Use Of Umbilical Cord Blood Research Articles

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,...

Cord blood banking and transplantation

A review of articles published since January 2012 on the topic of cord blood banking and cord blood stem cell transplantation was conducted for this the 25th anniversary year of the first cord blood transplant performed in a human. Cord blood banking is performed throughout the world. Umbilical cord blood (UCB) transplantation is recognized as an acceptable alternative stem cell source for paediatric and adults requiring a haematopoietic transplant, particularly for patients of racial and ethnic minorities. To further advance the use of UCB, methods to enhance UCB stem cell expansion, engraftment and maintenance may be required. Controversy on the most effective and economically sustainable model for banking and storing an optimal UCB product continues to persist. Cord blood banking and transplantation of cord blood stem cells has advanced rapidly over the initial 25 years, as more than 30 ,000 patients have benefited from the therapy. New concepts on the use of methods to expand UCB stem cells for transplantation and use for nonhaematopoietic indications may increase demand for UCB over the next few decades.

Cord blood graft composition impacts the clinical outcome of allogeneic stem cell transplantation

Despite routine use of umbilical cord blood (CB) grafts as stem cell source for allogeneic stem cell transplantations, much remains unknown regarding their cell composition and correlation with clinical outcome. We analyzed material from 30 CB units used for allogeneic hematopoietic stem cell transplantation by multicolor flow cytometry. Phenotypic data were correlated with various clinical outcomes such as survival, graft-versus-host disease (GVHD), relapse, rejection, viral reactivation, and bacteremia. We found that above-median frequencies of CD69+ T cells, naïve CD8+ T cells, and CD127+ B cells in the CB graft were each associated with significantly improved patient survival. Moreover, a statistically significant correlation was seen between higher levels of CD94+ T cells and herpes simplex virus and varicella zoster virus reactivation post transplantation. A similar correlation was seen for the frequency of CD95+ cells in total CD3+, as well as CD4+ and CD8+ T-cell subsets, and viral reactivation. Finally, a higher frequency of naïve CD8+ T cells was associated with the incidence of acute GVHD. Our study highlights the importance of further exploration of graft composition before CB transplantation as a tool for risk prediction.

Improving Engraftment and Immune Reconstitution in Umbilical Cord Blood Transplantation

Umbilical cord blood (UCB) is an important source of hematopoietic stem cells (HSC) for allogeneic transplantation when HLA-matched sibling and unrelated donors (MUD) are unavailable. Although the overall survival results for UCB transplantation are comparable to the results with MUD, UCB transplants are associated with slow engraftment, delayed immune reconstitution, and increased opportunistic infections. While this may be a consequence of the lower cell dose in UCB grafts, it also reflects the relative immaturity of cord blood. Furthermore, limited cell numbers and the non-availability of donor lymphocyte infusions currently prevent the use of post-transplant cellular immunotherapy to boost donor-derived immunity to treat infections, mixed chimerism, and disease relapse. To further develop UCB transplantation, many strategies to enhance engraftment and immune reconstitution are currently under investigation. This review summarizes our current understanding of engraftment and immune recovery following UCB transplantation and why this differs from allogeneic transplants using other sources of HSC. It also provides a comprehensive overview of promising techniques being used to improve myeloid and lymphoid recovery, including expansion, homing, and delivery of UCB HSC; combined use of UCB with third-party donors; isolation and expansion of natural killer cells, pathogen-specific T cells, and regulatory T cells; methods to protect and/or improve thymopoiesis. As many of these strategies are now in clinical trials, it is anticipated that UCB transplantation will continue to advance, further expanding our understanding of UCB biology and HSC transplantation.

Use of allogenic umbilical cord blood for red cells transfusion in premature infants: utopia or reality?

Extremely low birth weight (ELBW) infants almost always receive blood transfusions early in life. Newborn infants are currently transfused with leukocyte-depleted, irradiated red blood cells (RBCs) obtained from adult donor, which contains adult hemoglobin. Adult hemoglobin affinity for oxygen is lower than fetal, therefore red cell transfusion could be responsible for increased oxygen delivery to tissues increasing the risk of the “oxygen radicals disease of the newborn”. Though clinical studies have demonstrated that autologous cord blood transfusions in newborns is feasible, the clinical use of umbilical cord blood (UCB) for RBC transfusion purposes is still limited, expecially because of the small volumes achieved after processing of the UCB unit. The preliminary results of the first clinical study assessing the feasibility and the effectiveness of a transfusional program in preterm infants with packed RBSs obtained from allogenic UCB are shown.

