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Peck RC, Knapp-Wilson A, Burley K, Dorée C, Griffin J, Mumford AD, Stanworth S, Sharplin K. Scoping Review of Factors Associated with Stem Cell Mobilization and Collection in Allogeneic Stem Cell Donors. Transplant Cell Ther 2024; 30:844-863. [PMID: 38851322 DOI: 10.1016/j.jtct.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
There is wide interindividual variation in the efficacy of CD34+ cell mobilization and collection in healthy allogenic hematopoietic stem cell donors. Donor characteristics, blood cell counts, and various factors related to mobilization and collection have been associated with blood CD34+ cell count and CD34+ cell yield after granulocyte colony-stimulating factor (G-CSF) mobilization and collection. Given the heterogenous nature of the literature reporting these associations, in this scoping review we clarify the determinants of CD34+ count and yield. Studies published between 2000 and 2023 reporting allogeneic donors undergoing G-CSF mobilization and peripheral blood stem cell (PBSC) collection were evaluated. Eligible studies were those that assessed blood CD34+ cell count or CD34+ cell yield in the first PBSC collection after mobilization with 4 or 5 days of G-CSF treatment. Associations were recorded between these outcomes and donor factors (age, sex, weight, ethnicity), mobilization factors (G-CSF scheduling or dose), collection factors (venous access, processed blood volume [PBV]) or laboratory factors (blood cell counts at baseline or after mobilization). The 52 studies evaluated between 15 and 20,884 donors. Forty-three studies were retrospective, 33 assessed blood CD34+ cell counts, and 39 assessed CD34+ cell yield from PBSCs. Blood CD34+ cell counts consistently predicted CD34+ cell yield. Younger donors usually had higher blood CD34+ cell counts and CD34+ cell yield. Most studies that investigated the effect of donor ancestry found that donors of non-European ancestry had higher blood CD34+ cell counts after mobilization and higher CD34+ cell yields from collection. The poor consensus about the best predictors of blood CD34+ cell count and yield necessitates further prospective studies, particularly of the role of donor ancestry. The current focus on donor sex as a major predictor requires re-evaluation.
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Affiliation(s)
- Rachel C Peck
- NHS Blood and Transplant, Bristol, United Kingdom; Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.
| | - Amber Knapp-Wilson
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Kate Burley
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | | | - Andrew D Mumford
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Simon Stanworth
- NHS Blood and Transplant, Bristol, United Kingdom; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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2
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Barker JN, Mazis CM, Devlin SM, Davis E, Maloy MA, Naputo K, Nhaissi M, Wells D, Scaradavou A, Politikos I. Evaluation of Cord Blood Total Nucleated and CD34 + Cell Content, Cell Dose, and 8-Allele HLA Match by Patient Ancestry. Biol Blood Marrow Transplant 2019; 26:734-744. [PMID: 31756534 DOI: 10.1016/j.bbmt.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 12/16/2022]
Abstract
How cord blood (CB) CD34+ cell content and dose and 8-allele HLA match vary by patient ancestry is unknown. We analyzed cell content, dose, and high-resolution HLA-match of units selected for CB transplantation (CBT) by recipient ancestry. Of 544 units (286 infused, 258 next-best backups) chosen for 144 racially diverse adult patients (median weight, 81 kg), the median total nucleated cell (TNC) and CD34+cell +contents were higher for Europeans than for non-Europeans: 216 × 107versus 197 × 107 (P = .002) and 160 × 105 versus 132 × 105 (P = .007), respectively. There were marked cell content disparities among ancestry groups, with units selected for Africans having the lowest TNC (189 × 107) and CD34+ cell (122 × 105) contents. Units for non-Europeans were also more HLA-mismatched (P = .017). When only the 286 transplanted units were analyzed, the adverse effect of reduced cell content was exacerbated by the higher weights in some groups. For example, northwestern Europeans (high patient weight, high unit cell content) had the best-dosed units, and Africans (high weight, low unit cell content) had the lowest. In Asians, low cell content was partially compensated for by lower weight. Marked differences in 8-allele HLA-match distribution were also observed by ancestry group; for example, 23% of units for northwestern Europeans were 3/8 to 4/8 HLA-matched, compared with 40% for southern Europeans, 46% for white Hispanics, and 51% for Africans. During the study period, 20 additional patients (17 non-Europeans; median weight, 98 kg) did not undergo CBT owing to the lack of a suitable graft. CB extends transplantation access to most patients, but racial disparities exist in cell content, dose, and HLA match.
