Clinical Progress and Preclinical Insights Into Umbilical Cord Blood Transplantation Improvement

Abstract

The application of umbilical cord blood (UCB) as an important source of hematopoietic stem and progenitor cells (HSPCs) for hematopoietic reconstitution in the clinical context has steadily grown worldwide in the past 30 years. UCB has advantages that include rapid availability of donors, less strict HLA-matching demands, and low rates of graft-versus-host disease (GVHD) versus bone marrow (BM) and mobilized peripheral blood (PB). However, the limited number of HSPCs within a single UCB unit often leads to delayed hematopoietic engraftment, increased risk of transplant-related infection and mortality, and proneness to graft failure, thus hindering wide clinical application. Many strategies have been developed to improve UCB engraftment, most of which are based on 2 approaches: increasing the HSPC number ex vivo before transplantation and enhancing HSPC homing to the recipient BM niche after transplantation. Recently, several methods have shown promising progress in UCB engraftment improvement. Here, we review the current situations of UCB manipulation in preclinical and clinical settings and discuss challenges and future directions.

Impact of donor NKG2D and MICA gene polymorphism on clinical outcomes of adult and paediatric allogeneic cord blood transplantation for malignant diseases

“…However, disadvantages of CB, such as lower numbers of HSCs, can lead to delayed engraftment, increased infection, or graft failure. 2 Natural Killer (NK) cells are the first lymphocyte population to reconstitute and proliferate to normal levels within one month post-HCT, 3 providing critical immunity against malignant cells, protecting against infections, and limiting GVHD. 4 NK cell activation is governed by an array of activating and inhibitory killer immunoglobulin-like receptors (KIR) determining their initiation and potency.…”

“…Advantages include rapid availability of donors, less stringent HLA matching requirements, and reduced chronic GVHD compared with bone marrow (BM) or peripheral blood (PB)‐derived HSC. However, disadvantages of CB, such as lower numbers of HSCs, can lead to delayed engraftment, increased infection, or graft failure 2 …”