Factors affecting umbilical cord blood stem cell suitability for transplantation in an in utero collection program

The greatest limiting factor in the use of umbilical cord blood (UCB) for transplantations is the number of stem cells available in any given collected unit. This study examines maternal, neonatal, and obstetric factors that influence the suitability for banking and transplantation of UCB units collected in utero. This study examined 7839 UCB units collected in utero at two hospitals from August 1, 2008, to August 31, 2011. The variables were collected from cord blood records, patient charts, delivery records, and data processed by StemCyte, Inc. (Covina, CA), our parent bank. The mean total nucleated cell (TNC) count between units selected for transplant and those banked but not selected for transplant were also compared. Of the 11 variables evaluated, six had a significant influence on the acceptable banking TNC count of at least 90 × 10(7) . Of these, cord blood volume was the best predictor. The other variables that were predictors of the acceptable TNC count of significance were gestational age, infant race, parity, birthweight, and infant sex. The minimal bankable TNC count for banking is considerably lower than the mean TNC count of units actually selected for transplantation. Maternal, neonatal, and obstetric factors can all influence the acceptability of a cord blood unit collected in utero for banking. Furthermore, units with high TNC counts are more likely to be selected for banking. Identifying these variables in potential donors can likely increase the number of adequate collections.

Umbilical Cord Blood Transplantation

The use of umbilical cord blood (UCB) as a stem cell donor source has dramatically increased over the last 2 decades. Patients undergoing UCB transplantation share medical management issues with patients receiving a hematopoietic stem cell transplantion using adult donor sources (peripheral blood stem cells or bone marrow stem cells) and may also have more complex medical issues that appear to be related to delayed immune recovery from UCB-derived stem cells. The interface with critical care providers is likely to occur in the transplant and posttransplant setting. Patients may experience UCB infusion reactions that range from mild to rarely severe. Following transplant, patients are transfusion dependent for long periods due to the prolonged engraftment of UCB cells. They are at high risk of infection, particularly viral. Once engrafted, UCB transplant patients have a lower rate of graft versus host disease compared to other donor sources. Some of the other complications that are seen in patients undergoing UCB transplant are posttransplant lymphoproliferative disease, diffuse alveolar hemorrhage, and posterior reversible encephalopathy will also be discussed.

Impact of disease status and stem cell source on the results of reduced intensity conditioning transplant for Hodgkin's lymphoma: a retrospective study from the French Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

The role of reduced intensity allogeneic stem cell transplantation for the treatment of relapsed/refractory Hodgkin's lymphoma remains controversial. We retrospectively analyzed 191 patients who underwent reduced intensity allogeneic stem cell transplantation between 1998 and 2008 for relapsed or refractory Hodgkin's lymphoma and whose data were reported to the French registry. The median follow-up was 36 months. The estimated 3-year overall survival rate, progression-free survival rate, cumulative incidence of relapse and cumulative incidence of non-relapse mortality were 63%, 39%, 46%, and 16%, respectively. There was no difference in outcome between patients in complete response and in partial response at the time of transplantation with regards to overall survival (70% versus 74%, no significant difference) and progression-free survival (51% versus 42%, no significant difference). Patients with chemoresistant disease had a shorter overall survival (39% at 3 years; P=0.0003) and progression-free survival (18% at 3 years; P=0.001) than patients in complete remission. The use of umbilical cord blood as the source of stem cells was associated with a poor outcome with an increased risk of death with a hazard ratio of 3.49 (95% confidence interval: 1.26 to 9.63; P=0.016). The use of peripheral blood was associated with a better outcome for patients who where alive 1 year after transplantation with a hazard ratio of 0.38 (95% confidence interval: 0.17 to 0.83; P=0.016). Disease status at transplantation remains the most important risk factor for outcome. Our data suggest that the use of peripheral blood should be preferred whereas umbilical cord blood should be used with caution.

