The discovery that blood remaining in the placenta after delivery - placental or cord blood - is enriched in hemopoietic progenitors, paved the way to routine cord blood banking and allogeneic cord blood transplantation. As compared to adult bone marrow or mobilized peripheral blood, cord blood suffers from the disadvantage of a limited absolute number of hemopoietic progenitors (in turn related to the limited available volume, which may range from less than 50 to slightly more than 200 mL) but offers the advantages of being more readily available, microbiologically cleaner and immunologically naïve. The latter condition translates into less acute and chronic graft versus host disease. In a recent large multicenter study coordinated by Eurocord, nonadjusted estimates of 2-year event-free survival of 541 children transplanted with cord blood (n=99). Tceli depleted unrelated bone marrow (n=180) and nonmanipulated unrelated bone marrow (n=262) were 31, 37 and 43% respectively (Rocha et al. Blood 20()1;97:2962-71). At the time of this writing it can be estimated that there are at least 20 active and large cord blood banking programs storing more than 80,000 cryopreserved cord blood units available for allogeneic unrelated transplant. The largest banking program is located in New York. Approximately 40% of the units available worldwide are managed by banks affiliated in the Netcord organization. International accreditation of the banking programs based on published standards is currently being pursued by Netcord and by the Foundation for the Accreditation of Hematopoietic Cell Therapy (FAHCT), a joint effort supported by European and NorthAmerican transplant organizations. Relevant information on most banking programs active worldwide can be obtained at the Bone Marrow Donors Worldwide website. Since the first procedure performed by Eliane Gluckman in 1988, more than 100 transplant teams have performed more than 2000 transplants. Of these, 125 transplants have been performed in 14 countries during February 1995 - July 2001 with units provided by the Milano Cord Blood Bank, which has a local inventory of 4000 units and coordinates the ISO 9002 certified Italian GRACE network including the banks in Milan, Turin, Florence. Rome and Padua. Due to the evidence that recipients of less than 10 million nucleated cells per kg body weight have a very poor outcome, most cord blood transplants are currently performed in pédiatrie or low-weight adult recipients, mainly suffering from hématologie malignancies and inherited disorders. Nonetheless, also the number of successful adult recipients is growing, as witnessed by a recent encouraging detailed report from 68 adults transplanted in one center. Of them, 18 (26%) were disease-free 40 months after transplant (Laughlin et al, NEJM 2001:344:1860-1). Moreover, procedures for ex-vivo expansion of cord blood are being developed to overcome limitations due to low cell numbers in cord blood. Besides the traditional hematologic applications, cord blood hemopoietic progenitors and stem cells are currently being investigated in regard to their plasticity, ie the ability to generate cells which do not belong to the hemopoietic lineage. This characteristic, which is probably shared by or inducible in stem cells present in different tissues and organs, prompted the development of research programs in the area of tissue repair. Exciting findings support the possibility of transforming the above cells into neurons, muscle cells, cardiomyocytes. hepatocytes, endothelial cells, although some evidences have been obtained only in animal models. Transformations in the opposite direction have also been obtained. To further explore these possibilities with a clinically oriented perspective, we built a Cell Factory in our hospital-based institution, which includes 2 BL3 rooms suitable for clinical grade cell manipulation. In this unit we are currently working at cord blood stem cell expansion and plasticity.
|Number of pages||2|
|Journal||Infusionstherapie und Transfusionsmedizin|
|Issue number||SUPPL. 1|
|Publication status||Published - 2001|
ASJC Scopus subject areas
- Food Science