Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

Teofili, Luciana; Papacci, Patrizia; Orlando, Nicoletta; Bianchi, Maria; Molisso, Anna; Purcaro, Velia; Valentini, Caterina Giovanna; Giannantonio, Carmen; Serrao, Francesca; Chiusolo, Patrizia; Nicolotti, Nicola; Pellegrino, C; Carducci, Brigida; Vento, Giovanni; Stefano, Valerio De

doi:10.1111/bjh.16851

Cited by 25 publications

(32 citation statements)

References 31 publications

(78 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our group has been working for years on an alternative transfusion approach for preterm neonates, based on RBC concentrates obtained from cord blood solidary donations at our public cord blood bank ( 39 ). We have carried out a recent “proof of concept” study demonstrating that cord RBC units prevent HbF depletion in transfused neonates ( 20 ). Likewise, we gathered evidence that neonates receiving transfusions from adult donors experienced at each transfusion a HbF reduction of about 40% of starting levels and that these values slowly recovered during the subsequent weeks if no additional transfusions were administered ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates

Teofili¹,

Papacci

Bartolo³

et al. 2022

Front. Pediatr.

Self Cite

View full text Add to dashboard Cite

Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA (p = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332–15.573, p = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Throughout the study period, ROP examinations were performed by the same experienced pediatric ophthalmologists (DL and AB), and diagnosis and staging of ROP were performed according to standardized criteria ( 19 ). Decisional algorithms for transfusing were the same over the study period and have been detailed elsewhere ( 20 ).…”

Section: Methodsmentioning

confidence: 99%

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates

Teofili¹,

Papacci

Bartolo³

et al. 2022

Front. Pediatr.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Multicomponent CB Banking using platelets, plasma and red blood cells from a proportion of currently discarded CB units could contribute to increasing the therapeutic value and reducing the financial deficit of public CB banking programs ( Querol et al, 2021 ; Scaradavou, 2021 ). International regulatory harmonization and multicenter, large laboratory and clinical studies with sufficient statistical power are necessary to support the preliminary evidences reported in the literature ( Bhattacharya et al, 2001 ; Bhattacharya, 2006 ; Khodabux et al, 2008 ; Khodabux and Brand, 2009 ; Khodabux et al, 2011 ; Hassall et al, 2012 ; Erdem et al, 2014 ; Rosso et al, 2014 ; Versura et al, 2014 ; Yoon, 2014 ; Bianchi et al, 2015 ; Hassall et al, 2015 ; Sharma et al, 2016 ; Piccin et al, 2017a ; Piccin et al, 2017b ; Giannaccare et al, 2017 ; Volpe et al, 2017 ; Bianchi et al, 2018 ; Buzzi et al, 2018 ; Campos et al, 2018 ; Gelmetti et al, 2018 ; Neema, 2018 ; Sarin et al, 2018 ; Sindici et al, 2018 ; Teofili et al, 2018 ; Bianchi et al, 2020 ; Bisceglia et al, 2020 ; Samarkanova et al, 2020c ; Giannaccare et al, 2020 ; González et al, 2020 ; Lopriore et al, 2020 ; Teofili et al, 2020 ; Volpe et al, 2020 ; Samarkanova et al, 2021 ; Torkamaniha et al, 2021 ) and achieve these important goals.…”

Section: Discussionmentioning

confidence: 99%

Recycling Apparent Waste Into Biologicals: The Case of Umbilical Cord Blood in Italy and Spain

Rebulla

Querol

Pupella³

et al. 2022

Front. Cell Dev. Biol.

View full text Add to dashboard Cite

Most public cord blood banking programs are currently facing financial difficulties due to a progressive decline in the number of cord blood transplants performed worldwide and to a high discard rate of the donated units caused by progressively increasing thresholds of the stem cell dose required to perform safe and effective hemopoietic cord blood transplants. Recycling a proportion of unused cord blood units to prepare novel cord blood components obtained with minimal manipulation (platelets, plasma, red blood cells) and to develop more technologically complex products regulated in the US as Cellular and Gene Therapy Products and in Europe as Advanced Therapy Medicinal Products [e.g. virus-specific T cells (VST), natural killer (NK) cells, induced pluripotent stem cells (iPSCs) is a promising strategy to increase the therapeutic value and reduce the financial deficits of public cord blood banking. Based on encouraging preliminary evidences reported in the literature, additional laboratory studies, large multicenter clinical trials and international regulatory harmonization are necessary to achieve these important goals. This article describes organizational, methodological and regulatory advancements developed in Italy and Spain to promote the clinical use of cord blood platelets, plasma and red blood cells.

show abstract

“…CB for special transfusion (extreme preterm babies): [102][103][104][105][106][107] CB RBC transfusions to prevent various complications observed in extremely preterm babies transfused with adult blood including necrotising enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and overall mortality CB plasma and platelet-derived products: [108][109][110][111][112] an innovative therapy for wound healing.…”

Section: Cb Multicomponents For Specialized Transfusionmentioning

confidence: 99%

The wider perspective: cord blood banks and their future prospects

2021

View full text Add to dashboard Cite

Summary Over the past three decades, cord blood transplantation (CBT) has established its role as an alternative allograft stem cell source. But the future of stored CB units should be to extend their use in updated transplant approaches and develop new CB applications. Thus, CBT will require a coordinated, multicentric, review of transplantation methods and an upgrade and realignment of banking resources and operations. Significant improvements have already been proposed to support the clinical perspective including definition of the cellular threshold for engraftment, development of transplantation methods for adult patients, engraftment acceleration with single cell expansion and homing technologies, personalised protocols to improve efficacy, use of adoptive cell therapy to mitigate delayed immune reconstitution, and further enhancement of the graft‐versus‐leukaemia effect using advanced therapies. The role of CB banks in improving transplantation results are also critical by optimizing the collection, processing, storage and characterization of CB units, and improving reproducibility, efficiency and cost of banking. But future developments beyond transplantation are needed. This implies the extension from transplantation banks to banks that support cell therapy, regenerative medicine and specialized transfusion medicine. This new “CB banking 2.0” concept will require promotion of international scientific and technical collaborations between bank specialists, clinical investigators and transplant physicians.

show abstract

Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB‐TrIP study

Cited by 25 publications

References 31 publications

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates

Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates

Recycling Apparent Waste Into Biologicals: The Case of Umbilical Cord Blood in Italy and Spain

The wider perspective: cord blood banks and their future prospects

Contact Info

Product

Resources

About