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. 2009 Apr;94(4):536-41.
doi: 10.3324/haematol.2008.002741. Epub 2009 Feb 19.

Cord blood stem cells for hematopoietic stem cell transplantation in the UK: how big should the bank be?

Sergio Querol  1 , Ghulam J Mufti, Steven G E Marsh, Antonio Pagliuca, Ann-Margaret Little, Bronwen E Shaw, Robert Jeffery, Joan Garcia, John M Goldman, J Alejandro Madrigal
Affiliations

Cord blood stem cells for hematopoietic stem cell transplantation in the UK: how big should the bank be?

Sergio Querol et al. Haematologica. 2009 Apr.

Abstract

Background: A stored cord blood donation may be a valuable source of hemopoietic stem cells for allogeneic transplantation when a matched sibling donor is not available. We carried out a study to define the optimal size of a national cord blood bank for the UK.

Design and methods: We calculated the actual numbers of possible donors and the chance of finding at least one donor for 2,000 unselected and for 722 non-North Western European patients for whom searches had been initiated as a function of three levels of HLA matching (4, 5 and 6 out of 6 alleles by HLA-A, -B low and -DRB1 high resolution HLA typing) according to various donor bank sizes.

Results: With a bank size of 50,000, 80% of patients will have at least one donor unit available at the 5 out of 6 HLA allele match level (median 9 donors per patient), and 98% will have at least one donor at the 4 out of 6 allele match level (median 261). Doubling the size of the bank yields at least one donor for only an additional 6% of patients at the 5 of 6 allele match level. Moreover, for non-North Western European patients a 50,000 unit bank provides a donor for 50% at the 5 allele match level, and for 96% at the 4 allele match level.

Conclusions: A bank containing 50,000 units is optimal for the UK and larger banks would only marginally increase the chance of finding suitable units.

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Figures

Figure 1.
Figure 1.
Flowchart on the outcome of patients requiring allogeneic hemopoietic stem cell transplantation at Kings College Hospital during 2005. During this period 104 candidates for allogeneic transplantation were identified. Eleven sibling transplants were considered second line therapy and 20 unrelated searches were withdrawn after the original request. The survey analyses outcome after intention-to-treat of 73 patients whose allogeneic transplantation was their first option (allo-mandatory). Time is expressed in median weeks (range). Figures in the boxes represent the actual number of patients reaching each stage and the percentage from the starting 60 patients requesting an unrelated donor.
Figure 2.
Figure 2.
The probability of finding at least one donor 4, 5 or 6 out 6 HLA A, B by low and DRB1 by high resolution according to different inventory size for 2,000 consecutive patients requesting stem cell grafts recently at the Anthony Nolan Trust. Curves were calculated after assessing percentage of patients finding at least one donor for each predefined donor size (1, 10, 100, 1,000, 10,000, 50,000, 100,000 and 150,000) selected from those listed having a known DRB1 high resolution typing.
Figure 3.
Figure 3.
The probability of finding at least one donor 4, 5 or 6 out 6 HLA A, B by low and DRB1 by high resolution according to different inventory size for 2,000 consecutive patients with a known non-North Western Europe origin and high resolution DRB1 typing. Curves were calculated after assessing the percentage of patients finding a donor for each predefined donor registry size (1, 10, 100, 1,000, 10,000, 50,000, 100,000 and 150,000) selected from those listed with a known DRB1 high resolution typing.
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