Adult umbilical cord blood transplantation: a comprehensive review

Abstract

Recent registry studies have established umbilical cord blood (UCB) transplantation as a safe and feasible alternative to bone marrow transplantion in adults when no sibling donor is available. There is, however, no gold standard to guide optimal treatment choices. We review here factors leading to the choice of the 'best available donor' and 'best available unit' in the case of UCB. For instance, it is clear that higher cell dose may partially overcome the negative impact of certain histocompatibility leukocyte antigen (HLA) disparities in UCB transplantation, leading us to choose the more closely HLA-matched unit with a cell dose 42.5 Â 10 7 /kg. New approaches in adult UCB transplantation are systematically covered, with a quantitative appreciation of the evidence available to date. Reduced intensity conditioning, for example, broadens the range of potential recipients by reducing transplant-related mortality, but suffers from unproven risks and benefits long term. Potential advantages of multiple units over single unit transplants are discussed, with a particular emphasis on confounding factors that impact interpretation. The limited clinical results of ex vivo UCB expansion, the possible benefits of co-infusion of haploidentical cells and controversial issues (e.g. killer immunoglobulin-like receptor matching and alternative graft sources) are also addressed with a debate on the future of UCB transplantation.

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

“…[8][9][10] In addition, several registry and single institution studies have shown, both for children and adults, overall and disease-free survival rates similar to other allogeneic HSC transplants, although with different causes of mortality. [11][12][13][14][15][16][17][18] Slow and low rate of engraftment, infections during lengthy post-transplant neutropenia and toxicity of preparative regimens were recognized as factors for early TRM of CBT in large registry-based observational studies.…”

Cord blood transplantation in adults

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Recently several reviews including the clinical results of adult CBT have been published. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In this review, we focus on recent results of myeloablative CBT in adults.…”

Expansion of human hematopoietic stem cells for transplantation: trends and perspectives

“…perfusion chambers (Koller et al 1998;Van Zant et al 1994), and stirred tanks (De Leon et al 1998;Collins et al 1998;De León et al 2001), showing advantages over static cultures. Reviews on approaches to expand HSC (Robinson et al 2005;Cabrita et al 2003) and clinical trials (Schoemans et al 2006;Devine et al 2003) have been published elsewhere. Therefore, we have focused this review on more recent biotechnological approaches aiming to increase the HSC content for transplantation.…”