[Cord blood transplantation: current status and future perspectives]

Area of Science:

• Hematology
• Transplantation Immunology

Background:

• Cord blood (CB) is a rich source of hematopoietic stem/progenitor cells for allogeneic hematopoietic cell transplantation (HCT).
• Cord blood transplantation (CBT) now represents approximately 30% of adult allogeneic HCT in Japan, addressing donor shortages due to demographic changes.
• Unique aspects of Japanese CBT include single-unit use in adults, and its application in elderly patients and those with advanced hematologic diseases.

Purpose of the Study:

• To highlight the characteristics and advantages of cord blood transplantation (CBT) as a significant cell source for allogeneic HCT, particularly within the Japanese context.
• To discuss the efficacy of CBT in overcoming challenges like HLA-incompatibility and donor shortages.
• To emphasize the favorable graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) profiles associated with CBT.

Main Methods:

• Analysis of clinical outcomes and characteristics of CBT in a Japanese cohort.
• Comparison of CBT with other HCT methods, focusing on GVHD, GVL effects, and engraftment.
• Evaluation of specific protocols, including intensified conditioning regimens, in the context of CBT.

Main Results:

• CBT demonstrates a lower incidence and severity of graft-versus-host disease (GVHD), even in HLA-incompatible settings.
• A stronger graft-versus-leukemia (GVL) effect is observed in CBT compared to other HCT methods.
• Japanese CBT protocols show the utility of intensified conditioning and a survival benefit in mild GVHD, alongside a potent GVL effect.

Conclusions:

• Cord blood transplantation is an established and crucial source for allogeneic HCT, offering unique immunological advantages.
• CBT effectively mitigates donor shortages and provides a favorable safety and efficacy profile, particularly regarding GVHD and GVL.
• The Japanese experience underscores the versatility and success of CBT in adult, elderly, and advanced disease populations, highlighting its role in modern HCT.