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Collection and storage of umbilical cord blood for hematopoietic cell transplantation

Bertram H Lubin, MD
Section Editors
Robert S Negrin, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Alan G Rosmarin, MD


Reconstitution of the bone marrow is an important and potentially curative treatment option for a wide variety of malignant and nonmalignant diseases, including acute and chronic leukemia, lymphoma, aplastic anemia, sickle cell anemia, thalassemia major, and a number of other genetic and acquired disorders. The pluripotent hematopoietic stem cells required for this procedure are usually obtained from the bone marrow, peripheral blood, or umbilical cord blood of an allogeneic (non-self) related or unrelated donor. In some situations where extensive myeloablative chemotherapy is required to treat a malignancy not involving the bone marrow, autologous (self) stem cells may be used.

Engraftment and survival rates following hematopoietic cell transplantation (HCT) are optimized when the donor and recipient are genetically compatible. The risk of graft-versus-host disease (GVHD) correlates with the level of human leukocyte antigen (HLA) disparity. Unfortunately, finding an HLA-matched donor is not always possible, especially for minorities. While autologous hematopoietic stem cells provide perfectly compatible tissue, this type of transplantation is not appropriate in many cases, due to the presence of the disease to be treated in the collected autologous stem cells. Each full sibling potential donor has only a 25 percent chance of being fully HLA-matched with a sibling who requires a transplant. Therefore, many patients do not have an HLA-identical relative.

When a suitable related donor is not available, a search is conducted to identify a potential unrelated HLA-matched donor. Finding an appropriate donor through a national registry is a lengthy process that is not always successful, especially for individuals who are not of Northern European descent. As a result, many patients who might benefit from HCT are not afforded this opportunity, or die during the extended process of securing a donor. (See "Donor selection for hematopoietic cell transplantation", section on 'Unrelated donors'.)

Because of the lack of matched related donors and the risk of severe GVHD that accompanies mismatched unrelated bone marrow or peripheral blood HCT, alternative sources of hematopoietic stem cells have been sought. Umbilical cord blood, the blood remaining in the umbilical cord and placenta following the birth of an infant, has emerged as a potential alternative source of hematopoietic stem cells in allogeneic HCT. Collection, storage, and ethical issues regarding the use of cord blood for HCT will be discussed here. Other issues related to umbilical cord blood transplantation are discussed separately, including the advantages and limitations to cord blood as a stem cell source and the administration of cord blood transplantation in adults using myeloablative and non-myeloablative preparative regimens. (See "Selection of an umbilical cord blood graft for hematopoietic cell transplantation" and "Umbilical cord blood transplantation in adults using myeloablative and nonmyeloablative preparative regimens" and "Sources of hematopoietic stem cells" and "Donor selection for hematopoietic cell transplantation".)


Unrelated umbilical cord blood offers many practical advantages over unrelated donor bone marrow or mobilized peripheral blood progenitor cells as a source of hematopoietic stem cells including an expanded donor pool, ease of procurement and lack of donor attrition, lack of need for a complete human leukocyte antigen (HLA) match, and decreased graft-versus-host disease for the degree of HLA disparity. Limitations to umbilical cord blood include an increased risk of graft failure, delayed immune reconstitution, limited stem cell number, and unavailability of the donor for additional donations (ie, donor lymphocyte infusions). This is discussed in more detail separately. (See "Selection of an umbilical cord blood graft for hematopoietic cell transplantation", section on 'Advantages and limitations of cord blood'.)

