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Lee HR, Roh EY, Kim N, Song EY, Park H, Yoon JH, Shin S. Total nucleated cell counts are driving clinician's choice rather than cryopreservation period: Lesson for cord blood banks. Transfus Apher Sci 2020; 59:102849. [PMID: 32616364 DOI: 10.1016/j.transci.2020.102849] [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: 03/02/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
According to the increase in both the number of cryopreserved cord blood (CB) units and the cryopreservation period for each CB unit in the largest public CB bank in Korea, we are pursuing greater efficiency in CB bank management. Thus, we analyzed whether the cryopreservation period has a negative impact on the selection of CB units for CB transplantation (CBT). Until December 2019, 468 CB units were used for transplantation. The cryopreservation period, total nucleated cell (TNC), and CD34+ cell counts were analyzed among the CB units according to the CBT-year and the donation year. The results showed that the cryopreservation period was increased in recent CBT-year groups. The transplanted CB units showed similar TNC counts irrespective of the donation year, and the mean TNC count was 13.9 × 108/unit. CB units cryopreserved for a relatively long period were transplanted consistently. The mean TNC count of CB units cryopreserved for over 10 years was 16.4 × 108/unit. The mean CD34+ cell counts were not significantly different among the CB units transplanted after CBT-2013 and among the CB units donated after CBT-2011. Through an analysis of the CB units selected by clinicians for CBT, this study revealed that clinicians placed more weight on the TNC counts than on the cryopreservation period of cryopreserved CB units. Therefore, the minimum TNC count of CB units suitable for cryopreservation should be increased up to 13.0 × 108/unit to balance the satisfaction of clinicians' needs with the efficiency of the CB bank.
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Affiliation(s)
- Hye Ryun Lee
- Department of Laboratory Medicine, National Medical Center, Seoul, South Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Seoul Metropolitan Government Public Cord Blood Bank (Allcord), Seoul, South Korea
| | - Namhee Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Seoul Metropolitan Government Public Cord Blood Bank (Allcord), Seoul, South Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Seoul Metropolitan Government Public Cord Blood Bank (Allcord), Seoul, South Korea
| | - Jong Hyun Yoon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Seoul Metropolitan Government Public Cord Blood Bank (Allcord), Seoul, South Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea; Seoul Metropolitan Government Public Cord Blood Bank (Allcord), Seoul, South Korea.
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Opstelten R, Slot MC, Lardy NM, Lankester AC, Mulder A, Claas FHJ, van Rood JJ, Amsen D. Determining the extent of maternal-foetal chimerism in cord blood. Sci Rep 2019; 9:5247. [PMID: 30918307 PMCID: PMC6437214 DOI: 10.1038/s41598-019-41733-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/14/2019] [Indexed: 12/28/2022] Open
Abstract
During pregnancy, maternal T cells can enter the foetus, leading to maternal-foetal chimerism. This phenomenon may affect how leukaemia patients respond to transplantation therapy using stem cells from cord blood (CB). It has been proposed that maternal T cells, primed to inherited paternal HLAs, are present in CB transplants and help to suppress leukaemic relapse. Several studies have reported evidence for the presence of maternal T cells in most CBs at sufficiently high numbers to lend credence to this idea. We here aimed to functionally characterise maternal T cells from CB. To our surprise, we could not isolate viable maternal cells from CB even after using state-of-the-art enrichment techniques that allow detection of viable cells in heterologous populations at frequencies that were several orders of magnitude lower than reported frequencies of maternal T cells in CB. In support of these results, we could only detect maternal DNA in a minority of samples and at insufficient amounts for reliable quantification through a sensitive PCR-based assay to measure In/Del polymorphisms. We conclude that maternal microchimerism is far less prominent than reported, at least in our cohort of CBs, and discuss possible explanations and implications.
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Affiliation(s)
- Rianne Opstelten
- Sanquin Research, Dept of Hematopoiesis, Amsterdam, The Netherlands, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Manon C Slot
- Sanquin Research, Dept of Hematopoiesis, Amsterdam, The Netherlands, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Neubury M Lardy
- Sanquin Diagnostics BV, Department of Immunogenetics, Amsterdam, The Netherlands
| | - Arjan C Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Arend Mulder
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Jon J van Rood
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk Amsen
- Sanquin Research, Dept of Hematopoiesis, Amsterdam, The Netherlands, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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High quality cord blood banking is feasible with delayed clamping practices. The eight-year experience and current status of the national Swedish Cord Blood Bank. Cell Tissue Bank 2016; 17:439-48. [PMID: 27342904 DOI: 10.1007/s10561-016-9565-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
The National Swedish Cord Blood Bank (NS-CBB) is altruistic and publicly funded. Herein we describe the status of the bank and the impact of delayed versus early clamping on cell number and volume. Cord Blood Units (CBUs) were collected at two University Hospitals in Sweden. Collected volume and nucleated cell content (TNC) were investigated in 146 consecutive Cord Blood (CB) collections sampled during the first quarter of 2012 and in 162 consecutive CB collections done in the first quarter of 2013, before and after clamping practices were changed from immediate to late (60 s) clamping. NS-CBB now holds close to 5000 units whereof 30 % are from non-Caucasian or mixed origins. Delayed clamping had no major effect on collection efficiency. The volume collected was slightly reduced (mean difference, 8.1 ml; 95 % CI, 1.3-15.0 ml; p = 0.02), while cell recovery was not (p = 0.1). The proportion of CBUs that met initial total TNC banking criteria was 60 % using a TNC threshold of 12.5 × 10(8), and 47 % using a threshold of 15 × 10(8) for the early clamping group and 52 and 37 % in the late clamping group. Following implementation of delayed clamping practices at NS-CBB; close to 40 % of the collections in the late clamping group still met the high TNC banking threshold and were eligible for banking, implicating that that cord blood banking is feasible with delayed clamping practices.
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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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Basford C, Forraz N, Habibollah S, Hanger K, McGuckin C. The cord blood separation league table: a comparison of the major clinical grade harvesting techniques for cord blood stem cells. Int J Stem Cells 2014; 3:32-45. [PMID: 24855539 DOI: 10.15283/ijsc.2010.3.1.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Well over 1 million Umbilical Cord Blood units (UCB) have been stored globally in the last 10 years. Already, over 20,000 transplants been performed using UCB for haematopoietic reconstitution alone, now this potential is joined by regenerative medicine. However, more needs to be known about processing of this stem cell source for it to reach full potential. METHODS AND RESULTS IN THIS STUDY WE EVALUATED FIVE SEPARATION METHODS: plasma depletion, density gradient, Hetastarch, a novel method known as PrepaCyte-CB and an automated centrifugal machine. Sepax gives the highest recovery of nucleated cells, an average of 78.8% (SD±21.36). When looking at CD34+ haematopoietic stem cells PrepaCyte-CB provided the greatest recovery at 74.47% (SD±8.89). For volume reduction density gradient was the most effective leaving 0.03×10(6) RBC/ml, 8 times more efficient than its nearest competitor PrepaCyte-CB (p<0.05). Finally PrepaCyte-CB processing left samples with the highest clonogenic potential after processing and more significantly after cryopreservation: 9.23 CFU/10(8) cells (SD±2.33), 1.5 fold more effective than its nearest rival Sepax (p<0.05). CONCLUSIONS PrepaCyte-CB was the most flexible method; the only processing type unaffected by volume. Results indicate that processing choice is important depending on your final intended use.
