Abstract
Selection of cord blood (CB) units for transplantation involves combining both cell dose and HLA matching as independent yet overlapping variables. Cell dose and cell yield at the time of transplant are critical given that the transplants are being performed with minimal cells for reliable engraftment. In transplants for malignant disorders, the greater allogenicity and lower relapse rate associated with the less well-matched units balance any benefit of better HLA matching on TRM. The only factor that has repeatedly been associated with improved outcome post CB transplant is cell dose. The CB inventories are rapidly increasing in size and the quality of CB units being banked (larger, better characterized) is improving. With this, some of our current limitations in CB availability will soon become moot. Explorations into CB expansion and multiple CB unit transplants are addressing the limited cell doses attainable with a single CB collection.1, 2, 3, 4 At this point, one must conclude that bigger is better when selecting CB units for transplantation.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Shpall Ej E, McNiece Ik I, De Lima M, McMannis Jd J, Robinson S, Peled T et al. Transplantation of ex vivo expanded cord blood. Biol Blood Marrow Transplant 2004; 10: 738.
Shpall EJ, Quinones R, Giller R, Zeng C, Baron AE, Jones RB et al. Transplantation of ex vivo expanded cord blood. Biol Blood Marrow Transplant 2002; 8: 368–376.
Peled T, Landau E, Mandel J, Glukhman E, Goudsmid NR, Nagler A et al. Linear polyamine copper chelator tetraethylenepentamine augments long-term ex vivo expansion of cord blood-derived CD34+ cells and increases their engraftment potential in NOD/SCID mice. Exp Hematol 2004; 32: 547–555.
Majhail NS, Brunstein CG, Wagner JE . Double umbilical cord blood transplantation. Curr Opin Immunol 2006; 18: 571–575.
Grewal SS, Barker JN, Davies SM, Wagner JE . Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood 2003; 101: 4233–4244.
Eapen M, Rubinstein P, Zhang MJ, Camitta BM, Stevens C, Cairo MS et al. Comparable long-term survival after unrelated and HLA-matched sibling donor hematopoietic stem cell transplantations for acute leukemia in children younger than 18 months. J Clin Oncol 2006; 24: 145–151.
Bunin N, Carston M, Wall D, Adams R, Casper J, Kamani N et al. Unrelated marrow transplantation for children with acute lymphoblastic leukemia in second remission. Blood 2002; 99: 3151–3157.
Hwang WY, Samuel M, Tan D, Koh LP, Lim W, Linn YC . A meta-analysis of unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplantation in adult and pediatric patients. Biol Blood Marrow Transplant 2007; 13: 444–453.
Chao NJ, Liu CX, Rooney B, Chen BJ, Long GD, Vredenburgh JJ et al. Nonmyeloablative regimen preserves ‘niches’ allowing for peripheral expansion of donor T-cells. Biol Blood Marrow Transplant 2002; 8: 249–256.
Cornetta K, Laughlin M, Carter S, Wall D, Weinthal J, Delaney C et al. Umbilical cord blood transplantation in adults: Results of the prospective cord blood transplantation (COBLT). Biol Blood Marrow Transplant 2005; 11: 149–160.
Laughlin MJ, Eapen M, Rubinstein P, Wagner JE, Zhang MJ, Champlin RE et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med 2004; 351: 2265–2275.
Ballen KK, Spitzer TR, Yeap BY, McAfee S, Dey BR, Attar E et al. Double unrelated reduced-intensity umbilical cord blood transplantation in adults. Biol Blood Marrow Transplant 2007; 13: 82–89.
Brunstein CG, Barker JN, Weisdorf DJ, DeFor TE, Miller JS, Blazar BR et al. Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic disease. Blood 2007; 110: 3064–3070.
Takahashi S, Iseki T, Ooi J, Tomonari A, Takasugi K, Shimohakamada Y et al. Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. Blood 2004; 104: 3813–3820.
Kernan N, Carter S, Wagner J, Baxter-Lowe L, Wall D, Kapoor N . Umbilical cord blood transplantation in pediatric patients: results of the prospective, multi-institutional cord blood transplantation study (COBLT). Biol Blood Marrow Transplant 2006; 12 (Suppl 1): 14 (abstract 33).
Roncarolo MG, Bigler M, Martino S, Ciuti E, Tovo PA, Wagner J . Immune functions of cord blood cells before and after transplantation. J Hematother 1996; 5: 157–160.
Han P, Hodge G . Intracellular cytokine production and cytokine receptor interaction of cord mononuclear cells: relevance to cord blood transplantation. Br J Haematol 1999; 107: 450–457.
Rainsford E, Reen DJ . Interleukin 10, produced in abundance by human newborn T cells, may be the regulator of increased tolerance associated with cord blood stem cell transplantation. Br J Haematol 2002; 116: 702–709.
Gardiner CM, Meara AO, Reen DJ . Differential cytotoxicity of cord blood and bone marrow-derived natural killer cells. Blood 1998; 91: 207–213.