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Literature review current through: Dec 2017. | This topic last updated: Apr 25, 2016.
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  1. Barker JN, Wagner JE. Umbilical-cord blood transplantation for the treatment of cancer. Nat Rev Cancer 2003; 3:526.
  2. Rebulla P. Cord blood banking 2002: 112,010 of 7,914,773 chances. Transfusion 2002; 42:1246.
  3. Cord blood banks. Med Lett Drugs Ther 2001; 43:84.
  4. Nishihira H, Kato K, Isoyama K, et al. The Japanese cord blood bank network experience with cord blood transplantation from unrelated donors for haematological malignancies: an evaluation of graft-versus-host disease prophylaxis. Br J Haematol 2003; 120:516.
  5. Moise KJ Jr. Umbilical cord stem cells. Obstet Gynecol 2005; 106:1393.
  6. Reed W, Smith R, Dekovic F, et al. Comprehensive banking of sibling donor cord blood for children with malignant and nonmalignant disease. Blood 2003; 101:351.
  7. Askari S, Miller J, Clay M, et al. The role of the paternal health history in cord blood banking. Transfusion 2002; 42:1275.
  8. Wall D. Umbilical cord blood transplantation. In: Pediatric Stem Cell Transplantation, Mehta P (Ed), Jones and Bartlett Publishers, Sudbury, MA 2004. p.337.
  9. Navarrete C, Contreras M. Cord blood banking: a historical perspective. Br J Haematol 2009; 147:236.
  10. Fernandez CV, Gordon K, Van den Hof M, et al. Knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells. CMAJ 2003; 168:695.
  11. Vawter DE, Rogers-Chrysler G, Clay M, et al. A phased consent policy for cord blood donation. Transfusion 2002; 42:1268.
  12. Lasky LC, Lane TA, Miller JP, et al. In utero or ex utero cord blood collection: which is better? Transfusion 2002; 42:1261.
  13. Wong A, Yuen PM, Li K, et al. Cord blood collection before and after placental delivery: levels of nucleated cells, haematopoietic progenitor cells, leukocyte subpopulations and macroscopic clots. Bone Marrow Transplant 2001; 27:133.
  14. Cord blood banking for potential future transplantation: subject review. American Academy of Pediatrics. Work Group on Cord Blood Banking. Pediatrics 1999; 104:116.
  15. Study, CBT. Chapter 3. Collection Procedures. In: Cord Blood Transplantation Study Cord Blood Bank Standard Operating Procedures. National Heart, Lung, and Blood Institute,1998.
  16. Program, SDCB. Collection Instructions for Obstetrician/Midwife. Oakland, CA 2003.
  17. Program, NYBCNCB. Collection of Placental/Umbilical Cord Blood Units. New York, NY 2003.
  18. Lecchi L, Rebulla P, Ratti I, et al. Outcomes of a program to evaluate mother and baby 6 months after umbilical cord blood donation. Transfusion 2001; 41:606.
  19. Rogers I, Sutherland, Holt D, et al. Human UC-blood banking: impact of blood volume, cell separation and cryopreservation on leukocyte and CD34(+) cell recovery. Cytotherapy 2001; 3:269.
  20. Nakagawa R, Watanabe T, Kawano Y, et al. Analysis of maternal and neonatal factors that influence the nucleated and CD34+ cell yield for cord blood banking. Transfusion 2004; 44:262.
  21. Aufderhaar U, Holzgreve W, Danzer E, et al. The impact of intrapartum factors on umbilical cord blood stem cell banking. J Perinat Med 2003; 31:317.
  22. Ballen KK, Wilson M, Wuu J, et al. Bigger is better: maternal and neonatal predictors of hematopoietic potential of umbilical cord blood units. Bone Marrow Transplant 2001; 27:7.
  23. Donaldson C, Armitage WJ, Laundy V, et al. Impact of obstetric factors on cord blood donation for transplantation. Br J Haematol 1999; 106:128.
  24. Askari S, Miller J, Chrysler G, McCullough J. Impact of donor- and collection-related variables on product quality in ex utero cord blood banking. Transfusion 2005; 45:189.
  25. Aroviita P, Teramo K, Hiilesmaa V, Kekomäki R. Cord blood hematopoietic progenitor cell concentration and infant sex. Transfusion 2005; 45:613.
  26. George TJ, Sugrue MW, George SN, Wingard JR. Factors associated with parameters of engraftment potential of umbilical cord blood. Transfusion 2006; 46:1803.
