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Isolation of Precursor B-cell Subsets from Umbilical Cord Blood
Published on: April 16, 2013
Scoring system for optimal cord blood unit selection for single cord blood transplantation
Mizuki Watanabe1, Takaaki Konuma2, Nobuhiko Imahashi3
1Department of Hematology, Kyoto University Hospital, Kyoto, Japan; Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Insights
Optimal cord blood units (CBUs) for transplantation were identified through a ranked categorization system. These CBUs significantly improved overall survival and engraftment in female patients, matching outcomes from conventional bone marrow or peripheral blood stem cell donors.
Area of Science:
- Hematology
- Transplantation Medicine
- Immunology
Background:
- Cord blood unit (CBU) selection is critical for successful transplantation.
- Identifying optimal CBUs can improve patient outcomes and reduce transplantation-related risks.
Purpose of the Study:
- To categorize cord blood units (CBUs) to identify optimal units for transplantation.
- To compare the efficacy of selected CBUs with conventional bone marrow (BM) and peripheral blood stem cell (PBSCT) transplantation.
Main Methods:
- A retrospective analysis of 8503 adult patients undergoing their first single cord blood transplantation (CBT) between 2000-2019.
- Factors influencing overall survival (OS) and neutrophil engraftment were identified to create ranked CBU categories.
- Comparison with HLA-matched unrelated and related bone marrow/peripheral blood stem cell transplantations.
Main Results:
- For females, CBUs with specific CD34+ cell and CFU-GM counts, and no sex-mismatch, demonstrated the best OS, comparable to related BM/PBSCT and unrelated BM/PBSCT in high-risk disease.
- Male patients did not show significant factors affecting OS based on CBU characteristics.
- Categorization effectively predicted female OS and engraftment but not OS in males.
Conclusions:
- Ranked CBU categorization effectively predicts outcomes in female recipients.
- Optimally selected CBUs provide outcomes comparable to conventional donors for females, but not for males.
- This study provides a framework for selecting superior CBUs for female patients undergoing CBT.
Background:
We conducted a retrospective study to categorize the cord blood unit (CBU)s to identify the optimal units.
Methods:
A total of 8503 adults (female, n = 3592; male, n = 4911) receiving their first single cord blood transplantation (CBT) in 2000-2019 were analyzed. Factors associated with CBUs affecting overall survival (OS) and neutrophil engraftment were selected to create ranked categorization for each outcome, followed by comparison with transplantation using HLA-matched bone marrow (BMT)/peripheral blood stem cell (PBSCT) from unrelated (n = 6052) and related donors (n = 4546).
Results:
Sex-mismatch, CD34+ cell and CFU-GM counts were selected in the OS analysis. Considering the strong interaction between sex mismatch and CD34+ cell counts, we analyzed females and males separately. For females, female CBU with CD34+ cell counts {greater than or equal to} 0.5 × 10e5/kg and CFU-GM counts {greater than or equal to} 15 × 10e3/kg offered the best OS (Group I), followed by other groups with any (Groups II-IV) or all (Group V) of the risk factors. Group I consistently showed favorable OS (Group IV: HR1.22, P = 0.027; Group V: HR1.31, P = 0.047), comparable to those of rBMT/PBSCT (OS: HR1.02, P = 0.654) and uBM/PBSCT in patients with higher rDRI (HR1.07, P = 0.353). Male patients lacked significant factors affecting OS. Categorization for neutrophil engraftment consisting of CD34+ cell and CFU-GM counts, sex-mismatch, presence of donor-specific antibodies, and the number of HLA-mismatches was effective but not predicted OS.
Conclusion:
Our ranked categorizations sufficiently predicted female OS and engraftment. The best-ranked CBUs offered preferable outcomes comparable to conventional BM/PB donors in female but not in male patients.
