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 2020 (FY20) annual numbers, 51% of the more than 260,000 umbilical cord blood units (CBUs) on the Be The Match Registry® are ethnically diverse. 

In FY20, ~31% of umbilical cord blood transplants were for ethnically diverse transplant patients.

Related research: 

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.

Related research: 

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.

Related research: 

“For me, the number one benefit of cord blood transplantation is the marked decrease in chronic graft-versus-host disease that cord blood patients have after their transplant, presuming everything else is going well. That is probably the number one, two and three reason why we are such big fans of cord blood.”

Jonathan Gutman, MD
Director, Allogeneic Stem Cell Transplant
UCHealth University of Colorado Hospital

Graft-versus-leukemia effect

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.

Related research: 

“Cord blood is a great option that really should be considered in line with the other donor sources. It shouldn't be considered a second or third or fourth choice for patients. That’s especially true for pediatric patients where we're trying to provide them with quality of life for decades to come as well as curing their disease.”

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- and post-transplant.

We offer many avenues of support for clinicians who are looking for assistance with CBU selection and transplantation.

Cord Blood Consultation service

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.

Donor and cord blood unit selection guidelines

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.

“How to” guide to cord blood transplantation

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

Cord blood bank Global Search Tool

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

Questions

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