Umbilical cord blood (UCB) has been used successfully as a source of hematopoietic stem cells (HSCs) for allogeneic transplantation in children and adults in the treatment of hematologic diseases. However, compared with marrow or mobilized peripheral blood stem cell grafts from adult donors, significant delays in the rates and kinetics of neutrophil and platelet engraftment are noted after UCB transplant. These differences relate in part to the reduced numbers of HSCs in UCB grafts. To improve the rates and kinetics of engraftment of UCB HSC, several strategies have been proposed, including ex vivo expansion of UCB HSCs, addition of third-party mesenchymal cells, intrabone delivery of HSCs, modulation of CD26 expression, and infusion of two UCB grafts. This article will focus on ex vivo expansion of UCB HSCs and strategies to enhance UCB homing as potential solutions to overcome the problem of low stem cell numbers in a UCB graft.Keywords cord blood transplantation; CXCR4; engraftment; ex vivo expansion; hematopoietic stem cell; Notch; SDF-1; stem cell homing; umbilical cord blood
Umbilical cord blood as an alternative source of hematopoietic stem cells for hematopoietic transplantsWith more than 12,000 umbilical cord blood (UCB) transplantations performed since 1988 for the treatment of hematologic malignancies and selected non-malignant disorders, UCB has emerged as an alternative source of hematopoietic stem cells (HSCs) for transplantation. This is especially important for minority patients and patients of mixed ethnicity, where UCB is a particularly attractive alternative donor stem cell source because it is readily available with no † Author for correspondence: Tel.: +1 216 368 5693, mary.laughlin@case.edu.For reprint orders, please contact reprints@expert-reviews.com
Financial & competing interests disclosureMary Laughlin has received funding from the NIH (5RC1HL099447-02). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. [3,4]. Despite this, the outcomes in adults undergoing HSC transplant with an UCB graft are significantly influenced by the low cell dose of the graft. Numerous clinical studies have consistently demonstrated that the total nucleated cell (TNC) and CD34 + cell doses in cord blood grafts are highly correlated with the rate of neutrophil and platelet engraftment, as well as the incidence of graft failure and early transplant-related complication [5][6][7][8][9][10][11][12][13]. Based on these studies, critical cell-dose thresholds have been established and outcomes for patients receiving less than the generally accepted threshold of over 2.5 × 10 7 TNC/kg are significantly inferior in terms of engraftment, transplant-related mortality and overall survival. For adult patients and children weighing more than 35-40 ...