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Status of umbilical cord blood transplantation in the year 2001
1Division of Transplantation Sciences, Blue Zone A, Entrance 11, Southmead Health Services, University of Bristol, Westbury on Trym, Bristol BS10 5NB, UK. jill.hows@bristol.ac.uk
Insights
Umbilical cord blood (UCB) transplantation offers reduced graft-versus-host disease compared to bone marrow. However, UCB use is limited by cell dose, primarily benefiting smaller patients and ethnic minorities.
Area of Science:
- Hematology
- Transplantation Immunology
- Pediatric Oncology
Background:
- Umbilical cord blood (UCB) transplantation is a valuable alternative to bone marrow transplantation.
- Current limitations in UCB transplantation include the low hematopoietic cell dose, restricting its use primarily to smaller recipients.
- Ethnic minority children may particularly benefit from UCB transplantation due to donor matching challenges.
Purpose of the Study:
- To review the current status and tentative recommendations for umbilical cord blood transplantation.
- To compare UCB transplantation with bone marrow transplantation regarding graft-versus-host disease and leukemic relapse.
- To outline criteria for UCB collection and patient selection.
Main Methods:
- Retrospective analysis of cohort-controlled data comparing UCB and bone marrow transplantation.
- Review of existing literature and clinical observations regarding UCB transplantation outcomes.
- Formulation of tentative recommendations based on current evidence.
Main Results:
- UCB transplantation from HLA-identical siblings shows significantly less acute and chronic graft-versus-host disease compared to sibling marrow.
- Data on graft-versus-host disease in unrelated donor UCB transplantation are pending.
- The difference in leukemic relapse rates between UCB and bone marrow transplantation is currently unknown.
Conclusions:
- UCB collection is indicated for healthy newborn siblings when urgent transplantation is needed for an older child.
- Antenatal fetal HLA typing is not recommended.
- UCB should be considered for pediatric patients lacking an HLA-identical sibling or a well-matched unrelated adult donor, with a minimum nucleated cell dose of 2 x 10(7)/kg.
Abstract:
Umbilical cord blood (UCB) transplantation is limited to small recipients because of the low haemopoietic cell dose. Children from ethnic minority groups may benefit most from cord blood transplantation. Cohort controlled retrospective data indicate that there is significantly less acute and chronic graft versus host disease associated with the transplantation of human major histocompatibility complex (HLA) identical sibling cord blood compared with HLA identical sibling marrow. Controlled data are not yet available to confirm this observation in unrelated donor cord blood transplantation. The difference in leukaemic relapse seen after cord blood compared with bone marrow transplantation is also unknown. Tentative recommendations for the use of umbilical cord blood for transplantation are as follows. Collection is indicated from healthy newborn siblings when urgent transplantation is required for an older child in a family. The haematologist responsible for the older child, with the approval of the family and the obstetric team, should contact the medical director of the nearest cord blood bank to discuss arrangements for the UCB to be collected and HLA typed. Antenatal blood sampling to HLA type the fetus is not recommended. Umbilical cord blood should be considered when allogeneic transplantation is the treatment of choice for a child who does not have an HLA identical sibling, or a well matched unrelated adult volunteer donor. The potential advantages and disadvantages of using an HLA haplotype matched peripheral blood stem cell family donor rather than an unrelated cord blood donation should be discussed. There are no comparative data available as yet. At present, UCB transplantation should only be considered if a suitably matched donation contains at least 2 x 10(7)/kg nucleated cells. Effectively, this means that most adults and larger children are not suitable recipients.