  27. Manegold G, Meyer-Monard S, Tichelli A, et al. Cesarean section due to fetal distress increases the number of stem cells in umbilical cord blood. Transfusion 2008; 48:871.
  28. Solves P, Perales A, Mirabet V, Roig R. Stress factors and umbilical cord blood banking. Transfus Med 2007; 17:205.
  29. Solves P, Perales A, Fillol M, et al. Presence of meconium-stained amniotic fluid in cesarean deliveries increases the total nucleated cell content of umbilical cord blood units. Transfusion 2009; 49:388.
  30. Yamada T, Okamoto Y, Kasamatsu H, et al. Factors affecting the volume of umbilical cord blood collections. Acta Obstet Gynecol Scand 2000; 79:830.
  31. Jones J, Stevens CE, Rubinstein P, et al. Obstetric predictors of placental/umbilical cord blood volume for transplantation. Am J Obstet Gynecol 2003; 188:503.
  32. Solves P, Moraga R, Saucedo E, et al. Comparison between two strategies for umbilical cord blood collection. Bone Marrow Transplant 2003; 31:269.
  33. Solves P, Mirabet V, Larrea L, et al. Comparison between two cord blood collection strategies. Acta Obstet Gynecol Scand 2003; 82:439.
  34. Surbek DV, Visca E, Steinmann C, et al. Umbilical cord blood collection before placental delivery during cesarean delivery increases cord blood volume and nucleated cell number available for transplantation. Am J Obstet Gynecol 2000; 183:218.
  35. Sparrow RL, Cauchi JA, Ramadi LT, et al. Influence of mode of birth and collection on WBC yields of umbilical cord blood units. Transfusion 2002; 42:210.
  36. Cairo MS, Wagner EL, Fraser J, et al. Characterization of banked umbilical cord blood hematopoietic progenitor cells and lymphocyte subsets and correlation with ethnicity, birth weight, sex, and type of delivery: a Cord Blood Transplantation (COBLT) Study report. Transfusion 2005; 45:856.
  37. Eichler H, Meckies J, Schmut N, et al. [Aspects of donation and processing of stem cell transplants from umbilical cord blood]. Z Geburtshilfe Neonatol 2001; 205:218.
  38. Study, CBT. Chapter 6. Sample Testing and Characterization. Cord Blood Transplant Study Standard Operating Procedures, 1999.
  39. Hubel A, Carlquist D, Clay M, McCullough J. Cryopreservation of cord blood after liquid storage. Cytotherapy 2003; 5:370.
  40. Hahn T, Bunworasate U, George MC, et al. Use of nonvolume-reduced (unmanipulated after thawing) umbilical cord blood stem cells for allogeneic transplantation results in safe engraftment. Bone Marrow Transplant 2003; 32:145.
  41. Petz L, Jaing TH, Rosenthal J, et al. Analysis of 120 pediatric patients with nonmalignant disorders transplanted using unrelated plasma-depleted or -reduced cord blood. Transfusion 2012; 52:1311.
  42. June 28, 2010 Investigator letter from the National Marrow Donor Program, RE: BB-IND#7555: “A Centralized Cord Blood Registry to Facilitate Allogeneic, Unrelated Umbilical Cord Blood Transplantation.”
  43. Choi S, Hoffmann S, Cooling L. Another case of acute cardiopulmonary toxicity with cord blood infusion: is dextran the culprit? Transfusion 2012; 52:207.
  44. Ma RW, Kwan JM, Ma DD, Fay KC. Acute life-threatening cardiovascular toxicity with umbilical cord blood infusion: the role of dextran. Am J Hematol 2010; 85:722.
  45. Davey S, Armitage S, Rocha V, et al. The London Cord Blood Bank: analysis of banking and transplantation outcome. Br J Haematol 2004; 125:358.
  46. Wada RK, Bradford A, Moogk M, et al. Cord blood units collected at a remote site: a collaborative endeavor to collect umbilical cord blood through the Hawaii Cord Blood Bank and store the units at the Puget Sound Blood Center. Transfusion 2004; 44:111.
  47. Samuel GN, Kerridge IH, Vowels M, et al. Ethnicity, equity and public benefit: a critical evaluation of public umbilical cord blood banking in Australia. Bone Marrow Transplant 2007; 40:729.
  48. Goodwin HS, Grunzinger LM, Regan DM, et al. Long term cryostorage of UC blood units: ability of the integral segment to confirm both identity and hematopoietic potential. Cytotherapy 2003; 5:80.
