Alternative haematopoietic stem cell sources for transplantation: place of umbilical cord blood

Abstract

Umbilical cord blood has rapidly become a valuable alternative stem cell source for allogeneic haematopoietic stem cell transplantation. Extensive research over the last 20 years has established the safety and efficacy of umbilical cord blood transplantation in both children and adults with a variety of malignant and non-malignant diseases. This research has clearly shown that this stem cell source has several unique characteristics resulting in distinct advantages and disadvantages when compared to transplantation with unrelated bone marrow or peripheral blood stem cells. This article reviews the most recent literature comparing the outcomes after umbilical cord blood transplantation with other alternative stem cell sources.

Figures

Figure 1

Probability of leukemia-free survival after bone marrow and cord blood transplantation adjusted for disease status at transplantation. Reprinted from The Lancet, 369, Eapen, M., Rubinstein, P., Zhang, M.J., Stevens, C., Kurtzberg, J., Scaradavou, A., Loberiza, F.R., Champlin, R.E., Klein, J.P., Horowitz, M.M. & Wagner, J.E. Copyright 2007 Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study. Lancet1947-1954. Copyright 2007, with permission from Elsevier.

Figure 2

Probability of overall survival This research was originally published in Blood. Prasad, V., Mendizabal, A., Parikh, S., Szabolcs, P., Driscoll, T., Page, K., Lakshminarayanan, S., Allison, J., Wood, S., Semmel, D., Escolar, M., Martin, P., Carter, S. & Kurtzberg, J. Unrelated donor umbilical cord blood transplantation for inherited metabolic disorders in 159 pediatric patients from a single center: influence of cellular composition of the graft on transplantation outcomes. Blood, (2008) 112, 2979-2989. © American Society of Hematology

Figure 3

(A) Estimated progression-free survival according to histological subtype. Patients with indolent non-Hodgkin lymphoma (NHL: yellow line), mantle-cell lymphoma (blue line), aggressive NHL (grey line), and Hodgkin lymphoma (red line). (B) Estimated progression-free survival according to the use of total-body irradiation (TBI). Patients who received low-dose TBI-containing regimens (yellow line), high-dose TBI (blue line), or no TBI (gray line) after umbilical cord blood transplantation for lymphoid malignancies. From Rodrigues, C et al J Clin Oncol, 27, (2009) 256-263. Reprinted with permission. © 2009 American Society of Clinical Oncology. All rights reserved.