umbilical cord blood banks face the challenge of building inventory while managing limited resources and are faced with decisions regarding which units can be stored and which units that have been collected should be discarded or used for other endeavours such as research. To this end, we sought to review parameters influencing the decision to bank a collected cord blood unit. In this paper, we will address parameters associated with graft potency and address other factors that guide the decision to bank collected units.

The present and the future of stem cell therapies

StemCyte is a leading Umbilical Cord Blood Stem Cell Therapy Company with one of the largest and most racially diverse Public Cord blood inventories in the world. We have been providing a life saving cellular therapy product since 2001 and have delivered high quality, HLA matched umbilical cord blood stem cells for more than 1600 transplants to 240+ of the world's leading Transplant Centers in over 30 countries. StemCyte has operations in the US, Taiwan and India and has embarked on a very deliberate strategy over the past 8 years to enhance our base business by consistently growing our revenue, year over year, while supporting research and being engaged in new clinical indications for stem cells sourced from umbilical cord blood. This presentation “The Present and Future of Stem Cell Therapies from the perspective of a Public Umbilical Cord Blood Bank CEO”; .chronicles the advances in UCB Clinical life saving applications, the current indications being explored by StemCyte and others and what we believe to be the potential uses of this rich source of adult stem cells while understanding the regulatory environment as well as the need to remain focused and sustain our ongoing business objectives.

Cord Blood Banking and Transplantation in China: A Ten Years Experience of a Single Public Bank

Background: Umbilical cord blood (UCB) has successfully used for transplantation to treat hematologic malignancies and genetic diseases. Herein, we describe the experience generated in a single public UCB bank at Zhejiang Province in China. Methods: Good manufacturing practice and standard operating procedures were used to address donor selection as well as UCB collection, processing, and cryopreservation. Total nucleated cells (TNCs), cellular viability, CD34+ cells, and colony-forming units were determined, and infectious diseases screening test, sterility test, and HLA typing for UCB units were done. Results: Only 18.51% of all collected UCB units met storage criteria, and 7,056 UCB units were cryopreserved in 10 years. The volume of UCB units was 95.0 ± 22.0 ml. The number of TNCs before and after processing was 13.32 ± 3.63 × 10⁸ and 10.63 ± 2.80 × 10⁸, respectively, and the recovery rate was 80.71 ± 11.26%. 0.4344 ± 0.1874% of the TNCs were CD34+ cells. The CFU-GM was 32.1 ± 28.0 colonies per 1 × 10⁵ nucleated cells. Based mainly on HLA and nucleated cell content, 26 UCB units were released for transplantation. Conclusions A public UCB bank was successfully established in China; collection and processing of UCB units should be optimized in order to gain maximum volume and cell count.

On the estimation of the necessary inventory for hellenic public cord blood banks using simulation

Allogeneic hematopoietic stem cell transplantation is a relative new treatment method for a wide range of diseases including hematopoietic malignancies, immunodeficiency disorders, metabolic diseases and genetic disorders. Umbilical Cord Blood (UCB) is a modern and effective source of hematopoietic stem cells with increasing usage throughout the world. Thus, the establishment and operation of public UCB banks has emerged as a common practice all over the world. In Greece, the development of such a UCB bank network is still in its infancy. This paper presents the development of a methodology for estimating the required inventory level of UCB units in Greece (bank size), in order to ensure an adequate probability that a Greek patient finds a Human Leukocyte Antigen (HLA)-compatible unit/donor (with a match at least for 4 out of 6 HLA histocompatibility antigens). To this end, we have adopted a Monte Carlo simulation approach. The available histocompatibility data include detailed genotypes of 8,500 Greeks. These data were fed into the system simulation model to emulate a UCB bank operation. The results of the simulation process reveal that an inventory of 10,000 cryopreserved UCB units could ensure a 4 out of 6 HLA matching for a Greek patient with a probability exceeding 95%. The determination of the bank size is a strategic, pivotal decision; thus, the proposed methodology provides the input for the National Healthcare System to decide on developing or not an UCB Bank (along with its designing parameters).