Adult umbilical cord blood transplantation: A comprehensive review

Department of Hematology, Gasthuisberg University Hospital Leuven, Leuven, Belgium.
Bone Marrow Transplantation (Impact Factor: 3.57). 07/2006; 38(2):83-93. DOI: 10.1038/sj.bmt.1705403
Source: PubMed


Recent registry studies have established umbilical cord blood (UCB) transplantation as a safe and feasible alternative to bone marrow transplantation in adults when no sibling donor is available. There is, however, no gold standard to guide optimal treatment choices. We review here factors leading to the choice of the 'best available donor' and 'best available unit' in the case of UCB. For instance, it is clear that higher cell dose may partially overcome the negative impact of certain histocompatibility leukocyte antigen (HLA) disparities in UCB transplantation, leading us to choose the more closely HLA-matched unit with a cell dose >2.5 x 10(7)/kg. New approaches in adult UCB transplantation are systematically covered, with a quantitative appreciation of the evidence available to date. Reduced intensity conditioning, for example, broadens the range of potential recipients by reducing transplant-related mortality, but suffers from unproven risks and benefits long term. Potential advantages of multiple units over single unit transplants are discussed, with a particular emphasis on confounding factors that impact interpretation. The limited clinical results of ex vivo UCB expansion, the possible benefits of co-infusion of haploidentical cells and controversial issues (e.g. killer immunoglobulin-like receptor matching and alternative graft sources) are also addressed with a debate on the future of UCB transplantation.

Download full-text


Available from: Johan Maertens, Jan 30, 2015
  • Source
    • "The involvement of UCB in therapeutic application was reported since 1972, when clinicians treated one case of lymphoblastic leukemia (Ende and Ende, 1972). Nowadays, the translational potential of the clinical applications of UCB stem cells is increased due to important advantages such as the ease to recover the cells right after birth without any risk for the donor, the lack of ethical issues, the low onset of graft-versus-host disease (GVHD) (Broxmeyer et al., 1989; Ballen, 2005; Schoemans et al., 2006; Brunstein et al., 2007; Hwang et al., 2007; Broxmeyer, 2010), and finally the high proliferation rate and long telomere maintenance (Kim et al., 1999; Pipes et al., 2006). Starting from 2003, Pesce and co-workers demonstrated muscle amelioration after injection of CD34+ UCB cells in injured adductor muscle and new MYOD+ cells of UCB origin (Pesce et al., 2003) in a CD1 mouse model of hindlimb ischemia. "
    [Show abstract] [Hide abstract]
    ABSTRACT: More than 40% of the body mass is represented by muscle tissue, which possesses the innate ability to regenerate after damage through the activation of muscle-specific stem cells, namely satellite cells. Muscle diseases, in particular chronic degenerative states of skeletal muscle such as dystrophies, lead to a perturbation of the regenerative process, which causes the premature exhaustion of satellite cell reservoir due to continuous cycles of degeneration/regeneration. Nowadays, the research is focused on different therapeutic approaches, ranging from gene and cell to pharmacological therapy, but still there is no definitive cure in particular for genetic muscle disease. Keeping this in mind, in this article, we will give special consideration to muscle diseases and the use of fetal derived stem cells as a new approach for therapy. Cells of fetal origin, from cord blood to placenta and amniotic fluid, can be easily obtained without ethical concern, expanded and differentiated in culture, and possess immune-modulatory properties. The in vivo approach in animal models can be helpful to study the mechanism underneath the operating principle of the stem cell reservoir, namely the niche, which holds great potential to understand the onset of muscle pathologies.
    Full-text · Article · Aug 2014 · Frontiers in Aging Neuroscience
  • Source
    • "The result of these experiments for replication (32-34) or differentiation (35) of stem cells was performed. Finally it caused better BMT and other hematic transplantations (36-38) or even without entering the clinical stage, biological or synthetic structures were used for stem cell proliferation (39-42). In Tan and colleagues research -2011(43), three-dimensional structure was derived from the bone tissue for stem cell proliferation to achieve 7.5-fold expansion. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective(s): Ex vivo expansion of hematopoitic stem cells is an alternative way to increase umbilical cord blood (UCB)-CD34+ cells for bone marrow transplantation. For this purpose demineralized bone matrix (DBM) and mineralized bone allograft (MBA) as two scaffolds based on bone matrix and stem cell niche, were simultaneously used to enhance the effect of human mesenchymal progenitor cells (MPCs) - unrestricted somatic stem cells (USSCs) - as a feeder layer. Materials and Methods: USSCs were isolated and characterized by morphological and immunological analysis then seeded on both scaffolds as a feeder layer. UCB-CD34+ were isolated by MACS method and were co-culture expanded by USSC in 3D and 2D environments. After 3 weeks expansion, cells were counted and were assessed by karyotype, flow cytometry, clonogenic activity, and long-term culture-initiating cells (LTC-IC). Results: Co-culture expansion in DBM and MBA was 29.22-fold and 27.77-fold, no significant differences in colony and LTC-IC were obtained. Maximum number of colonies belonged to the day 14 with the 73% CFU-GM (Colony Forming Unit- Granulocyte/Macrophage) in contrast to the day 0 which was BFU-E/CFU-E (Burst/Colony Forming Unit-Erythroid). Flow cytometry indicated that the percentage of CD34+ marker was decreased in USSC co-culture and the highest percentage was observed in simple 2D culture. Conclusion: Because of acid extraction in the DBM production process, mineral materials were removed and the protein background that was more flexible was presented. Therefore these results suggest that USSC-DBM can be a suitable ex vivo mimicry niche by intensifying of surface/volume ratio and supporting the stem cell differentiation and expansion.
    Full-text · Article · Oct 2013 · Iranian Journal of Basic Medical Science
  • Source
    • "Cord blood transplantation (CBT) has become an increasingly utilized method of HCT.14 Cord blood T cells are immunologically naive; therefore, they do not supply passive immunity to the HCT recipient. Although HCT recipients of all donor sources were affected by CMV antigenemia and disease, an increased risk for viral infections after CBT is a concern.4,15,16 "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was performed in order to evaluate the incidence and characteristics of cytomegalovirus (CMV) infection in children with acute leukemia according to donor source and graft type. We retrospectively identified children with acute leukemia who had received allogeneic hematopoietic cell transplantation at Samsung Medical Center in Korea from October 1998 to December 2009. In total, 134 recipients were identified. The patients were classified into the following three groups: unrelated cord blood (CB, n=36), related bone marrow or peripheral blood stem cells (RD, n=41), and unrelated bone marrow or peripheral blood stem cells (UD, n=57). The 365-day cumulative incidence of CMV antigenemia was not significantly different among the three groups (CB 67% vs. RD 49% vs. UD 65%, p=0.17). However, CB recipients had the highest median value of peak antigenemia (CB 160/2×10⁵ leukocytes vs. RD 7/2×10⁵ leukocytes vs. UD 19/2×10⁵ leukocytes, p<0.01) and the longest duration of CMV antigenemia than the other stem cell source recipients (CB 87 days vs. RD 17 days vs. UD 28 days, p<0.01). In addition, the 730-day cumulative incidence of CMV disease was the highest in the CB recipients (CB 36% vs. RD 2% vs. UD 5%, p<0.01). Thirteen CB recipients developed CMV disease, in which five of them had more than one organ involvement. Two patients, who were CB recipients, died of CMV pneumonia. This study suggests that CB recipients had both longer and higher cumulative incidences of CMV infection. Therefore, a more aggressive and effective strategy of CMV management should be considered in CB recipients.
    Full-text · Article · Mar 2012 · Yonsei medical journal
Show more