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Affiliation(s)
- Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Christopher M Mazis
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kristine Naputo
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Nhaissi
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah Wells
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andromachi Scaradavou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
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McDermott MM, Polonsky TS, Guralnik JM, Ferrucci L, Tian L, Zhao L, Stein J, Domanchuk K, Criqui MH, Taylor DA, Li L, Kibbe MR. Racial Differences in the Effect of Granulocyte Macrophage Colony-Stimulating Factor on Improved Walking Distance in Peripheral Artery Disease: The PROPEL Randomized Clinical Trial. J Am Heart Assoc 2019; 8:e011001. [PMID: 30661439 PMCID: PMC6497365 DOI: 10.1161/jaha.118.011001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/06/2018] [Indexed: 12/14/2022]
Abstract
Background The effects of race on response to medical therapy in people with peripheral artery disease ( PAD ) are unknown. Methods and Results In the PROPEL (Progenitor Cell Release Plus Exercise to Improve Functional Performance in PAD) Trial, PAD participants were randomized to 1 of 4 groups for 6 months: supervised treadmill exercise+granulocyte-macrophage colony-stimulating factor ( GM - CSF ) (Group 1), exercise+placebo (Group 2), attention control+ GM - CSF (Group 3), or attention control+placebo (Group 4). Change in 6-minute walk distance was measured at 12- and 26-week follow-up. In these exploratory analyses, groups receiving GM - CSF (Groups 1 and 3), placebo (Groups 2 and 4), exercise (Groups 1 and 2), and attention control (Groups 2 and 4) were combined, maximizing statistical power for studying the effects of race on response to interventions. Of 210 PAD participants, 141 (67%) were black and 64 (30%) were white. Among whites, GM - CSF improved 6-minute walk distance by +22.0 m (95% CI : -4.5, +48.5, P=0.103) at 12 weeks and +44.4 m (95% CI : +6.9, +82.0, P=0.020) at 26 weeks, compared with placebo. Among black participants, there was no effect of GM - CSF on 6-minute walk distance at 12-week ( P=0.26) or 26-week (-5.0 m [-27.5, +17.5, P=0.66]) follow-up, compared with placebo. There was an interaction of race on the effect of GM - CSF on 6-minute walk change at 26-week follow-up ( P=0.018). Exercise improved 6-minute walk distance in black ( P=0.006) and white ( P=0.034) participants without interaction. Conclusions GM - CSF improved 6-minute walk distance in whites with PAD but had no effect in black participants. Further study is needed to confirm racial differences in GM - CSF efficacy in PAD . Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01408901.
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Affiliation(s)
- Mary M. McDermott
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | | | - Luigi Ferrucci
- Division of Intramural ResearchNational Institute on AgingBaltimoreMD
| | - Lu Tian
- Department of Health Research and PolicyStanford UniversityPalo AltoCA
| | - Lihui Zhao
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - James Stein
- Department of MedicineUniversity of WisconsinMadisonWI
| | - Kathryn Domanchuk
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | | | - Lingyu Li
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Melina R. Kibbe
- Department of SurgeryUniversity of North CarolinaCharlotteNC
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Tahhan AS, Hammadah M, Mohamed-Kelli H, Kim JH, Sandesara PB, Alkhoder A, Kaseer B, Gafeer MM, Topel M, Hayek SS, O’Neal WT, Obideen M, Ko YA, Liu C, Hesaroieh I, Mahar E, Vaccarino V, Waller EK, Quyyumi AA. Circulating Progenitor Cells and Racial Differences. Circ Res 2018; 123:467-476. [PMID: 29930146 PMCID: PMC6202175 DOI: 10.1161/circresaha.118.313282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Blacks compared with whites have a greater risk of adverse cardiovascular outcomes. Impaired regenerative capacity, measured as lower levels of circulating progenitor cells (CPCs), is a novel determinant of adverse outcomes; however, little is known about racial differences in CPCs. OBJECTIVE To investigate the number of CPCs, PC-mobilizing factors, PC mobilization during acute myocardial infarction and the predictive value of CPC counts in blacks compared with whites. METHODS AND RESULTS CPCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34+, CD133+, VEGF2R+, and CXCR4+ epitopes in 1747 subjects, mean age 58.4±13, 55% male, and 26% self-reported black. Patients presenting with acute myocardial infarction (n=91) were analyzed separately. Models were adjusted for relevant clinical variables. SDF-1α (stromal cell-derived factor-1α), VEGF (vascular endothelial growth factor), and MMP-9 (matrix metallopeptidase-9) levels were measured (n=561), and 623 patients were followed for median of 2.2 years for survival analysis. Blacks were younger, more often female, with a higher burden of cardiovascular risk, and lower CPC counts. Blacks had fewer CD34+ cells (-17.6%; [95% confidence interval (CI), -23.5% to -11.3%]; P<0.001), CD34+/CD133+ cells (-15.5%; [95% CI, -22.4% to -8.1%]; P<0.001), CD34+/CXCR4+ cells (-17.3%; [95% CI, -23.9% to -10.2%]; P<0.001), and CD34+/VEGF2R+ cells (-27.9%; [95% CI, -46.9% to -2.0%]; P=0.04) compared with whites. The association between lower CPC counts and black race was not affected by risk factors or cardiovascular disease. Results were validated in a separate cohort of 411 patients. Blacks with acute myocardial infarction had significantly fewer CPCs compared with whites ( P=0.02). Blacks had significantly lower plasma MMP-9 levels ( P<0.001) which attenuated the association between low CD34+ and black race by 19% (95% CI, 13%-33%). However, VEGF and SDF-1α levels were not significantly different between the races. Lower CD34+ counts were similarly predictive of mortality in blacks (hazard ratio, 2.83; [95% CI, 1.12-7.20]; P=0.03) and whites (hazard ratio, 1.79; [95% CI, 1.09-2.94]; P=0.02) without significant interaction. CONCLUSIONS Black subjects have lower levels of CPCs compared with whites which is partially dependent on lower circulating MMP-9 levels. Impaired regenerative capacity is predictive of adverse outcomes in blacks and may partly account for their increased risk of cardiovascular events.
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Affiliation(s)
- Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Heval Mohamed-Kelli
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Belal Kaseer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Mohamad Mazen Gafeer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Matthew Topel
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Wesley T O’Neal
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Malik Obideen
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Iraj Hesaroieh
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ernestine Mahar
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Edmund K. Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Mousavi SH, Abroun S, Zarrabi M, Ahmadipanah M. The effect of maternal and infant factors on cord blood yield. Pediatr Blood Cancer 2017; 64. [PMID: 27905684 DOI: 10.1002/pbc.26381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/05/2016] [Accepted: 11/07/2016] [Indexed: 11/11/2022]
Abstract
Umbilical cord blood (CB) can be used as an alternative hematopoietic stem cell source for transplantation in hematological malignancy and blood disorders. The success of transplantation is highly related to the levels of total nucleated cell and CD34+ cell counts. The evaluation of optimal conditions can decrease the rate of graft rejection due to low cell count and increases the quality of CB units (CBUs) in the blood bank and the success rate of engraftment. To this end, we review the maternal and infant parameters affecting the quality and quantity of CBUs.