Novel alginate three‐dimensional static and rotating culture systems for effective ex vivo amplification of human cord blood hematopoietic stem cells and in vivo functional analysis of amplified cells in NOD/SCID mice

Autologous and allogeneic hematopoietic stem cell (HSC) transplantations serve as effective therapy for a variety of hematologic and other diseases. Umbilical cord blood (UCB) is an important source of HSCs. However, it is difficult to obtain a sufficient number of HSCs with complete self-renewal capability derived from a single unit of UCB for use in adult transplantation. In this study, we investigated two novel three-dimensional (3D) culture systems (static and rotating) for ex vivo expansion of HSCs from UCB. We encapsulated the human cord blood mononuclear cells (CBMCs) in alginate 3D static and rotating culture systems, compared the cell number amplification, the proportion of CD34+ cells, and the colony-forming capacity of these systems to those of the conventional two-dimensional (2D) system. The amplified cells were transplanted into nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice to confirm the hematopoiesis reconstruction capacity of the cells. The increase in the cell number and the proportion of CD34+ cells in the CBMCs was more effective in these 3D alginate culture systems than in the conventional 2D culture system under the same conditions (p < 0.05). The stem cell maintenance capability was confirmed by flow cytometry and colony-forming assay ex vivo and NOD/SCID mice xenogeneic transplantation model in vivo. Our results demonstrated that these 3D alginate culture systems are an efficient way to amplify cord blood HSCs for extended periods without having them lose their self-renewal capacity in vivo. These novel 3D alginate culture systems are promising for the amplification of UCB-derived HSCs for clinical application in the future.

Blood stem cell products: Toward sustainable benchmarks for clinical translation

Robust ex vivo expansion of umbilical cord blood (UCB) derived hematopoietic stem and progenitor cells (HSPCs) should enable the widespread use of UCB as a source of cells to treat hematologic and immune diseases. Novel approaches for HSPC expansion have recently been developed, setting the stage for the production of blood stem cell derived products that fulfill our current best known criteria of clinical relevance. Translating these technologies into clinical use requires bioengineering strategies to overcome challenges of scale-up, reproducibility, and product quality assurance. Clinical-scale implementation should also define criteria and targets for cost-effective cell manufacturing. As production strategies become more effective, new opportunities in the therapeutic use of ex vivo expanded hematopoietic cell products will emerge. Herein we examine key technological milestones that need to be met in order to move ex vivo expanded HSPC therapies from the bench-top to the bedside in a robust and reliable manner.

Expression of scleraxis and tenascin C in equine adipose and umbilical cord blood derived stem cells is dependent upon substrata and FGF supplementation

Recovery from tendon injury is based on long periods of rest, which results in sub-optimal repair, often replacing tendon with fibrocartilage scar tissue. Recently, the use of stem cells in equine tendon repair has been attempted with variable success. The objective of this work was to determine the expression of scleraxis (scx) and tenascin C (TnC), two markers of tenocytes, in adipose (AdMSC) and umbilical cord blood (UCB) stem cells during culture on various substrata and in response to fibroblast growth factor (FGF) treatment. Equine UCB and AdMSC were cultured on gelatin-coated plasticware, 30% matrigel or collagen-coated Cytodex beads and treated with 10ng/ml FGF2, FGF4 or FGF5 prior to measurement of proliferation, kinase activity and tenocyte gene expression. Supplementation with FGF2 or FGF5 activated the ERK1/2 signaling pathway in AdMSC and UCB; no effect of FGF4 was observed in UCB. FGF2 increased proliferation in AdMSC but not UCB. Conversely, FGF5 stimulated proliferation of UCB. Culture in matrigel increased scx expression in both cell populations and increased TnC in AdMSC. In AdMSC grown in matrigel, supplementation with FGF2 or FGF5 increased TnC expression. Thus, culture conditions (substrata and FGF supplementation) impact markers of tenocytes in AdMSC and UCB stem cells, indicating that careful consideration should be given to culture conditions prior to use of UCB or AdMSC as therapeutic aids. Optimal culture conditions may promote early differentiation of these cells, improving their ability to aid tendon regeneration and facilitating more efficient recovery from tendon injury.

Umbilical Cord Blood Hematopoietic Stem Cell Expansion Ex Vivo

Umbilical cord blood is an attractive source of hematopoietic stem and progenitor cells in the treatment of hematologic diseases, especially in allogeneic hematopoietic cell transplantation. However, due to the low abundance of these cells, the therapeutic use of umbilical cord blood has been limited mostly to the pediatric setting. The strategies for adult umbilical cord blood transplantation have been improved, with the recent development of various approaches for expanding stem cells in vitro and enhancing their long-term homing efficiency. In this brief review, we discuss a number of strategies for stimulating the proliferation of umbilical cord blood hematopoietic stem cells in vitro, including the utility of transcription factors and growth factors (cytokine cocktails), as well as co-culturing with stromal cells. Ultimately, we make the case that improvements in umbilical cord blood stem cell expansion will be critical for enhancing transplantation engraftment efficacy and providing potential cure for hematological diseases.