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Affiliation(s)
- Christina Basford
- Newcastle Centre for Cord Blood, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, NE1 3BZ, United Kingdom
| | - Nicolas Forraz
- CTI-LYON, Cell Therapy Research Institute, Parc Technologique de Lyon-St Priest, Cèdre 1, 97 Allée Alexandre Borodine, 69800 SAINT PRIEST LYON, France
| | - Saba Habibollah
- Newcastle Centre for Cord Blood, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, NE1 3BZ, United Kingdom
| | - Kendal Hanger
- Newcastle Centre for Cord Blood, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, NE1 3BZ, United Kingdom
| | - Colin McGuckin
- CTI-LYON, Cell Therapy Research Institute, Parc Technologique de Lyon-St Priest, Cèdre 1, 97 Allée Alexandre Borodine, 69800 SAINT PRIEST LYON, France
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Ebrahimkhani S, Farjadian S, Ebrahimi M. The Royan Public Umbilical Cord Blood Bank: Does It Cover All Ethnic Groups in Iran Based on HLA Diversity? ACTA ACUST UNITED AC 2014; 41:134-8. [PMID: 24847189 DOI: 10.1159/000357997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/03/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Umbilical cord blood (UCB) stem cells allow the transplantation of partially human leukocyte antigen (HLA)-matched grafts and are a valuable resource for the treatment of hematologic malignancies and heritable hematologic, immunologic and metabolic diseases, especially when a compatible bone marrow donor is unavailable. The aim of this study was to determine how many ethnic groups in Iran are covered by the available UCB units based on HLA diversity. METHODS From 2009 until mid-2013, 4,981 (30.3%) of the 16,437 UCB samples collected met the storage criteria and were cryopreserved at a public cord blood bank (CBB) in Tehran, Iran. HLA-A, -B and -DRB1 were typed in 1,793 samples. RESULTS The mean volume of the cryopreserved samples was 81.25 ± 20.3 ml. The range of total nucleated cells per unit was 51 × 10(7)-107 × 10(7). The most common HLA alleles were HLA-A*2 (17%) and HLA-A*24 (15.6%), HLA-B*35 (16.8%) and HLA-B*51 (13.9%), and HLA-DRB1*11 (20%) and HLA-DRB1*15 (14%). The predominant haplotypes were HLA-A*24-B*35-DRB1*11 (2%), HLA-A*02-B*50-DR*07 (1.8%), and HLA-A*02-B*51-DRB1*11 (1.5%). CONCLUSIONS Based on the HLA-DRB1 profiles, the UCB units available at the Royan public UCB bank are a potentially adequate resource for hematopoietic stem cell transplantation for Iranian recipients belonging to particular ethnic groups. Regular educational programs to improve the public knowledge of UCB for transplantation can enhance the public CBB stocks for all Iranian ethnic groups in the future.
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Affiliation(s)
- Saeideh Ebrahimkhani
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Shirin Farjadian
- Department of Immunology, Shiraz University of Medical Sciences, Tehran, Iran
| | - Marzieh Ebrahimi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran ; Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Jamali M, Atarodi K, Nakhlestani M, Abolghasemi H, Sadegh H, Faranoosh M, Golzade K, Fadai R, Niknam F, Zarif MN. Cord blood banking activity in Iran National Cord Blood Bank: a two years experience. Transfus Apher Sci 2014; 50:129-35. [PMID: 24262492 DOI: 10.1016/j.transci.2013.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 09/09/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
Today umbilical cord blood (UCB) has known as a commonly used source of hematopoietic stem cells for allogeneic transplantation and many cord blood banks have been established around the world for collection and cryopreservation of cord blood units. Herein, we describe our experience at Iran National Cord Blood Bank (INCBB) during 2 years of activity. From November 2010 to 2012, UCBs were collected from 5 hospitals in Tehran. All the collection, processing, testing, cryopreservation and storage procedures were done according to standard operation procedures. Total nucleated cells (TNC) count, viability test, CD34+ cell count, colony forming unit (CFU) assay, screening tests and HLA typing were done on all banked units. Within 3770 collected units, only 32.9% fulfilled banking criteria. The mean volume of units was 105.2 ml and after volume reduction the mean of TNC, viability, CD34+ cells and CFUs was 10.76×10(8), 95.2%, 2.99×10(6) and 7.1×10(5), respectively. One unit was transplanted at Dec 2012 to a 5-year old patient with five of six HLA compatibilities. In our country banking of UCB is new and high rate of hematopoietic stem cell transplants needs expanding CB banks capacity to find more matching units, optimization of methods and sharing experiences to improve biological characterization of units.
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Affiliation(s)
- Mostafa Jamali
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran
| | - Kamran Atarodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran
| | - Mozhdeh Nakhlestani
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran
| | - Hasan Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Sadegh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mohammad Faranoosh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Khadije Golzade
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran
| | - Razieh Fadai
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Fereshte Niknam
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran
| | - Mahin Nikougoftar Zarif
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran; Iran National Cord Blood Bank, Iran Blood Transfusion Organization, Tehran, Iran.
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Wang TF, Wen SH, Yang KL, Yang SH, Yang YF, Chang CY, Wu YF, Chen SH. Reasons for exclusion of 6820 umbilical cord blood donations in a public cord blood bank. Transfusion 2014; 54:231-7. [PMID: 23718644 DOI: 10.1111/trf.12269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND To provide information for umbilical cord blood (UCB) banks to adopt optimal collection strategies and to make UCB banks operate efficiently, we investigated the reasons for exclusion of UCB units in a 3-year recruitment period. STUDY DESIGN AND METHODS We analyzed records of the reasons for exclusion of the potential UCB donation from 2004 to 2006 in the Tzu-Chi Cord Blood Bank and compared the results over 3 years. We grouped these reasons for exclusion into five phases, before collection, during delivery, before processing, during processing, and after freezing according to the time sequence and analyzed the reasons at each phase. RESULTS Between 2004 and 2006, there were 10,685 deliveries with the intention of UCB donation. In total, 41.2% of the UCB units were considered eligible for transplantation. The exclusion rates were 93.1, 48.4, and 54.1% in 2004, 2005, and 2006, respectively. We excluded 612 donations from women before their child birth, 133 UCB units during delivery, 80 units before processing, 5010 units during processing, and 421 units after freezing. There were 24 UCB units with unknown reasons of ineligibility. Low UCB weight and low cell count were the first two leading causes of exclusion (48.6 and 30.9%). The prevalence of artificial errors, holiday or transportation problem, low weight, and infant problems decreased year after year. CONCLUSION The exclusion rate was high at the beginning of our study as in previous studies. Understanding the reasons for UCB exclusion may help to improve the efficiency of UCB banking programs in the future.
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Affiliation(s)
- Tso-Fu Wang
- Department of Hematology and Oncology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan; Buddhist Tzu-Chi Stem Cells Center, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan; Department of Medicine, College of Medicine, Tzu-Chi University, Hualien, Taiwan
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Goldstein G, Bielorai B, Stein J, Stepensky P, Elhasid R, Zaidman I, Chetrit A, Yaniv I, Nagler A, Toren A. Analysis of risk factors of cord blood transplantation for children. Pediatr Blood Cancer 2013; 60:2007-11. [PMID: 24039183 DOI: 10.1002/pbc.24600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/18/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND As cord blood (CB) is being used frequently as a source for heamtopoetic stem cell transplantation defining risk factors for transplantation outcome is an important issue. PROCEDURE The data of all single unit CB transplantation preformed in Israel from 1992 to 2011 were collected. The risk factors for myeloid engraftment, event free survival (EFS) and overall survival (OS) were studied in 87 children. RESULTS There were 49 children with hematological malignancies and 38 with non-malignant diseases. Cumulative rate of neutrophil recovery was 78.3%, while median time to myeloid recovery was 26 days. The incidence of platelet engraftment at 150 days was 53%, and the median time to platelet recovery was 36 days. ABO blood group matching between CB unit and recipient was associated with superior myeloid engraftment. Acute graft versus host disease of grades II-IV occurred in 33% of the patients. Chronic graft versus host disease occurred in 16% of patients. Probabilities of EFS and OS at 1 year were 45% and 57%, respectively. Factors associated with inferior OS were Rh major mismatch versus matched Rh and transplantation from unrelated donor versus related donor. CONCLUSIONS These results indicate that matching of ABO blood groups is an important factor that affects engraftment, and also that Rh matching seem to have an impact on OS, which was not previously described in the setting of CB transplantation.
