Extending Cord Blood Transplant to Adults: Dealing With Problems and Results Overall

Blood and Marrow Transplant Program, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.
Seminars in Hematology (Impact Factor: 3.27). 01/2010; 47(1):86-96. DOI: 10.1053/j.seminhematol.2009.10.010
Source: PubMed


The development of newer strategies to overcome, in particular, the cell dose limitation, has increased the availability of umbilical cord blood (UCB) as a source of hematopoietic stem cells (HSC) for transplantation of adults. Among these strategies is the development of the double UCB, ex vivo, and reduced-intensity transplantation platforms. Several ongoing registry-based and single-institution and multicenter clinical trials are investigating ways to make UCB transplantation safer and to improve the outcomes of adults after UCB transplantation. We review the background data and promising newer strategies that will further expand the utilization of UCB for the treatment of adults.

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Available from: Mary J Laughlin,
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    ABSTRACT: Haemopoietic stem cell transplantation (HSCT) is a curative therapy for severe haematological disorders. It was fi rst carried out successfully ~50 years ago. With technological advances, HSCT has expanded rapidly over the past 20 years. 1,2 Current indications for HSCT include leukaemias, lymphomas, solid tumours (e.g. neuroblastomas), severe combined immunodefi ciencies, inborn errors of metabolism, autoimmune diseases and severe anaemias. 1-3 HSCT is now provided to ~70,000 patients p.a. worldwide. In the UK, approximately 3,000 HSC transplants are performed p.a. (www.bsbmt.com), contributing to ~25,000 p.a. across Europe. 1-4 Of those HSCT provided worldwide, ~70-80% have autologous or related allogeneic HSCT. The remainder have unrelated HSCT, of which almost 20% are sourced from unrelated umbilical cord blood (UCB) donations in the USA and 50% in Japan. 4 Despite significant advances, overall survival following HSCT can vary because of disease relapse, engraftment failure, infections and Graft versus Host Disease (GvHD). 5,6 In this review, we describe the current use, advantages and limitations of UCB for HSCT, principally concentrating on unrelated allogeneic UCB units. However, UCB and the umbilical cord (UC) also contain other stem/progenitor cells (e.g. mesenchymal stem cells (MSC)) and hence we extend our discussions to these describing their potential therapeutic use in HSCT and regenerative medicine.

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