Total nucleated cells as a sole predictor of distinct targets of hematopoietic potential (<scp>CD</scp>34+ cells) in cord blood units: the results of a large series analysis in autologous cord blood units

Mazzocchetti, Daniele; Berti, Amy Maria; Sartini, Roberta; Lucarini, Alessandra; Ragusa, Giuseppe; Caroli, Matteo Giuliano; Pierelli, Luca

doi:10.1111/trf.12458

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…62 In Italy, a study of 1309 UCB units collected for autologous UCB banking allowed units to be separated by total nucleated cell count, with larger units potentially being eligible for unrelated use and smaller units for family-directed use. 63 The authors conclude that the integrated bank model would increase public UCBT with a reduction in national health-care system costs as private money is being used to expand public inventory, and the quality of autologous UCB would be improved. Family banking is not available to all as a fee is charged, between US $1350 to $2300 initially at accredited banks and a yearly storage fee of $100 to $175.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Umbilical cord blood donation: public or private?

Ballen

Verter²,

Kurtzberg

2015

Bone Marrow Transplant

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Umbilical cord blood (UCB) is a graft source for patients with malignant or genetic diseases who can be cured by allogeneic hematopoietic cell transplantation (HCT), but who do not have an appropriately HLA-matched family or volunteer unrelated adult donor. Starting in the 1990s, unrelated UCB banks were established, accepting donations from term deliveries and storing UCB units for public use. An estimated 730 000 UCB units have been donated and stored to date and ∼ 35 000 UCB transplants have been performed worldwide. Over the past 20 years, private and family banks have grown rapidly, storing ∼ 4 million UCB units for a particular patient or family, usually charging an up-front and yearly storage fee; therefore, these banks are able to be financially sustainable without releasing UCB units. Private banks are not obligated to fulfill the same regulatory requirements of the public banks. The public banks have released ∼ 30 times more UCB units for therapy. Some countries have transitioned to an integrated banking model, a hybrid of public and family banking. Today, pregnant women, their families, obstetrical providers and pediatricians are faced with multiple choices about the disposition of their newborn's cord blood. In this commentary, we review the progress of UCB banking technology; we also analyze the current data on pediatric and adult unrelated UCB, including the recent expansion of interest in transplantation for hemoglobinopathies, and discuss emerging studies on the use of autologous UCB for neurologic diseases and regenerative medicine. We will review worldwide approaches to UCB banking, ethical considerations, criteria for public and family banking, integrated banking ideas and future strategies for UCB banking.

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Section: Ethical Considerationsmentioning

confidence: 99%

Umbilical cord blood donation: public or private?

Ballen

Verter²,

Kurtzberg

2015

Bone Marrow Transplant

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“…However, in selected cases, a human leucocyte antigen (HLA) identical sibling UCB can be used for the treatment of a patient in need of transplantation (Gluckman et al , ). One of the main limitations of UCBT is the low cellular content of a single UCB unit (Wagner et al , ; Warkentin, ; Gluckman et al , Barker et al , ; Mazzocchetti et al , ), and the association between cell dose and outcome after UCBT has already been consistently demonstrated (Gluckman et al , ; Barker et al , ; Mazzocchetti et al , ). While public unrelated cord blood banks have set stringent quality criteria (Warkentin, ), UCB units available for related use have often been stored in private facilities or local cell‐therapy units that do not always follow the same rules, especially those concerning the minimum number of total nucleated cells (TNC) collected, as very often they are stored regardless of the cellular content.…”

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confidence: 99%

Combined cord blood and bone marrow transplantation from the same human leucocyte antigen‐identical sibling donor for children with malignant and non‐malignant diseases

