Placental-Blood Banking — A New Frontier in Transfusion Medicine

Over more than three decades, The Anthony Nolan Trust (ANT) has provided an unrelated donor (UD) for over 4000 children and adults lacking a suitable family member donor, and has remained at the forefront of developments in haematopoietic stem cell transplantation (HSCT) and bone marrow register management. These three decades have seen major changes in clinical practice of UD-HSCT, including new indications, increased use of alternative haematopoietic cell sources, significant improvement of the outcome as a result of better support care, less-toxic conditioning regimens, and better donor selection, and expansion to older patients with higher comorbidities. In order to foster our goal of improving UD-HSCT availability and outcome in a progressively more complex clinical scenario, a new initiative from ANT was launched in 2005 to convene an experts workshop to address the topical issues in this field. Four consecutive panels addressed factors influencing donor selection and transplant outcome, the use of cord blood, regulatory and accreditation issues, and future developments in this field. This report summarizes the discussions held in this workshop, which will likely develop into a periodic event where transplant clinicians, scientists and registry members will meet to share their experience and vision in the field of UD-HSCT. Bone Marrow Transplantation (2006) 37, 901-908.

Section: Cord Blood Usagementioning

confidence: 99%

Topical issues in unrelated donor haematopoietic stem cell transplants: a report from a workshop convened by the Anthony Nolan Trust in London – 2005

Duarte

Pamphilon

Cornish

et al. 2006

“…Among the 10 patients who engrafted, acute GVHD occurred in eight patients at a median of 11 days from UCB transplant (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. It was of grade I involving only the skin in five, while we observed a more aggressive course of the disease in the remaining three cases with two having grade II acute GVHD and 1 grade III.…”

Section: Gvhdmentioning

confidence: 99%

“…[5][6][7] As an alternative to international bone marrow donor registries, the expansion of UCB banks both in Europe and in North America opened new perspectives of transplantation for a significant proportion of leukemic patients lacking an HLA-matched related donor. [8][9][10] Therefore since April 1995 we adopted a policy of searching stem cell sources in UCB banks for patients with high risk leukemia. So far, 14 patients prepared with an identical regimen of conditioning and GVHD prophylaxis have been submitted to an HLA-mismatched unrelated UCB transplant.…”

mentioning

confidence: 99%

Umbilical cord blood transplant from unrelated HLA-mismatched donors in children with high risk leukemia

Arcese

Guglielmi

Iori

et al. 1999

Summary:In the last 3 years, 14 children with high-risk leukemia (11 ALL, 2 AML and 1 CML) underwent cord blood transplantation from unrelated HLA-mismatched donors at a median of 99 days from the start of search. Eight patients were transplanted in second CR, one in accelerated phase, three at relapse and two patients in first CR. Conditioning regimen (fractionated TBI, etoposide, CY and anti-lymphocyte serum) and prophylaxis of GVHD (CsA and 6-methylprednisolone) were identical for all patients. Neutrophils > 0.5 ؋ 10 9 /l were reached at a median of 33 days from transplant, but in four cases we observed an autologous hematopoietic reconstitution (three spontaneous, one after autologous BM rescue). Acute and chronic GVHD were observed in 10/14 and 3/8 evaluable cases, respectively. Three patients died of transplant-related toxicity and three patients relapsed. The probabilities of event-free, disease-free and overall survival were 50, 53 and 64%, respectively. Cord blood transplant from HLA-mismatched unrelated donor is a valid option for the treatment of children with high-risk leukemia. With our eligibility criteria, conditioning regimen and prophylaxis of graft-versus-host disease, the main obstacles to successful transplant were represented by graft failure and fatal acute GVHD. Keywords: cord blood; leukemia; children; transplantation The majority of children and a significant proportion of adults with acute leukemia may be cured of their disease by standard treatments which do not include up-front allogeneic BMT. However, some patient categories are predicted to have a dismal outcome and may be salvaged by supralethal chemoradiotherapy followed by allogeneic BM rescue. Alternative sources of hemopoietic stem cells might be exploited in patients lacking an HLA-matched related or unrelated BM donor.Hemopoietic progenitor cells have been recognized in the umbilical cord blood (UCB) since 1974. 1 Thereafter, Correspondence: Dr W Arcese, Cattedra di Ematologia, via Benevento 6, 00161 Roma, Italy Received 11 September 1998; accepted 29 October 1998 many studies suggested that the UCB could be employed for transplantation, 2 and finally the first UCB transplant was successfully performed in a patient with Fanconi anemia in 1988. 3 The indication for a UCB transplant extended rapidly from patients with an HLA-matched or -mismatched sibling donor 4 to candidates for transplantation from unrelated donors. [5][6][7] As an alternative to international bone marrow donor registries, the expansion of UCB banks both in Europe and in North America opened new perspectives of transplantation for a significant proportion of leukemic patients lacking an HLA-matched related donor. [8][9][10] Therefore since April 1995 we adopted a policy of searching stem cell sources in UCB banks for patients with high risk leukemia. So far, 14 patients prepared with an identical regimen of conditioning and GVHD prophylaxis have been submitted to an HLA-mismatched unrelated UCB transplant. Five of these patients (UPN 300, UPN 312, UPN 324, U...

“…The possibility of using precursor cells from umbilical cord blood has been demonstrated, [1][2][3] leading to the development of cord blood banks world-wide. [4][5][6] Cord blood transplants are an alternative for providing hematopoietic stem cells in children and adults with hematological disorders. 7 We examined several maternal, obstetric, and neonatal factors, and related them to the characteristics of the cord blood, in order to determine those factors which could help in the choice of the more ideal cords for cryopreservation according to their foreseeable cellularity, volume, CD34 ϩ cells, and other factors.…”

mentioning

confidence: 99%

“…3 A CT scan typically shows multiple hypodense lesions in both hemispheres and basal ganglia with nodular or peripheral enhancement after contrast medium infusion. 3,4 We report a case of fatal disseminated toxoplasmosis infection presenting as a single cerebral hemorrhagic lesion on the CT scan.…”

mentioning

confidence: 99%

Contribution of maternal and neonatal factors to the evaluation of umbilical cord blood

Prat

Hernandez

Ortiz

et al. 1999