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Affiliation(s)
- Seyed Hadi Mousavi
- Department of Hematology, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Abroun
- Department of Hematology, School of Medical Sciences, Tarbiat Modarres University, Tehran, Iran
| | - Morteza Zarrabi
- Royan Stem Cell Technology Institute, Cord Blood Bank, Tehran, Iran
| | - Mona Ahmadipanah
- Royan Stem Cell Technology Institute, Cord Blood Bank, Tehran, Iran
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6
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Panch SR, Yau YY, Fitzhugh CD, Hsieh MM, Tisdale JF, Leitman SF. Hematopoietic progenitor cell mobilization is more robust in healthy African American compared to Caucasian donors and is not affected by the presence of sickle cell trait. Transfusion 2017; 56:1058-65. [PMID: 27167356 DOI: 10.1111/trf.13551] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Granulocyte-colony-stimulating factor (G-CSF)-stimulated hematopoietic progenitor cells (HPCs) collected by apheresis have become the predominant graft source for HPC transplantation in adults. Among healthy allogeneic donors, demographic characteristics (age, sex, body mass index [BMI]) and baseline hematologic counts affect HPC mobilization, leading to variability in CD34+ apheresis yields. Racial differences in HPC mobilization are less well characterized. STUDY DESIGN AND METHODS We retrospectively analyzed data from 1096 consecutive G-CSF-stimulated leukapheresis procedures in healthy allogeneic African American (AA) or Caucasian donors. RESULTS In a multivariate analysis, after adjusting for age, sex, BMI, baseline platelet and mononuclear cell counts, and daily G-CSF dose, peak CD34+ cell mobilization was significantly higher among AAs (n = 215) than Caucasians (n = 881; 123 ± 87 × 10(6) cells/L vs. 75 ± 47 × 10(6) cells/L; p < 0.0001). A ceiling effect was observed with increasing G-CSF dose (10 µg/kg/day vs. 16 µg/kg/day) in AAs (123 ± 88 × 10(6) cells/L vs. 123 ± 87 × 10(6) cells/L) but not in Caucasians (74 ± 46 × 10(6) cells/L vs. 93 ± 53 × 10(6) cells/L; p < 0.001). In AA donors, the presence of sickle cell trait (SCT; n = 41) did not affect CD34+ mobilization (peak CD34+ 123 ± 91 × 10(6) cells/L vs. 107 ± 72 × 10(6) cells/L, HbAS vs. HbAA; p = 0.34). Adverse events were minimal and similar across race. CONCLUSIONS AAs demonstrated significantly better CD34 mobilization responses to G-CSF than Caucasians. This was independent of other demographic and hematologic variables. Studying race-associated pharmacogenomics in relation to G-CSF may improve dosing strategies. Adverse event profile and CD34 mobilization were similar in AA donors with and without SCT. Our findings suggest that it would be safe to include healthy AA donors with SCT in unrelated donor registries.
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Affiliation(s)
- Sandhya R Panch
- Hematology/Transfusion Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Yu Ying Yau
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Courtney D Fitzhugh
- Hematology/Transfusion Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland.,National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Matthew M Hsieh
- Hematology/Transfusion Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland.,National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - John F Tisdale
- Hematology/Transfusion Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland.,National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Susan F Leitman
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Eldjerou LK, Cogle CR, Rosenau EH, Lu X, Bennett CA, Sugrue MW, Hoyne J, Lambert A, Ashley L, Sazama K, Fields G, Wingard JR, Zubair AC. Vitamin D effect on umbilical cord blood characteristics: a comparison between African Americans and Caucasians. Transfusion 2015; 55:1766-71. [DOI: 10.1111/trf.13124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Lamis K. Eldjerou
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | - Christopher R. Cogle
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | - Emma H. Rosenau
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | - Xiaomin Lu
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | | | - Michele W. Sugrue
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | - Jonathan Hoyne
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - Amy Lambert
- Michigan Blood Cord Blood Bank; Grand Rapids Michigan
| | | | - Kathleen Sazama
- San Diego Blood Bank Cord Blood Program; San Diego California
| | - Gary Fields
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
| | - John R. Wingard
- Departments of Pediatric Blood & Marrow Transplantation; Medicine and Biostatistics, University of Florida; Gainesville Florida
| | - Abba C. Zubair
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Jacksonville Florida
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8
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Cord blood collection and banking from a population with highly diverse geographic origins increase HLA diversity in the registry and do not lower the proportion of validated cord blood units: experience of the Marseille Cord Blood Bank. Bone Marrow Transplant 2015; 50:531-5. [PMID: 25621799 DOI: 10.1038/bmt.2014.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/09/2014] [Accepted: 11/29/2014] [Indexed: 12/11/2022]
Abstract
Several Cord Blood (CB) Bank studies suggested that ethnicity impaired CB unit (CBU) qualification. The Bone Marrow Donors Worldwide registries present an over-representation of unrelated donors (UD) from Northwestern European descent. This raises the question of equality of access to hematopoietic stem cells transplant, especially in the Mediterranean zone, which has taken in many waves of immigration. The aim of our study is to address whether, in the Marseille CB Bank, CBU qualification rate is impaired by geographic origin. The study compared biological characteristics of 106 CBU disqualified for total nucleated cell (TNC) count (dCBU) and 136 qualified CBU in relation to registry enrichment and haplotype origin. A high proportion (>80%) of both dCBU and CBU had at least one non-European haplotype and enrich CB and UD registries to a higher extent than those with two European haplotypes (P<0.001). No difference was observed between TNC count and volume according to geographic origin. Our study shows that diverse Mediterranean origins do not have an impact on the CBU qualification rate. Partnership with Mediterranean birth clinics with highly trained staff is a reasonable option to increase the HLA diversity of CB Bank inventories and to improve the representation of minorities.
