Umbilical cord stem cell transplantation – two decades of clinical experience
AbstractUmbilical cord blood (UCB) is an abundant source of haematopoietic stem cells (HSC) for allogeneic HSC transplant. Since the first UCB transplant in 1988, many scientific data have been collected. Many umbilical cord blood banks have been established worldwide for the collection and cryopreservation as well as for the international exchange with more than 400,000 UC units available. There is probably a twofold figure of UCB units collected for the private UCB banks. More than 20,000 UCB units have been used for treating malignant and non-malignant diseases both in adults and children. Unrelated UCB HSCs became an alternative to bone-marrow derived HSCs based on their advantages, including a prompt availability, decrease of graftversus- host disease (GVHD) and better longterm immune recovery, resulting in a similar long-term survival. UCB stem cells can be transplanted to an allogeneic patient in spite of the high degree of HLA mismatches, which is highly important for the patients who cannot find a HLA-identical allogeneic donor. Since the low number of cells in the UCB units still represents the main cause of failure of engraftment, new strategies, such as double-unit UCB transplantation, intra-bone injection of UCB cells, simultaneous transplantation of accessory cells and the reduced intensity conditioning regimen, were developed to increase the success of UCB transplantation. Several clinical studies using UCB stem cells that have been previously expanded in vitro are underway. These procedures and the future development of regenerative medicine will further broaden possible indications for the use of UCB derived stem cells in adults.
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