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Affiliation(s)
- Gal Goldstein
- Department of Pediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children's Hospital, Ramat Gan, Israel
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Jaime-Perez JC, Monreal-Robles R, Colunga-Pedraza J, Mancías-Guerra C, Rodríguez-Romo L, Gómez-Almaguer D. Cord blood banking activities at a university hospital in northeast Mexico: an 8-year experience. Transfusion 2012; 52:2606-13. [PMID: 22486418 DOI: 10.1111/j.1537-2995.2012.03638.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Umbilical cord blood (UCB) represents an alternative source of stem cells for transplantation for the treatment of hematologic malignancies and genetic disorders. There is scarce information detailing cord blood bank (CBB) collection and transplantation activities from developing countries. We documented our experience at a public university hospital in northeast Mexico. STUDY DESIGN AND METHODS We carried out a retrospective and descriptive analysis of our CBB activity during an 8-year period from May 2002 to September 2010. Collection, processing, and cryopreservation of CB were carried out following standard operating procedures. The minimum volume and total nucleated cell (TNC) content for cryopreservation were 80 mL and 8.0 × 10(8) , respectively. RESULTS A total of 1256 UCB units were collected; 428 (34%) were banked and 828 (66%) were discarded. The main reason for exclusion was biologic: low volume and/or low number of TNC accounted for 84% of the total discarded units. Cryopreserved cord blood units (CBUs) had a median volume of 113.8 mL (range, 80-213.2 mL) and 13.0 × 10(8) (range, 8 × 10(8) -36.6 × 10(8) ) TNCs. Cell viability was 99.3% (88-100%). The median CD34+ cell content was 4.0 × 10(6) (0.46 × 10(6) -19.38 × 10(6) ). Sixteen units have been released for transplantation, leading to a utilization rate of 3.7%. CONCLUSION CBB demands considerable human and financial resources; it is then essential for centers at developing countries to share their experience, results, and databases to increase the probability of finding matching units for their patients. Efforts to create and maintain CBBs allow to offer this therapeutic option at an affordable cost.
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Affiliation(s)
- Jose C Jaime-Perez
- Department of Hematology, Dr. José E. González University Hospital of the School of Medicine of the Autonomous University of Nuevo Leon, Monterrey, Mexico.
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Mekala NK, Baadhe RR, Parcha SR, Prameela DY. Osteoblast differentiation of umbilical cord blood-derived mesenchymal stem cells and enhanced cell adhesion by fibronectin. Tissue Eng Regen Med 2012. [DOI: 10.1007/s13770-012-0359-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pope B, Mitsakos K, Bilgin A, Hokin B, Grant R. Predicting overall viability of cord blood harvests. Transfusion 2011; 52:1079-85. [DOI: 10.1111/j.1537-2995.2011.03386.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Chow R, Lin A, Tonai R, Bolanos R, Connor C, Mendoza A, Heminger R, Chow M, Ho E, Kang J, Gindy L, Fu C, Rao A, Gau JF, Wang BC, Klich I, Ratajczak J, Ratajczak M, Petz LD. Cell recovery comparison between plasma depletion/reduction- and red cell reduction-processing of umbilical cord blood. Cytotherapy 2011; 13:1105-19. [PMID: 21867465 DOI: 10.3109/14653249.2011.592524] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AIMS Limited cell dose has hampered the use of cord blood transplantation (CBT) in adults. One method of minimizing nucleated cell loss in cord blood (CB) processing is to deplete or reduce plasma but not red blood cells - plasma depletion/reduction (PDR). METHODS The nucleated cell loss of PDR was studied, and determined to be less than 0.1% in the discarded supernatant plasma fraction in validation experiments. After testing and archival sampling, the median nucleated cell recovery for PDR processing was 90%, and median CD34(+) cell recovery 88%. In a CB bank inventory of 12 339 products with both pre- and post-processing total nucleated cells (TNC), PDR processing resulted in median post-processing TNC recoveries of 90.0% after testing and archival samples removal. Using the same 10 CB units divided into two halves, we compared directly the recovery of PDR against hydroxyethyl starch red cell reduction (RCR) for TNC, CD34(+) cells and colony-forming units (CFU-GM, CFU-E, CFU-GEMM and total CFU) after parallel processing. We also compared the loss of very small embryonic-like stem cells (VSEL). RESULTS We demonstrated significantly higher recoveries using PDR for TNC (124%), CD34(+) cells (121%), CFU-GM (225%), CFU-GEMM (201%), total CFU (186%) and VSEL (187%). The proportion of high TNC products was compared between 10 912 PDR and 38 819 RCR CB products and found to be 200% higher for products that had TNC ≥150 × 10(7) (P = 0.0001) for the PDR inventory. CONCLUSIONS Our data indicate that PDR processing of CB provides a significantly more efficient usage of this valuable and scarce resource.
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Affiliation(s)
- Robert Chow
- StemCyte International Cord Blood Center, Covina, California 91722, 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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Wang M, Qiu Y, Wang X, Zhao F, Jin M, Xu M, Rong R, Ge H, Zhang Y, Wang X, Zhu T. Role of HLA-G and NCR in protection of umbilical cord blood haematopoietic stem cells from NK cell mediated cytotoxicity. J Cell Mol Med 2010; 15:2040-5. [PMID: 21073654 PMCID: PMC4394215 DOI: 10.1111/j.1582-4934.2010.01214.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Allogeneic umbilical cord blood haematopoietic stem cells (UCB-HSCs) can be transplanted into a host with the intact innate immunity with limited immuno-reaction, although the mechanisms remain unclear. The present studies aimed at investigating potential mechanisms of allogeneic UCB-HSCs escape from the cytolysis of natural killer (NK) cells. We compared UCB-HSCs ability to protect from NK-mediated cytotoxicity with peripheral blood or bone marrow haematopoietic stem cells (PB-HSCs and BM-HSCs). HSCs expressed lower levels of natural cytotoxicity receptor ligands including NKp30L, NKp44L and NKp46L than monocytes. Blocking these ligands respectively or in combination could increase the resistance of HSCs against NK cell mediated cytotoxicity. High expression of HLA-G was noticed on UCB-HSCs, rather than PB-HSCs or BM-HSCs, whereas blockade of HLA-G significantly elevated NK cell mediated cytolysis to UCB-HSCs. Thus, we conclude that natural cytotoxicity receptors and HLA-G on HSCs may contribute to the escape from NK cells, and activate and inhibitory NK cell receptors and their ligands can be novel therapeutic targets in cell transplantation.
