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New Documents ABO Blood Group System Acute Hemolytic Transfusion Reaction Allergic Reactions Anaphylactic Reactions Antibody Adsorption Procedures Antibody Identification Apheresis Autologous Blood Donation Blood Infusion Blood Salvage CMV Negative Blood Components Compatibility Testing Cord Blood Direct Antiglobulin Testing Cryoprecipitate Delayed Hemolytic Transfusion Reaction Direct Antiglobulin Test Directed Blood Donations Drug Induced Thrombocytopenia Febrile Nonhemolytic Reactions Fetal Maternal Hemorrhage Hemophilia A Hemophilia B Heparin Induced Thrombocyopenia Previous Documents ABO Blood Group System ABO Mismatched Allogeneic Transplants Albumin Autoimmune Hemolytic Guidelines Blood Administration Blood Component Transfusion Guidelines Blood Donation CMV Negative Blood Components Compatibility Testing Cryoprecipitate Factor IX Complex Factor VIIa Factor VIII Concentrate Factor VIII Inhibitors Fresh Frozen Plasma Granulocyte Transfusion Hemolysis Following Allogeneic BMT Informed Consent Irradiated Blood Components Leukocyte Reduced Red Cells & Platelets Massive Transfusion Neonatal Alloimmune Thrombocytopenia Nitric Oxide Banked Blood Other Blood Group Systems Pediatric & Neonatal Transfusion Practices Platelet Transfusion Prenatal & Perinatal Immunohematologic Testing RBC Transfusion Trigger Red Blood Cell Transfusion Rh Blood Group System RhIG for HDN Prevention RhIG for Treatment of ITP Saline Washed Red Blood Cells Sickle Cell Disease Transfusion Therapeutic Apheresis Thrombotic Thrombocytopenic Purpura Transfusion Reactions Transfusion Related Acute Lung Injury Trypanosoma Cruzi Donor Screening Umbilical Cord Blood Stem Cells von Willebrands Disease Warm Autoimmune Hemolytic Anemia

Umbilical Cord Blood Stem Cells

Stem cells from umbilical cord blood have increasingly become a viable alternative source of progenitor cells for hematopoietic cell transplantation (HCT). To date, cord blood stem cells have been used in over 6000 unrelated-donor transplantations throughout the world.

When autologous stem cells are not an option, the ideal source of progenitor cells is from the bone marrow or peripheral blood of an HLA-matched sibling. An HLA match decreases the risk of severe graft-versus-host disease (GVHD) and increases the chances of a successful engraftment. However, a full HLA-match occurs in only 25% of sibling donors. While HLA-matched allogeneic donors may be used, the process of finding a suitable donor can be lengthy and a fully HLA-matched donor may never be found for some patients. A full match from an unrelated donor is even less likely for potential recipients with a non-Northern European heritage due to fewer non-white donors and genetic heterogeneity. For these reasons, umbilical cord blood from unrelated, partially HLA-mismatched donors has become a reasonable alternative source of stem cells for bone marrow reconstitution.

Transplantation across HLA barriers, rapid availability and decreased risk of transmission of infectious diseases are advantages of the use of cord blood over peripheral blood or bone marrow HCT. In addition, studies have shown that the incidence and severity of GVHD decreases with partially HLA-mismatched cord blood HCT when compared to partially mismatched unrelated bone marrow or peripheral blood HCT.

The New York Blood Center (NYBC) recently collaborated with the Center for International Blood and Marrow Transplant Research (CIBMTR) in the analysis of HCT treatment of children (under 16 years old) with leukemia or myelodysplasia. They found similar three-year survival rates for those receiving unrelated cord blood transplants and those receiving equally well-matched unrelated bone marrow transplants.

Adults have also been found to be good candidates for cord blood HCT. According to a study published in the November 25, 2004 issue of the New England Journal of Medicine (NEJM), "HLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor." This study involved 600 adults and resulted in participants who received cord blood with a 5/6 or 4/6 HLA match doing as well as those who received bone marrow with a 5/6 HLA match.

Cord blood transplantation can be limited by the number of cells present in a given unit, particularly for adults or larger pediatric patients. If a single unit is inadequate for engraftment, multiple cord blood units are sometimes attempted. A double umbilical cord blood transplantation has been shown to have success (in terms of GVHD, rates of engraftment, survival and transplant-related mortality) similar to single umbilical cord blood transplantation and unrelated bone marrow transplantation. Other studies involving ex vivo expansion of cord blood stem cells to increase their numbers per unit are also under investigation.