Cord blood transplantation

Most experience is with HLA-matched donors umbilical cord blood transplantation is being evaluated... 

Staba, S. L., Escolar, M. L., Poe, M. et al. Cord-blood transplants from unrelated donors in patients with Hurler s syndrome. N. Engl. J. Med. 350 1960-1969, 2004. 

Przepiorka D, Petropoulos D, Mullen C et al. Tacrolismus for prevention of graft-versus-host-disease after mismatched unrelated donor cord blood transplantation. Bone Marrow Transplantation 1999 23 1291-1295... 

Mizutami E, Narimatsu H, Murata M, Tomita A, et al. 2007. Successful second cord blood transplantation using fludarabine and cyclophosphamide as a preparative regimen for graft rejection following reduced intensity cord blood transplantation. Bone Marrow Transplant. 40 85-87. 

Cohen Y, Nagler A (2004), Umbilical cord blood transplantation - how, when and for whom , Blood Rev. 18 167-179. 

Gluckman E, Rocha V (2009) Cord blood transplantation state of the art. Haematologica 94(4) 451 54... 

A patient with acute myeloid leukemia developed pulmonary alveolar proteinosis during the period of leukopenia following an unrelated umbilical cord blood transplantation (49). 

Mao P, Liao C, Zhu Z, Wang H, Wang S, Xu Y, Mo W, Ying Y, Li Q, Liu B. Umbilical cord blood transplantation from unrelated HLA-matched donor in an adult with severe aplastic anemia. Bone Marrow Transplant 2000 26(10) 1121-3. 

Tomonari A, Shirafuji N, Iseki T, Ooi J, Nagayama H, Masunaga A, Tojo A, Tani K, Asano S. Acquired pulmonary alveolar proteinosis after umbilical cord blood transplantation for acute myeloid leukemia. Am J Hematol 2002 70(2) 154-7. 

Laws HJ, Nurnberger W, Korholz D, Kogler G, Fischer J, Niehues T, Wernet P, Gobel U. Successful treatment of relapsed CML after cord blood transplantation with donor leukocyte infusion IL-2 and IFNalpha. Bone Marrow Transplant 2000 25(2) 219-22. 

Goldberg SL, Pecora AL, Rosenbluth RJ, Jennis AA, Preti RA. Treatment of leukemic relapse following unrelated umbilical cord blood transplantation with interleukin-2 potential for augmenting graft-versus-leukemia and graft-versus-host effects with cytokines. Bone Marrow Transplant 2000 26(3) 353-5. 

Nieto Y, Russ P, Everson G, Bearman SI, Cagnoni PJ, Jones RB, Shpall EJ. Acute pancreatitis during immunosuppression with tacrolimus following an allogeneic umbilical cord blood transplantation. Bone Marrow Transplant 2000 26(1) 109-11. 

Auerbach AD, Liu Q, Ghosh R, et al. Prenatal identification of potential donors for umbihcal cord blood transplantation for Fanconi anemia. Transfusion 1990 30 682-687. 

Koh L-P, Chao NJ. Umbilical cord blood transplantation in adults using myeloablative and nonmyeloablative preparative regimens. Biol Blood Marrow Transplant 2004 10 1-22. 

Hows J M (2001). Status of umbilical cord blood transplantation in the year 2001. /. Clin. Pathol. 54 428-434. 

Of 34 patients with primary immune deficiencies treated with cord blood transplants, seven developed grade III-IV acute GVHD, of whom three died. The incidence of grade III-IV acute GVHD was associated with a higher dose of total nucleated cells. Five patients out of 17 who survived for more than 100 days developed chronic GVHD [100. ... 

With the administration of two units of cord blood, a higher dose of total nucleated cells can be administered. The introduction of double-unit cord blood transplantation... 

In a Spanish study the incidence of GVHD was low with co-infusion of mobilized hemopoietic stem cells as support for single-unit unrelated cord blood transplantation. However, GVHD occurred more often in patients who received unrelated cord blood transplants (63%) compared with patients who received transplants from related HLA-matched-identical donors (33%) [102. ... 