et al. 2014

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SummaryUmbilical cord blood (UCB) from an human leucocyte antigen (HLA)-identical sibling can be used for transplantation of patients with malignant and non-malignant diseases. However, the low cellular content of most UCB units represents a limitation to this approach. An option to increase cell dose is to harvest bone marrow (BM) cells from the same donor and infuse them along with the UCB. We studied 156 children who received such a combined graft between 1992 and 2011. Median age was 7 years and 78% of patients (n = 122) were transplanted for non-malignant diseases, mainly haemoglobinopathies. Acute leukaemia (n = 26) was the most frequent malignant diagnosis. Most patients (91%) received myeloablative conditioning. Median donor age was 1Á7 years, median infused nucleated cell dose was 24Á4 9 10 7 /kg and median follow-up was 41 months. Sixtydays neutrophil recovery occurred in 96% of patients at a median of 17 d. The probabilities of grade-II-IV acute and chronic graft-versus-host disease (GVHD) were 19% and 10%, respectively. Four-year overall survival was 90% (68% malignant; 97% non-malignant diseases) with 3% probability of death. In conclusion, combined UCB and BM transplantation from an HLA-identical sibling donor is an effective treatment for children with malignant and non-malignant disorders with high overall survival and low incidence of GVHD.

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“…For autologous CB the safe minimum dose of CD34 + cells is unknown but, due to the lack of histocompatibility diversities, is supposed to be less than that for allogeneic transplantations. Previously, we observed that volume is a less important predictor than TNC for CD34 + cell content and may not be used as a selection criterion [11]. In order to establish a CBU quality, the number of CD34 + and TNC cells in each CBU represent well de ned predictors but also maternal and neonatal factors should be evaluated for a more accurate quality prediction of individual CBU, also considering future perspectives where CBU might be used in autologous or family related settings for new therapeutic indications.…”

mentioning

confidence: 99%

Predictors of Cord Blood Unit Cell Content in a Volume Unrestricted Large Series Collections: a Chance for a Fast and Cheap Multiparameter Selection Model

Fumarola¹,

Lucarini²,

Lucchetti³

et al. 2022

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Background Cord blood plays a very important role in stem cell transplantation and therapy, with an emerging implication also in regenerative medicine. The number of cells available in a single cord blood unit (CBU), in particular the CD34 + and total nucleated cell (TNC) content, influences the transplantation clinical outcome. We analysed a very large series of CBUs, collected for private banking without any specific volume restriction, to deeply investigate the best predictors of cord blood stem cells content. Methods Maternal and neonatal clinic laboratory data of a total 2583 UCBs were obtained from the InScientiaFides cord blood bank based in Republic of San Marino. Univariate and multivariate analysis were conducted to better interpret the data and to build a predictive model to select, the CBU with high CD34 + content. Results Our univariate analysis show that seasonality and the geographical area affect the quality of umbilical cord blood. Gestational age, babie’s gender and birth weight have a positive correlation with CB TNC content. The babie’s birth weight affect positively also CD34 + content and CBU volume while the cesarean delivery affect the CB volume only. Our predictive model, based on multivariate analysis, shows that male babie’s, gestational age lower to 39 weeks, cesarean delivery and CBUs with a content of TNC higher than 3,44x 108 (group A) have a significant higher CD34 + content than group B (female babie’s, gestational age higher than 39 weeks and vaginal delivery). The group A have a 37,5% of CBUs with a concentration of CD34 + > 2x106, while no CBUs with high concentration of CD34 + were detect in group B. Conclusion This study, conducted on a very large series of CBUs without any specific volume constraint, highlighted the prenatal and maternal factors that significantly influence the quality of the CBU collected. Specifically, it highlights that volume is not the best predictor of CD34 + CBU content; for this reason it cannot be taken into consideration alone for the analysis of the collected samples. Our final aim is to identify relevant factors, immediately available, that help to choice UCB with high CD34 + cell content, especially in simultaneous deliveries.

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Total nucleated cells as a sole predictor of distinct targets of hematopoietic potential (CD34+ cells) in cord blood units: the results of a large series analysis in autologous cord blood units

Abstract: This analysis, carried out on a large, unrestricted CBU series, shows that TNC alone is the best predictor of distinct targets of hematopoietic potential with the chance to predict CBU potentially useful for unrelated recipients or limited for family-directed or autologous use.

Cited by 9 publications

References 12 publications

Umbilical cord blood donation: public or private?

Umbilical cord blood donation: public or private?

Combined cord blood and bone marrow transplantation from the same human leucocyte antigen‐identical sibling donor for children with malignant and non‐malignant diseases

Predictors of Cord Blood Unit Cell Content in a Volume Unrestricted Large Series Collections: a Chance for a Fast and Cheap Multiparameter Selection Model

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