Current status of umbilical cord blood transplantation in children

Abstract

Summary The first umbilical cord blood (UCB) transplantation was performed 30 years ago. UCB transplantation (UCBT) is now widely used in children with malignant and non‐malignant disorders who lack a matched family donor. UCBT affords a lower incidence of graft‐versus‐host disease compared to alternative stem cell sources, but also presents a slower immune recovery and a high risk of infections if serotherapy is not omitted or targeted within the conditioning regimen. The selection of UCB units with high cell content and good human leucocyte antigen match is essential to improve the outcome. Techniques, such as double UCBT, ex vivo stem cell expansion and intra‐bone injection of UCB, have improved cord blood engraftment, but clinical benefit remains to be demonstrated. Cell therapies derived from UCB are under evaluation as potential novel strategies to reduce relapse and viral infections following transplantation. In recent years, improvements within haploidentical transplantation have reduced the overall use of UCBT as an alternative stem cell source; however, each may have its relative merits and disadvantages and tailored use of these alternative stem cell sources may be the optimal approach.

Predictive Value of Dynamic Peri-Transplantation MRD Assessed By MFC Either Alone or in Combination with Other Variables for Outcomes of Patients with T-Cell Acute Lymphoblastic Leukemia

“…Third, we did not perform subgroup analysis of cases who received MSDT due to the small number of patients in subgroup. Therefore, a prospective, multicenter study with training and validation sets is needed to further confirm whether our findings are suitable for T-ALL cases who either received haploidentical HSCT (including haploidentical HSCT based on immune tolerance induced by post-transplantation cyclophosphamide), MSDT, MUD transplantation [5] or umbilical cord blood transplantation [40] .…”

Unresolved issues in allogeneic hematopoietic cell transplantation for non-malignant diseases

“…Unrelated CB has several advantages over unrelated BM or PBSCs, such as more rapid availability and lower incidence of acute and chronic GVHD despite donor-recipient HLA disparity. Unrelated CB also has certain disadvantages, such as higher rates of slow hematological recovery and GF due to the limited cell number of cells transplanted [6,12]. Unrelated cord blood transplantation is often performed for NMDs during infants or young children, as the relatively higher number of cells transplanted can overcome the slow hematological recovery or GF [13].…”

Effects of Structured Exercise Intervention on Fatigue, Quality of Life and Clinical Outcomes During Umbilical Cord Blood Transplantation in Children and Adolescents

“…Umbilical cord blood (UCB) has been a valuable alternative stem cell source for treating malignant and nonmalignant hematopoietic disorders, especially for children 1,2 . With improving survival rates, there has been an increase in the number of pediatric patients who have undergone UCB transplantation (UCBT) 3,4 .…”

“…Compared to other types of hematopoietic stem cell transplantation (HSCT), UCBT patients often suffer from delayed engraftment and higher rates of infection and transplant-related mortality [1][2][3][4] . In addition, patients experience treatment-related negative symptoms during hospitalization, particularly severe fatigue and a decline in quality of life (QoL) [5][6][7] .…”