Frangoul H, Wang L, Harrell FE Jr, Manes B, Calder C, Domm J. Unrelated umbilical cord blood transplantation in children with immune deficiency results of a multicenter study. Bone Marrow Transplant 2010 45(2) 283-8. 

Ferreira E, Laporte JP, Fernandez M, Chastang C. Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and MarrowTransplan-tation Group. N Engl J Med 1997 337(6) 373-81. 

Delaney C. Single-unit dominance after double-unit umbilical cord blood transplantation coincides with a specific CDS 4-T-cell response against the nonengrafted unit. Blood 2010 115(4) 757-65. 

Umbilical cord blood transplantation using non-myeloablative conditioning is currently considered by many as a useful alternative... 

Death Although umbilical cord blood transplantation has become standard treatment in children with hematological malignancies, in adults it is limited by a minimum cell dose. A new option is administration of two partially matched units of cord blood, but this increases the risk of complications. Death has occurred after double cord blood transplantation and multiple transfusions in a woman in whom an earlier pregnancy might have predisposed to sensitization [IIS ]. 

Rokicka M, Styczynski J, Michalewska B, Torosian T, Tomaszewska A, Gronkowska A, Pogorzala M, Wysocki M, Lakomy M, Wiktor-Jedrzejczak W. Fatal combined immune hemolytic anemia after double cord blood transplantation in imati-nib-resistant CML. Bone Marrow Transplant 2009 44(6) 383-5. 

Susceptibility factors It has been postulated that defective thymic function may have a role in the onset of GCV-resistant CMV, as exemplified by a case, following cord blood transplantation (CBT) [33 ]. 

Cantisan S, Martin C, Romero-Sanchez MC, Ferrando-Martinez S, Martinez F, Rivero A, et al. Role of defective th)miic function in onset of ganciclovir-resistant cytomegalovirus after cord blood transplantation. Clin Vaccine Immunol 2012 19(12) 1994-8. 

Observational studies Researchers examined the outcomes in 249 paediatric patients with severe combined immunodeficiency [168 -]. Mismatched related donor and unrelated umbilical cord blood transplantation was performed in 175 and 74 patients, respectively. Recipients of umbilical cord blood transplant demonstrated higher frequency of complete donor chimerism (75% vs 33%, p = 0.001), faster total lymphocyte count recovery (at 6months, p=0.001) and discontinuation of immxmoglobulin replacement therapy sooner (at 3 years 45% vs 31%, p=0.023) however, umbilical cord blood transplant also had higher rates of chronic graft-versus-host disease (22% vs 10%, p=s0.03). 

A metanalysis contrasted unrelated umbilical cord transplant and unrelated bone marrow transplant in acute leukaemia patients [170 ]. The incidence of engraftment failure was higher in umbilical cord blood transplant (RR 4.27, 95% Cl = 2.94-6.210). Transplant-related mortality was higher in umbilical cord blood transplant (RR 1.27,95% Cl = 1.01-1.59). The rate of acute graft-versus-host disease was lower with bone marrow transplant (RR 0.71, 95% Cl = 0.65-0.79). The rate of chronic graft-versus-host disease was lower with bone marrow transplant (RR 0.69,95% Cl = 0.52-0.91). Leukaemia-free survival was lower with umbilical cord transplant (RR 1.14, 95% Cl = 1.07-1.22). Overall survival was also lower with umbilical cord transplant (RR 1.31,95% Cl=1.16-1.48). 

Zhang H, Chen J, Que W. A meta-analysis of unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplantation in acute leukemia patients. Biol Blood Marrow Transpl 2012 18(8) 1164-73. 

Gluckman, E. 2009. Flistory of cord blood transplantation. Bone Marrow Transplant. 44 621-6. 

B, and -DR antigens are analyzed in transplants between siblings, whereas HLA-A, -B, -C, DRBl and DQBl alleles are studied in unrelated pairs. No more than one antigen mismatch is acceptable if the donor is a relative of the recipient, and no more than one allele mismatch in transplants from unrelated volunteers. In umbilical cord blood transplantation, units are selected by HLA-A and -B serologic or low-resolution DNA typing, whereas allele identification is required for matching at HLA-DRBl. Up to two HLA disparities are acceptable in this type of transplantation. 

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