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Collection and storage of umbilical cord blood for hematopoietic cell transplantation

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

INTRODUCTION

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".)

CORD BLOOD AS A RESOURCE

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: Nov 2016. | This topic last updated: Mon Apr 25 00:00:00 GMT+00:00 2016.
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