Generation of Functional CLL-Specific Cord Blood CTL Using CD40-Ligated CLL APC

Though remissions have been observed following allo-HSCT for the treatment of CLL, many CLL patients are ineligible for transplant due to the lack of HLA-compatible donors. The use of umbilical cord blood (UCB) permits transplantation of many patients who lack HLA-compatible donors due to reduced requirements for stringent HLA matching between graft and recipient; however, disease relapse remains a concern with this modality. The generation of CLL-specific CTL from UCB T-cells, primed and expanded against the leukemic clone, might enhance the GVL effect and improve outcomes with UCB transplantation. Here we report the generation of functional, CLL-specific CTL using CD40-ligated CLL cells to prime partially-HLA matched UCB T-cells. Functionality and specificity were demonstrated by immune synapse assay, IFN-γ ELISpot, multi-parametric intracellular cytokine flow cytometry, and 51Cr release assay. The use of patient-specific, non-CLL controls demonstrated the generation of both alloantigen and CLL-specific responses. Subsequently, we developed a clinically-applicable procedure permitting separation of alloreactive CTL from leukemia-specific CTL. Leukemia-specific CTL were able to mediate in vivo killing of CLL in humanized mice without concurrent or subsequent development of xenoGVHD. Our results demonstrate that generation of CLL-specific effectors from UCB is feasible and practical, and the results support further exploration of this strategy as a treatment modality for CLL.

Umbilical cord blood transplantation: a maturing technology

Abstract The use of umbilical cord blood (CB) as a source of hematopoietic progenitor cells for patients with high-risk hematologic disorders receiving allogeneic hematopoietic cell transplantations (HCTs) has increased significantly. Single-institution and registry studies have shown a decreased relapse rate and an increased transplantation-related mortality rate with similar overall survival rates after allogeneic HCT with CB compared with other donor sources. The transplantation of double CB units has overcome the dose limitation inherent in a single CB unit and thus has markedly extended the use of CB to larger children and adults. Similarly, the use of reduced intensity conditioning in the CB transplantation setting has allowed the treatment of older patients who would be unable to tolerate the myeloablative regimens used in the original CB transplantation protocols.

Ex vivo expansion of umbilical cord blood: where are we?

Since the first successful clinical use of umbilical cord blood (UCB) in 1988, UCB grafts have been used for over 20,000 patients with both malignant and non-malignant diseases. UCB has several practical advantages over other transplantable graft sources. For example, the ease of procurement, the absence of donor risks, the reduced risk of transmissible infections, and the availability for immediate use make UCB an appealing graft choice. However, UCB grafts suffer from a few limitations related to the limited cell dose available for transplantation in each UCB unit and to defects in UCB stem cell homing. These limitations lead to increased post-transplant complications. In this review, we focus on the issue of limited cell dose in UCB units and discuss the possible approaches to overcome this limitation. We also summarize the various cellular pathways that have been explored to expand UCB units.

A comparative analysis of the opinions from European national and international ethics committees regarding the collection, storage and use of umbilical cord blood.

