The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Optimal Selection of Cord Blood for Hematopoietic Stem Cell Transplantation

조혈모세포이식을 위한 최적의 제대혈 선택 지침

  • Yoo, Keon Hee (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 유건희 (성균관대학교 의과대학 삼성서울병원 소아과)
  • Published : 2014.01.01
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Abstract

Umbilical cord blood (CB) has been an alternative hematopoietic stem cell source especially for patients without an appropriate marrow or mobilized peripheral blood donor. Although many studies have shown similar overall survival rates after CB transplantation compared with other donor sources, higher rate of non-relapse mortality is a major obstacle for a successful CB transplantation. Thus, selecting a best appropriate unit is very important to improve the outcome of CB transplantation. Adequate cell dose and better HLA matching (antigen-level for -A, -B, and allele-level for -DRB1) have been considered most important criteria of donor choice for CB transplantation. In recent, other criteria including non-inherited maternal antigens, HLA-C matching, allele-level matching at 8 loci (-A, -B, -C, -DRB1), and anti-HLA antibodies are also suggested as factors that might affect the outcome of CB transplantation. This review will highlight current issues regarding criteria of donor choice for CB transplantation. Finally, I will introduce the algorithm and detailed guideline for CB selection recently developed in Korea, which may help physicians to choose best unit available.

Keywords

Acknowledgement

Supported by : Seoul Metropolitan Public Cord Blood Bank

References

  1. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood 2013;122:491-498. https://doi.org/10.1182/blood-2013-02-453175
  2. Yoo KH, Lee SH, Sung KW, et al. Current status of pediatric umbilical cord blood transplantation in Korea: a multicenter retrospective analysis of 236 cases. Am J Hematol 2011;86:12-17. https://doi.org/10.1002/ajh.21886
  3. Yoshimi A, Suzuki R, Atsuta Y, et al. Hematopoietic SCT activity in Asia: a report from the Asia-Pacific Blood and Marrow Transplantation Group. Bone Marrow Transplant 2010;45:1682-1691. https://doi.org/10.1038/bmt.2010.34
  4. Shaw BE, Veys P, Pagliuca A, et al. Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: conditioning protocols and donor selection algorithms. Bone Marrow Transplant 2009;44:7-12. https://doi.org/10.1038/bmt.2008.420
  5. Boo M, Ballen K, Maiers M. Cord blood unit access and selection: 2010 and beyond: best practices and emerging trends in cord blood unit selection. Biol Blood Marrow Transplant 2011;17(1 Suppl):S46-51. https://doi.org/10.1016/j.bbmt.2010.11.010
  6. Barker JN, Byam C, Scaradavou A. How I treat: the selection and acquisition of unrelated cord blood grafts. Blood 2011;117:2332-2339. https://doi.org/10.1182/blood-2010-04-280966
  7. Cutler C, Ballen KK. Improving outcomes in umbilical cord blood transplantation: state of the art. Blood Rev 2012;26:241-246. https://doi.org/10.1016/j.blre.2012.08.001
  8. Rocha V, Gluckman E; Eurocord-Netcord Registry and European Blood and Marrow Transplant Group. Improving outcomes of cord blood transplantation: HLA matching, cell dose and other graft- and transplantation-related factors. Br J Haematol 2009;147:262-274. https://doi.org/10.1111/j.1365-2141.2009.07883.x
  9. Barker JN, Scaradavou A, Stevens CE. Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies. Blood 2010;115:1843-1849. https://doi.org/10.1182/blood-2009-07-231068
  10. Flomenberg N, Baxter-Lowe LA, Confer D, et al. Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood 2004;104:1923-1930. https://doi.org/10.1182/blood-2004-03-0803
  11. Eapen M, Klein JP, Sanz GF, et al. Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis. Lancet Oncol 2011;12:1214-1221. https://doi.org/10.1016/S1470-2045(11)70260-1
  12. Eapen M, Klein JP, Ruggeri A, et al. Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy. Blood 2013 Dec 3 [Epub]. http://dx.doi.org/10.1182/blood-2013-05-506253.
  13. Dutta P, Burlingham WJ. Microchimerism: tolerance vs. sensitization. Curr Opin Organ Transplant 2011;16:359-365. https://doi.org/10.1097/MOT.0b013e3283484b57
  14. Van Rood JJ, Stevens CE, Smits J, Carrier C, Carpenter C, Scaradavou A. Reexposure of cord blood to noninherited maternal HLA antigens improves transplant outcome in hematological malignancies. Proc Natl Acad Sci U S A 2009;106:19952-19957. https://doi.org/10.1073/pnas.0910310106
  15. Rocha V, Spellman S, Zhang MJ, et al. Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes after mismatched umbilical cord blood transplantation for hematologic malignancy. Biol Blood Marrow Transplant 2012;18:1890-1896. https://doi.org/10.1016/j.bbmt.2012.07.010
  16. Takanashi M, Atsuta Y, Fujiwara K, et al. The impact of anti-HLA antibodies on unrelated cord blood transplantations. Blood 2010;116:2839-2846. https://doi.org/10.1182/blood-2009-10-249219
  17. Cutler C, Kim HT, Sun L, et al. Donor-specific anti-HLA antibodies predict outcome in double umbilical cord blood transplantation. Blood 2011;118:6691-6697. https://doi.org/10.1182/blood-2011-05-355263
  18. Ruggeri A, Rocha V, Masson E, et al. Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Societe Francophone d'Histo-compatibilite et d'Immunogenetique (SFHI) and Societe Francaise de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC) analysis. Haematologica 2013;98:1154-1160. https://doi.org/10.3324/haematol.2012.077685