Unrelated Umbilical Cord Blood Unit Selection

Immobilisation of Delta-like 1 ligand for the scalable and controlled manufacture of hematopoietic progenitor cells in a stirred bioreactor

Background

Umbilical cord blood provides a source of hematopoietic stem cells for transplantation with immunological and availability advantages over conventional bone marrow sources. Limited cell numbers and slower engraftment from umbilical cord blood units has led to the clinical development of immobilised Notch ligand Delta-Like 1 to promote ex vivo expansion of a rapidly engrafting cell population. However, current immobilisation methods are not simple to scale in a controlled manner.

Results

Delta-Like 1 was immobilised onto streptavidin coated magnetic particles via a heterobifunctionalised polyethylene glycol linker molecule to provide an easily manipulated format of surface protein presentation. CD34⁺ enriched cord blood cells were treated with Delta-Like 1 immobilised particles, and immunophenotypic markers measured to monitor population distributions using cluster identification, characterization, and regression software. The amenability of the approach to scalability was evaluated in a micro-scale stirred tank bioreactor. Surface concentration of Delta-Like 1 was well controlled used differing stoichiometric reagent ratios. Protein immobilisation was a cost effective process and particles were efficiently removed from the final cell product. Immobilised Delta-Like 1 is functional and stimulates qualitatively similar CD34^hi, CD38^lo, CD90^lo, CD133^hi, CD135^hi progenitor expansion in both static culture and scalable stirred culture platforms.

Conclusions

Immobilised Delta-Like 1 in this form has the potential to improve the manufacturing efficiency and control of final ex vivo expanded cell product through compatibility with highly controlled and characterised suspension culture systems.

Electronic supplementary material

The online version of this article (doi:10.1186/s12896-017-0383-0) contains supplementary material, which is available to authorized users.

The Impact of High-resolution HLA-A, HLA-B, HLA-C, and HLA-DRB1 on Transplant-related Outcomes in Single-unit Umbilical Cord Blood Transplantation in Pediatric Patients

Current practice for selecting donor units for umbilical cord blood transplant (UCBT) involves matching at HLA-A and HLA-B by low-resolution typing and the HLA-DRB1 allele by high-resolution (HR) typing. We retrospectively studied the impact of HR allele matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1 on transplant-related outcomes in 60 single-unit UCBTs in pediatric patients with malignant and nonmalignant conditions. Five-year overall survival of our cohort was 71% (95% confidence interval, 58-81); 27% experienced primary graft failure. Applying HR typing, donor-recipient mismatch variability increased ranging from 1/8 to 8/8, however, no impact on primary graft failure, graft-versus-host disease or posttransplant infection was observed. UCBTs with ≥6/8 HR matches did have a better overall survival (P=0.04) and decreased transplant-related mortality (P=0.02) compared with <6/8 HR matches. Using standard HLA typing, we showed an increased incidence of acute graft-versus-host disease (grade II to IV) and decreased transplant-related mortality in comparing the matched (6/6) versus ≤5/6 group (P=0.05 and 0.05, respectively). These data support the use of current guidelines for umbilical cord blood selection and encourage utilization of HR typing to select umbilical cord blood units matched at ≥6/8 especially when appropriate ≥5/6 units are available.

Phase I/II Trial of StemRegenin-1 Expanded Umbilical Cord Blood Hematopoietic Stem Cells Supports Testing as a Stand-Alone Graft

Clinical application of umbilical cord blood (UCB) as a source of hematopoietic stem cells for transplantation is limited by low CD34+ cell dose, increased risk of graft failure, and slow hematopoietic recovery. While the cell dose limitation is partially mitigated by using two UCB units, larger-dosed single units would be preferable. We have evaluated the feasibility and safety of StemRegenin-1 (SR-1), an aryl hydrocarbon receptor antagonist that expands CD34+ cells, by placing one of the two units in expansion culture. SR-1 produced a 330-fold increase in CD34+ cells and led to engraftment in 17/17 patients at a median of 15 days for neutrophils and 49 days for platelets, significantly faster than in patients treated with unmanipulated UCB. Taken together, the marked expansion, absence of graft failure, and enhanced hematopoietic recovery support testing of SR-1 expansion as a stand-alone graft and suggest it may ameliorate a limitation of UCB transplant.

Retraction: The effect of anticoagulant choice on collection of cord blood

"The effect of anticoagulant choice on collection of cord blood" by M. Badowski, C. Shultz and D.T. Harris. Transfusion. First published online: June 12, 2014. The above article, published online on June 12, 2014 on Wiley Online Library (wileyonlinelibrary.com), has been withdrawn for legal reasons by agreement between the authors, the journal Editor in Chief, Paul M. Ness, MD, the AABB, and Wiley Periodicals, Inc. The withdrawal has been agreed due to violation of a research agreement between the Cord Blood Registry, which commissioned the article, and the authors.

REFERENCE

Badowski M, Shultz C and Harris DT. The effect of anticoagulant choice on collection of cord blood. Transfusion. 2014. doi: 10.1111/trf.12744. First published online: 12 JUN 2014.

