Effect of Cord Blood Processing on Transplantation Outcomes after Single Myeloablative Umbilical Cord Blood Transplantation

Abstract

Variations in cord blood manufacturing and administration are common, and the optimal practice, not known. We compared processing and banking practices at 16 public cord blood banks (CBB) in the United States, and assessed transplant outcomes on 530 single umbilical cord blood (UCB) myeloablative transplantations for hematologic malignancies, facilitated by these banks. UCB banking practices were separated into three mutually exclusive groups based on whether processing was automated or manual; units were plasma and red blood cell reduced or buffy coat production method or plasma reduced. Compared to the automated processing system for units, the day-28 neutrophil recovery was significantly lower after transplantation of units that were manually processed and plasma reduced (red cell replete) (odds ratio [OR] 0.19 p=0.001) or plasma and red cell reduced (OR 0.54, p=0.05). Day-100 survival did not differ by CBB. However, day-100 survival was better with units that were thawed with the dextran-albumin wash method compared to the “no wash” or “dilution only” techniques (OR 1.82, p=0.04). In conclusion, CBB processing has no significant effect on early (day 100) survival despite differences in kinetics of neutrophil recovery.

Cord Blood Stem Cell Processing, Banking and Thawing

“…To summarize, The results of outcome of the patients in the first MaxCell series [18] appear to be at least comparable to those reported in the medical literature [19,[23][24][25][26][27][28][29][30][31][32][33][34] and in some instances, superior to those reported for RCR CB products [18,[35][36][37][38][39][40][41][42][43][50][51][52][53][54][55][56][57][58][59]. Though, there are no published data indicating inferior outcomes with transplantation using MaxCell units [8,[35][36][37][38][39][40][41][42][43][50][51][52][53]…”

“…In fact, in clinical studies of MaxCell CB products, outstanding clinical outcome in terms of engraftment and patient survival have been achieved. Table 4 showed published engraftment and survival outcome for transplantation using 1st Gen RCR CB products from diverse CB banks (NYBC, EuroCord, COBLT CBB, London CBB, French CBB) or large outcome data registries, such as CIBMTR or NMDP [19,[23][24][25][26][27][28][29][30][31][32][33][34] versus 2nd/3rd Gen Max Cell CB products [8].…”

“…Ballen et al [34] studied the outcome of manually processed RCR CB products, automated processed RCR CB products, and manually processed MaxCell 2nd Gen CB products. While acknowledging some of the significant design flaws in their study, the authors concluded that automated processing systems resulted in higher day-28 neutrophil recovery than manually processed plasma-reduced products; however, overall survival by day-100 was not different among the three groups.…”

High Integrity and Fidelity of Long-Term Cryopreserved Umbilical Cord Blood for Transplantation

“…The clinical outcomes of transplantation are influenced by the number of TNCs and CD34+ cells, and by HLA (human leukocyte antigen) matching [ 29 , 30 , 31 ]. However, the reduced CB volume post-processing has not been observed to affect transplantation outcomes [ 32 , 33 ]. Cryopreservation for future use and establishment of insurance reimbursement have met the increasing demand for precision health care.…”

The Future State of Newborn Stem Cell Banking

“…For cord blood, clinical outcomes of transplants are influenced by the graft characteristics, including nucleated cell dose, stem cell dose, and HLA match, while the impact of the volume reduction processing technology used in preparing cord blood for cryopreservation is less evident, assuming that units selected meet appropriate criteria for the individual recipient and appropriate methods for thawing are followed [36,37]. While cryopreservation of umbilical cord tissue and placenta as source material have been an integral part of stimulating new avenues of clinical research, their rapid adoption led to a variety of different approaches for preparation and cryopreservation.…”