Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols

Allogeneic haemopoietic stem cell transplantation offers a potentially curative treatment option for a wide range of life‐threatening malignant and non‐malignant disorders of the bone marrow and immune system in patients of all ages. With rapidly emerging advances in the use of alternative donors, such as mismatched unrelated, cord blood and haploidentical donors, it is now possible to find a potential donor for almost all patients in whom an allograft is indicated. Therefore, for any specific patient, the transplant physician may be faced with a myriad of potential choices, including decisions concerning which donor to prioritize where there is more than one, the optimal selection of specific umbilical cord blood units and which conditioning and graft‐versus‐host disease prophylactic schedule to use. Donor choice may be further complicated by other important factors, such as urgency of transplant, the presence of alloantibodies, the disease status (homozygosity or heterozygosity) of sibling donors affected by inherited disorders and the cytomegalovirus serostatus of patient and donor. We report UK consensus guidelines on the selection of umbilical cord blood units, the hierarchy of donor selection and the preferred conditioning regimens for umbilical cord blood transplantation, with a summary of rationale supporting these recommendations.

[1]  M. Perales,et al.  High Disease-Free Survival with Enhanced Protection against Relapse after Double-Unit Cord Blood Transplantation When Compared with T Cell-Depleted Unrelated Donor Transplantation in Patients with Acute Leukemia and Chronic Myelogenous Leukemia. , 2015, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[2]  R. Porcher,et al.  Impact of the source of hematopoietic stem cell in unrelated transplants: Comparison between 10/10, 9/10‐HLA matched donors and cord blood , 2015, American journal of hematology.

[3]  P. Chevallier,et al.  Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire. , 2015, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[4]  J. Sierra,et al.  Comparison of outcomes after unrelated cord blood and unmanipulated haploidentical stem cell transplantation in adults with acute leukemia , 2015, Leukemia.

[5]  J. Bourhis,et al.  Comparison of unrelated cord blood and peripheral blood stem cell transplantation in adults with myelodysplastic syndrome after reduced-intensity conditioning regimen: a collaborative study from Eurocord (Cord blood Committee of Cellular Therapy & Immunobiology Working Party of EBMT) and Chronic Mal , 2015, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[6]  K. Ohashi,et al.  Comparison of cord blood transplantation with unrelated bone marrow transplantation in patients older than fifty years. , 2015, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[7]  M. Robin,et al.  Allogeneic hematopoietic cell transplantation outcomes in acute myeloid leukemia: similar outcomes regardless of donor type. , 2015, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[8]  N. Russell,et al.  Patient/Donor CMV Matching Is a Critical Determinant of Survival in Unrelated Donor Haematopoietic Stem Cell Transplantation , 2014 .

[9]  S. Devlin,et al.  Dominant unit CD34+ cell dose predicts engraftment after double-unit cord blood transplantation and is influenced by bank practice. , 2014, Blood.

[10]  S. Devlin,et al.  Sustained donor engraftment in recipients of double-unit cord blood transplantation is possible despite donor-specific human leukoctye antigen antibodies. , 2014, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[11]  M. Perales,et al.  Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia in first and second complete remission: a comparison with allografts from adult unrelated donors , 2014, Haematologica.

[12]  A. Nagler,et al.  Alternative donor hematopoietic stem cell transplantation for mature lymphoid malignancies after reduced-intensity conditioning regimen: similar outcomes with umbilical cord blood and unrelated donor peripheral blood , 2014, Haematologica.

[13]  J. Klein,et al.  Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy. , 2014, Blood.

[14]  J. Wagner,et al.  Myeloablative cord blood transplantation in adults with acute leukemia: comparison of two different transplant platforms. , 2013, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[15]  C. Craddock,et al.  Equality Of Access To Transplant For Ethnic Minority Patients Through Use Of Cord Blood and Haploidentical Transplants , 2013 .

[16]  D. Hanau,et al.  Impact of donor-specific anti-HLA antibodies on graft failure and survival after reduced intensity conditioning-unrelated cord blood transplantation: a Eurocord, Société Francophone d’Histocompatibilité et d’Immunogénétique (SFHI) and Société Française de Greffe de Moelle et de Thérapie Cellulaire ( , 2013, Haematologica.

