Cord Blood Establishing a National Hematopoietic Stem Cell Bank Program (2005) / Chapter Skim
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2 Hematopoietic Stem Cell Transplantation
2 Hematopoietic Stem Cell Transplantation
Pages 33-55
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From page 33... ...
. Umbilical cord blood is a rich source of these committed progenitor cells and, presumably, multipotent HPCs (Knudtzon, 1974)
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From page 34... ...
a broad range of disorders for which transplantion of HPCs from an adult donor is also successful, including hematological malignancies, solid tumors, constitutional and acquired bone marrow failure syndromes, hemoglobinopathies, congenital immune deficiencies, and inherited disorders of metabolism (Gluckman et al., 1997; Locatelli et al., 1999; Rocha et al., 2000; Locatelli et al., 2003)
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From page 35... ...
in 1993, and the Japanese Cord Blood Banking Network in 1996 -- expedited the clinical evaluation of the efficacy and safety of transplantation of cord blood from unrelated donors. With more than 6,000 transplants of cord blood from related and unrelated donors performed thus far, cord blood has emerged as an acceptable, alternative source of HPCs that has some advantages over adult sources of HPCs and the availability of which represents an important development in the field.
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From page 36... ...
Several investigators have also explored the ex vivo expansion of cord blood cells, but no data supporting faster engraftment by this approach are available and few comparative studies of the clinical outcomes obtained by transplantation of HPCs from adult donors and cord blood have been conducted. The fact that cord blood transplants can be successful, even though they involve degrees of HLA disparity typically associated with an increased risk of GVHD in the adult donor setting, allows transplant physicians some leeway in determining which units can be selected for transplantation.
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From page 37... ...
. Most cord blood transplants are done with units mismatched for a maximum of two HLA antigens (HLA-A and HLA-B)
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From page 38... ...
CORD BLOOD TRANSPLANTATION Allogeneic Transplantation Most cord blood banking involves the collection, storage, and distribution of cells for transplantation to unrelated individuals. These units are typed and stored anonymously so that any patient who might have a medical need may use them.
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From page 39... ...
· Controversial studies are · Controversial; studies ongoing to define role are ongoing to define the related to conventional role related to therapy and autologous conventional therapy and transplantation allogeneic transplantation Bone and soft tissue · Very rarely indicated · Rarely indicated and sarcomas, Wilms' tumor, effectiveness unproven brain tumors Aplastic anemia and other · Effective · Not indicated cytopenias (not environmentally caused) Immune deficiency (e.g., · Effective · Not indicated severe combined immunodeficiency disease)
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From page 40... ...
and is generally lower than that after adult bone marrow or peripheral blood transplantation. More rapid neutrophil and platelet recovery occurs in patients receiving higher cord blood cell doses (Wagner et al., 1996; Barker et al., 2001; Rubinstein et al., 2001; Grewal et al., 2003)
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From page 41... ...
. Outcomes of HPC Transplantation from Unrelated Adult Donors Transplantation of HPCs from unrelated donors for the treatment of acute leukemia in adults is associated with a high risk of GVHD and treatment failure (Ash et al., 1991; Laughlin et al., 2004)
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From page 42... ...
. Both studies concluded that cord blood grafts in adults were acceptable alternatives to bone marrow grafts if no suitably matched bone marrow donors were available, even though the cord blood units transplanted contained lower numbers of nucleated cells.
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From page 43... ...
Both found lower rates of acute GVHD among individuals who received cord blood, although Laughlin and colleagues (2004) found that this was true only when they compared the outcomes for HLA-mismatched bone marrow transplants receipients with those for HLA-mismatched cord blood transplant recipients.
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From page 44... ...
(2000) reported that cord blood transplantation results in a delayed and lower cumulative incidence of hematopoietic recovery compared with that achieved with bone marrow transplantation.
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From page 45... ...
. These studies demonstrate that the transplantation of cord blood from a related donor results in reliable engraftment, a reduction in the incidence of acute and chronic GVHD, and an overall survival rate equivalent to that achieved with bone marrow transplants.
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From page 46... ...
Two other studies have compared the frequencies of GVHD in the receipients of bone marrow and cord blood from unrelated donors (Barker et al., 2001; Rocha et al., 2001)
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From page 47... ...
. Relapse and Graft-Versus-Leukemia Effect Current experience comparing the risk of relapse after cord blood transplantation with that after bone marrow transplantation is limited.
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From page 48... ...
Patients were considered eligible to receive a cord blood unit if they were either unable to find an appropriate bone marrow match or unable to wait for the transplant because of the severity of their illness. An appropriately HLA-matched cord blood unit (a high-resolution match at HLA-DRB1 and a low-resolution match at HLAA and HLA-B)
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From page 49... ...
The study staff was having difficulty encouraging potential transplant recipients to use what was essentially an experimental product (i.e., cord blood transplantation) , and it was competing with other banks outside the study that often had more suitably matched units for the transplant patients.
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From page 50... ...
The increase in the number of transplant centers and access to additional units facilitated the completion of the COBLT study. In addition, cord blood units were made available to patients who did not meet specific transplant criteria for the COBLT study strata through a separate protocol called the Expanded Access Protocol.
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From page 51... ...
2003. Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning.
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From page 52... ...
1997. Outcome of cord blood transplantation from related and unrelated donors.
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From page 53... ...
1998. Bone marrow trans plants from unrelated donors for patients with chronic myeloid leukemia.
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From page 54... ...
2001. Comparison of out comes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia.
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From page 55... ...
1994. Treatment of advanced acute leukaemia with allogeneic bone marrow transplantation from unrelated donors.
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