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9
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Navarrete C. Cord Blood Banking. CORD BLOOD STEM CELLS AND REGENERATIVE MEDICINE 2015. [PMCID: PMC7150031 DOI: 10.1016/b978-0-12-407785-0.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Akyurekli C, Chan JY, Elmoazzen H, Tay J, Allan DS. Impact of ethnicity on human umbilical cord blood banking: a systematic review. Transfusion 2014; 54:2122-7. [DOI: 10.1111/trf.12630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/09/2014] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Celine Akyurekli
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Regenerative Medicine; Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Joshua Y.S. Chan
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
| | - Heidi Elmoazzen
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
| | - Jason Tay
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Clinical Epidemiology Programs; Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - David S. Allan
- Blood and Marrow Transplant Program; Department of Medicine; University of Ottawa; Ottawa Ontario Canada
- Regenerative Medicine; Ottawa Hospital Research Institute; Ottawa Ontario Canada
- National Public Cord Blood Bank; Canadian Blood Services; Ottawa Ontario Canada
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11
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Page KM, Mendizabal A, Betz-Stablein B, Wease S, Shoulars K, Gentry T, Prasad VK, Sun J, Carter S, Balber AE, Kurtzberg J. Optimizing donor selection for public cord blood banking: influence of maternal, infant, and collection characteristics on cord blood unit quality. Transfusion 2014; 54:340-52. [PMID: 23711284 PMCID: PMC3766489 DOI: 10.1111/trf.12257] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/07/2013] [Accepted: 04/09/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Banked unrelated donor umbilical cord blood (CB) has improved access to hematopoietic stem cell transplantation for patients without a suitably matched donor. In a resource-limited environment, ensuring that the public inventory is enriched with high-quality cord blood units (CBUs) addressing the needs of a diverse group of patients is a priority. Identification of donor characteristics correlating with higher CBU quality could guide operational strategies to increase the yield of banked high-quality CBUs. STUDY DESIGN AND METHODS Characteristics of 5267 CBUs donated to the Carolinas Cord Blood Bank, a public bank participating in the National Cord Blood Inventory, were retrospectively analyzed. Eligible CBUs, collected by trained personnel, were processed using standard procedures. Routine quality and potency metrics (postprocessing total nucleated cell count [post-TNCC], CD34+, colony-forming units [CFUs]) were correlated with maternal, infant, and collection characteristics. RESULTS High-quality CBUs were defined as those with higher post-TNCC (>1.25 × 10(9)) with CD34+ and CFUs in the upper quartile. Factors associated with higher CD34+ or CFU content included a shorter interval from collection to processing (<10 hr), younger gestational age (34-37 weeks; CD34+ and CFUs), Caucasian race, higher birthweight (>3500 g), and larger collection volumes (>80 mL). CONCLUSIONS We describe characteristics identifying high-quality CBUs, which can be used to inform strategies for CBU collection for public banks. Efforts should be made to prioritize collections from larger babies born before 38 weeks of gestation. CBUs should be rapidly transported to the processing laboratory. The lower quality of CBUs from non-Caucasian donors highlights the challenges of building a racially diverse public CB inventory.
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Affiliation(s)
- Kristin M. Page
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | | | | | | | - Kevin Shoulars
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | - Tracy Gentry
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | - Vinod K. Prasad
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | - Jessica Sun
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | | | - Andrew E. Balber
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
| | - Joanne Kurtzberg
- Robertson Cell and Translational Therapy Program, Carolinas Cord Blood Bank, Duke University Medical Center, Durham, NC 27705
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Ballen KK, Klein JP, Pedersen TL, Bhatla D, Duerst R, Kurtzberg J, Lazarus HM, LeMaistre CF, McCarthy P, Mehta P, Palmer J, Setterholm M, Wingard JR, Joffe S, Parsons SK, Switzer GE, Lee SJ, Rizzo JD, Majhail NS. Relationship of race/ethnicity and survival after single umbilical cord blood transplantation for adults and children with leukemia and myelodysplastic syndromes. Biol Blood Marrow Transplant 2012; 18:903-12. [PMID: 22062801 PMCID: PMC3874400 DOI: 10.1016/j.bbmt.2011.10.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/25/2011] [Indexed: 12/15/2022]
Abstract
The relationship of race/ethnicity with outcomes of umbilical cord blood transplantation (UCBT) is not well known. We analyzed the association between race/ethnicity and outcomes of unrelated single UCBT for leukemia and myelodysplastic syndromes. Our retrospective cohort study consisted of 885 adults and children (612 whites, 145 blacks, and 128 Hispanics) who received unrelated single UCBT for leukemia and myelodysplastic syndromes between 1995 and 2006 and were reported to the Center for International Blood and Marrow Transplant Research. A 5-6/6 HLA-matched unit with a total nucleated cell count infused of ≥2.5 × 10(7)/kg was given to 40% white and 42% Hispanic, but only 21% black patients. Overall survival at 2 years was 44% for whites, 34% for blacks, and 46% for Hispanics (P = .008). In multivariate analysis adjusting for patient, disease, and treatment factors (including HLA match and cell dose), blacks had inferior overall survival (relative risk of death, 1.31; P = .02), whereas overall survival of Hispanics was similar (relative risk, 1.03; P = .81) to that of whites. For all patients, younger age, early-stage disease, use of units with higher cell dose, and performance status ≥80 were independent predictors of improved survival. Black patients and white patients infused with well-matched cords had comparable survival; similarly, black and white patients receiving units with adequate cell dose had similar survival. These results suggest that blacks have inferior survival to whites after single UCBT, but outcomes are improved when units with a higher cell dose are used.
