Umbilical cord blood transplantation: the first 25 years and beyond

Abstract

Umbilical cord blood is an alternative hematopoietic stem cell source for patients with hematologic diseases who can be cured by allogeneic hematopoietic cell transplantation. Initially, umbilical cord blood transplantation was limited to children, given the low cell dose infused. Both related and unrelated cord blood transplants have been performed with high rates of success for a variety of hematologic disorders and metabolic storage diseases in the pediatric setting. The results for adult umbilical cord blood transplantation have improved, with greater emphasis on cord blood units of sufficient cell dose and human leukocyte antigen match and with the use of double umbilical cord blood units and improved supportive care techniques. Cord blood expansion trials have recently shown improvement in time to engraftment. Umbilical cord blood is being compared with other graft sources in both retrospective and prospective trials. The growth of the field over the last 25 years and the plans for future exploration are discussed.

Figure 1

OS at 2 y after UCBT for patients with acute myeloid leukemia, acute lymphoid leukemia, and myelodysplasia in Europe and North America. (A) Children (≤16 years) from Europe: UCBT period 1996-1999 (n = 142), OS: 37 ± 4%; 2000-2005 (n = 441), OS: 41 ± 2%; 2006-2011 (n = 749), OS: 54 ± 2%. (B) Children (≤16 y) from North America: UCBT period 1996-1999 (n = 276), OS: 45 ± 6%; 2000-2005 (n = 843), OS: 50 ± 3%; 2006-2011 (n = 993), OS: 56 ± 6%. (C) Adults from Europe: UCBT period 1996-1999 (n = 46), OS: 26 ± 6%; 2000-2005 (n = 339), OS: 37 ± 3%; 2006-2011 (n = 1595), OS: 36 ± 2%. (D) Adults from North America: UCBT period 1996-1999 (n = 87), OS: 22 ± 8%; 2000-2005 (n = 359), OS: 31 ± 4%; 2006-2011 (n = 1210), OS: 34 ± 3%.