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Affiliation(s)
- Ming Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
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Lauber S, Latta M, Klüter H, Müller-Steinhardt M. The Mannheim Cord Blood Bank: Experiences and Perspectives for the Future. ACTA ACUST UNITED AC 2010; 37:90-97. [PMID: 20737051 DOI: 10.1159/000289589] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 02/11/2010] [Indexed: 11/19/2022]
Abstract
SUMMARY: BACKGROUND AND METHODS: As a source of hematopoietic stem cells, cord blood (CB) is an alternative to bone marrow or peripheral blood stem cells (PBSC). The Mannheim Cord Blood Bank has currently stored about 1,750 allogeneic CB units. Here we report our experiences and discuss future perspectives of CB banking. We analyzed CB units for nucleated cell (NC), mononucleated cell (MNC) and CD34+ cell count, volume, colony-forming units (CFU-GM) as well as ethnic background of the donor. Transplanted CB units were analyzed for patient and transplant characteristics and compared to stored CB units. RESULTS: Only 25% of all collected CB units met storage criteria. Main reasons for exclusion were: i) insufficient volume (57.7%), ii) delayed arrival at the processing site (19.2%) and iii) little cell count (7.2%). Up to now 36 CB units have been released for transplantation mainly to children (62%). Transplant indications were hematological diseases, immune deficiencies and metabolic diseases. Transplanted CB units showed significantly higher cell counts compared to stored units (NC: 12.5 vs. 7.2 x 10(8), MNC: 4.7 vs. 2.9 x 10(8), CD34+ cells: 3.3 vs. 1.8 x 10(6), mean; p < 0.001 each) and were found more often in ethnic minority groups (36 vs. 20%; p = 0.04). CONCLUSIONS: Even though cell count and volume are key parameters for the eligibility of CB units, our data indicate that the ethnic background of the donor also plays a major role. Collection and processing of CB should be optimized in order to gain maximum volume and cell counts.
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Affiliation(s)
- Stephanie Lauber
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Red-Cross Blood Service of Baden-Wuerttemberg - Hessen, Mannheim, Germany
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Rocha V, Gluckman E. Improving outcomes of cord blood transplantation: HLA matching, cell dose and other graft- and transplantation-related factors. Br J Haematol 2010; 147:262-74. [PMID: 19796275 DOI: 10.1111/j.1365-2141.2009.07883.x] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of unrelated umbilical cord blood (UCB) as an alternative source of haematopoietic stem cells transplantation (HSCT) has been widely used for patients lacking a human leucocyte antigen (HLA) matched donor. One of the disadvantages of using UCB is the limited number of haematopoietic stem cells and, consequently, delayed engraftment and increased risk of early mortality. Many approaches have been investigated in the attempt to improve engraftment and survival. Among those, studies analysing prognostic factors related to patients, disease, donor and transplantation have been performed. Variable factors have been identified, such as factors related to donor choice (HLA, cell dose and others) and transplantation (conditioning and graft-versus-host disease prophylaxis regimens). This review will focus on the interactions between HLA, cell dose and other modifiable factors related to the UCB unit selection and transplantation that may improve outcomes after UCB transplantation.
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Affiliation(s)
- Vanderson Rocha
- Department of Haematology, Eurocord-Netcord-EBMT office, Institut Universitaire, Hôpital Saint Louis, Université de Paris 7, 1 Av Claude Vellefaux, 75010 Paris, France.
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Abstract
OBJECTIVE To investigate the cost-effectiveness of private umbilical cord blood banking. METHODS A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. RESULTS Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. CONCLUSION Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. LEVEL OF EVIDENCE III.
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Dinç H, Sahin NH. Pregnant women's knowledge and attitudes about stem cells and cord blood banking. Int Nurs Rev 2009; 56:250-6. [PMID: 19646176 DOI: 10.1111/j.1466-7657.2008.00689.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study was to determine pregnant women's knowledge and attitudes towards stem cells and cord blood banking in Istanbul, Turkey. BACKGROUND Stem cell research is one of the most important and, at the same time, the most controversial topics of science and technology today. Nurses need to understand stem cell research so they can enter the debate on this issue. They can become important sources of information in order to help parents understand the issues. METHODS This exploratory descriptive study was conducted in two antenatal outpatient clinics in Istanbul. The sample consisted of 334 pregnant women during routine prenatal visits. Data were collected in interviews by using an interview form developed by the researchers according to the literature. The form included demographic characteristics of participants and 20 questions about stem cells, storing cord blood and banking and 10 independent attitude statements. RESULTS The majority of the participants had a lack of knowledge about stem cells and cord blood banking and wanted more information. Before pregnancy, they received some information through the media (newspaper, Internet, television, etc.), but unintentionally. It was determined that they wanted information before becoming pregnant, more from their obstetrician but also from nurses and midwives. The majority also wanted to store their infants' cord blood and stated that they would be more likely to choose a public cord blood bank. CONCLUSION Those giving ante- and perinatal care need to offer accurate and scientific counselling services on this subject to parents who need to be informed.
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Affiliation(s)
- H Dinç
- Department of Obstetric and Gynecologic Nursing, Bakirkoy School of Health, Istanbul University, Istanbul, Turkey
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Rocha V, Kabbara N, Ionescu I, Ruggeri A, Purtill D, Gluckman E. Pediatric related and unrelated cord blood transplantation for malignant diseases. Bone Marrow Transplant 2009; 44:653-9. [DOI: 10.1038/bmt.2009.291] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Basford C, Forraz N, Habibollah S, Hanger K, McGuckin CP. Umbilical cord blood processing using Prepacyte-CB increases haematopoietic progenitor cell availability over conventional Hetastarch separation. Cell Prolif 2009; 42:751-61. [PMID: 19758367 DOI: 10.1111/j.1365-2184.2009.00646.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Currently the most frequently used method for umbilical cord blood separation in many hospitals across the UK and the rest of the world, where small-to-medium amounts of samples are processed, is Hetastarch, a mechanical, starch-based method, which causes red cell agglutination by rouleaux formation. AIM In this study, a novel method (Prepa-Cyte-CB), in comparison with Hetastarch as part of an FDA-approved clinical study, was evaluated. MATERIALS AND METHODS Validation of data included recovery of nucleated and CD34+ cells, red blood cell reduction, colony forming unit potential, flow cytometric analysis and sterility tests. RESULTS PrepaCyte-CB, in comparison with Hetastarch offers fast, reliable separation with improved recovery of nucleated cells, 72.03% (+/-8.48 SD) compared to 58.09% (+/-20.06 SD), and CD34+ haematopoietic progenitor cells, 76% (+/-19.54 SD) compared to 64.19% (+/-29.77 SD). PrepaCyte-CB was also 12-fold more efficient in removing red blood cells and haemoglobin (P < 0.001) than Hetastarch. CONCLUSIONS These results show that PrepaCyte-CB offers superior separation of UCB when compared to Hetastarch.
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Affiliation(s)
- C Basford
- Newcastle Centre for Cord Blood, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK
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Bruinsma M, van Soest PL, Leenen PJM, Löwenberg B, Cornelissen JJ, Braakman E. Keratinocyte growth factor improves allogeneic bone marrow engraftment through a CD4+Foxp3+ regulatory T cell-dependent mechanism. THE JOURNAL OF IMMUNOLOGY 2009; 182:7364-9. [PMID: 19494258 DOI: 10.4049/jimmunol.0803253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Keratinocyte growth factor (KGF) protects mice from acute graft-vs-host disease and graft rejection by cytoprotective and yet incompletely understood immunological mechanisms. Recently, we showed that administration of KGF induces selective peripheral expansion of CD4(+)Foxp3(+) regulatory T cells (Treg). In this study, we set out to assess whether the peripheral expansion of Treg accounts for the immunomodulatory effects of KGF after bone marrow (BM) transplantation. To exclude potentially confounding cytoprotective and thymopoietic effects of KGF, we applied KGF to congenic wild-type mice that served as T cell provider mice for T and B cell-deficient RAG-1(-/-) mice that were subsequently transplanted with allogeneic BM. Treatment of congenic T cell provider mice with KGF significantly improved engraftment and reduced graft rejection in BMT recipients. CD4(+)Foxp3(+) Treg remained increased for 4 wk, while expansion of congenic CD3(+) T cells was inhibited. To assess a causal relationship between expansion of Treg and improved BM engraftment, congenic Scurfy mice, which lack Foxp3(+) Treg, served as T cell provider mice and were treated with KGF. KGF-treatment of Scurfy mice did not affect engraftment nor did it inhibit the expansion of congenic T cells. These data demonstrate that administration of KGF to the T cell provider mice improves engraftment of allogeneic BM through a CD4(+)Foxp3(+) Treg-dependent mechanism.
