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Logo of jclinpathJournal of Clinical PathologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Clin Pathol. 2001 June; 54(6): 428–434.
PMCID: PMC1731437

Status of umbilical cord blood transplantation in the year 2001

Abstract

Umbilical cord blood (UCB) transplantation is limited to small recipients because of the low haemopoietic cell dose. Children from ethnic minority groups may benefit most from cord blood transplantation. Cohort controlled retrospective data indicate that there is significantly less acute and chronic graft versus host disease associated with the transplantation of human major histocompatibility complex (HLA) identical sibling cord blood compared with HLA identical sibling marrow. Controlled data are not yet available to confirm this observation in unrelated donor cord blood transplantation. The difference in leukaemic relapse seen after cord blood compared with bone marrow transplantation is also unknown. Tentative recommendations for the use of umbilical cord blood for transplantation are as follows. Collection is indicated from healthy newborn siblings when urgent transplantation is required for an older child in a family. The haematologist responsible for the older child, with the approval of the family and the obstetric team, should contact the medical director of the nearest cord blood bank to discuss arrangements for the UCB to be collected and HLA typed. Antenatal blood sampling to HLA type the fetus is not recommended. Umbilical cord blood should be considered when allogeneic transplantation is the treatment of choice for a child who does not have an HLA identical sibling, or a well matched unrelated adult volunteer donor. The potential advantages and disadvantages of using an HLA haplotype matched peripheral blood stem cell family donor rather than an unrelated cord blood donation should be discussed. There are no comparative data available as yet. At present, UCB transplantation should only be considered if a suitably matched donation contains at least 2 x 107/kg nucleated cells. Effectively, this means that most adults and larger children are not suitable recipients.

Key Words: umbilical cord blood transplantation • graft versus host disease • bone marrow transplantation • leukaemia • cell expansion

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Figure 1 The relation between the infused CD34+ cell dose and (A) platelet and (B) neutrophil recovery after unrelated umbilical cord blood transplantation. The numbers within the graphs refer to the dose of CD34+ cells (x106/kg). There is a strong direct ...
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Figure 2 The effect of CD34+ cell dose on survival after unrelated umbilical cord blood transplantation. (A) There is a direct correlation between increasing cell dose and the probability of survival at one year post transplant. Patients receiving less ...
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Figure 3 The proportion of recipients of different weight for whom an optimal cord blood donation (> 3.7 x 107/kg nucleated cells) or a just sufficient donation (> 2.0 x 107/kg) of nucleated blood cells is available in the Bristol cord ...
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Figure 4 Engraftment of human cord blood cells with or without in vitro expansion in non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice after five weeks. Cord blood CD34+ cells were cultured in vitro for three, seven, or 10 days in stem ...

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