Umbilical cord blood transplantation: the first 25 years and beyond.

This year marks the 25th anniversary of the first umbilical cord blood (UCB) transplantation (UCBT) performed in France in a child with Fanconi Anemia (FA). Over the last 25 years, the field of UCB banking and transplantation has grown exponentially. Over 600 000 UCB units have been stored for transplantation worldwide, and .30 000 UCBTs have been performed. UCB serves as an alternative stem cell source; only 30% of patients who require an allograft will have a human leukocyte antigen (HLA)-matched sibling donor. Despite .20 million adult volunteer donors in the National Marrow Donor Program and affiliated registries, many patients, particularly patients of diverse racial/ethnic backgrounds, will not have a suitably matched, unrelated volunteer donor identified in the required time period. UCB has extended access to transplantation, especially to patients of racial and ethnic minorities, and is rapidly available. In this review, the scientific basis of UCBT is discussed, the historic first UCBT is revisited, and recent pediatric and adult UCBT outcome data are presented. Strategies for future improvement include: utilization of UCB expansion, ex vivo and in vivo homing techniques, in vivo nurturing procedures, selection of the optimal UCB unit, and enhancement of immune recovery.