Cord Blood Benefits and Use Considerations
Expand transplant to more patients in need
While cord blood unit selection and use include different components than adult related and unrelated donors, it remains a valuable graft source for clinicians to consider early in the search process. This is especially true for patients with a low likelihood of a 10/10 related or unrelated donor and those who need transplants quickly.
On this page, you can explore:
- Benefits of cord blood transplant, including related research
- Current resources to support cord blood unit selection and transplant
Benefits of cord blood as a graft source
Cord blood as a graft source offers many potential benefits to patients from expanding the donor pool to more patients in need to greater speed to transplant to lower incidence of chronic graft-versus-host disease (cGVHD) and greater graft-versus-leukemia effect.
Transplant availability for more patients
Cord blood’s unique nature allows for greater matching flexibility. This extends the availability of transplant to more patients, including those who are ethnically diverse.
According to the National Marrow Donor Program® (NMDP)/Be The Match® fiscal year 2019 (FY19) annual numbers, 50% of the more than 300,000 umbilical cord blood units (CBUs) on the Be The Match Registry® are ethnically diverse.
In FY19, 30% of umbilical cord blood transplants were for ethnically diverse transplant patients.
- Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities (Barker JN, et al., Biol Blood Marrow Transplant)
- HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry (Gragert N, et al., N Engl J Med)
- The influence of stem cell source on transplant outcomes for pediatric patients with acute myeloid leukemia (Keating AK, et al., Blood Advances)
Speed to transplant
For diseases in which speed to transplant is critical, cord blood units allow for rapid utilization.
With CBUs already stored, typed and disease tested, transplant centers can typically acquire a cord blood unit faster than marrow or PBSC from an unrelated adult donor.
of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD
and EBMT collaborative analysis (Ustun C, et al., Leukemia)
Chronic graft-versus-host disease incidence
Chronic GVHD after transplant is a well-known complication after allogeneic transplant that can impact patient outcomes and quality-of-life.
Some research has shown that patients who receive cord blood as a graft source experience a lower incidence of cGVHD or less severe cGVHD.
- GVHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes (Chen Y-B, et al., Bone Marrow Transplant)
- Risk factors for acute and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation with umbilical cord blood and matched sibling donors (Lazaryan A, et al., Biol Blood Marrow Transplant)
Jonathan Gutman, MD
Director, Allogeneic Stem Cell Transplant
UCHealth University of Colorado Hospital
Patients with acute leukemias who have minimal residual disease pre-transplant may benefit from cord blood.
Published research shows some evidence that graft-versus leukemia effects seems to be stronger with cord blood than other donor sources.
- Cord-blood transplantation in patients with minimal residual disease (Milano F, et al., N Engl J Med)
Kristin Page, MD
Assistant Professor of Pediatrics, Pediatric Transplant and Cellular Therapy
Duke University Medical Center
Support for cord blood unit selection and transplant
Cord blood unit selection, conditioning regimens and prophylactic use post-transplant all impact patient outcomes. Whether you’re new to cord blood transplant or use cord blood infrequently, you may have questions about selection and patient care pre-
We offer many avenues of support for clinicians who are looking for assistance with CBU selection and transplantation.
Choosing the best cord blood unit for a patient requires different considerations than a related or unrelated donor. Our Cord Blood Consultation service provides you direct contact with an experienced cord blood transplant physician who can help you select
the best CBU for your patient.
In addition, the physician can discuss conditioning regimens and prophylactic antivirals and antifungals.
When selecting a cord blood unit, HLA-match is only one consideration. Access the 2019 unrelated donor and cord blood unit selection guidelines for a summary of current evidence-based research for search and selection, including non-HLA criteria such
as CBU quality and cell dose.
The National Marrow Donor Program® (NMDP)/Be The Match®, the CIBMTR® (Center for International Blood and Marrow Transplant Research®), and the NMDP/Be The Match Histocompatibility Advisory Group published the updated guidelines in Blood in September 2019.
Using cord blood transplantation best practices from patient and cord blood unit selection through post-transplant can help lower the risk for complications and improve outcomes.
The NMDP/Be The Match and the American Society for Transplantation and Cellular Therapy’s (ASTCT) Cord Blood Special Interest Group published Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies—a how-to guide based on the best practices of six U.S. transplant centers with experience in cord blood transplantation.
The article published in Biology of Blood and Marrow Transplantation discusses targeted care strategies such as:
- Patient selection
- Factors to consider in selecting a cord blood unit, including cell dose, HLA match and CBU quality
- Conditioning regimens
- Thawing and infusion practices
- Preventing and managing graft-versus-host disease (GVHD)
- Preventing, monitoring for and treating infection
Once you have confirmed a CBU is appropriate for your patient, you can request the cord blood unit for shipment. Explore information on requesting a cord blood unit for shipment and details of the process for shipment, receipt and transfusion.“Yes, [cord blood transplant] takes experience. But every kind of transplant really has some sort of experience necessary to do it well. I don't think that should be a drawback from choosing cord blood as a graft source.”
Leland Metheny, MD
University Hospitals Seidman Cancer Center
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