Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Commentary on 2003-808: Infusion of unwashed umbilical cord blood stem cells after thawing for allogeneic transplantation

Bone Marrow Transplantation volume 34, page 741 (2004)Cite this article

Insufficient cell dose is currently the primary limitation to extending cord blood transplantation to adult patients. Excessive cell loss upon removing DMSO from thawed, previously frozen cord blood units (CBUs) further restricts the utility of this stem cell source for transplantation. This has led to experimentation using CBUs that have not been washed,1, 2 despite the report by Kurtzberg et al,3 demonstrating that unwashed CBUs delayed myeloid and platelet engraftment in that study. Delayed engraftment may have been associated with the use of methotrexate given to the study population as GVHD prophylaxis. In all of the published studies to date, platelet engraftment was measured as days to 20 000 per mm3. Further studies are required to determine the best approach for infusion of thawed CBUs, which control for the conditioning regimen (ablative vs nonablative) and GVHD prophylaxis, and monitor platelet engraftment as days to 50 000 per mm3.

The decision to wash a CBU should be dependent upon a number of factors. First, the method used to process the CBU prior to cryopreservation should be taken into consideration. Although most cord blood banks volume-reduce CBUs by removing red blood cells and plasma, this is not a universal practice. There are currently no published data demonstrating that whole-blood CBUs perform better or worse than volume-reduced CBUs with regard to engraftment and/or survival. A whole-blood CBU may be the best option in a given situation and would require washing upon thawing to remove excessive cell debris and free hemoglobin. Second, the effects of DMSO and cell lysis products upon infusion must be evaluated for each recipient, particularly children. When performed carefully (and using the method recommended by the cord blood bank), cell loss can be minimized to 10–15% following a washing procedure. This requires training and ongoing practice at the transplant facility to maintain proficiency. Furthermore, washing protocols can vary substantially from lab to lab even when based on a single published method. The laboratory performing the thawing procedure should have the opportunity to validate the procedure using ‘practice’ units provided by the cord blood bank of origin prior to obtaining the actual CBU intended for transplant.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Hahn T, Bunworasate U, George MC et al. Use of non-volume reduced (unmanipulated after thawing) umbilical cord blood stem cells for allogeneic transplantation results in safe engraftment. Bone Marrow Transplant 2003; 32: 145–150.

    Article  CAS  Google Scholar 

  2. Nagamura-Inoue T, Shioya M, Sugo M et al. Wash-out of DMSO does not improve the speed of engraftment of cord blood transplantation: follow-up of 46 adult patients with units shipped fro a single cord blood bank. Transfusion 2003; 43: 1285–1294.

    Article  Google Scholar 

  3. Kurtzberg J, Laughlin M, Graham ML et al. Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. N Engl J Med 1996; 335: 157–166.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hematology Division, Bone Marrow Transplant, SOM 4C416, University of Utah, School of Medicine, Internal Medicine, 30 N 1900 E, Salt Lake City, 84132, UT, USA

    L Kelley

Authors
  1. L Kelley
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kelley, L. Commentary on 2003-808: Infusion of unwashed umbilical cord blood stem cells after thawing for allogeneic transplantation. Bone Marrow Transplant 34, 741 (2004). https://doi.org/10.1038/sj.bmt.1704652

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704652

Search

Advanced search

Quick links