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Affiliation(s)
- Karen K Ballen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Effects of obstetric factors and storage temperatures on the yield of endothelial colony forming cells from umbilical cord blood. Angiogenesis 2011; 14:381-92. [PMID: 21720855 PMCID: PMC3155043 DOI: 10.1007/s10456-011-9222-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/16/2011] [Indexed: 11/08/2022]
Abstract
As umbilical cord blood (UCB) is a rich source of endothelial colony-forming cells (ECFC), our aim was twofold: (1) to examine potential obstetric selection criteria for achieving the highest ECFC yields from UCB units, and (2) to determine whether transient storage temperatures of fresh UCB and cryopreservation of UCB units affected ECFC yield and function. ECFC quality was assessed before and after cryopreservation by their clonogenic proliferative potential. Of the 20 factors examined, placental weight was the only statistically significant obstetric factor that predicted ECFC frequency in UCB. Studies on the effects of storage revealed that transient storage of fresh UCB at 4°C reduced ECFC yield compared with storage at 22°C, while cryopreservation of UCB MNCs significantly reduced ECFC recoveries. To our knowledge, this is the first demonstration that placental weight and temperature of storage prior to processing or culture have significant effects on ECFC frequency in UCB. Our studies further support the evidence that cryopreservation of UCB MNCs compromises ECFC recovery.
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14
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Chang YH, Yang SH, Wang TF, Lin TY, Yang KL, Chen SH. Complete blood count reference values of cord blood in Taiwan and the influence of gender and delivery route on them. Pediatr Neonatol 2011; 52:155-60. [PMID: 21703558 DOI: 10.1016/j.pedneo.2011.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/05/2010] [Accepted: 08/14/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cord blood banking has become more popular in recent years. Checking cord blood complete blood count (CBC) and white blood cell (WBC) differential counts (DCs) is essential before cryopreserving the cord blood units. Therefore, establishing the normal reference values of cord blood CBC and WBC DC is important in clinical practice and research. OBJECTIVES To obtain a large-scale population-based normal CBC and WBC DC reference values of healthy neonates' cord blood from a public cord blood bank and to investigate the influence of the gender and delivery route. METHODS From September 2001 to November 2006, the cord blood of healthy Taiwanese neonates with gestational age 36 weeks and more were collected by Tzu Chi Cord Blood Bank with written informed consents. All cord blood samples were analyzed by Sysmex XE2100 automated hematology analyzer (Sysmex Corporation, Kobe, Japan) to obtain the CBC. The WBC DC was calculated by manual method. We used Student's t test and Mann-Whitney U test for investigating the influences of gender and delivery route on the CBC and WBC DC reference values. The results were presented by mean±standard deviation or 2.5-97.5th percentiles. RESULTS In the study period, totally 5602 cord blood samples were collected eligibly for analysis. The cord blood CBC and WBC DC normal reference values were calculated. The female neonates had significantly higher mean corpuscular volume, platelet count, and WBC count, but lower red blood cell (RBC) count, hemoglobin (Hb), hematocrit, and mean corpuscular Hb concentration values (p<0.001). Newborns through vaginal delivery had significantly higher RBC count, Hb, hematocrit, platelet count, and WBC count (p<0.001). The percentages of some different types WBC were significantly influenced by gender and delivery routes. Male babies had higher lymphocyte, monocyte, eosinophil, basophil, and nucleated RBC ratios than the female neonates. Newborns through cesarean section had significantly lower neutrophil, monocyte, and nucleated RBC ratios, but higher lymphocyte and eosinophil ratios, than newborns through vaginal delivery. CONCLUSION We successfully obtained the normal CBC and WBC DC reference values of the cord blood in Taiwan. Gender and delivery routes were important confounding factors that influenced the cord blood CBC and WBC DC values.
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Affiliation(s)
- Yu-Hsun Chang
- Department of Pediatrics, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan
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15
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Balan S, Kale VP, Limaye LS. A large number of mature and functional dendritic cells can be efficiently generated from umbilical cord blood-derived mononuclear cells by a simple two-step culture method. Transfusion 2011; 50:2413-23. [PMID: 20497510 DOI: 10.1111/j.1537-2995.2010.02706.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Advances in the past two decades in dendritic cell (DC) biology paved the way to exploit them as a promising tool in cancer immunotherapy. The prerequisite for DC vaccine preparations is large-scale in vitro generations of homogeneous, mature, and functional DCs. Frequent improvements are being made in the existing in vitro DC production protocols to achieve this goal. In our previous study we reported a large-scale generation of mature, functional DCs from umbilical cord blood (UCB) CD34+ cells. Here we report that this method can be used for the efficient generation of DCs from UCB mononuclear cells (MNCs) and thus the hematopoietic stem cell isolation step is not essential. STUDY DESIGN AND METHODS MNCs or CD34+ cells isolated from the same cord blood (CB) samples were used for the generation of DCs. DCs were characterized for morphology, phenotype, and functional assays including antigen uptake, chemotaxis, and mixed leukocyte reaction. Similarly DCs generated from the MNCs of same fresh and frozen CB units were compared. RESULTS The morphologic, phenotypic, and functional characterization of the DCs generated from various sets show that they were comparable in nature irrespective of the starting population used. CONCLUSION We conclude that the CD34+ isolation step is not essential for the generation of mature, functional DCs and thus can be eliminated. More importantly, we show that DCs can be generated with equal efficiency from the MNCs of frozen CB units. Our culture method will be useful for exploiting the potential of UCB as an additional source for allogeneic DCs in the clinical settings.