  49. Broxmeyer HE, Lee MR, Hangoc G, et al. Hematopoietic stem/progenitor cells, generation of induced pluripotent stem cells, and isolation of endothelial progenitors from 21- to 23.5-year cryopreserved cord blood. Blood 2011; 117:4773.
  50. Mugishima H, Harada K, Chin M, et al. Effects of long-term cryopreservation on hematopoietic progenitor cells in umbilical cord blood. Bone Marrow Transplant 1999; 23:395.
  51. Jubert C, Wagner E, Bizier S, et al. Length of cord blood unit cryopreservation does not impact hematopoietic engraftment. Transfusion 2008; 48:2028.
  52. McCullough J, McKenna D, Kadidlo D, et al. Mislabeled units of umbilical cord blood detected by a quality assurance program at the transplantation center. Blood 2009; 114:1684.
  53. http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/CellularandGeneTherapy/default.htm (Accessed on July 21, 2011).
  54. Boo M, Ballen K, Maiers M. Cord blood unit access and selection: 2010 and beyond: best practices and emerging trends in cord blood unit selection. Biol Blood Marrow Transplant 2011; 17:S46.
  55. Warkentin PI, Foundation for the Accreditation of Cellular Therapy. Voluntary accreditation of cellular therapies: Foundation for the Accreditation of Cellular Therapy (FACT). Cytotherapy 2003; 5:299.
  56. Private cord blood banks. Med Lett Drugs Ther 2004; 46:21.
  57. Querol S, Rubinstein P, Marsh SG, et al. Cord blood banking: 'providing cord blood banking for a nation'. Br J Haematol 2009; 147:227.
  58. Gluckman E, Eurocord Netcord Organisation. Ethical and legal aspects of placental/cord blood banking and transplant. Hematol J 2000; 1:67.
  59. Wadlow RC, Porter DL. Umbilical cord blood transplantation: where do we stand? Biol Blood Marrow Transplant 2002; 8:637.
  60. Burgio GR, Gluckman E, Locatelli F. Ethical reappraisal of 15 years of cord-blood transplantation. Lancet 2003; 361:250.
  61. Annas GJ. Waste and longing--the legal status of placental-blood banking. N Engl J Med 1999; 340:1521.
  62. Munzer SR, Smith FO. Limited property rights in umbilical cord blood for transplantation and research. J Pediatr Hematol Oncol 2001; 23:203.
  63. Munzer SR. The special case of property rights in umbilical cord blood for transplantation. Rutgers Law Rev 1999; 51:493.
  64. Danzer E, Holzgreve W, Troeger C, et al. Attitudes of Swiss mothers toward unrelated umbilical cord blood banking 6 months after donation. Transfusion 2003; 43:604.
  65. Steinbrook R. The cord-blood-bank controversies. N Engl J Med 2004; 351:2255.
  66. Sullivan MJ. Banking on cord blood stem cells. Nat Rev Cancer 2008; 8:555.
  67. Grewal SS, Kahn JP, MacMillan ML, et al. Successful hematopoietic stem cell transplantation for Fanconi anemia from an unaffected HLA-genotype-identical sibling selected using preimplantation genetic diagnosis. Blood 2004; 103:1147.
  68. Adams KE. Ethical considerations of applications of preimplantation genetic diagnosis in the United States. Med Law 2003; 22:489.
  69. American Academy of Pediatrics Section on Hematology/Oncology, American Academy of Pediatrics Section on Allergy/Immunology, Lubin BH, Shearer WT. Cord blood banking for potential future transplantation. Pediatrics 2007; 119:165.
  70. ACOG Committee Opinion No. 648: Umbilical Cord Blood Banking. Obstet Gynecol 2015; 126:e127.
  71. Johnson FL. Placental blood transplantation and autologous banking--caveat emptor. J Pediatr Hematol Oncol 1997; 19:183.
  72. Nietfeld JJ, Pasquini MC, Logan BR, et al. Lifetime probabilities of hematopoietic stem cell transplantation in the U.S. Biol Blood Marrow Transplant 2008; 14:316.
  73. Gale KB, Ford AM, Repp R, et al. Backtracking leukemia to birth: identification of clonotypic gene fusion sequences in neonatal blood spots. Proc Natl Acad Sci U S A 1997; 94:13950.
  74. Rowley JD. Backtracking leukemia to birth. Nat Med 1998; 4:150.
  75. Tussiwand R, Maia A, Cazzaniga G, et al. Identification of pre-leukemic precursors of hyperdiploid ALL in cord blood (abstract). Blood 2003; 102:381a.
  76. Reed W, Walters M, Trachtenberg E, et al. Sibling donor cord blood banking for children with sickle cell disease. Pediatr Pathol Mol Med 2001; 20:167.