![]() ![]() Outcomes of CBT have improved since the early days of implementation. ![]() 2-4 Early trials demonstrated that cell dose (CD) was rate limiting for engraftment, 2, 3 The fact that CB is the only banked source of HSCs led to regulation as a commercial product resulting in increased costs compared to nonregulated HSC sources. Historically, CB was associated with slower hematopoietic engraftment and immune reconstitution, higher infectious complications and transplant-related mortality (TRM). CB is rapidly available, enables permissive HLA-matching, low rates of graft versus host disease (GvHD), and enhanced graft versus leukemia (GvL) effects. Introductionįorty years ago, Hal Broxmeyer discovered that umbilical cord blood (CB) contained hematopoietic stem and progenitor cells (HSCs), 1 leading to the use of CB as an alternative donor for hematopoietic stem cell transplantation (HSCT). Analysis of this large dataset identified changes in practice, over time, that have improved outcomes and answered critical questions about HLA, cell dose, and the use of TBI and ATG in conditioning regimens, which have not been answerable in past studies using smaller patient datasets. This article presents the largest report of outcomes of unrelated donor cord blood transplantation in pediatric patients with malignant and non-malignant conditions over nearly 30 years, starting with the first unrelated donor cord blood transplant ever performed in the world. Relative contributions of cell dose and HLA matching to transplant outcomes were also assessed and showed that HLA matching was more important than cell dose in this pediatric cohort. The incidence of TRM and GvHD decreased while the incidence of relapse remained unchanged. OS, times to engraftment, and DFS improved over time. Increased cell dose and degree of HLA matching were observed over time. Changes in standard transplant outcomes (overall survival, disease free survival, acute and chronic graft-versus-host disease, treatment related mortality, and relapse) over 3 time periods (1: 2010 to 2019) were studied. We hypothesized that improvements in CB banking and transplantation favorably impacted outcomes of CBT today and performed a retrospective study combining data from Eurocord and Duke University in 4834 children transplanted with a single unrelated CB unit (CBU) from 1993 to 2019. Early outcomes of CBT were mixed and demonstrated the importance of cell dose from the CB donor. Since that time, >40 000 CBTs have been performed worldwide. established an unrelated donor CB bank, and in 1993, the first unrelated CBT used a unit from this bank. reported the first successful matched sibling cord blood transplant (CBT) in a child with Fanconi Anemia. demonstrated that umbilical cord blood (CB) contained hematopoietic stem cells (HSC) and hypothesized that CB could be used as a source of donor HSC for rescue of myeloablated bone marrow. ![]()
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