Cord blood immunology and stem cell transplantation

Allogeneic stem cell transplantation can be curative in a variety of malignant and nonmalignant disorders. Unfortunately, more than 75% of potential recipients lack a matched family donor. Although 50% of these recipients may find a matched unrelated adult stem cell donor from one of the worldwide registries, the other 50% have had no other viable donor alternatives. Cord blood cellular immunity is immature at birth and allows for a greater human leukocyte antigen disparity between a cord blood donor and recipient after an unrelated cord blood transplant. More than 25 cord blood banks have been developed worldwide to support the growing clinical needs of unrelated cord blood transplantation. Standard operating procedures have been developed for maternal donor screening and consent, cord blood collection, processing, cryopreservation, characterization, shipping, and thawing. Cord blood transplantation after myeloablative and reduced-intensity conditioning has been successfully demonstrated, resulting in long-term full donor chimerism, decreased Grade 3/4 acute graft-versus-host disease and improvements in overall survival. Several areas of ongoing research include ex vivo expansion of cord blood hematopoietic progenitor cells to enhance the rapidity of engraftment and isolation and activation of select immune cell populations for prevention or treatment of acute graft-versus-host disease, infectious complications, and tumor reoccurrence.