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Affiliation(s)
- Sreekumar Balan
- National Centre for Cell Science, Pune University Campus, Pune, India
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16
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Hsieh MM, Tisdale JF, Rodgers GP, Young NS, Trimble EL, Little RF. Neutrophil count in African Americans: lowering the target cutoff to initiate or resume chemotherapy? J Clin Oncol 2010; 28:1633-7. [PMID: 20194862 DOI: 10.1200/jco.2009.24.3881] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institute of Diabetes, Digestive, and Kidney Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Kurtzberg J, Prasad VK, Carter SL, Wagner JE, Baxter-Lowe LA, Wall D, Kapoor N, Guinan EC, Feig SA, Wagner EL, Kernan NA. Results of the Cord Blood Transplantation Study (COBLT): clinical outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with hematologic malignancies. Blood 2008; 112:4318-27. [PMID: 18723429 PMCID: PMC2581998 DOI: 10.1182/blood-2007-06-098020] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 08/08/2008] [Indexed: 11/20/2022] Open
Abstract
Outcomes of unrelated donor cord blood transplantation in 191 hematologic malignancy children (median age, 7.7 years; median weight, 25.9 kg) enrolled between 1999 and 2003 were studied (median follow-up, 27.4 months) in a prospective phase 2 multicenter trial. Human leukocyte antigen (HLA) matching at enrollment was 6/6 (n = 17), 5/6 (n = 58), 4/6 (n = 111), or 3/6 (n = 5) by low-resolution HLA-A, -B, and high-resolution (HR) DRB1. Retrospectively, 179 pairs were HLA typed by HR. The median precryopreservation total nucleated cell (TNC) dose was 5.1 x 10(7) TNC/kg (range, 1.5-23.7) with 3.9 x 10(7) TNC/kg (range, 0.8-22.8) infused. The median time to engraftment (absolute neutrophil count > 500/mm(3) and platelets 50 000/muL) was 27 and 174 days. The cumulative incidence of neutrophil engraftment by day 42 was 79.9% (95% confidence interval [CI], 75.1%-85.2%); acute grades III/IV GVHD by day 100 was 19.5% (95% CI, 13.9%-25.5%); and chronic GVHD at 2 years was 20.8% (95% CI, 14.8%-27.7%). HR matching decreased the probability of severe acute GVHD. The cumulative incidence of relapse at 2 years was 19.9% (95% CI, 14.8%-25.7%). The probabilities of 6-month and 2-year survivals were 67.4% and 49.5%. Unrelated donor cord blood transplantation from partially HLA-mismatched units can cure many children with leukemias. The study was registered at www.clinicaltrials.gov as #NCT00000603.
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19
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Raj R. Progress in Umbilical Cord Blood Transplantation. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60485-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Donor demographic and laboratory predictors of allogeneic peripheral blood stem cell mobilization in an ethnically diverse population. Blood 2008; 112:2092-100. [PMID: 18523146 DOI: 10.1182/blood-2008-03-143677] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A reliable estimate of peripheral blood stem cell (PBSC) mobilization response to granulocyte colony-stimulating factor (G-CSF) may identify donors at risk for poor mobilization and help optimize transplantation approaches. We studied 639 allogeneic PBSC collections performed in 412 white, 75 black, 116 Hispanic, and 36 Asian/Pacific adult donors who were prescribed G-CSF dosed at either 10 or 16 microg/kg per day for 5 days followed by large-volume leukapheresis (LVL). Additional LVL (mean, 11 L) to collect lymphocytes for donor lymphocyte infusion (DLI) and other therapies was performed before G-CSF administration in 299 of these donors. Day 5 preapheresis blood CD34(+) cell counts after mobilization were significantly lower in whites compared with blacks, Hispanics, and Asian/Pacific donors (79 vs 104, 94, and 101 cells/microL, P < .001). In addition, donors who underwent lymphapheresis before mobilization had higher CD34(+) cell counts than donors who did not (94 vs 79 cells/microL, P < .001). In multivariate analysis, higher post-G-CSF CD34(+) cell counts were most strongly associated with the total amount of G-CSF received, followed by the pre-G-CSF platelet count, pre-G-CSF mononuclear count, and performance of prior LVL for DLI collection. Age, white ethnicity, and female gender were associated with significantly lower post-G-CSF CD34(+) cell counts.
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Wofford J, Kemp J, Regan D, Creer M. Ethnically mismatched cord blood transplants in African Americans: the Saint Louis Cord Blood Bank experience. Cytotherapy 2008; 9:660-6. [PMID: 17917882 DOI: 10.1080/14653240701620570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND For ethnic minority patients where a suitably matched BM or peripheral blood donor is frequently unavailable, cord blood offers an opportunity for hematopoietic stem cell transplantation. Focused recruitment of ethnic minorities for cord blood donation has been proposed as the preferred strategy to improve access for minority recipients to cord blood for transplantation. The aim of this study was to evaluate cord blood characteristics for Caucasian and African American donors and the success of ethnically mismatched UC blood transplantation in African American recipients. METHODS Retrospective data analysis was performed comparing the characteristics of 556 cord blood units from African American and Caucasian donors. The outcomes of 18 African American ethnically mismatched transplant recipients were compared with a paired sample of 18 ethnically matched Caucasian recipients. RESULTS The fraction of collected units meeting acceptability criteria from African Americans was significantly lower compared with Caucasians (P = <0.0001). Additionally, African Americans had a significantly lower post-processing total nucleated cell count (TNC) compared with Caucasians (P=0.007) but there were no other significant differences in conventionally measured product characteristics. In the transplant analysis, there was no difference in overall survival at 1 year (P=0.85) or time to neutrophil engraftment (P=0.92) between the two patient populations. DISCUSSION At comparable levels of TNC dose and HLA matching, the use of ethnically mismatched UC blood units as a source for allogeneic unrelated transplant can result in successful transplant outcomes for African American patients.