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Affiliation(s)
- Marieke Bruinsma
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Watt SM, Austin E, Armitage S. Cryopreservation of hematopoietic stem/progenitor cells for therapeutic use. Methods Mol Biol 2008; 368:237-59. [PMID: 18080475 DOI: 10.1007/978-1-59745-362-2_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
To date, more than 25,000 hematopoietic transplants have been carried out across Europe for hematological disorders, the majority being for hematological malignancies. At least 70% of these are autologous transplants, the remaining 30% being allogeneic, which are sourced from related (70% of the allogeneic) or unrelated donors. Peripheral blood mobilized with granulocyte colony stimulating factor is the major source of stem cells for transplantation, being used in approx 95% of autologous transplants and in approx 65% of allogeneic transplants. Other cell sources used for transplantation are bone marrow and umbilical cord blood. One crucial advance in the treatment of these disorders has been the development of the ability to cryopreserve hematopoietic stem cells for future transplantation. For bone marrow and mobilized peripheral blood, the majority of cryopreserved harvests come from autologous collections that are stored prior to a planned infusion following further treatment of the patient or at the time of a subsequent relapse. Other autologous harvests are stored as backup or "rainy day" harvests, the former specifically being intended to rescue patients who develop graft failure following an allogeneic transplant or who may require this transplant at a later date. Allogeneic bone marrow and mobilized peripheral blood are less often cryopreserved than autologous harvests. This is in contrast to umbilical cord blood that may be banked for directed or sibling (related) hematopoietic stem cell transplants, for allogeneic unrelated donations, and for autologous donations. Allogeneic unrelated donations are of particular use for providing a source of hematopoietic stem cells for ethnic minorities, patients with rare human leukocyte antigen types, or where the patient urgently requires a transplant and cannot wait for the weeks to months required to prepare a bone marrow donor. There are currently more than 200,000 banked umbilical cord blood units registered with the Bone Marrow Donors Worldwide registry. In this chapter, we describe several protocols that we have used to cryopreserve these different sources of hematopoietic stem/progenitor cells, keeping in mind that the protocols may vary among transplant processing centers.
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Affiliation(s)
- Suzanne M Watt
- National Blood Service-Oxford and Manchester, NHS Blood and Transplant Authority, UK
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Warwick RM, Rushambuza FG, Brown J, Patel R, Tabb S, Poniatowski S, Ranson AJ, Brown CJ. Confirmation of cadaveric blood sample identity by DNA profiling using Short Tandem Repeat (STR) analysis. Cell Tissue Bank 2008; 9:323-8. [PMID: 18483780 DOI: 10.1007/s10561-008-9071-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 04/15/2008] [Indexed: 12/01/2022]
Abstract
Blood samples collected from deceased tissue donors for mandatory transfusion microbiology testing may be taken either at the time of tissue donation, or residual samples may be retrieved from hospital laboratories where they were originally used for ante-mortem tests. In the latter case, sample labelling may not conform to the required standard, which stipulates that three independent identifiers be provided. If no alternative adequately labelled sample is available for testing the donated tissues may have to be discarded, which can adversely affect tissue sufficiency. An alternative method to ensure that the blood sample to be tested is from the intended deceased donor is to confirm the identity of the blood sample by Deoxyribonucleic Nucleic Acid (DNA) Short Tandem Repeats (STR) analysis, then comparing the DNA profile with the DNA from the donated tissues. If the two DNA profiles are identical, probability calculations can demonstrate the chance of the two samples of DNA being from the same or different individuals. The authors have used this approach to salvage deceased tissue donations.
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Affiliation(s)
- Ruth M Warwick
- Tissue Services, NHS Blood and Transplant (NHSBT), Deansbrook Road, Edgware, Middlesex, HA8 9BD, UK.
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Affiliation(s)
- Nicholas M Fisk
- Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN.
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Alternative Allogeneic Donor Sources for Transplantation for Childhood Diseases: Unrelated Cord Blood and Haploidentical Family Donors. Biol Blood Marrow Transplant 2008; 14:44-53. [DOI: 10.1016/j.bbmt.2007.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McGuckin CP, Basford C, Hanger K, Habibollah S, Forraz N. Cord blood revelations: the importance of being a first born girl, big, on time and to a young mother! Early Hum Dev 2007; 83:733-41. [PMID: 17942249 DOI: 10.1016/j.earlhumdev.2007.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2007] [Indexed: 12/11/2022]
Abstract
Umbilical cord blood (UCB) has become an alternative source for providing haematopoietic stem/progenitor cells as well as non-haematopoietic stem cells, compared to the conventional sources of bone marrow (BM) and peripheral blood (PB). Although UCB has many advantages over BM and PB there are still limitations to its use in the clinical setting, principally cell numbers. Thus, this study aimed to characterise components that comprise UCB samples and the physiological factors that affect them: (i) gender, (ii) obstetric history, (iii) infant birth weight, (iv) gestation stage and (v) mother's age. Our results show that UCB total nucleated cell (TNC) and haematopoietic stem cell (CD45+/CD34+) content is significantly affected by the baby's birth weight, mother's age at delivery, mother's obstetric history, and gestational stage at due date, all with p values<0.0001. The only parameter not found to be significant was gender, although results did suggest that female infants provide greater stem cell numbers than their male counterparts. Other UCB cellular sub-types affected were T-cells, dendritic cells and B-cells. In conclusion, this study demonstrates that many different obstetric factors must be taken into account when processing and cryo-banking UCB units for transplantation.
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Affiliation(s)
- C P McGuckin
- Newcastle Centre for Cord Blood, Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, UK.
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Chow R, Nademanee A, Rosenthal J, Karanes C, Jaing TH, Graham ML, Tsukahara E, Wang B, Gjertson D, Tan P, Forman S, Petz LD. Analysis of hematopoietic cell transplants using plasma-depleted cord blood products that are not red blood cell reduced. Biol Blood Marrow Transplant 2007; 13:1346-57. [PMID: 17950921 DOI: 10.1016/j.bbmt.2007.07.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 07/21/2007] [Indexed: 11/26/2022]
Abstract
Limited cell dose hampers wider use of cord blood transplantation (CBT). By depleting plasma but not RBC during processing, nucleated cell (NC) loss is reduced to <0.1% which increases significantly the proportion of high cell dose products-3-fold for products with NC >or=200 x 10(7). Clinical outcome for plasma depleted (PD) CBT was previously unavailable. A retrospective audited analysis was performed on 118 PD CBT, with mean and median NC doses of 7.6 x 10(7)/kg and 5.6 x 10(7)/kg, respectively, for this mostly pediatric population. The median times to engraftment and engraftment rates for ANC 500 and platelet 20K were 22 and 50 days, respectively, and 90% +/- 3% and 77% +/- 5%, respectively. The incidences of grade III-IV acute graft-versus-host disease (aGVHD) and extensive chronic GVHD (cGVHD) were 13% +/- 4% and 17% +/- 6%, respectively. Relapse rate for malignancies was 25% +/- 6% and 100-day treatment-related mortality (TRM) was 16% +/- 3%. With a median follow-up of 557 days, the 1-year overall survival and relapse-free survival are 65% +/- 5% and 51% +/- 6%, respectively. These results demonstrate that PD CBT is safe and effective, and that eliminating RBC reduction or depletion improves cell recovery during CB processing, resulting in a larger proportion of the inventory with high NC number.
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Affiliation(s)
- Robert Chow
- StemCyte International Cord Blood Center, Arcadia, California 91722, USA.
