Since the first human cord blood transplant, performed in 1988, the safety and efficacy of umbilical cord blood transplantation in both children and adults with a variety of malignant and non-malignant diseases have been clearly established. This is the outcome of a survey performed by Dr Annalisa Ruggeri from Eurocord, Hôpital Saint Louis in Paris, France and presented at the 16th Congress of the European Hematology Association in London.

The advantages of umbilical cord blood (UCB) transplants were first recognized in related donors. Later, Cord Blood Banks (CBB) were established for collection and cryopreservation (freezing/storing) of cord blood for unrelated use.

Criteria for the standardization of the collection, banking, processing, and distribution of UCB were established by CBB and accreditation agencies, ensuring high quality products. Currently, the global network of CBB has a common inventory of an estimated 500.000 UCB units, and more than 20.000 units have already been distributed to transplant centers worldwide.

"Cord blood cells have several unique characteristics resulting in distinct advantages and disadvantages when compared to transplantation with unrelated bone marrow or peripheral blood stem cells", says Dr Ruggeri.

"The main practical advantages of using cord blood as stem cell source are the relative easy procurement, the absence of risk for mothers and donors and the decreased incidence of acute graft versus host disease. On the other hand, due to the low content of hematopoietic stem cells in a cord blood unit, engraftment after UCBT is delayed.

Currently, many approaches are being investigated to improve engraftment rate and decrease transplant related mortality such as the use of double UCBT transplants and reduced intensity conditioning regimen, intrabone infusion of UCB, ex-vivo expansion, co-transplantation with accessory cells and others."

The Eurocord group reports the results of a survey on 604 adults with de novo acute myeloid leukemia (AML) transplanted with UCBT from 2000-2010 in EBMT centers. Patients were transplanted using one or two UCB units, and with high-dose or reduced intensity conditioning regimens according to the transplant center policy.

Disease status at transplant (remission versus advanced) was the main factor associated with improved leukemia-free-survival. This retrospective analysis confirms that UCBT is an optional treatment for adults with high risk AML without a suitable matched donor after a high-dose or reduced conditioning regimen pre-transplantation.

Source: European Hematology Association