Since the first cord blood transplant was performed in a patient with Fanconi’s anaemia in 19881, umbilical cord blood has successfully been used as a source of stem cells, mostly in children, for haematopoietic reconstitution in allogeneic haematopoietic stem cell transplantation as an alternative to bone marrow or peripheral blood progenitor cells2. Related and unrelated umbilical cord blood transplants have been used for children with malignant3,4 and non-malignant5 diseases. Fewer data are available on adult cord blood transplants6, with most reported cases involving patients with haemoglobinopathies7. Cord blood as a source of stem cells has important advantages when compared with human leucocyte antigen (HLA)-matched unrelated bone marrow transplants. These advantages include: a lower incidence of Graft-versus-Host disease, absence of risks and pain for donors, immediate availability for access and use, minimal cell manipulation and better long-term immune recovery resulting in a similar long-term survival8. In 1991 the first public cord blood bank was established at the New York Blood Center9. Two main cord blood banking options are available: public and private10–14. Public non-profit accredited cord blood banks receive umbilical cord blood following informed parental consent. Cell count and volume are key parameters for the eligibility of cord blood units for storage. If the unit of blood meets the requisites for therapeutic use it will be screened using a series of tests, registered in international registries and made available to national and foreign transplant centres15. In this case the cord blood becomes the property of the public bank for subsequent clinical use. Approximately 20% of all collected cord blood units meet the established criteria for storage16. Samples that are not suitable, or that cease to be suitable, for storage for therapeutic purposes may be used for research purposes17. In this way society also benefits from discarded blood units18. Most banks co-operate through international registries that list publicly banked cord blood units in searchable databases such as Bone Marrow Donors Worldwide (BMDW), the NetCord Foundation, the National Marrow Donor Program (NMDP) and other national registries, in order to provide access to all patients in need. International accreditation bodies, such as the NetCord Foundation for the Accreditation of Cellular Therapy (FACT) and governmental regulatory requirements are in place to ensure that publicly available cord blood units meet strict quality criteria. On 21st November 2011 the Bone Marrow Donor Worldwide website reported that a total of 497,501 cord blood units were stored by 43 banking networks in 26 countries19. These free and anonymous donations resulted in over 20,000 unrelated cord blood transplantations worldwide20. Private cord blood banks obtain blood samples and store them for individual use by families. In this case the blood remains the property of the child under the guardianship of the parents. Cord blood samples stored in private banks for either autologous or allogeneic transplants (for the infant donor or for a related family member) are not searchable by the public. Indeed, the major criticism of private banks is precisely the non-availability to the public of this blood21. Moreover, both scientific and clinical data show that the estimated chance that an individual will develop a disease treatable with his or her own stored cord blood is between 0.04% and 0.005%22. More than 780,000 cord blood units are stored in over 130 private cord blood banks worldwide23. Other models of banking (family directed24, mixed public-private25, and others) also exist. For instance, in the United Kingdom, Richard Branson launched Virgin Health Bank, an innovative experiment in dual banking (mixed public-private storage): 20% of the cord blood sample is stored for private use, for the child or a family member, and 80% is donated to the public part of the bank, which is accessible to anyone in the world who needs it, at no cost. Virgin Health Bank’s challenge is to combine the known potential of public-sector allogeneic storage with the possible, albeit at present remote, applications of autologous storage in specific fields of regenerative medicine26. Numerous research teams continue to investigate the usefulness of cord blood for purposes other than haematological disorders, including in particular: repairing damage caused by heart disease and infarcts, diabetes mellitus, traumatic brain and spinal injuries and stroke27. Although the therapeutic usefulness of cord blood for these diseases and pathological conditions has not yet been demonstrated and there are currently very few validated indications for autologous storage, significant advances are being made28. In this regard, according to many authors “the possibility for future discovery or additional indications for autologous cord blood transplant” motivates “us to re-examine our attitudes towards private cord blood banking”29. In particular, “directed-family cord blood banking activities should be encouraged”30.

Hematopoietic stem cell transplantation in children with acute leukemia: similar outcomes in recipients of umbilical cord blood versus marrow or peripheral blood stem cells from related or unrelated donors

PurposeThis study compared outcomes in children with acute leukemia who underwent transplantations with umbilical cord blood (UCB), bone marrow, or peripheral blood stem cells from a human leukocyte antigen (HLA)-matched related donor (MRD) or an unrelated donor (URD).MethodsThis retrospective study included consecutive acute leukemia patients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) at Samsung Medical Center between 2005 and 2010. Patients received stem cells from MRD (n=33), URD (n=46), or UCB (n=41).ResultsNeutrophil and platelet recovery were significantly longer after HSCT with UCB than with MRD or URD (P<0.01 for both). In multivariate analysis using the MRD group as a reference, the URD group had a significantly higher risk of grade III to IV acute graft-versus-host disease (GVHD; relative risk [RR], 15.2; 95% confidence interval [CI], 1.2 to 186.2; P=0.03) and extensive chronic GVHD (RR, 6.9; 95% CI, 1.9 to 25.2; P<0.01). For all 3 donor types, 5-year event-free survival (EFS) and overall survival were similar. Extensive chronic GVHD was associated with fewer relapses (RR, 0.1; 95% CI, 0.04 to 0.6; P<0.01). Multivariate analysis showed that lower EFS was associated with advanced disease at transplantation (RR, 3.2; 95% CI, 1.3 to 7.8; P<0.01) and total body irradiation (RR, 2.1; 95% CI, 1.0 to 4.3; P=0.04).ConclusionSurvival after UCB transplantation was similar to survival after MRD and URD transplantation. For patients lacking an HLA matched donor, the use of UCB is a suitable alternative.

