The Placental/Umbilical Cord Blood Program of the New York Blood Center A Progress Report

Abstract

The transplantation of placental/umbilical cord blood (P/CB) has been used successfully to reconstitute bone marrow function in both related and unrelated recipients. We report here the experience of the New York Blood Center P/CB Program. Since its inception in 1992, over 400 unrelated transplants were supported between July 1993 and September 1997. Overall, event-free survival for all diagnoses and ages approached 0.45. Success and rapidity of engraftment correlated most strongly with the degree of human leukocyte antigen (HLA) disparity and cell dose/kg body weight recipient. Acute graft-versus-host disease (GVHD) was common in all patients but, surprisingly, did not differ between those patients who received grafts having one or more antigen mismatches. Chronic GVHD was uncommon and only rarely contributed to death. These results demonstrate the feasibility of large-scale P/CB banking for the provision of cryopreserved stem cell preparations for unrelated transplants. The degree of the program's success argues strongly for additional P/CB banks in order to increase the likelihood of finding a suitable stem cell preparation for patients for whom related matched donors do not exist.

Eleven million donors in Bone Marrow Donors Worldwide! Time for reassessment?

“…26 For populations with a different racial background than the NW European one, we certainly need more donors, but these can for logistic reasons most efficiently be recruited via cord blood collection. 8 As we just discussed, one of our major weaknesses is that it takes too long before a donor is selected, tested and the pre-transplant work-up of the patient is completed. Figure 4a shows the ED search time span data.…”

“…Many Cord Blood Banks have followed the example of the National Cord Blood Program of the NYBC (NCBP-NYBC) and make a special effort to store cord bloods from minority group donors, which are underrepresented in the registries. 8 This can have a major impact on the ability to provide stem cell transplants to patients from minority groups as illustrated in Table 3. In this table, the performances in the year 2002 of the NYBC and the National Marrow Donor Program (NMDP) are compared for their ability to provide stem cells to minority group patients.…”

“…7 In 1993, Pablo Rubinstein started collections of cord blood units in the first Cord Blood Bank at the New York Blood Center (NYBC) and issued the grafts for the first two matched, unrelated cord blood transplants. 8 The number of registries and donors continued to grow. Today over 11 million bone marrow donors and cord blood units from 58 registries and 36 cord blood banks are available to provide life-saving stem cells to patients in need of them and can easily be contacted through BMDW.…”

“…This is due not only to the advantage of cord blood HLA matching (for A and B at the antigen level and only for DRB1 at the allele level), but also reflects the relatively high numbers of unique HLA phenotypes present in cord blood banks as compared to registry donors. 8,9 The NMDP has since recruited over 50 000 cord blood units in order to be better able to provide stem cells to minority group patients. 1 Many TCs follow nowadays a three line approach, if a patient is in urgent need of a transplant: not only is a suitable stem cell donor and/or cord blood looked for in BMDW, but also at the same time it is checked whether a suitable haploidentical family donor might be preferable.…”

Optimum storage conditions for cord blood-derived hematopoietic progenitor cells prior to isolation

“…Although colonyforming units (CFUs) are still present in cord blood even after 72 h, 2 cryopreservation within 24 h following delivery is recommended to guarantee an optimum output. 7 Another study demonstrated that cord blood units tolerated shipment of up to 48 h without a significant reduction of the cell number, viability or plating efficiency. 8 Quality parameters usually consist of the number of viable cells, CFU and sometimes the frequency of CD34 þ cells, [8][9][10] but the capacities of the isolated progenitor cells have not yet been an objective.…”