Joshi SS, Tarantolo SR, Kuszynski CA, Kessinger A . Antitumor therapeutic potential of activated human umbilical cord blood cells against leukemia and breast cancer. Clin Cancer Res 2000; 6: 4351–4358.
El Marsafy S, Dosquet C, Coudert MC, Bensussan A, Carosella E, Gluckman E . Study of cord blood natural killer cell suppressor activity. Eur J Haematol 2001; 66: 215–220.
Hodge S, Hodge G, Flower R, Han P . Cord blood leucocyte expression of functionally significant molecules involved in the regulation of cellular immunity. Scand J Immunol 2001; 53: 72–78.
Nomura A, Takada H, Jin CH, Tanaka T, Ohga S, Hara T . Functional analyses of cord blood natural killer cells and T cells: a distinctive interleukin-18 response. Exp Hematol 2001; 29: 1169–1176.
Gorin NC, Labopin M, Rocha V, Arcese W, Beksac M, Gluckman E et al. Marrow versus peripheral blood for geno-identical allogeneic stem cell transplantation in acute myelocytic leukemia: influence of dose and stem cell source shows better outcome with rich marrow. Blood 2003; 102: 3043–3051.
Sierra J, Storer B, Hanson J, Bjerke J, Martin P, Petersdorf E . Transplantation of marrow cells from unrelated donor for the treatment of high-risk acute leukemia: the effect of leukemia burden, donor HLA matching, and marrow cell dose. Blood 1997; 89: 4226–4235.
Hurley C, Baxter-Lowe L, Logan B, Karanes C, Anasetti C, Weisdorf D . National Marrow Donor Program HLA-matching guidelines for unrelated marrow transplants. Biol Blood Marrow Transplant 2003; 9: 610–615.
Lee SJ, Klein J, Haagenson M, Baxter-Lowe LA, Confer DL, Eapen M et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood 2007; 110: 4576–4583.
Peterdorf E, Kollman C, Hurley C, Dupont P, Nademannee A, Bogovich A . Effect of HLA class II gene disparity on clinical outcome in unrelated donor hematopoietic cell transplantation for chronic myeloid leukemia: the US National Marrow Donor Program experience. Blood 2001; 98: 2922–2929.
Flomenberg N, Baxter-Lowe L, Confer D, Fernandez-Vina M, Filipovich A, Horowitz M . Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood 2004; 104: 1923–1930.
Serna DS, Lee SJ, Zhang MJ, Baker S, Eapen M, Horowitz MM et al. Trends in survival rates after allogeneic hematopoietic stem-cell transplantation for acute and chronic leukemia by ethnicity in the United States and Canada. J Clin Oncol 2003; 21: 3754–3760.
Sasazuki T, Juji T, Morishima Y, Kinukawa N, Kashiwabara H, Inoko H . Effect of matching class I alleles on clinical outcome after transplantation of hematopoietic stem cells from an unrelated donor. N Engl J Med 1998; 339: 1177–1185.
Migliaccio AR, Adamson JW, Stevens CE, Dobrila NL, Carrier CM, Rubinstein P . Cell dose and speed of engraftment in placental/umbilical cord blood transplantation: graft progenitor cell content is a better predictor than nucleated cell quantity. Blood 2000; 96: 2717–2722.
Wall DA, Noffsinger JM, Mueckl KA, Alonso III JM, Regan DM, Johnson CE et al. Feasibility of an obstetrician-based cord blood collection network for unrelated donor umbilical cord blood banking. J Matern Fetal Med 1997; 6: 320–323.
Stevens CE, Gladstone J, Taylor PE, Scaradavou A, Migliaccio AR, Visser J et al. Placental/umbilical cord blood for unrelated-donor bone marrow reconstitution: relevance of nucleated red blood cells. Blood 2002; 100: 2662–2664.
Goodwin HS, Grunzinger LM, Regan DM, McCormick KA, Johnson CE, Oliver DA et al. Long term cryostorage of UC blood units: ability of the integral segment to confirm both identity and hematopoietic potential. Cytotherapy 2003; 5: 80–86.
Gluckman E, Rocha V, Arcese W, Michel G, Sanz G, Chan KW et al. Factors associated with outcomes of unrelated cord blood transplant: guidelines for donor choice. Exp Hematol 2004; 32: 397–407.
Rubinstein P, Stevens CE . Placental blood for bone marrow replacement: the New York Blood Center's program and clinical results. Baillieres Best Pract Res Clin Haematol 2000; 13: 565–584.
Wagner JE, Barker JN, DeFor TE, Baker KS, Blazar BR, Eide C et al. Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34 cell dose and HLA disparity on treatment-related mortality and survival. Blood 2002; 100: 1611–1618.