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Smythe J, Armitage S, McDonald D, Pamphilon D, Guttridge M, Brown J, Green A, Brown C, Warwick RM, Lankester A, Fehily D, Contreras M, Navarrete C, Watt SM. Directed sibling cord blood banking for transplantation: the 10-year experience in the national blood service in England. Stem Cells 2007; 25:2087-93. [PMID: 17510215 DOI: 10.1634/stemcells.2007-0063] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Umbilical cord blood (UCB) is an important source of hematopoietic stem cells for transplantation. Although UCB is often collected from unrelated donors, directed umbilical cord blood (DCB) from sibling donors also provides an important source of UCB for transplantation. This report summarizes the experience in collection, testing, storage, and transplantation of DCB units by the National Blood Service for England and North Wales over 10 years. Eligibility for collection was based on an existing sibling suffering from a disease that may be treated by stem cell transplantation or a family history that could result in the birth of a sibling with a disease that could be treated by stem cell transplantation. Collections were made on the provision that the sibling's clinician was willing to financially support the collection and to take responsibility for medical review of the mother and potential recipient. Given the high investment in UCB banking and the introduction of new regulations and mandatory licensing under the European Union Tissues and Cells Directive and those proposed in the U.S., this report details the procedures that we have used for DCB donations, the outcome data where donations have been used for transplantation, and it provides some timely recommendations for best practices. Disclosure of potential conflicts of interest is found at the end of this article.
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Affiliation(s)
- Jon Smythe
- Stem Cells and Immunotherapies Department, National Blood Service, NHS Blood and Transplant, Headington, Oxford, UK.
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Troeger C, Meyer-Monard S, Tichelli A, Manegold G, Pauli D, Surbek D, Holzgreve W, Bürki N. Problems in Umbilical Cord Blood Collection. Transfus Med Hemother 2007. [DOI: 10.1159/000099611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Lemarie C, Esterni B, Calmels B, Dazey B, Lapierre V, Lecchi L, Meyer A, Rea D, Thuret I, Chambost H, Curtillet C, Chabannon C, Michel G. CD34+ progenitors are reproducibly recovered in thawed umbilical grafts, and positively influence haematopoietic reconstitution after transplantation. Bone Marrow Transplant 2007; 39:453-60. [PMID: 17334384 DOI: 10.1038/sj.bmt.1705618] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cord blood (CB) units are increasingly used for allogeneic transplantation. Cell dose, a major factor for CB selection, is evaluated before freezing by each CB bank, using various techniques. This may introduce variability and affect the prediction of cell recovery after thawing, or haematopoietic reconstitution. Forty-two children were transplanted at the same institution with unrelated CB units. All units were thawed and evaluated at the same cell therapy facility, using standard procedures. We investigated: (i) factors that affect cell loss after thawing, and (ii) the importance of CD34(+) cell doses. Prefreeze and post-thaw CD34(+) cell doses were statistically correlated, thus suggesting that variability in numeration techniques used by different CB banks does not compromise the biological and clinical value of these figures. CD34(+) cell recovery appeared to be correlated with the absolute number of CD34(+) cells per frozen bag. Infused CD34(+) is the cell dose that better correlates with platelet reconstitution delay; in addition, when using a quartile comparison, haematopoietic recovery appeared to be related with prefreeze and post-thaw CD34(+) cell doses. We conclude that enumeration of CD34(+) cells in CB units is of biological significance, and may help select CB units and identify patients at risk of delayed recovery.
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Affiliation(s)
- C Lemarie
- Centre de Thérapie Cellulaire et Génique, Département de Biologie, Institut Paoli-Calmettes, Marseille, France.
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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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35
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Rocha V, Gluckman E. Clinical use of umbilical cord blood hematopoietic stem cells. Biol Blood Marrow Transplant 2006; 12:34-41. [PMID: 16399582 DOI: 10.1016/j.bbmt.2005.09.006] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 09/23/2005] [Indexed: 01/28/2023]
Abstract
Umbilical cord blood hematopoietic stem cells coming from related or unrelated donors are an alternative source of hematopoietic stem cells for patients undergoing transplantation for a wide variety of diseases. In the unrelated donor transplant setting, shorter time to transplant, which is particularly relevant to patients requiring urgent transplantation, and tolerance of 1-2 human leukocyte antigen mismatch, which increases the chance of finding a suitable donor, are evident advantages over bone marrow transplantation. The speed of engraftment is slower after cord blood transplantation but it is counterbalanced by a lower incidence of severe graft-versus-host disease. Cell dose and human leukocyte antigen are major factors influencing outcome after umbilical cord blood transplantation. Retrospective comparisons of clinical outcomes between unrelated cord blood and unrelated bone transplantation in children and adults have shown similar results, showing the value of this source of hematopoietic stem cell for transplantation. This review describes the recent clinical results and discusses developing research strategies aimed at optimizing the results of cord blood transplantation.
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Affiliation(s)
- Vanderson Rocha
- Eurocord Office Bone Marrow Transplant Hematology Department, Hôpital Saint Louis, Paris, France.
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Slatter MA, Gennery AR. Umbilical cord stem cell transplantation for primary immunodeficiencies. Expert Opin Biol Ther 2006; 6:555-65. [PMID: 16706603 DOI: 10.1517/14712598.6.6.555] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary immunodeficiencies (PIDs) are a rare but important cause of mortality and morbidity in childhood: the most severe--known as severe combined immunodeficiency (SCID)--are fatal within the first year of life; other PIDs are less immediately life-threatening, but have a poor long-term outlook. Haematopoietic stem cell transplantation (HSCT) is the best treatment for SCID and is increasingly offered for other PIDs. The best results are achieved with an HLA-matched family donor. Umbilical cord stem cells (UCSCs) are an alternative stem cell source. Results using UCSCs in the treatment of haematological disorders and malignancy are as good as those for which marrow is the stem cell source. Although PIDs make up a small proportion of disorders amenable to treatment by HSCT, UCSCs are an ideal source of haematopoietic stem cells for many of these patients. Of the 52 patients with SCID or other PIDs for whom detailed information on outcome is available, results of engraftment, immune reconstitution, incidence of graft-versus-host disease and survival are comparable with other stem cell sources. Small stem cell dose and prolonged time to viral immunity limit the patients for whom UCSCs can be used. Newer methods of achieving better engraftment, ex vivo expansion of stem cells and generation of antigen-specific cytotoxic T cells are being developed at present, and will widen the application of UCSCs as a viable source for more patients.
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Affiliation(s)
- M A Slatter
- Department of Paediatric Immunology, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK
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Berger ME, Christensen DM, Lowry PC, Jones OW, Wiley AL. Medical management of radiation injuries: current approaches. Occup Med (Lond) 2006; 56:162-72. [PMID: 16641501 DOI: 10.1093/occmed/kql011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The current approach to medical management of irradiated patients begins with early diagnosis of radiation injury. Medical assessment of radiation dose is based on event history, symptomatology and laboratory results, with emphasis on time to emesis and lymphocyte depletion kinetics. Dose assessment provides a basis for early use of haematopoietic growth factors that can shorten the period of neutropaenia for patients with acute radiation syndrome. Assessments of haematopoietic, gastrointestinal and cutaneous syndromes have improved in recent years, but treatment options remain limited. Selected examples of current developments are presented.