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Affiliation(s)
- J Wofford
- Saint Louis Cord Blood Bank at SSM Cardinal Glennon Children's Medical Center, St Louis, MO 63110, USA.
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22
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Ballen KK, Haley NR, Kurtzberg J, Lane TA, Lindgren BR, Miller JP, Newman B, McCullough J. Outcomes of 122 diverse adult and pediatric cord blood transplant recipients from a large cord blood bank. Transfusion 2007; 46:2063-70. [PMID: 17176317 DOI: 10.1111/j.1537-2995.2006.01032.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Umbilical cord blood is a useful stem cell source for some patients. The American Red Cross Cord Blood Program was established as a national network of cord blood banks. Nine thousand cord blood units were cryopreserved for transplant use. STUDY DESIGN AND METHODS This report summarizes the experience with the first 125 cord blood units that have been distributed for transplant for 122 patients at 36 different transplant centers worldwide. Patients were treated with a variety of conditioning regimens. RESULTS Most patients had acute myelogeneous leukemia (21%), genetic disorders (22%), or acute lymphoblastic leukemia (18%). The median age of the patients was 11 years with a range of 2 months to 63 years. The patients ranged in size from 3 to 120 kg (median, 39 kg). The median number of days to neutrophil engraftment was 22, and the median number of days to platelet engraftment was 63. Thirty percent of patients experienced Grades III to IV acute graft-versus-host disease (GVHD). Survival at 1 year after transplant was 35 percent, with recurrent disease the major cause of death. In multivariate analysis, only age less than 18 years was a significant predictor for improved survival. Forty-two percent of patients were non-Caucasian. Engraftment, GVHD, survival, and disease-free survival were similar among Caucasian and non-Caucasian patients. CONCLUSION Umbilical cord blood serves as a satisfactory stem cell source for a diverse group of pediatric and adult patients.
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Affiliation(s)
- Karen K Ballen
- American Red Cross Cord Blood Program, St Paul, Minnesota, USA.
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Umbilical Cord Blood (UCB) Transplantation: An Alternative to the Use of Unrelated Volunteer Donors? Hematology 2007:55-61. [DOI: 10.1182/asheducation-2007.1.55] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractCryopreserved umbilical cord blood (UCB) from 4-6/6 HLA-A,B antigen and DRB1 allele matched unrelated neonatal donors contains sufficient numbers of hematopoietic stem cells (HSC) to engraft most younger pediatric patients with leukemia. Recent data demonstrate promising results in larger children and adults, as well as in patients with nonmalignant disorders. As a result, the number of UCB transplantations (UCBT) being performed is increasing dramatically. UCB has the clear benefits of rapid availability and a reduced stringency of requirement for HLA match. The latter attribute has the potential to extend the donor pool, which is of great importance for racial and ethnic minorities. Furthermore, new preparative regimens combined with double-unit grafts have been associated with improved engraftment and survival in larger children and adults, making UCBT a viable potential alternative to unrelated volunteer donor transplantation, especially in preference to transplantation using mismatched volunteers. This review summarizes the current status of unrelated donor UCBT and describes both the challenges and current areas of research associated with this HSC source.
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Abstract
In recent years, umbilical cord blood, which contains a rich source of hematopoietic stem and progenitor cells, has been used successfully as an alternative allogeneic donor source to treat a variety of pediatric genetic, hematologic, immunologic, and oncologic disorders. Because there is diminished risk of graft-versus-host disease after transplantation of cord stem cells using matched related donors, the use of less-than-completely matched HLA cord blood stem cells may incur less risk of graft-versus-host disease than mismatched cells from either a related or unrelated "walking" donor, although this remains to be proven. Gene-therapy research involving modification of autologous cord blood stem cells for the treatment of childhood genetic disorders, although experimental at the present time, may prove to be of value. These scientific advances have resulted in the establishment of not-for-profit and for-profit cord blood-banking programs for allogeneic and autologous cord blood transplantation. Many issues confront institutions that wish to establish or participate in such programs. Parents often seek information from their physicians about this new biotechnology option. This document is intended to provide information to guide physicians in responding to parents' questions about cord blood donation and banking and the types and quality of cord blood banks. Provided also are recommendations about appropriate ethical and operational standards, including informed consent policies, financial disclosures, and conflict-of-interest policies for physicians, institutions, and organizations that operate or have a relationship with cord blood-banking programs.