Barker J, Scaradavou A, Stevens C, Rubinstein P . Analysis of 608 umbilical cord blood transplants: HLA-match is a critical determinant of transplant-related mortality in the post-engraftment period even in the absence of acute graft-versus-host disease. Blood 2005; 106 (abstract 303).
Gluckman E, Rocha V . Donor selection for unrelated cord blood transplants. Curr Opin Immunol 2006; 18: 565–570.
Kogler G, Enczmann J, Rocha V, Gluckman E, Wernet P . High-resolution HLA typing by sequencing for HLA-A, -B, -C, -DR, -DQ in 122 unrelated cord blood/patient pair transplants hardly improves long-term clinical outcome. Bone Marrow Transplant 2005; 36: 1033–1041.
van Heeckeren WJ, Fanning LR, Meyerson JH, Fu P, Lazarus HM, Cooper BW et al. Influence of HLA disparity and graft lymphocytes on allogeneic engraftment and survival after umbilical cord blood transplants in adults. Brit J Haematol 2007; 139: 464–474.
Moretta A, Locatelli F, Mingrat G, Rondini G, Montagna D, Comoli P et al. Characterisation of CTL directed towards non-inherited maternal alloantigens in human cord blood. Bone Marrow Transplant 1999; 24: 1161–1166.
van Rood JJ . Double role of HLA in organ transplantation. World J Surg 2000; 24: 823–827.
van Rood JJ, Roelen DL, Claas FH . The effect of noninherited maternal antigens in allogeneic transplantation. Semin Hematol 2005; 42: 104–111.
van Rood JJ, Loberiza Jr FR, Zhang MJ, Oudshoorn M, Claas F, Cairo MS et al. Effect of tolerance to noninherited maternal antigens on the occurrence of graft-versus-host disease after bone marrow transplantation from a parent or an HLA-haploidentical sibling. Blood 2002; 99: 1572–1577.
Wagner JE, Kurtzberg J . Allogeneic umbilical cord blood transplantation. in: Broxmeyer HE (ed). Cellular Characteristics of Cord Blood and Cord Blood Transplantation. AABB Press: Bethesda, MD, 1998, pp 113–145.
Rocha V, Chastang C, Souillet G, Pasquini R, Plouvier E, Nagler A et al. Related cord blood transplants: the Eurocord experience from 78 transplants. Eurocord Transplant group. Bone Marrow Transplant 1998; 21 (Suppl 3): S59–S62.
Gluckman E, Rocha V, Ionescu I, Bierings M, Harris RE, Wagner J et al. Results of unrelated cord blood transplant in fanconi anemia patients: risk factor analysis for engraftment and survival. Biol Blood Marrow Transplant 2007; 13: 1073–1082.
Tomonari A, Takahashi S, Ooi J, Tsukada N, Konuma T, Kobayashi T et al. Impact of ABO incompatibility on engraftment and transfusion requirement after unrelated cord blood transplantation: a single institute experience in Japan. Bone Marrow Transplant 2007; 40: 523–528.
Gluckman E . Cord blood transplantation. Biol Blood Marrow Transplant 2006; 12: 808–812.
Barker JN, Weisdorf DJ, Defor TE, Blazar BR, McGlave PB, Miller JS et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood 2005; 105: 1343–1347.
Majhail N, Brunstein C, Wagner J . Double umbilical cord blood transplantation. Curr Opin Immunol 2006; 18: 571–575.
Lister J, Gryn JF, McQueen KL, Harris DT, Rossetti JM, Shadduck RK . Multiple unit HLA-unmatched sex-mismatched umbilical cord blood transplantation for advanced hematological malignancy. Stem Cells Dev 2007; 16: 177–186.
Chan K, Grimley M, Taylor C, Wall D . Primary graft failure after unrelated donor cord blood transplant: risk factors and management. Blood 2006; 108 (abstract 44): 18a.
Gibbons R . Appendix: G Statistical Report. Cord Blood: Establishing a National Hematopoietic Stem Cell Bank Program. The National Academies Press, 2005, pp 273–282.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wall, D., Chan, K. Selection of cord blood unit(s) for transplantation. Bone Marrow Transplant 42, 1–7 (2008). https://doi.org/10.1038/bmt.2008.100
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2008.100
Keywords
This article is cited by
-
Cord blood attached segment: is this a relevant quality control to predict a good hematopoietic stem cell graft?
Bone Marrow Transplantation (2017)
-
Association of CD34+ and CD90+ Stem Cells of Cord Blood with Neonatal Factors: A Cross-sectional Study
The Indian Journal of Pediatrics (2016)
-
A survey of the supportive care needs of informal caregivers of adult bone marrow transplant patients
Supportive Care in Cancer (2013)
-
Irradiated allogeneic cells enhance umbilical cord blood stem cell engraftment in immunodeficient mice
Bone Marrow Transplantation (2012)
-
Unrelated cord blood transplantation in pediatric patients: a report from Saudi Arabia
Bone Marrow Transplantation (2010)