Umbilical Cord Blood: A Review of the Medical Literature


Since the first umbilical cord blood transplant in 1988 (Gluckman et al., 1989) the medical literature on umbilical cord blood collection, storage, and transplantation has increased on an almost daily basis. A summary of the most important points follows:

• Umbilical cord blood storage and transplantation is now widely accepted by the medical and scientific profession as a valid and immensely useful procedure. More than 3,000 patients with at least 45 different pathologies have now been treated using cord blood cells. (Fasouliotis & Schenker, 2000; Barker & Wagner, 2002).

• The rapid availability of cord blood for transplantation is a particular advantage for those patients requiring urgent transplantation (Barker et al., 2002; Sanz & Sanz, 2002).

• Transplant patients receiving umbilical cord blood transplants from a relative are significantly less likely to develop graft-versus-host disease (GVHD) (Gluckman et al., 1997).

• There is a significantly reduced rate of GVHD and greater immunological naivete compared to bone marrow (Perlow, 2002; Laughlin et al., 2001).

• There are also studies which have shown the acceptability and advantages of using cord blood for HLA mismatched recipients (Kurtzberg et al., 1996) and also to HLA matched siblings (Rocha et al., 2000).

• Umbilical cord blood is also a recognized alternative to bone marrow in the reconstitution of the haemopoietic system following treatment for cancer (Barker & Wagner, 2003).
    
Other significant recent advances in the use of cord blood include:

• Successful cord blood transplantation following relapse of an autologous transplantation in non-Hodgkin’s lymphoma (Ooi et al.,
2003),

• Transplantation in Wiskott Aldrich syndrome (Knutsen et al., 2003),

• Unrelated cord blood transplantation for beta-thallasemia major (Fang et al., 2003), sibling cord blood banking for children with sickle cell disease (Reed et al., 2001), transplantation for chronic granulomatous disease (Bhattacharya et al., 2003).

• Unrelated transplantation for severe combined immunodeficiency syndrome (Fagioli et al., 2003) and transplantation in     myelodysplastic syndrome and Behcet disease (Yamato2003).

Further current research has also shown the potential of umbilical cord blood stem cells in the repair of non-haematological tissue such as the liver (Kakinuma et al., 2003).
REFERENCES

Barker, J.N. & Wagner, J.E. (2002). Umbilical cord blood transplantation: current state of the art. Curr Opin Oncol, 14, 160-164

Barker, J.N. et al., (2002). Searching for unrelated donor hematopoietic system cells: availability and speed of umbilical cord blood versus bone marrow. Biol Blood Marrow Transplant, 8, 257-260

Barker, J.N. & Wagner, J.E. (2003). Umbilical-cord blood transplantation for the treatment of cancer. Nature Reviews Cancer, 3, 526-532

Bhattacharya, A. et al., (2003). Successful umbilical cord blood stem cell transplantation for chronic granulomatous disease. Bone Marrow Transplant, 31, 403-405.

Bron, D. et al., (2002). Hematopoietic stem cells: source, indications and perspectives. Bull. Mem. Acad. R. Med Belg., 157, 135-145

Fagioli, F. et al., (2003). Successful unrelated cord blood transplantation in two children with severe combined immunodeficiency syndrome. Bone Marrow Transplant, 31, 133-136

Fang, J. et al., (2003). Unrelated umbilical cord blood transplant for beta-thalassemia major. J. Trop. Pediatr, 49, 71-73

Fasouliotis, S.J. & Schenker, J.G. (2000). Human umbilical cord blood banking and transplantation: a state of the art. Eur J Obstet Gynecol Reprod Biol, 90, 13-25

Gluckman, E. et al., (1989). Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilical-cord blood from an HLA-identical sibling. N. Eng. J. Med, 321, 1174-1178.

Gluckman, E. et al., (1997). Outcome of cord blood transplantation from related and unrelated donors. N Engl J Med, 337, 373-381

Greaves, M.F. et al., (2003). Leukemia in twins: lessons in natural history. Blood, 102, 2321-2333

Hotfilder, M. et al., (2002). Immature CD34+CD19- progenitor/stem cells in TEL/AML1-positive acute lymphoblastic leukaemia are genetically and functionally normal. Blood, 100, 640-646

Kakinuma, S. et al., (2003). Human umbilical cord blood as a source of transplantable hepatic progenitor cells. Stem Cells, 21, 217-227

Knutsen, A.P. et al., (2003). Umbilical cord blood transplantation in Wiskott Aldrich syndrome. J. Pediatr, 142, 519-523

Kurtzberg, J. et al., (1996). Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. N Engl J Med, 335, 157-166

Laughlin, M.J. et al., (2001). Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. N Engl J Med, 344, 1815-1822

Masako, M. et al., (2003). SHED: Stem cells from human exfoliated deciduous teeth. Proc. Natl. Acad. Sci USA, 100, 5807-5812

Ooi, J. et al., (2002). Successful unrelated cord blood transplantation for relapse after autologous transplantation in non-Hodgkin’s lymphoma. Leuk Lymphoma, 43, 653-655

Perlow, J.H. (2002). Cord blood banking: an ob’s perspective. Contemporary Ob/Gyn, 31-43

Rocha, V. et al., (2000). Graft-versus-host disease in children who have received a cord blood or bone marrow transplant from an HLA identical sibling. N Engl J Med, 342, 1846-1854

Reed, W. et al., (2001). Sibling donor cord blood banking for children with sickle cell disease. Paed Pathol Mol Med, 2, 167-174

Sanz, M.A. & Sanz, G.F. (2002).Unrelated donor umbilical cord blood transplantation in adults. Leukemia, 10, 1884-1991

Surbek, D.V. & Holzgreve, W. (2002). Stem cells from cord blood: current status and future potential. Ther. Umsch. 59, 577-582

Wiemels, J.L. et al., (1999). Prenatal origin of acute lymphoblastic leukaemia in children. Lancet, 354, 1499-1503

Yamato, K. (2003). Successful cord blood stem cell transplantation for myelodysplastic syndrome with Bechet disease. Int J Hematol, 77, 82-85