Umbilical cord blood (UCB) is a very effective alternative source of blood-forming stem cells, especially for patients with blood cancers or disorders where there are matched donors that are not immediately available. Notwithstanding the fact that 50 million donors are registered in the USA bone marrow programs, many minority groups, will not be able to find a suitable, unrelated donor within a quick period to be able to save the life of the patient. In this respect, UCB has expanded transplant availability for many patients of racial and ethnic minorities across the world.
Since the first UCB transplant in 1988, over 50 000 stem cell transplants are being performed annually worldwide, and that number is growing. Over half of the patients have been cured with this technique. In the USA only 30% of patients who need a stem cell transplant can find an appropriate donor within their family, while the rest must turn to public registries of bone marrow donors and donated cord blood units. For the past 4 decades, paediatric UCB transplants have been performed with high success rates both for blood-related diseases as well as metabolic storage diseases.
The transplant of UCB has several advantages over bone marrow and blood stem cells. These include less stringent immune-matching (HLA-matching) criteria, the naïve state of cord blood stem cells which leads to a lower incidence of rejection, better stem cell growth potential, immediate availability of the cryopreserved stem cells, and a lower risk of relapse. Currently, even the transplant rate and success of donor UCB transplants in adults have improved. Although there are disadvantages to using donor UCBs, such as slower engraftment of certain cells and overall immune recovery, these two factors have been overcome by various techniques. Some of the techniques for donor UCBs include the improvement of recovery of certain types of blood cells that helps with immune recovery and engraftment, multiplying -, “homing” – and delivery of the stem cells, and the use of double cord blood units per transplant (1,2). Another way to improve the scope of application of UCB transplants in elderly and really sick patients is to have less intense treatments before transplants which allow for better engraftment after the transplant.
In addition to the oncology applications, UCBs have also been used in the treatment of several nerve and heart disorders with varying degrees of success. These diseases, once approved, will hold great promise for the application of UCB transplants in the future.
References:
- https://parentsguidecordblood.org/en/news/competing-strategies-expand-cord-blood-use-transplants
- https://parentsguidecordblood.org/en/faqs/how-are-cord-blood-stem-cells-different-other-sources-stem-cells
- https://www.lls.org/sites/default/files/file_assets/cordbloodstemcelltransplantation.pdf
- Malgieri A, Kantzari E, Patrizi MP, Gambardella S. Bone marrow and umbilical cord blood human mesenchymal stem cells: state of the art. Int J Clin Exp Med. 2010 Sep 7;3(4):248
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