[Cord blood: from bench to bedside].
Since 1974, umbilical cord blood (CB) has been shown to contain haematopoietic stem cells similar to stem cells from the bone marrow. In 1988, E. Gluckman and her colleagues performed - successfully - the first familial CB transplantation and cured a 5 years old child suffering from Fanconi's anemia. Rapidly, CB banks were organised throughout in the world and thanks to this novel source of haematopoietic stem cells, we can now find a donor for 75 % of the patients requiring a "bone marrow" transplantation. The major benefit of CB as a source of hematopoietic stem cells is its easy access. CB also allows a more significant degree of HLA incompatibility and thus offers an opportunity of transplantation to ethnic minorities for whom no HLA identical donors are available. However, several studies have shown that the number of cells harvested in a CB was closely correlated with the engraftment post transplantation and today, a minimum of 3.7 x 10(7) mononucleated cells/kg is recommended. This required amount of cells is not always reached due to the small volume often harvested from a CB. Therefore, to apply CB transplantations to adults, different approaches are currently being investigated : coinfusion of haploidentical cells, mesenchymal cells, a second CB, or the addition of CB expanded ex-vivo. Among these approaches, double CB transplantation seems nowadays the most promising alternative and ongoing studies should soon inform us whether the duration of aplasia will be improved.
Bron
Dominique
D
Département de médecine interne, Institut Jules Bordet, 121 bd de Waterloo, 1000 Bruxelles, Belgique. dbron@ulb.ac.be
De Bruyn
Cécile
C
Balasse
H
H
Ley
P
P
De Hemptinne
D
D
von Lennep
E
E
Homans
C
C
Marckowicz
E
E
Mathieu
P
P
Deleuse
M-D
MD
Francotte
J
J
Thomas
D
D
Dorval
C
C
Dejeneffe
M
M
Andrien
M
M
Delforge
A
A
D000328:Adult; D001771:Blood Banks / Q000941:ethics / Q000458:organization & administration; D001772:Blood Cell Count / Q000592:standards; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000941:ethics; D005312:Fetal Blood / Q000166:cytology*; D006801:Humans; D012016:Reference Values; D012737:Sex Factors; D014184:Transplantation, Homologous