Hematopoietic stem cell expansion facilitates multilineage engraftment in a nonhuman primate cord blood transplantation model

The use of umbilical cord blood for allogeneic transplantation has increased dramatically over the past years. However, the limited number of cells available in a single cord blood unit remains a serious obstacle. Here, we wished to establish a nonhuman primate cord blood transplantation model that would allow us to test various hematopoietic stem cell expansion and gene therapy strategies. We implemented HOXB4-mediated expansion based on our previous experience with HOXB4 in autologous cells. Cord blood units were divided into two equal parts; half of the cells were transduced with a yellow fluorescent protein control vector and cryopreserved, and half were transduced with a HOXB4GFP vector, expanded, and cryopreserved. Both fractions of cells were transplanted into Macaca nemestrina subjects. We found that neutrophil recovery occurred within 19 days in all animals, and both neutrophil and platelet recovery were substantially accelerated compared to human single unit cord blood transplants. In addition, HOXB4-transduced and expanded cells resulted in superior engraftment of all hematopoietic lineages in all animals over nonexpanded controls. In conclusion, we have successfully established a nonhuman primate cord blood transplantation model and demonstrated that HOXB4 stimulates expansion and engraftment of repopulating cells. The availability of such a model has significant implications for developing and testing strategies to improve clinical cord blood transplantation, as it will allow comparison of different stem cell expansion methodologies within a single animal. Furthermore, it can be used in long-term follow-up studies to determine how specific expansion techniques affect engraftment of various hematopoietic lineages.

Human placenta and chorion: potential additional sources of hematopoietic stem cells for transplantation

Hematopoietic stem cell (HSC) transplantation is an essential element of medical therapy, leading to cures of previously incurable hematological and nonhematological diseases. Many patients do not find matched donors in a timely manner, which has driven efforts to find alternative pools of transplantable HSCs. The use of umbilical cord blood (UCB) as a source of transplantable HSCs began more than two decades ago. However, the use of UCB as a reliable source of HSCs for transplantation still faces crucial challenges: the number of HSCs present in a unit of UCB is usually sufficient for younger children but not for adults, and the persistent delayed engraftment often seen can result in high rates of infection and mortality. We propose a new approach to a solution of these problems: a potential increase of the limited number of UCB-HSCs available by harvesting HSCs contained in the placenta and the fetal chorionic membrane available at birth. We investigated the presence of hematopoietic progenitors and HSCs in human placenta and chorion at different gestational ages. The characterization of these cells was performed by flow cytometry and immunolocalization, and their functional status was investigated by transplanting them into immunodeficient mice. HSCs are present in extraembryonic tissues and could be banked in conjunction to the UCB-HSCs. This novel approach could have a large impact on the field of HSC banking and, more crucially, on the outcome of patients undergoing this treatment by greatly improving the use of life-saving hematopoietic transplants.

Awareness and acceptance of public cord blood banking among practicing obstetricians in the United States

This study measured: 1) levels of awareness and understanding among practicing obstetricians regarding umbilical cord blood (UCB) donation and the use of UCB in transplant therapy, 2) motivations for obstetricians to support donation and collection for donation to a public cord blood bank (CBB), and 3) current practices for discussing this option with their patients. Obstetricians practicing in major metropolitan areas in the United States were randomly surveyed in 2009. Of 2041 surveys mailed, 295 were returned, 139 from obstetricians with privileges at hospitals affiliated with a public CBB (affiliated) and 156 from obstetricians without such privileges (nonaffiliated). Cross-tabulation analyses were conducted to compare responses between these two groups. Both affiliated and nonaffiliated obstetricians report being somewhat or very familiar with the use of cord blood in transplant therapy (88% vs. 82%, respectively; p = NS), but some misperceptions concerning clinical application exist. Eighty percent of affiliated obstetricians feel confident discussing cord blood options with their patients; however, 49% indicated that they have insufficient knowledge of cord blood donation to effectively answer patients' questions about donation. Obstetricians are generally familiar with the utility of donated cord blood in transplantation, but could benefit from additional information regarding how cord blood is used in transplantation. Further, obstetricians play an important role in encouraging women to donate their baby's cord blood to a public CBB, are willing to do so, and indicate a desire for more information so they can effectively educate their patients.