[17]  A. Fischer,et al.  Outcomes of transplantation using various hematopoietic cell sources in children with Hurler syndrome after myeloablative conditioning. , 2013, Blood.

[18]  S. Davies,et al.  Comparison of outcomes after HLA-matched sibling and unrelated donor transplantation for children with high-risk acute lymphoblastic leukemia. , 2012, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[19]  A. Fischer,et al.  Transplantation in patients with SCID: mismatched related stem cells or unrelated cord blood? , 2012, Blood.

[20]  J. Ritz,et al.  Donor-specific anti-HLA antibodies predict outcome in double umbilical cord blood transplantation. , 2011, Blood.

[21]  J. Wagner,et al.  Anti-HLA antibodies in double umbilical cord blood transplantation. , 2011, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[22]  A. Scaradavou,et al.  Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies. , 2010, Blood.

[23]  G. Heller,et al.  A "no-wash" albumin-dextran dilution strategy for cord blood unit thaw: high rate of engraftment and a low incidence of serious infusion reactions. , 2009, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[24]  E. Gluckman,et al.  Improving outcomes of cord blood transplantation: HLA matching, cell dose and other graft‐ and transplantation‐related factors , 2009, British journal of haematology.

[25]  N. Russell,et al.  Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: conditioning protocols and donor selection algorithms , 2009, Bone Marrow Transplantation.

[26]  M. Maris,et al.  Comparison of outcomes of HLA-matched related, unrelated, or HLA-haploidentical related hematopoietic cell transplantation following nonmyeloablative conditioning for relapsed or refractory Hodgkin lymphoma. , 2008, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[27]  J. Wagner,et al.  Reduced intensity compared with high dose conditioning for allotransplantation in acute myeloid leukemia and myelodysplastic syndrome: A comparative clinical analysis , 2007, American journal of hematology.

[28]  J. Klein,et al.  Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study , 2007, The Lancet.

[29]  H. Koo,et al.  The impact of post-thaw colony-forming units-granulocyte/macrophage on engraftment following unrelated cord blood transplantation in pediatric recipients , 2007, Bone Marrow Transplantation.

[30]  D. Kadidlo,et al.  Cell loss and recovery in umbilical cord blood processing: a comparison of postthaw and postwash samples , 2005, Transfusion.

[31]  F. Mandelli,et al.  Pre-transplant prognostic factors for patients with high-risk leukemia undergoing an unrelated cord blood transplantation , 2004, Bone Marrow Transplantation.

[32]  M. Bernstein,et al.  Results of an unrelated transplant search strategy using partially HLA-mismatched cord blood as an immediate alternative to HLA-matched bone marrow , 2004, Bone Marrow Transplantation.

[33]  A. Fischer,et al.  Long-term survival and transplantation of haemopoietic stem cells for immunodeficiencies: report of the European experience 1968–99 , 2003, The Lancet.

[34]  J. Wagner,et al.  Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched-pair analysis. , 2001, Blood.

[35]  A. Zander,et al.  Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia. , 2001, Blood.

[36]  J. V. Stone,et al.  Impact of donor type on outcome of bone marrow transplantation for Wiskott-Aldrich syndrome: collaborative study of the International Bone Marrow Transplant Registry and the National Marrow Donor Program. , 2001, Blood.

[37]  J. Adamson,et al.  Outcomes among 562 recipients of placental-blood transplants from unrelated donors. , 1998, The New England journal of medicine.

[38]  J. Wagner,et al.  Hurler syndrome: II. Outcome of HLA-genotypically identical sibling and HLA-haploidentical related donor bone marrow transplantation in fifty-four children. The Storage Disease Collaborative Study Group. , 1998, Blood.

[39]  C. Chastang,et al.  Outcome of cord-blood transplantation from related and unrelated donors , 1997 .

[40]  C. Chastang,et al.  Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group. , 1997, The New England journal of medicine.