Analysis of 120 pediatric patients with nonmalignant disorders transplanted using unrelated plasma-depleted or -reduced cord blood

BACKGROUND

Unrelated cord blood (CB) is an important stem cell source for unrelated hematopoietic cell transplantation (HCT) of patients with nonmalignant disorders. Processing methods to prepare red blood cell-reduced CB units incur significant nucleated cell loss. In contrast, plasma depletion or reduction (PDR) processing of CB units entails the removal of only a portion of the plasma with minimal nucleated cell loss. However, there are relatively limited data regarding outcomes of CB transplants using units processed by PDR.

STUDY DESIGN AND METHODS

A Center for International Blood and Marrow Transplant Research (CIBMTR)-audited analysis was performed on 120 pediatric patients with nonmalignant disorders transplanted between November 2001 and January 2008 at 29 US and 17 international centers using PDR CB units from two CB banks.

RESULTS

Transplant characteristics were as follows: median age, 3.5 years (range, 0.1-14 years); median patient weight, 15 kg (range, 4-61 kg); 58% male; HLA matches (intermediate-resolution HLA-A and HLA-B and high-resolution HLA-DRB1) of the units used in these patients six of six in 26, five of six in 48, four of six in 47, and three of six or two of six in 6; median prefreeze total nucleated cell dose, 10.5×10(7)/kg; median prefreeze CD34+ dose, 3.7×10(5)/kg; and nonmyeloablative regimen in 24%. The median times to myeloid and platelet engraftment were 21 and 49 days, respectively. The cumulative incidence of reported Grade II to IV acute graft-versus-host disease (aGVHD) was 38±5%, and 19±4% had Grade III to IV aGVHD. The Kaplan-Meier estimates of 3-year transplant-related mortality, overall survival, and disease-free survival were 20±4, 79±4, and 70±6%, respectively.

CONCLUSION

These data demonstrate the effectiveness of PDR CB units for HCT.

Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis

BACKGROUND

The importance of matching at the HLA C locus has not been well defined for unrelated umbilical-cord blood transplantation. The selection algorithm for umbilical-cord blood units generally considers intermediate resolution HLA typing at A and B and allele-level typing at DRB1. We aimed to establish the relative importance of additional matching at HLA C.

METHODS

We used Cox regression to assess retrospectively the effect of donor-recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome. Our primary endpoint was transplant-related mortality. HLA typing was done with molecular techniques with a minimum of intermediate resolution for HLA A, B, and C, and at the allele-level for DRB1.

FINDINGS

The median age of our study population was 10 years (range <1-62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation. Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27-12·40; p=0·018). Transplant-related mortality risk was also higher after transplantations with a single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06-2·74; p=0·029) compared with transplantations matched at HLA C with a single mismatch at HLA A, B, or DRB1 (n=127). Assessing the overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at two (n=259; 3·27, 1·42-7·54; p=0·006), three (n=253; 3·34, 1·45-7·71; p=0·005), or four (n=75; 3·51, 1·44-8·58; p=0·006) loci compared with matched units (n=69).

INTERPRETATION

Our data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks.

FUNDING

National Cancer Institute, National Heart Lung and Blood Institute, National Institute for Allergy and Infectious Diseases, Leukemia and Lymphoma Society, US Department of the Navy, Children's Leukemia Research Association, and INSERM.

How I treat: the selection and acquisition of unrelated cord blood grafts

Use of unrelated donor cord blood (CB) as an alternative stem cell source is increasing, and yet there is little information to guide transplant centers in the unique aspects of the search and selection of CB grafts. There is no mechanism to easily access the global inventory of CB units, nor is the product information provided by all banks standardized. To address these challenges, this manuscript reviews the logistics of the search, selection process, and acquisition of CB grafts as practiced by our center. Topics include who should be considered for a CB search, how to access the global CB inventory, and how to balance total nucleated cell dose and human leukocyte antigen match in unit selection. We discuss aspects of unit quality and other graft characteristics (processing methods, unit age, availability of attached segments, infectious disease, and hemoglobinopathy screening) to be considered. We incorporate these considerations into a unit selection algorithm, including how to select double-unit grafts. We also describe how we plan for unit shipment and the role of backup grafts. This review aims to provide a framework for CB unit selection and help transplantation centers perform efficient CB searches.

Adults requiring cord blood transplants but have insufficient cell doses from a single cord blood unit can receive two units with successful engraftment kinetics similar to those of children receiving a single unit

We retrospectively evaluated neutrophil engraftment kinetics in 29 single versus nine double unit cord blood transplants (CBTs). All single CBTs were performed in pediatric patients (non-malignant/malignant diseases, 19/10), while all double CBTs were performed in adults (n = 8) and an adolescent (n = 1) with hematological malignancies. Median follow-up time was 2.3 years (range, 0.1-13.5 years). Engraftment was achieved in 69% and 89% of the single and double cord blood (CB) groups, respectively. Similarly, median day of engraftment was not different for the single versus the double CBTs, at 19 and 23 days, respectively, and the neutrophil engraftment kinetics was similar in the two groups. Our data indicate that adults without sufficient nucleated cell doses in a single CB unit may receive two units with similar engraftment kinetics to those of children receiving only a single unit.