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Affiliation(s)
- M E Berger
- Radiation Emergency Assistance Center/Training Site (REAC/TS), PO Box 117, Oak Ridge, TN 37831-0117, USA
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38
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Roback JD, Caliendo AM, Newman JL, Sgan SL, Saakadze N, Gillespie TW, Lane TA, Kurtzberg J, Hillyer CD. Comparison of cytomegalovirus polymerase chain reaction and serology for screening umbilical cord blood components. Transfusion 2005; 45:1722-8. [PMID: 16271096 DOI: 10.1111/j.1537-2995.2005.00596.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recipients of umbilical cord blood (UCB) transplants are susceptible to opportunistic infections, including cytomegalovirus (CMV). To prevent CMV transmission from UCB donors, most laboratories perform serology on corresponding maternal samples and quarantine units when the mother has immunoglobulin M (IgM) anti-CMV. STUDY DESIGN AND METHODS UCB units and associated samples (UCB plasma and red cell pellet; maternal whole blood and serum) from two cord blood banks were tested with two validated CMV polymerase chain reaction assays (UL54 and UL93 targets). Results were compared with maternal CMV serology (IgG and IgM). RESULTS Only 4 of 48 (8.3%) quarantined CMV IgM-positive units were also CMV nucleic acid testing (NAT)-positive (651-68,600 copies/mL). In contrast, 1 of 200 "CMV-safe" UCB units (CMV IgM-equivocal or -negative) had CMV DNA (0.5%). The corresponding maternal samples were CMV NAT-negative. Positive maternal IgM serology demonstrates only modest sensitivity (80%) and specificity (82%) and poor positive predictive value (8%), when correlated with the presence of CMV DNA in UCB units. CONCLUSION CMV NAT may be a useful adjunct to serologic screening, potentially reducing wastage of IgM-positive and NAT-negative units while also detecting potentially infectious units that would pass serologic screening. A prospective clinical trial to further evaluate the role of CMV NAT in UCB transplantation appears warranted.
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Affiliation(s)
- John D Roback
- Transfusion Medicine Program, the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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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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Adami V, Malangone W, Falasca E, Marini L, Risso A, Crini S, Toniutti E, Passoni Ferraro E, Del Frate G, Pittino M, Biffoni F, Rinaldi C, Degrassi A. A closed system for the clinical banking of umbilical cord blood. Blood Cells Mol Dis 2005; 35:389-97. [PMID: 16112591 DOI: 10.1016/j.bcmd.2005.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 07/19/2005] [Accepted: 07/20/2005] [Indexed: 11/30/2022]
Abstract
Umbilical cord blood (UCB) is a source of hematopoietic progenitor cells and is used as an alternative to the bone marrow or peripheral blood for treatment of several onco-hematological diseases. Because of the limited number of CD34+ hematopoietic stem cells present in UCB units and of the elevated costs of cryopreservation, it is of paramount importance to select the UCB units that are clinically useful before storage and optimize banking efficiency by designing reliable procedures to process and freeze the selected units. Among the different parameters characterizing UCB, nucleated cell (NC) and CD34+ cell content provides useful criteria to select UCB units since clinical data documented that the infused cell load (both NC and CD34+ cells) plays an important role in the successful outcome of transplants. By evaluating volume, CD34+ cell content, NC total amount, and NC density of 117 UCB units, we found a significant association between CD34+ cell content and NC density and total amount, indicating these parameters as useful to decide UCB clinical utility. Furthermore, we set up a fast procedure to process UCB units for storage. A system for NC separation and volume reduction of UCB samples in a dedicated, germ-free, closed circuit was developed, where plasma and red blood cells (RBC) depletion was obtained by sedimentation in the presence of a 3.5% Polygeline solution. By this separation system, both RBC depletion and high NC and CD34+ cell recoveries were achieved in 60 min, and the yield was comparable to the one obtained by other separation methods. Since Polygeline has been clinically used as a plasma expander and no toxic effects on patients were reported, the protocol can be applied in the large-scale banking of UCB.
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Affiliation(s)
- V Adami
- Consorzio Fenice, University of Udine, Italy
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De Bruyn C, Delforge A, Martiat P, Bron D. Ex Vivo Expansion of Megakaryocyte Progenitor Cells: Cord Blood Versus Mobilized Peripheral Blood. Stem Cells Dev 2005; 14:415-24. [PMID: 16137231 DOI: 10.1089/scd.2005.14.415] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thrombocytopenia is a problematic and potentially fatal occurrence after transplantation of cord blood stem cells. This problem may be alleviated by infusion of megakaryocyte progenitor cells. Here, we compared the ability of hematopoietic progenitor cells obtained from cord blood and expanded in culture to that of mobilized peripheral blood cells. The CD34(+) cells were plated for 10 days in presence of thrombopoietin (TPO) alone and combined with stem cell factor (SCF), Flt3-ligand (FL), interleukin-3 (IL-3), IL-6, and IL-11. Cells were analyzed for the CD41 and CD42b expression and for their ploidy status. Ex vivo produced platelets were enumerated. We show that (1) TPO alone was able to induce differentiation of CD34(+) cells into CD41(+) cells, with limited total leucocyte expansion; (2) the addition of SCF to TPO decreased significantly CD41(+) cell percentage in CB, but not in MPB; and (3) in CB, the addition of FL, IL-6, and IL-11 to TPO increased the leukocyte expansion with differentiation and terminal maturation into MK lineage. In these conditions, high numbers of immature CD34(+)CD41(+) MK progenitor cells were produced. Our results thereby demonstrate a different sensitivity of CB and MPB cells to SCF, with limited CB MK differentiation. This different sensitivity to SCF (produced constitutively by BM stromal cells) could explain the longer delay of platelet recovery after CB transplant. Nevertheless, in CB, the combination of TPO with FL, IL-6, and IL-11 allows generation of a suitable number of immature MK progenitor cells expressing both CD34 and CD41 antigens, which are supposed to be responsible for the platelet recovery after transplantation.
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Affiliation(s)
- C De Bruyn
- Experimental Hematology, Jules Bordet Institute, 1000 Brussels, Belgium.
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Solves P, Mirabet V, Planelles D, Blasco I, Perales A, Carbonell-Uberos F, Soler MA, Roig R. Red blood cell depletion with a semiautomated system or hydroxyethyl starch sedimentation for routine cord blood banking: a comparative study. Transfusion 2005; 45:867-73. [PMID: 15934983 DOI: 10.1111/j.1537-2995.2005.04357.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The major problem with long-term cord blood (CB) banking is the required storage space. In this sense, many studies have been performed to establish techniques for volume reduction of CB units. STUDY DESIGN AND METHODS We compared two different methods for CB volume reduction in both development and routine phases: hydroxyethyl starch (HES) sedimentation and top-and-bottom fractionation with the Optipress II (Baxter Healthcare). Monitoring the total nucleated cell (TNC) count, lymphocytes, CD34+ cells, and colony-forming unit (CFU) content in both preprocess and postprocess CB units assessed the volume reduction process. RESULTS The CB units processed in both groups had comparable volume and cells counts before and after volume reduction, except for number of red blood cells (RBCs), which was significantly greater for the Optipress II group. Recoveries of CD34+ and RBC depletion were significantly better for the HES group. For routine processing, TNC and lymphocyte recoveries were significantly better for CB units processed by the Optipress II system. There was, however, significantly less depletion of RBCs for this group. The time required for CB processing with the Optipress II was significantly shorter than the time needed for volume reduction by addition of HES (25+/-5 min vs. 55+/-10 min). CONCLUSION The volume reduction method with the Optipress II is a closed time-saving system that allows good cell recoveries. In contrast, the main advantage of the HES method is the higher RBC depletion that influences CFU content. Reducing RBC content must be the object of further improvements for volume reduction using the Optipress II method.
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Affiliation(s)
- Pilar Solves
- Valencia Cord Blood Bank, Valencia Transfusion Center, Valencia, Spain.
