Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor

Umbilical cord blood has several advantages of immediate availability, no risk to donors, a lower risk for acute and chronic GVHD despite major human leukocyte Ag (HLA) disparity, and a lower risk of transmitting infections. As a result of the early successes with pediatric cord blood transplantation (CBT), cord blood from unrelated donors have been increasingly used as an alternative stem cell source for adult patients with hematological malignancies. Recent single-institute and registry-based studies suggest that CBT is a safe, feasible and effective strategy for adult patients without suitable related or unrelated BM donors. In this review, we focus on recent results of myeloablative CBT in adults.

Section: New Strategies To Enhance Engraftment and Reduce Trmmentioning

confidence: 96%

Cord blood transplantation in adults

Ooi

2009

“…33 The Spanish groups pioneered the combination of a mismatched related or unrelated donor with a single UCBT; the haploidentical donor provides initial early engraftment and the UCB provides durable engraftment. 34 Elegant approaches to ex vivo expansion of cord blood cells are under development by several academic and biotech groups. These include expansion on Notch Ligand, with nicotinamide, and on third-party mesenchymal stem cells.…”

Section: Ucbt In Pediatricsmentioning

confidence: 99%

Umbilical cord blood donation: public or private?

Ballen

Verter²,

Kurtzberg

2015

Umbilical cord blood (UCB) is a graft source for patients with malignant or genetic diseases who can be cured by allogeneic hematopoietic cell transplantation (HCT), but who do not have an appropriately HLA-matched family or volunteer unrelated adult donor. Starting in the 1990s, unrelated UCB banks were established, accepting donations from term deliveries and storing UCB units for public use. An estimated 730 000 UCB units have been donated and stored to date and ∼ 35 000 UCB transplants have been performed worldwide. Over the past 20 years, private and family banks have grown rapidly, storing ∼ 4 million UCB units for a particular patient or family, usually charging an up-front and yearly storage fee; therefore, these banks are able to be financially sustainable without releasing UCB units. Private banks are not obligated to fulfill the same regulatory requirements of the public banks. The public banks have released ∼ 30 times more UCB units for therapy. Some countries have transitioned to an integrated banking model, a hybrid of public and family banking. Today, pregnant women, their families, obstetrical providers and pediatricians are faced with multiple choices about the disposition of their newborn's cord blood. In this commentary, we review the progress of UCB banking technology; we also analyze the current data on pediatric and adult unrelated UCB, including the recent expansion of interest in transplantation for hemoglobinopathies, and discuss emerging studies on the use of autologous UCB for neurologic diseases and regenerative medicine. We will review worldwide approaches to UCB banking, ethical considerations, criteria for public and family banking, integrated banking ideas and future strategies for UCB banking.

“…[1][2][3] In brief, patients were eligible for enrollment if older than 15 years and diagnosed with a high relapse-risk hematologic neoplasm, including CML beyond the initial chronic phase; acute leukemia beyond first remission, with high-risk cytogenetics or poor response to induction chemotherapy; severe myelodysplasia; and high-grade lymphomas with poor response to chemotherapy. Patients included in this study are a subset of those included in a previous study focused on myeloid reconstitution: 2 the 30 patients who were transplanted between July 2004 and December 2007.…”

Section: Regulatory Requirementsmentioning

confidence: 99%

“…This strategy results in early recovery of circulating granulocytes and high rates of cord blood (CB) engraftment and full chimerism, making CBT with single units of relatively low cell content feasible in adults. 1,2 In patients thus treated because of high-risk hematologic neoplasms, the main causes of morbidity and mortality are postengraftment opportunistic infections. Here we report data on the immune reconstitution of 30 adult recipients of dual CB/TPD-MHSC.…”

Section: Introductionmentioning

confidence: 99%

Immune reconstitution after cord blood transplants supported by coinfusion of mobilized hematopoietic stem cells from a third party donor

Martín-Donaire

Rico

Bautista

et al. 2009

Self Cite

Low severity of GVHD, substantial graft vs tumor (GVT) and slow development of protective immunity are welldocumented features of cord blood transplants (CBT). We have evaluated the immune reconstitution of adult recipients of single-unit CBT supported by the coinfusion of third party donor (TPD) mobilized hematopoietic stem cells (MHSC), a procedure-'dual CB/TPD-MHSC transplant'-that results in early recovery of circulating granulocytes, high rates of CB engraftment and full chimerism. Cumulative recovery of natural killer and B cells at or above the median values of normal controls were 1.0 and 0.76 by the sixth and ninth months. Recovery of T cells was much slower, naive cells lagging behind those of memory and effector (committed) immunophenotypes. Serial analyses of signal joint TCR excision circles showed a general pattern of very low levels by the third month after CBT, followed by recovery to levels persistently similar or higher than those observed before transplantation and in normal controls. Our results are consistent with the clinical observations of substantial GVT effect together with low incidence of serious GVHD and slow development of protective immunity and suggest that thymic function contributes substantially to the recovery of T-cell populations in adults receiving dual CB/TPD-MHSC transplants.