A modified cord blood collection method achieves sufficient cell levels for transplantation in most adult patients.
Umbilical cord blood transplantation (UCBT) has been used increasingly in both pediatric and adult patients. The total nucleated cell (NC) dose infused is the most critical factor in determining speed of engraftment and survival. Using standard collection techniques, the mean NC content of UCB units is about 10 x 10(8) and only 25% of these units reach the target cell dose of 2 x 10(7)/kg in UCBT patients weighing 50-70 kg. We have designed a modified placental/umbilical two-step collection method in which a standard blood fraction obtained by umbilical venipuncture is combined with a second fraction harvested after placental perfusion with 50 ml heparinized 0.9% saline. This second fraction contributed 32% volume and 15% NCs to the whole UCB unit (123.7 +/- 50.1 ml and 1.26 +/- 0.52 x 10(9) NC). The proportion of progenitor cells in both fractions was not significantly different, indicating that the hematopoietic potential of these larger units is 20% (range, 2%-100%) higher than UCB units collected by standard methods. In addition, the bacterial contamination rate associated with this novel collection method (2.78%) compares favorably. Since 1998 we have further enriched our units by processing only UCB units over 0.8 x 10(9) NCs, resulting in a 36% cell increment (1.46 +/- 0.52 x 10(9) NCs). Thus, 84% and 54% of the Madrid UCB Bank inventory would fulfill the target cell dose of 2 x 10(7)/kg in patients weighing 50 and 65 kg, respectively. This significant UCB banking improvement gives larger pediatric and adult patients a greater chance of finding adequate grafts in order to achieve better clinical outcomes after UCBT.
Bornstein
Rafael
R
Madrid Cord Blood Bank, Hospital 12 de Octubre, Avda. de Córdoba, s/n, Madrid 28041, Spain. rbornstein.hdoc@salud.madrid.org
Flores
Ana I
AI
Montalbán
M Angeles
MA
del Rey
Manuel J
MJ
de la Serna
Javier
J
Gilsanz
Florinda
F
D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D001772:Blood Cell Count; D001800:Blood Specimen Collection / Q000295:instrumentation / Q000379:methods*; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D004247:DNA / Q000097:blood / Q000235:genetics; D015672:Erythroid Precursor Cells / Q000166:cytology; D005260:Female; D005312:Fetal Blood / Q000166:cytology* / Q000378:metabolism; D005434:Flow Cytometry; D042381:Granulocyte Precursor Cells / Q000166:cytology; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006412:Hematopoietic Stem Cells / Q000737:chemistry / Q000166:cytology; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology; D010477:Perfusion; D010920:Placenta; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D014470:Umbilical Cord
D015703:Antigens, CD; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D004247:DNA