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George TJ, Sugrue MW, George SN, Wingard JR. Factors associated with parameters of engraftment potential of umbilical cord blood. Transfusion 2006; 46:1803-12. [PMID: 17002638 DOI: 10.1111/j.1537-2995.2006.00971.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Umbilical cord blood (UCB) is an acceptable source of hematopoietic cells for transplantation with success being associated with the nucleated cell count (NCC), CD34+ cells, and colony-forming unit-granulocyte-macrophage (CFU-GM) content infused. A total of 1033 UCB samples with neonatal and paternal characteristics that might influence hematopoietic content were examined. STUDY DESIGN AND METHODS UCB samples were screened, processed, and reevaluated for the above cell counts. These parameters of engraftment potential were analyzed for associations with neonatal and parental characteristics. RESULTS Postprocessed NCCs (median, 6.53 x 10(8)+/- 2.80 x 10(8) SD; mean 7.30 x 10(8)), CD34+ counts (median, 2.02 x 10(6) +/- 2.20 x 10(6) SD; mean, 2.65 x 10(6); r = 0.66; p < 0.001), and CFU-GM content (median, 2.65 x 10(5) +/- 3.16 x 10(5) SD; mean, 3.54 x 10(5); r = 0.61; p < 0.001) all were strongly interrelated. Both initial volume (median, 77.5 +/- 26.2 mL SD; mean, 81.9 mL) and initial NCC (median, 9.75 x 10(8) +/- 4.88 x 10(8) SD; mean, 10.9 x 10(8)) correlated well with postprocessed NCC (r = 0.60; r = 0.90; p < 0.01), CD34+ count (r = 0.40; r = 0.63; p < 0.01), and CFU-GM content (r = 0.38; r = 0.59; p < 0.01), with a stronger relationship seen with initial NCC. Infant birth weight (specifically, >3000 g), but not sex, gestational age, or cytomegalovirus status correlated strongly with collection volume and UCB cell counts. Units from minority volunteers contained relatively smaller volumes and hematopoietic content. CONCLUSION UCB banks should emphasize selecting the heaviest infants and processing large-volume units with high NCCs to optimize hematopoietic potential. Minority recruitment should be encouraged with consideration given to inherent racial differences in cell counts. There does not appear to be a significant relationship between other neonatal and parental characteristics and that of engraftment potential.
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Affiliation(s)
- Thomas J George
- University of Florida, College of Medicine, Gainesville, Florida, USA.
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Petropoulos D, Chan KW. Umbilical cord blood transplantation. Curr Hematol Malig Rep 2006; 1:197-200. [PMID: 20425351 DOI: 10.1007/s11899-996-0008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the past decade umbilical cord blood has been established as a viable source of hematopoietic stem cells for allogeneic transplantation. Early experience with umbilical cord blood transplantation (CBT) demonstrated a lower incidence of graft-versus-host disease even though the procedure was performed with HLA-disparate grafts. The overall outcome of CBT appears similar to that of allogeneic bone marrow transplantation. The expansion of the donor selection is particularly beneficial to ethnic minorities, whose representation in the marrow registries is relatively small. The major drawbacks of CBT are slow hematopoietic recovery and a high incidence of graft failure, as a result of a lower number of progenitors infused. This paper reviews the current results of CBT and ongoing investigations to increase its availability to a larger number of recipients.
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Affiliation(s)
- Demetrios Petropoulos
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Ballen KK, Colvin G, Dey BR, Porter D, Westervelt P, Spitzer TR, Quesenberry PJ. Cellular immune therapy for refractory cancers: novel therapeutic strategies. Exp Hematol 2006; 33:1427-35. [PMID: 16338484 PMCID: PMC1986765 DOI: 10.1016/j.exphem.2005.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 06/10/2005] [Accepted: 06/29/2005] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Allogeneic stem cell transplantation is curative for certain cancers, but the high doses of chemotherapy and radiotherapy may lead to toxicity. This review summarizes the field of cellular immune therapy using very-low-dose conditioning for refractory cancers. METHODS In our initial study, we treated 25 patients with refractory cancers with 100 cGy total body irradiation followed by allogeneic, nonmobilized peripheral blood cells. Eighteen patients received sibling and seven patients received unrelated cord blood stem cells. RESULTS None of the 13 patients with solid tumors achieved donor chimerism or had a sustained response. Twelve patients with hematologic malignancies were treated, 1 received a cord blood transplant and 11 received sibling donor cells. Nine of these 11 patients achieved donor chimerism, ranging from 5% to 100%. Four patients had sustained complete remission of their cancers. The patients who received cord blood transplants did not respond. Development of chimerism correlated with total previous myelotoxic chemotherapy (p < 0.001). We review additional studies in this area, including data in the haploidentical and unrelated donor setting. The data presented comprises studies performed at the four institutions represented by the authors, and a review of other pertinent studies in this area. CONCLUSIONS Cellular immune therapy is an emerging application of transplantation therapy, which may be appropriate for refractory cancers. New studies in solid tumors, and with alternative donors, will expand the application of this new and promising treatment.
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Affiliation(s)
- Karen K Ballen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, 02114, USA.
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28
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Abstract
Over the past decade umbilical cord blood has been established as a viable source of hematopoietic stem cell for allogeneic transplantation. Early experience with umbilical cord blood transplantation (CBT) demonstrated a lower incidence of graft-versus-host disease even though the procedure was performed with HLA-disparate grafts. The overall outcome of CBT appears similar to that of allogeneic bone marrow transplant. The expansion of the donor selection is particularly beneficial to ethnic minorities, whose representation in the marrow registries is relatively small. The major drawbacks of CBT are slow hematopoietic recovery and a high incidence of graft failure, as a result of a lower number of progenitors infused. This paper reviews the current results of CBT and ongoing investigations to increase its availability to a larger number of recipients.
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Affiliation(s)
- Demetrios Petropoulos
- Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 87, Houston, TX 77030, USA.
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Abstract
Since the first report of a successful umbilical cord blood transplantation in 1988, there has been great interest in the use of cord blood as an alternative stem cell source to treat cancer and genetic diseases. More than 4000 cord blood transplantations have been performed worldwide. In this review, the scientific rationale for this therapy, as well as related preclinical studies, cord blood banking issues, and ethical concerns, will be addressed. Results of studies in both pediatric and adult transplantation will be discussed. Finally, new indications for cord blood use and emerging technologies will be addressed.
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Affiliation(s)
- Karen K Ballen
- Massachusetts General Hospital, 100 Blossom St, Cox 640, Boston, MA 02114, USA.
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