Unrelated donor umbilical cord blood transplantation in adults

Abstract

Umbilical cord blood (UCB) has emerged as an appealing alternative source of hematopoietic stem cells for unrelated donor transplantation. Shorter time to transplant and an improved chance of finding a suitable graft are evident advantages over bone marrow transplantation from unrelated donors. The majority of UCB transplants from unrelated donors have been performed in children, but the number in adults has been growing steadily in recent years. We review herein the reported experience with that source of hematopoietic stem cells in adults with hematological malignancies. The available data support the use of UCB transplantation from unrelated donors for young adults with hematological malignancies and no appropriate bone marrow donor, especially for those requiring urgent transplantation.

Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

“…10 In our study cohort, the Kaplan-Meier estimate of neutrophil engraftment was 89% overall, which is similar to that reported in other studies. 1,2,10,14,20,34 Similar to Wagner et al, 10 our results also showed the importance of the CD34 cell dose; UCB recipients who received a higher infused CD34 cell dose (X1.7 Â 10 5 /kg) had a higher probability of engraftment. In addition, the time to neutrophil engraftment was significantly quicker with a higher infused CD34 cell dose.…”

“…The duration of neutropenia was reduced by a median of 8 days in recipients of cord units with a higher CD34 cell count. In contrast to other Unrelated cord blood transplant in Australia and New Zealand TE Petterson et al studies, however, 2,4,6,14,16,17 we found no impact on the probability or speed of neutrophil engraftment with larger infused TNC doses. Similarly, there was no impact of HLA disparity, diagnosis or conditioning regimen on neutrophil engraftment.…”

“…UCB is enriched with haematopoietic progenitor cells and contains sufficient numbers of HSCs to reconstitute most paediatric patients. 1,2,4,6,8,9,17,19,[26][27][28][29][30][31][32][33] Most studies have shown that the nucleated cell dose is of paramount importance for haematopoietic recovery, 2,4,6,14,16,17 Wagner et al 10 have also shown the CD34 cell dose as being a significant variable not only for haematopoietic recovery but also for survival. The importance of CD34 cell dose has been replicated in other studies.…”

“…[1][2][3][4]6,[8][9][10][11] It has been estimated that more than 95% of patients are able to find at least one potential 4 of 6 HLA matched cord blood unit on the National Marrow Donor Registry, with the majority finding a potential five of six match. 12 The known advantages of unrelated UCB over unrelated BM are well documented and include increased speed of availability, 13 absence of risk to the donor, reduced transmission of viral illnesses such as CMV, tolerance of HLA disparity between the donor and recipient, 9,14,15 better minority representation in UCB banks and reduced risk and severity of acute GVHD when compared to BM grafts. 1,2,[4][5][6]9,10,14,16,17 When compared to BM, however, cord blood results in less optimal engraftment kinetics with higher rate of graft failure and slower haematopoietic recovery time.…”

“…12 The known advantages of unrelated UCB over unrelated BM are well documented and include increased speed of availability, 13 absence of risk to the donor, reduced transmission of viral illnesses such as CMV, tolerance of HLA disparity between the donor and recipient, 9,14,15 better minority representation in UCB banks and reduced risk and severity of acute GVHD when compared to BM grafts. 1,2,[4][5][6]9,10,14,16,17 When compared to BM, however, cord blood results in less optimal engraftment kinetics with higher rate of graft failure and slower haematopoietic recovery time. 10,[18][19][20][21][22] Recent reports suggest that unrelated UCB transplants now account for 20% of all allogeneic transplantations performed in young patients less than 20 years of age.…”