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Watt SM, Contreras M. Stem cell medicine: umbilical cord blood and its stem cell potential. Semin Fetal Neonatal Med 2005; 10:209-20. [PMID: 15927877 DOI: 10.1016/j.siny.2005.02.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The ultimate aim of stem cell research is to improve patient outcomes and quality of life, and/or to effect a cure for a variety of inherited or acquired diseases. Improved treatments rely on developments in stem cell therapies and the discovery of new therapeutic drugs that regulate stem cell functions. These complement each other for the repair, regeneration and replacement of damaged or defective tissues. Stem cells may be sourced or derived from blood and tissues postnatally ('adult' stem cells), from the fetus (fetal stem cells) or from the blastocyst in the developing embryo prior to implantation (embryonic stem cells), each forming a unique component of the revolution in stem cell research and therapies. This review will concentrate on recent developments in the use of haemopoietic stem cells from umbilical cord blood for the transplantation of patients with haematological disorders. It will conclude with a summary of the potential of other umbilical cord blood-derived stem cells for tissue repair or regeneration.
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Affiliation(s)
- Suzanne M Watt
- National Blood Service, Oxford and Colindale, UK; Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
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Abstract
PURPOSE OF REVIEW Familiar and unrelated umbilical cord blood is an appealing alternative source of hematopoietic stem cells patients undergoing transplantation for a wide variety of diseases. In the unrelated donor transplant setting, shorter time to transplant, which is particularly relevant to patients requiring urgent transplantation, and tolerance of 1-2 human leukocyte antigen mismatch, which increases the chance of finding a suitable donor, are evident advantages over bone marrow transplantation. The speed of engraftment is slower after cord blood transplantation but it is counterbalanced by a lower incidence of severe graft-versus-host disease. Cell dose and human leukocyte antigen are major factors influencing outcome after umbilical cord blood transplantation. RECENT FINDINGS Unrelated donor cord blood transplantation is considered an acceptable option to bone marrow for pediatric transplantation, and recent data in adults point the same way. SUMMARY This review describes the recent clinical results of cord blood transplantation and discusses developing research strategies aimed at optimizing this kind of transplantation.
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Affiliation(s)
- Vanderson Rocha
- Eurocord Office, Bone Marrow Transplant, Hematology Department, Hôpital Saint Louis, Paris, France.
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Bornstein R, Flores AI, Montalbán MA, del Rey MJ, de la Serna J, Gilsanz F. A modified cord blood collection method achieves sufficient cell levels for transplantation in most adult patients. Stem Cells 2005; 23:324-34. [PMID: 15749927 DOI: 10.1634/stemcells.2004-0047] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Umbilical cord blood transplantation (UCBT) has been used increasingly in both pediatric and adult patients. The total nucleated cell (NC) dose infused is the most critical factor in determining speed of engraftment and survival. Using standard collection techniques, the mean NC content of UCB units is about 10 x 10(8) and only 25% of these units reach the target cell dose of 2 x 10(7)/kg in UCBT patients weighing 50-70 kg. We have designed a modified placental/umbilical two-step collection method in which a standard blood fraction obtained by umbilical venipuncture is combined with a second fraction harvested after placental perfusion with 50 ml heparinized 0.9% saline. This second fraction contributed 32% volume and 15% NCs to the whole UCB unit (123.7 +/- 50.1 ml and 1.26 +/- 0.52 x 10(9) NC). The proportion of progenitor cells in both fractions was not significantly different, indicating that the hematopoietic potential of these larger units is 20% (range, 2%-100%) higher than UCB units collected by standard methods. In addition, the bacterial contamination rate associated with this novel collection method (2.78%) compares favorably. Since 1998 we have further enriched our units by processing only UCB units over 0.8 x 10(9) NCs, resulting in a 36% cell increment (1.46 +/- 0.52 x 10(9) NCs). Thus, 84% and 54% of the Madrid UCB Bank inventory would fulfill the target cell dose of 2 x 10(7)/kg in patients weighing 50 and 65 kg, respectively. This significant UCB banking improvement gives larger pediatric and adult patients a greater chance of finding adequate grafts in order to achieve better clinical outcomes after UCBT.
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Affiliation(s)
- Rafael Bornstein
- Madrid Cord Blood Bank, Hospital 12 de Octubre, Avda. de Córdoba, s/n, Madrid 28041, Spain.
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Abstract
Umbilical cord blood--the blood that remains in the placenta after birth--can be collected and stored frozen for years. A well-accepted use of cord blood is as an alternative to bone marrow as a source of hematopoietic stem cells for allogeneic transplantation to siblings or to unrelated recipients; women can donate cord blood for unrelated recipients to public banks. However, private banks are now open that offer expectant parents the option to pay a fee for the chance to store cord blood for possible future use by that same child (autologous transplantation).
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Abstract
Cord blood (CB) is a unique product, rich in haemopoietic stem cells (HSC), that is currently used in the transplantation setting to restore haemopoiesis. It restores haemopoietic stem cell function in patients suffering from malignancies, bone marrow (BM) failure disorders and inherited metabolic and immunological disorders. Related and unrelated CB donations have been successfully transplanted in both the paediatric and adult settings. CB, previously considered a waste product, can be collected from both vaginal deliveries and caesarean sections, either in utero or ex utero, at no risk to the donor, processed to remove excess plasma and red cells, cryopreserved, tested, HLA-typed and stored to provide an 'off-the-shelf' product. CB has a lower risk of some important viral infections and a lower incidence and severity of acute and chronic graft versus host disease (GvHD) than BM. CB transplantation is under innovative development and international collaborative studies are investigating ways to improve transplant outcomes. Other uses for CB remain speculative and it is premature to speculate whether non-haemopoietic stem cells are present in cord blood in sufficient numbers for use against degenerative conditions, as is currently postulated by some commercial organisations. Cord blood banking in EU member countries is now regulated by an EU Directive, which provides a statutory basis for regulation safety to ensure efficacy. Compliance is required by 2006. It requires that all banking establishments are inspected and accredited by a Competent Authority. This includes public altruistic banking as well as directed banking activities.
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Affiliation(s)
- Ruth Warwick
- London Cord Blood Bank, National Blood Service, Edgware, Middlesex HA8 9BD, UK
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Gluckman E, Rocha V. Cord blood transplant: strategy of alternative donor search. ACTA ACUST UNITED AC 2004; 26:143-54. [PMID: 15549306 DOI: 10.1007/s00281-004-0157-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 04/18/2004] [Indexed: 10/26/2022]
Abstract
Unrelated cord blood transplantation has been used to treat patients with malignant and non-malignant hematopoietic disorders for whom an HLA-compatible hematopoietic stem cell donor is not available. The establishment of cord blood banks worldwide, the increased number of cord blood units frozen, and the shorter time to find a donor, have made it possible to use this source of hematopoietic stem cells to treat more than 2,500 patients. The Eurocord registry was established to study the clinical results of cord blood transplantation and to compare the outcomes of unrelated transplants using either cord blood or bone marrow. Briefly, we have found, in two distinct retrospective analyses of children or adults with acute leukemia given either an unrelated cord blood or bone marrow transplant, that leukemia-free survival and relapse were similar in both types of graft (with adjustment for confounding clinical factors). Cord blood recipients experienced a decreased incidence of acute graft-versus-host disease and delayed hematopoietic recovery compared to bone marrow recipients. To improve the delayed hematopoietic recovery after cord blood transplantation, certain approaches have been investigated such as ex vivo expansion of cord blood cells, double cord blood transplantation and reduced intensity conditioning regimen. We have also attempted to establish some guidelines for cord blood-donor choice based on cord blood cell dose and number of HLA disparities that have been found to be associated with hematopoietic recovery. In conclusion, an unrelated hematopoietic stem cell donor should be simultaneously searched for in cord blood banks and in bone marrow donor registries for patients lacking an HLA-identical sibling hematopoietic stem cell donor. The option of performing cord blood transplants should be based on urgency of the transplant, cord blood cell dose and number of HLA disparities.
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Affiliation(s)
- Eliane Gluckman
- Hematology-Bone Marrow Transplant Department and Eurocord office, Hospital Saint Louis, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.
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