Umbilical cord blood for allogeneic transplantation in children and adults

Abstract

Summary:Early clinical reports outlining outcomes for primarily pediatric patients undergoing UCB transplantation, point to delayed time to hematopoietic recovery, and favorable incidence and severity of graft-versus-host disease. Intensive clinical and laboratory research is ongoing focused on strategies to foster UCB allogeneic donor engraftment, thereby allowing wider application of this stem cell source for patients requiring allogeneic transplantation. Bone Marrow Transplantation (2001) 27, 1-6. Keywords: umbilical cord blood; allogeneic transplantation Allogeneic blood and bone marrow stem cell transplantation is limited by the availability of suitable HLAmatched related donors. In 1988, umbilical cord blood (UCB) hematopoietic stem cells (HSC) from a related sibling were transplanted successfully into a child with Fanconi anemia. 1 Subsequently, UCB from HLA-mismatched related 2 and unrelated donors has been shown to successfully engraft pediatric 3-8 and a few reported adult patients 6,9-11 with hematologic malignancies, immunodeficiency syndromes, inborn errors of metabolism, or marrow failure syndromes. This article will review the use of UCB as a suitable alternative for allogeneic transplantation. Tables 1 and 2 outline the advantages and disadvantages for the application of UCB as a new source of HSC for patients requiring allogeneic transplantation. UCB collection and bankingSince the first successful unrelated UCB transplant was performed by J Kurtzberg and the pediatric transplant team at Duke University in 1993, 7 clinical and laboratory studies have burgeoned and standard operating procedures have been developed for the collection, processing, and storage of UCB units. [12][13][14][15][16][17][18][19] UCB collection is performed during the final phase of labor or, more commonly, after delivery of

Stem cell factor improves SCID-repopulating activity of human umbilical cord blood-derived hematopoietic stem/progenitor cells in xenotransplanted NOD/SCID mouse model

“…Possible causes include the lower number of HS/PCs infused and the lack of a subpopulation to facilitate HS/PCs engraftment. 3,4 Recently, Wagner et al 6 clarified the importance of graft CD34 þ cell dose in determining the outcome after unrelated donor UCBTs, proposing a dose of 1.7 Â 10 5 CD34 þ cells/kg of the recipient's body weight as the threshold dose for UCBT recipients. 6 Therefore, the majority of UCBTs have been carried out in children due to limited numbers of HS/PCs in a single UCB unit.…”

“…However, compared with bone marrow transplantation (BMT) and mobilized peripheral blood stem cell transplantation (mPBSCT) recipients, UCBT recipients have prolonged recovery periods, which are reported to result from delayed neutrophil and platelet recoveries, and there is a documented 10-15% graft failure rate. [1][2][3][4] The severely delayed hematopoietic reconstitution of UCBT recipients due to their slow engraftment increased the risks of infectious and bleeding complications. Possible causes include the lower number of HS/PCs infused and the lack of a subpopulation to facilitate HS/PCs engraftment.…”

“…[1][2][3][4] Since the initial case, 5 more than 4000 UCB transplants (UCBT) have been performed worldwide to date. However, compared with bone marrow transplantation (BMT) and mobilized peripheral blood stem cell transplantation (mPBSCT) recipients, UCBT recipients have prolonged recovery periods, which are reported to result from delayed neutrophil and platelet recoveries, and there is a documented 10-15% graft failure rate.…”

Autocrine transforming growth factor-β regulation of hematopoiesis: many outcomes that depend on the context

“…TGF-b1 has been shown to regulate the cell surface expression of many cytokine receptors (Dubois et al, 1990(Dubois et al, , 1994Jacobsen et al, 1991aJacobsen et al, , 1992 as well as Fas (Dybedal et al, 1997). Since antisense treatment of 60 cells rescues a mouse from lethal irradiation, the HSC must undergo differentiation to short-term repopulating cells (Yang et al, 2005a, b) Umbilical cord blood cells (UCB) are being used as a source of stem cells in allogeneic bone marrow transplants (Laughlin 2001;Sorrentino, 2004). The good news is that because of the immaturity of the donor immune system, the incidence and severity of graft vs host disease is favorable compared to adult transplants.…”

Cobblestone area-forming cells, long-term culture-initiating cells and NOD/SCID repopulating cells in human neonatal blood: a comparison with umbilical cord blood

“…1,2 At birth, CB is rich in early stem and progenitor cells, thus rendering it an important source of hematopoietic cells for the transplant of patients suffering from malignant and non-malignant diseases. 3 Adult hematopoiesis is essentially a BM event and pluripotent stem cells are rarely detected in the adult circulation.…”